CHIEF COMPLAINT: disabling cludication

PRESENT ILLNESS: 70y/o nondiabetic with seizure disorder, hypertension,sleep
apnea with history of bilateral calf claudication at less than
[**2-2**] block.underwent outpatient angiogram. Returns for elective
vascular surgery.

MEDICAL HISTORY: seizure disorder, last seizure [**2141**]
hypertension
asthma
sleep apnea, uses CPAP
avascular necrosis of left hip
history of peptic ulcer disease
macular degeneration
colonic polyps
internal hemmroids
anxiety disorder
s/p left hip arthroplasty [**2128**]
s/ppartial gastrectomy [**2134**]
s/p left hip revision [**9-/2144**]
s//p umbilical hernia repair
BPH

MEDICATION ON ADMISSION: see d/c rx

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vital signs: 96.6-65-20 199/79  oxygen saturation 97% room air
General: alert ,cooperative white male . no acute distress
HEENT: carotids palpable no bruits
Lungs: clear to auscultation
Herat: regular rate rythmn without mumur
Abdomen: begnin
Pulses:palpable carotid, radial pulses bilaterally. Femorals not
palpable secondary to abdominal obesity.popliteal pulses
nonpalpable pedial pulses dopperable bilaterally
Neuro: intact

FAMILY HISTORY: unknown

SOCIAL HISTORY: retired print shop worker. married lives with his wife.
former [**Name2 (NI) 1818**] d/c 19 years ago
3 beer / night
Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of other part of foot,Cellulitis and abscess of other specified sites,Chronic obstructive asthma, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Acute respiratory failure,Blood in stool,Atrial flutter,Myasthenia gravis without (acute) exacerbation,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified,Other convulsions,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Other persistent mental disorders due to conditions classified elsewhere
Ath ext ntv art gngrene,Ulcer other part of foot,Cellulitis, site NEC,Chronic obst asthma NOS,Chr blood loss anemia,Acute respiratry failure,Blood in stool,Atrial flutter,Mysthna grvs w/o ac exac,Proteus infection NOS,Thrombocytopenia NOS,Convulsions NEC,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypotension NOS,Crnry athrscl natve vssl,Old myocardial infarct,Status-post ptca,Mental disor NEC oth dis
Admission Date:  [**2153-10-14**]              Discharge Date:   [**2153-11-9**]


Service: VSURG

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4748**]
Chief Complaint:
disabling cludication

Major Surgical or Invasive Procedure:
right femoral to peroneal bypass graft with insitu vein,
angioscopy and valvelysis [**2153-10-16**]
rt. 5th ray amputation with VAC dressing  [**11-5**]


History of Present Illness:
70y/o nondiabetic with seizure disorder, hypertension,sleep
apnea with history of bilateral calf claudication at less than
[**2-2**] block.underwent outpatient angiogram. Returns for elective
vascular surgery.

Past Medical History:
seizure disorder, last seizure [**2141**]
hypertension
asthma
sleep apnea, uses CPAP
avascular necrosis of left hip
history of peptic ulcer disease
macular degeneration
colonic polyps
internal hemmroids
anxiety disorder
s/p left hip arthroplasty [**2128**]
s/ppartial gastrectomy [**2134**]
s/p left hip revision [**9-/2144**]
s//p umbilical hernia repair
BPH


Social History:
retired print shop worker. married lives with his wife.
former [**Name2 (NI) 1818**] d/c 19 years ago
3 beer / night

Family History:
unknown

Physical Exam:
Vital signs: 96.6-65-20 199/79  oxygen saturation 97% room air
General: alert ,cooperative white male . no acute distress
HEENT: carotids palpable no bruits
Lungs: clear to auscultation
Herat: regular rate rythmn without mumur
Abdomen: begnin
Pulses:palpable carotid, radial pulses bilaterally. Femorals not
palpable secondary to abdominal obesity.popliteal pulses
nonpalpable pedial pulses dopperable bilaterally
Neuro: intact


Pertinent Results:
[**2153-10-14**] 08:45PM   GLUCOSE-249* UREA N-113* CREAT-3.0*#
SODIUM-130* POTASSIUM-5.2* CHLORIDE-94* TOTAL CO2-24 ANION
GAP-17
[**2153-10-14**] 08:45PM   CK(CPK)-156
[**2153-10-14**] 08:45PM   CK-MB-2 cTropnT-0.05*
[**2153-10-14**] 08:45PM   CALCIUM-8.6 PHOSPHATE-4.5 MAGNESIUM-2.8*
[**2153-10-14**] 08:45PM   WBC-12.9*# RBC-3.57* HGB-10.3* HCT-29.9*
MCV-84# MCH-28.9 MCHC-34.5 RDW-15.7*
[**2153-10-14**] 08:45PM   PLT COUNT-289#
[**2153-10-14**] 08:45PM   PT-31.5* PTT-62.6* INR(PT)-6.2
[**2153-10-14**] 06:27PM URINE  COLOR-LtAmb APPEAR-Cloudy SP [**Last Name (un) 155**]-1.020
[**2153-10-14**] 06:27PM URINE  BLOOD-LGE NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-MOD
[**2153-10-14**] 06:27PM URINE  RBC-791* WBC-52* BACTERIA-MANY
YEAST-MANY EPI-<1

Brief Hospital Course:
[**2153-10-14**] trnasfered to [**Hospital1 8482**] [**Last Name (un) 834**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for evaluation of
right foot wound.
Wound was sustaianed secondary to fall four weeks ago. Patient
suffered nondisplaced fracture of right hmerous and right
shoulder injury. Patient was placed in sling for immoblization.
He was noted to have a right foot necrotic wound.His anemia was
corrected with transfusion of 2 units packed red blood
cells.Blood and urine  cultures were no growth.
[**2153-10-15**] PICC line placed for poor Iv access and IV
antibiotics.Cardology ;consluted for abnormal admitting EKG.A
flutter note as rythmn on EKG. Recommendations were Pmibi,ECHO,
EPS consult for consideration of electrical conversion to sinus
rythmn.
Echo: left artrial dilitation. lefet ventricular wall thickness
and cavity size normal. No thrombs,valves without structural
disease. akensis of anterior and apical wall of left ventricle.
FE 55%. Stress negative for symptoms or EKG changes. Study fixed
defect of inferior and apical wall (severe) and fixed defect of
basal inferior wall. EF 45%. CT head done for mental status
changes. Ct consisted with old left occiptual  infract and left
frontal lobe old encephlomalicia no acute changes.
[**2153-10-16**] right excisionl foot wound debridment.Electrophysology
consulted. recommendations: af/flutter chronic. obtain PFT,
along with thyroid,and liver function test for base ine. Start
amidarone 400mgm tid x 4 days the 400mgm [**Hospital1 **]. No TEE required.
Patient can proceede with any surgical intervention.MRA obtained
.Bilateral femoral -tibial disease. recommend llimited angio
study to better define disease in affected foot.
[**2153-10-18**] patient converted to NSR on amidarone.betablocker and
losartan adjusted for
better for rate control and systolic hypertension.
[**2153-10-19**] angiogram toletated. thyroid and liver function studies
stable.Transfused 2 units for HCT. 26.
[**2153-10-22**] Vanco d/c oxycilin started.s/p right fem-pedal bypass
graft with composite svg.Transfered to PACU stable with palpable
pedal graft.
[**2153-10-23**] POD#1no overnight events. Nitro weaned. Chest Pt
continued . diet advanced as tolerated . qntbiotics continued
and patient remained in VICU.Thrombocytopenia noted.HIT
sent.result negative. Platlet count improved with d/c heparin.
[**10-26**] POD# 4 transfered to regular nursing floor.
[**2153-10-29**] POD# 7 rigth 5th ray amputation.transfused one unit
packed red blood cell for HCT of 25.8 secondary to wound
drainage.
[**2153-11-1**] POD# [**11-4**] VAc dressing to ray amputation last changes
[**2153-11-3**].Transfered to VICU for  mental status changes and HCt.
of 24. Transfused.GI consulted for positive stool guiac  and
positive NG drainage. Transfered to ICU for respiratory failure
secondary to hypercapnea ,reintubated.
Recommendations from GI, follow serial HCT's, hold
anticoagulation. consider GI scoping upper and lower  when
medically stqable.
Required vasopressor support for his hypotension. head CT
negative for acute bleed or infract.
[**2153-11-5**] Vac dressing changed with excisional debridment at bed
side. Duplex of  right upper extremity negative for DVT. [**Last Name (un) **]
consulted for glucose managment secondary to recurrent
hypoglycemic episodes on oral agents.Recommendations: hold oral
[**Doctor Last Name 360**], adjust regular insulin scale once taking by mouth.
[**2153-11-6**] POD#14/8 extubated and transfered to Vicu. No overnight
events. Aline discontinued. God large BM!!.glycemic control
improved with holding oral agents and using regular insulin
scale.Physical thearphy recommends rehabiltation prior to
discharge to home for continued strenghting and mobility.Foley
discontinued.
[**2153-11-7**] Central line taken out and D/C to rehab.  Will need to
stay on coumadin 1mg for awhile before advancing.  Will need to
follow up with Dr. [**Last Name (STitle) 1391**] in two weeks and need out patient GI
work up for the melena.



Medications on Admission:
see d/c rx

Discharge Medications:
1. Losartan Potassium 50 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
2. Glipizide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Rosiglitazone Maleate 8 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
4. Pravastatin Sodium 10 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for headache.
7. Tolterodine Tartrate 2 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q48H (every
48 hours).
9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO QD (once a day).
10. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO HS
(at bedtime).
11. Amiodarone HCl 200 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Health of [**Hospital3 **] - [**Location (un) 32944**]

Discharge Diagnosis:
disabling claudication
respiratory failure secondary to hypercapnea
blood loss anemia, corrected
GI bleed, stable


Discharge Condition:
stable

Discharge Instructions:
VAC dressing change q3days.last change [**2153-11-2**]

Followup Instructions:
Dr. [**Last Name (STitle) **] 2 weeks . call for appointment. [**Telephone/Fax (1) 1393**]
followup with GI for evaluation of GI bleed?



Completed by:[**2153-11-9**]
{'Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of other part of foot,Cellulitis and abscess of other specified sites,Chronic obstructive asthma, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Acute respiratory failure,Blood in stool,Atrial flutter,Myasthenia gravis without (acute) exacerbation,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified,Other convulsions,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Other persistent mental disorders due to conditions classified elsewhere'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: disabling cludication

PRESENT ILLNESS: 70y/o nondiabetic with seizure disorder, hypertension,sleep
apnea with history of bilateral calf claudication at less than
[**2-2**] block.underwent outpatient angiogram. Returns for elective
vascular surgery.

MEDICAL HISTORY: seizure disorder, last seizure [**2141**]
hypertension
asthma
sleep apnea, uses CPAP
avascular necrosis of left hip
history of peptic ulcer disease
macular degeneration
colonic polyps
internal hemmroids
anxiety disorder
s/p left hip arthroplasty [**2128**]
s/ppartial gastrectomy [**2134**]
s/p left hip revision [**9-/2144**]
s//p umbilical hernia repair
BPH

MEDICATION ON ADMISSION: see d/c rx

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vital signs: 96.6-65-20 199/79  oxygen saturation 97% room air
General: alert ,cooperative white male . no acute distress
HEENT: carotids palpable no bruits
Lungs: clear to auscultation
Herat: regular rate rythmn without mumur
Abdomen: begnin
Pulses:palpable carotid, radial pulses bilaterally. Femorals not
palpable secondary to abdominal obesity.popliteal pulses
nonpalpable pedial pulses dopperable bilaterally
Neuro: intact

FAMILY HISTORY: unknown

SOCIAL HISTORY: retired print shop worker. married lives with his wife.
former [**Name2 (NI) 1818**] d/c 19 years ago
3 beer / night 

### Response:
{'Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of other part of foot,Cellulitis and abscess of other specified sites,Chronic obstructive asthma, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Acute respiratory failure,Blood in stool,Atrial flutter,Myasthenia gravis without (acute) exacerbation,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Thrombocytopenia, unspecified,Other convulsions,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Other persistent mental disorders due to conditions classified elsewhere'}
