CHIEF COMPLAINT: Fever and low back pain

PRESENT ILLNESS: 49 yo morbidly obese female who weighs 310 lb with hx of IDDM,
MRSA bacteremia, and low back pain was transferred from [**Hospital1 **]
[**Location (un) 620**] today.  Pt initially presented to [**Hospital1 **] [**Location (un) 620**] with 16
hour history of fevers and left low back pain.  She also
complained of dysuria and abdominal discomfort 3 days prior to
admission and was seen by her PCP but her urine culture was
negative.  The night prior to admission, she experienced fever
of 101.5, chills, and diaphoresis.  She was initially admitted
to [**Hospital1 **] [**Location (un) 620**] for evaluation of her fever and flank pain.  She
was initially treated with Levaquin but was started on
Vancomycin 1g q12 once the blood culture grew out MRSA.  Blood
culture was positive for MRSA on multiple occasion and showed no
growth on [**7-25**].  Patient continued to spike fever with Tm=105.1
on [**2135-7-26**].  At that time Gentamycin was added for synergy after
ID consult.  TEE was done which was negative for any valvular
vegetation.  Patient has left paraspinal tenderness with high
grade MRSA bacteremia of unknown source, MRI of the L spine was
recommended to rule out epidural abscess.  However, patient is
claustrophobic  and can only do either open MRI or MRI under
general anesthesia.  For that reason, patient was transferred to
[**Hospital1 18**] to have the MRI done under general anesthesia.  Dr.
[**Last Name (STitle) 1338**] from neurosurgery is aware of her.  Today, pt was on 2L
oxygen but came to the hospital with 5L.  Patient now requiring
face mask to keep her saturation.

MEDICAL HISTORY: Non insulin dependent diabetes
Hypertension
Status post cholecystectomy
Obesity
Asthma
Fibromyalgia

MEDICATION ON ADMISSION: Vancomycin 1.5 gm q.12
Gentamycin 100 mg IV q.8
HCTZ 25 mg qd
ASA 325 mg qd
Advair 50/500
Vasotec 10 mg qd
[**Doctor First Name **] 60 mg qd
Avandia 4 mg qd
Prilosec 40 mg qd
Lopressor 12.5 mg [**Hospital1 **]
RISS
Heparin 5000 units sq tid
Senna 2 tablets q hs
Lactulose prn
Effexor 150 mg qd
Singulair 10 mg qd
Nortriptyline 10 mg qhs
Tylenol prn
Ibuprofen prn
Morphine sulfate 4 mg IV q2h prn
Lasix prn responding well
Lanazolid ordered at OSH but never received.

ALLERGIES: Penicillins / Sulfonamides

PHYSICAL EXAM: VS: T 101.2 BP 134/50 HR 102 R 24-40's O2 sat 5 L
Gen: breathing in labor with face mask, diaphoretic
HEENT: PERRL, EOMI, MMM, sweaty
Lungs: distant breath sound, crackle on right posterior exam,
diffuse wheezing.
Cor: distant heart sound, murmurs appreciated at outside
hospital but difficult to assess with her heavy rapid breathing
and oxygen.
Abd: Obese, difficult to assess liver, spleen.
Ext: 1+ edema bilaterally.
Musc: Warm to touch and slight erythema of left lumber
paraspinal region.  +Tenderness to palpation.
Neuro: Alert, oriented.  CN II-XII grosssly intact.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Mother lives with her at home- she has been sick recently with
cellulitis [**Month (only) **]-[**Month (only) 116**], requiring hospitalization. No recent
travel.  Works as case manager at facility/NH for MR patients.
Patients on case load have been MRSA/VRE positive. Denies
tobacco, ETOH, drugs. HCP is mother: [**Telephone/Fax (1) 95392**]
Methicillin susceptible Staphylococcus aureus septicemia,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Infection with microorganisms resistant to penicillins,Severe sepsis,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Meth susc Staph aur sept,Acute respiratry failure,Meth sus pneum d/t Staph,Inf mcrg rstn pncllins,Severe sepsis,Anemia NOS,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2135-7-27**]              Discharge Date:   [**2135-8-20**]

Date of Birth:  [**2085-9-21**]             Sex:   F

Service: MED

Allergies:
Penicillins / Sulfonamides

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Fever and low back pain

Major Surgical or Invasive Procedure:
endotracheal intubation & mechanical ventilation
tracheostomy

History of Present Illness:
49 yo morbidly obese female who weighs 310 lb with hx of IDDM,
MRSA bacteremia, and low back pain was transferred from [**Hospital1 **]
[**Location (un) 620**] today.  Pt initially presented to [**Hospital1 **] [**Location (un) 620**] with 16
hour history of fevers and left low back pain.  She also
complained of dysuria and abdominal discomfort 3 days prior to
admission and was seen by her PCP but her urine culture was
negative.  The night prior to admission, she experienced fever
of 101.5, chills, and diaphoresis.  She was initially admitted
to [**Hospital1 **] [**Location (un) 620**] for evaluation of her fever and flank pain.  She
was initially treated with Levaquin but was started on
Vancomycin 1g q12 once the blood culture grew out MRSA.  Blood
culture was positive for MRSA on multiple occasion and showed no
growth on [**7-25**].  Patient continued to spike fever with Tm=105.1
on [**2135-7-26**].  At that time Gentamycin was added for synergy after
ID consult.  TEE was done which was negative for any valvular
vegetation.  Patient has left paraspinal tenderness with high
grade MRSA bacteremia of unknown source, MRI of the L spine was
recommended to rule out epidural abscess.  However, patient is
claustrophobic  and can only do either open MRI or MRI under
general anesthesia.  For that reason, patient was transferred to
[**Hospital1 18**] to have the MRI done under general anesthesia.  Dr.
[**Last Name (STitle) 1338**] from neurosurgery is aware of her.  Today, pt was on 2L
oxygen but came to the hospital with 5L.  Patient now requiring
face mask to keep her saturation.

Past Medical History:
Non insulin dependent diabetes
Hypertension
Status post cholecystectomy
Obesity
Asthma
Fibromyalgia


Social History:
Mother lives with her at home- she has been sick recently with
cellulitis [**Month (only) **]-[**Month (only) 116**], requiring hospitalization. No recent
travel.  Works as case manager at facility/NH for MR patients.
Patients on case load have been MRSA/VRE positive. Denies
tobacco, ETOH, drugs. HCP is mother: [**Telephone/Fax (1) 95392**]


Family History:
noncontributory

Physical Exam:
VS: T 101.2 BP 134/50 HR 102 R 24-40's O2 sat 5 L
Gen: breathing in labor with face mask, diaphoretic
HEENT: PERRL, EOMI, MMM, sweaty
Lungs: distant breath sound, crackle on right posterior exam,
diffuse wheezing.
Cor: distant heart sound, murmurs appreciated at outside
hospital but difficult to assess with her heavy rapid breathing
and oxygen.
Abd: Obese, difficult to assess liver, spleen.
Ext: 1+ edema bilaterally.
Musc: Warm to touch and slight erythema of left lumber
paraspinal region.  +Tenderness to palpation.
Neuro: Alert, oriented.  CN II-XII grosssly intact.

Pertinent Results:
[**2135-7-28**] 04:42AM BLOOD WBC-10.6 RBC-4.20 Hgb-11.3* Hct-34.5*
MCV-82 MCH-27.0 MCHC-32.9 RDW-14.5 Plt Ct-277
[**2135-8-3**] 04:58AM BLOOD Neuts-80.6* Lymphs-11.6* Monos-5.6
Eos-1.9 Baso-0.4
[**2135-7-28**] 04:42AM BLOOD PT-12.8 PTT-31.6 INR(PT)-1.1
[**2135-7-28**] 04:42AM BLOOD Plt Ct-277
[**2135-8-18**] 04:30AM BLOOD Eos Ct-740*
[**2135-7-28**] 04:42AM BLOOD Glucose-123* UreaN-12 Creat-0.5 Na-141
K-3.2* Cl-98 HCO3-32* AnGap-14
[**2135-7-29**] 04:30AM BLOOD ALT-63* AST-53* LD(LDH)-230 AlkPhos-321*
TotBili-0.9
[**2135-7-28**] 04:42AM BLOOD Calcium-8.9 Phos-4.3 Mg-1.9
[**2135-7-28**] 01:06AM BLOOD Type-ART Temp-38.6 Rates-/30 O2-100
pO2-102 pCO2-53* pH-7.39 calHCO3-33* Base XS-5 AADO2-576 REQ
O2-92 Intubat-NOT INTUBA Vent-SPONTANEOU
[**2135-7-28**] 01:57AM BLOOD Type-ART Temp-38.3 Rates-/30 O2-100
pO2-82* pCO2-55* pH-7.39 calHCO3-35* Base XS-6 AADO2-594 REQ
O2-95 Intubat-NOT INTUBA Vent-SPONTANEOU
[**2135-7-28**] 01:06AM BLOOD Lactate-1.1

Brief Hospital Course:
Ms [**Known lastname 8520**] had positive blood cultures from OSH for MRSA, here
she had multiple blood cultures which were pertinent only for 1
bottle of coag neg staph. She did have persistently positive
sputum for MRSA with sparse gram negative rods speciated as
klebsiella & enterobacter. Urine negative, TEE negative, CT
abdomen unrevealing. tagged WBC scan negative.

Was on Vanc for 28 days & Cipro for 14 days. Had persistent
fevers to 102, ? was for drug fever vs persistent PNA.

CT scan showed RLL & LLL consolidation. Bronch & BAL was done.

Was intubated for worsening tachypnea, required sedation while
intubated [**2-28**] agitation.
Was extubated ~[**8-11**], but developed stridor & ? neg pressure pulm
edema requiring urgent reintubation.
Was trached on [**8-19**] & tolerated wean to trach collar well.

Infectious disease service followed here & helped manage
antibiotic regimen.


Medications on Admission:
Vancomycin 1.5 gm q.12
Gentamycin 100 mg IV q.8
HCTZ 25 mg qd
ASA 325 mg qd
Advair 50/500
Vasotec 10 mg qd
[**Doctor First Name **] 60 mg qd
Avandia 4 mg qd
Prilosec 40 mg qd
Lopressor 12.5 mg [**Hospital1 **]
RISS
Heparin 5000 units sq tid
Senna 2 tablets q hs
Lactulose prn
Effexor 150 mg qd
Singulair 10 mg qd
Nortriptyline 10 mg qhs
Tylenol prn
Ibuprofen prn
Morphine sulfate 4 mg IV q2h prn
Lasix prn responding well
Lanazolid ordered at OSH but never received.

Discharge Medications:
1. Albuterol Sulfate 0.083 % Solution Sig: 1-2 puffs Inhalation
Q6H (every 6 hours) as needed.
2. Salmeterol Xinafoate 50 mcg/DOSE Disk with Device Sig: One
(1) Disk with Device Inhalation Q12H (every 12 hours).
3. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation [**Hospital1 **] (2 times a day).
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Lorazepam 2 mg/mL Syringe Sig: 0.5-1.0 mg Injection Q4H
(every 4 hours) as needed for agitation/anxiety.
6. Avandia 4 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
1. Pneumonia
2. MRSA
3. Respiratory failure - resolved
4. s/p tracheostomy


Discharge Condition:
good

Discharge Instructions:
1. Trach collar maintenance
2. Physical therapy/occupational therapy to increase your
strength


Followup Instructions:
Call case management department here at [**Hospital3 **] for help
finding a new primary care physician
{'Methicillin susceptible Staphylococcus aureus septicemia,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Infection with microorganisms resistant to penicillins,Severe sepsis,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}


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: Fever and low back pain

PRESENT ILLNESS: 49 yo morbidly obese female who weighs 310 lb with hx of IDDM,
MRSA bacteremia, and low back pain was transferred from [**Hospital1 **]
[**Location (un) 620**] today.  Pt initially presented to [**Hospital1 **] [**Location (un) 620**] with 16
hour history of fevers and left low back pain.  She also
complained of dysuria and abdominal discomfort 3 days prior to
admission and was seen by her PCP but her urine culture was
negative.  The night prior to admission, she experienced fever
of 101.5, chills, and diaphoresis.  She was initially admitted
to [**Hospital1 **] [**Location (un) 620**] for evaluation of her fever and flank pain.  She
was initially treated with Levaquin but was started on
Vancomycin 1g q12 once the blood culture grew out MRSA.  Blood
culture was positive for MRSA on multiple occasion and showed no
growth on [**7-25**].  Patient continued to spike fever with Tm=105.1
on [**2135-7-26**].  At that time Gentamycin was added for synergy after
ID consult.  TEE was done which was negative for any valvular
vegetation.  Patient has left paraspinal tenderness with high
grade MRSA bacteremia of unknown source, MRI of the L spine was
recommended to rule out epidural abscess.  However, patient is
claustrophobic  and can only do either open MRI or MRI under
general anesthesia.  For that reason, patient was transferred to
[**Hospital1 18**] to have the MRI done under general anesthesia.  Dr.
[**Last Name (STitle) 1338**] from neurosurgery is aware of her.  Today, pt was on 2L
oxygen but came to the hospital with 5L.  Patient now requiring
face mask to keep her saturation.

MEDICAL HISTORY: Non insulin dependent diabetes
Hypertension
Status post cholecystectomy
Obesity
Asthma
Fibromyalgia

MEDICATION ON ADMISSION: Vancomycin 1.5 gm q.12
Gentamycin 100 mg IV q.8
HCTZ 25 mg qd
ASA 325 mg qd
Advair 50/500
Vasotec 10 mg qd
[**Doctor First Name **] 60 mg qd
Avandia 4 mg qd
Prilosec 40 mg qd
Lopressor 12.5 mg [**Hospital1 **]
RISS
Heparin 5000 units sq tid
Senna 2 tablets q hs
Lactulose prn
Effexor 150 mg qd
Singulair 10 mg qd
Nortriptyline 10 mg qhs
Tylenol prn
Ibuprofen prn
Morphine sulfate 4 mg IV q2h prn
Lasix prn responding well
Lanazolid ordered at OSH but never received.

ALLERGIES: Penicillins / Sulfonamides

PHYSICAL EXAM: VS: T 101.2 BP 134/50 HR 102 R 24-40's O2 sat 5 L
Gen: breathing in labor with face mask, diaphoretic
HEENT: PERRL, EOMI, MMM, sweaty
Lungs: distant breath sound, crackle on right posterior exam,
diffuse wheezing.
Cor: distant heart sound, murmurs appreciated at outside
hospital but difficult to assess with her heavy rapid breathing
and oxygen.
Abd: Obese, difficult to assess liver, spleen.
Ext: 1+ edema bilaterally.
Musc: Warm to touch and slight erythema of left lumber
paraspinal region.  +Tenderness to palpation.
Neuro: Alert, oriented.  CN II-XII grosssly intact.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Mother lives with her at home- she has been sick recently with
cellulitis [**Month (only) **]-[**Month (only) 116**], requiring hospitalization. No recent
travel.  Works as case manager at facility/NH for MR patients.
Patients on case load have been MRSA/VRE positive. Denies
tobacco, ETOH, drugs. HCP is mother: [**Telephone/Fax (1) 95392**] 

### Response:
{'Methicillin susceptible Staphylococcus aureus septicemia,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Infection with microorganisms resistant to penicillins,Severe sepsis,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
