CHIEF COMPLAINT: hip fracture s/p mechanical fall

PRESENT ILLNESS: Mr. [**Known lastname 21160**] is an 87 [**Hospital 100**] Rehab resident with a history of
coronary disease, s/p MI [**2167**], type II diabetes on oral therapy,
dementia, atrial fibrillation on warfarin who fell at his NH
this am and heard a "crack" in his hip - transfered to the [**Hospital1 18**]
ED where he is found to have a externally rotated and
foreshortened Rt LE and a comminuted right intertrochanteric
femur fracture. He was also noted to have a rt foot cellulitis.
He was afebrile on presentation, with a bp of 116/70, but was
soon noted to have a pressure drop to the 70's systolic and Hct
drop 27 to 22. He was guaiac neg. His INR was 2.6. He was given
2 U blood, 4 Units NS, 4 units FFP. His pressure responded well,
but he developed basilar crackles and mild dyspnea. He was noted
to have infero-lateral ST depressions during this episode with
relative tachycardia in the 120's (afib/rvr) - initial Trop T
0.03. Cardiology and Orthopedics were consulted.

MEDICAL HISTORY: CAD s/p MI [**2167**]
Afib on warfarin
Type II diabetes
Dementia

MEDICATION ON ADMISSION: ASA 81
Warfarin (? dose)
Glyburide 5 daily
Tylenol prn
Enalapril 2.5 daily
Toprol XL 75 daily

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 96.3 110 130/70 18 100% 2 lpm NC
HEENT: Pale, EOMI, PERRL, MMM
COR: Tachy, [**Last Name (un) 3526**] [**Last Name (un) 3526**], no mrg
PULM: bibasilar fine, wet rales, otw cta
ABD: diminished bowel sounds, soft, nt, nd
EXT: Rt foot dorsal celllulitis, 2+ edema bilaterally, rt LE
externally rotated and foreshortened
NEURO:fully alert and oriented, moves all four, face symmetric,
gait and station not evaluated

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Former bank teller. Lives at [**Hospital 100**] Rehab. Denies ETOH, tobacco.
Has cousins only still living for family. Makes own medical
decisions.
Closed fracture of intertrochanteric section of neck of femur,Unspecified fall,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Cellulitis and abscess of foot, except toes,Pressure ulcer, other site,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other persistent mental disorders due to conditions classified elsewhere,Old myocardial infarction
Intertrochanteric fx-cl,Fall NOS,Subendo infarct, initial,Atrial fibrillation,CHF NOS,Acute kidney failure NOS,Ac posthemorrhag anemia,Cellulitis of foot,Pressure ulcer, site NEC,Retention urine NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Mental disor NEC oth dis,Old myocardial infarct
Admission Date:  [**2169-9-11**]              Discharge Date:   [**2169-9-21**]


Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2962**]
Chief Complaint:
hip fracture s/p mechanical fall

Major Surgical or Invasive Procedure:
ORIF of right hip
Cardiac catheterization
Transesophageal echocardiogram
Cardioversion


History of Present Illness:
Mr. [**Known lastname 21160**] is an 87 [**Hospital 100**] Rehab resident with a history of
coronary disease, s/p MI [**2167**], type II diabetes on oral therapy,
dementia, atrial fibrillation on warfarin who fell at his NH
this am and heard a "crack" in his hip - transfered to the [**Hospital1 18**]
ED where he is found to have a externally rotated and
foreshortened Rt LE and a comminuted right intertrochanteric
femur fracture. He was also noted to have a rt foot cellulitis.
He was afebrile on presentation, with a bp of 116/70, but was
soon noted to have a pressure drop to the 70's systolic and Hct
drop 27 to 22. He was guaiac neg. His INR was 2.6. He was given
2 U blood, 4 Units NS, 4 units FFP. His pressure responded well,
but he developed basilar crackles and mild dyspnea. He was noted
to have infero-lateral ST depressions during this episode with
relative tachycardia in the 120's (afib/rvr) - initial Trop T
0.03. Cardiology and Orthopedics were consulted.

Past Medical History:
CAD s/p MI [**2167**]
Afib on warfarin
Type II diabetes
Dementia


Social History:
Former bank teller. Lives at [**Hospital 100**] Rehab. Denies ETOH, tobacco.
Has cousins only still living for family. Makes own medical
decisions.

Family History:
Noncontributory

Physical Exam:
VS: 96.3 110 130/70 18 100% 2 lpm NC
HEENT: Pale, EOMI, PERRL, MMM
COR: Tachy, [**Last Name (un) 3526**] [**Last Name (un) 3526**], no mrg
PULM: bibasilar fine, wet rales, otw cta
ABD: diminished bowel sounds, soft, nt, nd
EXT: Rt foot dorsal celllulitis, 2+ edema bilaterally, rt LE
externally rotated and foreshortened
NEURO:fully alert and oriented, moves all four, face symmetric,
gait and station not evaluated


Pertinent Results:
EKG [**2169-9-11**]: Atrial fibrillation with moderate ventricular
response; Indeterminate axis. Possible inferior infarct - age
undetermined. Cannot rule out anteroseptal infarct - age
undetermined . Lateral ST-T changes may be due to ischemia. No
previous tracing available for comparison

EKG [**2169-9-19**]: Probable atrial flutter.  Indeterminate axis.
Possible prior inferior infarct. Consider prior anterior
myocardial infarction. Nonspecific ST-T abnormalities. Consider
also in part chronic pulmonary disease or right ventricular
overload.

ADMISSION LABS
[**2169-9-11**] 09:43PM   HCT-24.0*
[**2169-9-11**] 02:08PM   HCT-27.2*
[**2169-9-11**] 07:05AM   HCT-22.2*
[**2169-9-11**] 04:30AM   WBC-7.6 RBC-2.87* HGB-9.3* HCT-26.8* MCV-93
MCH-32.6* MCHC-34.9 RDW-13.7

[**2169-9-11**] 02:08PM   GLUCOSE-194* UREA N-31* CREAT-1.5* SODIUM-139
POTASSIUM-5.1 CHLORIDE-105 TOTAL CO2-23 ANION GAP-16

[**2169-9-11**] 09:43PM   PT-21.6* INR(PT)-2.1*

[**2169-9-11**] 04:30AM BLOOD CK-MB-NotDone cTropnT-0.03*
[**2169-9-11**] 02:08PM BLOOD CK-MB-7 cTropnT-0.10*
[**2169-9-12**] 03:34AM BLOOD CK-MB-7 cTropnT-0.19*
[**2169-9-13**] 03:18AM BLOOD CK-MB-9 cTropnT-0.16*

DISCHARGE LABS

[**2169-9-21**] 07:00AM BLOOD WBC-8.6 RBC-3.03* Hgb-9.5* Hct-28.1*
MCV-93 MCH-31.4 MCHC-33.8 RDW-14.0 Plt Ct-284
[**2169-9-21**] 07:00AM BLOOD PT-37.3* PTT-47.5* INR(PT)-4.1*
[**2169-9-20**] 09:20AM BLOOD PT-24.6* PTT-49.9* INR(PT)-2.5*
[**2169-9-19**] 09:35AM BLOOD PT-20.6* PTT-42.7* INR(PT)-2.0*
[**2169-9-17**] 07:20AM BLOOD PT-19.2* PTT-37.2* INR(PT)-1.8*
[**2169-9-16**] 02:51AM BLOOD PT-17.4* PTT-34.1 INR(PT)-1.6*

[**2169-9-21**] 07:00AM BLOOD Glucose-107* UreaN-37* Creat-1.1 Na-140
K-4.0 Cl-104 HCO3-29 AnGap-11
[**2169-9-21**] 07:00AM BLOOD ALT-17 AST-25 LD(LDH)-278* AlkPhos-124*
TotBili-0.7

[**2169-9-19**] 09:35AM BLOOD TSH-5.8*

IMAGING
HIP  [**2169-9-11**] Comminuted right intertrochanteric femur fracture.

Echo [**2169-9-11**]
1. The left atrium is moderately dilated. The left atrium is
elongated. The  right atrium is moderately dilated.
2.There is mild symmetric left ventricular hypertrophy. The left
ventricular  cavity size is normal. Overall left ventricular
systolic function is normal  (LVEF>55%). Resting regional wall
motion abnormalities include mild distal  anteroseptal and
apical hypokinesis.
3. Right ventricular chamber size is normal. Right ventricular
systolic  function is normal.
4.The aortic valve leaflets (3) appear structurally normal with
good leaflet  excursion.
5.The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is  not present. Mild (1+) aortic regurgitation is
seen.
6.The mitral valve leaflets are structurally normal. There is
severe mitral  annular calcification. Mild (1+) mitral
regurgitation is seen.
7.Moderate to severe [3+] tricuspid regurgitation is seen.
8.There is moderate pulmonary artery systolic hypertension.
9.There is no pericardial effusion.

Cardiac Cath [**2169-9-12**]
Coronary angiography of this right dominant system demonstrated
severe 3 vessel and left main coronary artery disease.  The LMCA
had a mid-segment 70% stenosis.  The LAD was calcific and
diffusely diseased in the mid-segment with 70% stenosis.  The
LCx was heavily calcified with an origin OM1 60% stenosis,
patent OM2, and totally occluded OM3 that filled via
collaterals.  There was distal occlusion of the AV groove LCx
after the takeoff of the OM2.  The RCA was severely calcified
with diffuse disease throughout the entire vessel.  There was
origin 90% stenosis and serial 70-80% stenoses in the mid
segment.  The RCA also had a total occlusion in the distal
segment.  The RPL filled briskly via collaterals from the LAD.
2.  Limited resting hemodynamics revealed normal systemic
arterial pressures (114/63 mm Hg).

[**2169-9-15**]
Interval placement of dynamic femoral hip rod with improvement
of alignment of right intertrochanteric femoral fracture.

TEE [**2169-9-20**]
No spontaneous echo contrast or thrombus is seen in the body of
the left  atrium/left atrial appendage or the body of the right
atrium/right atrial  appendage. No mass or thrombus is seen in
the right atrium or right atrial  appendage. No atrial septal
defect is seen by 2D or color Doppler. There are   three aortic
valve leaflets. Mild (1+) eccentric aortic regurgitation is
seen.   Mild (1+) mitral regurgitation is seen with Significant
pulmonic regurgitation   is seen. Tricuspid regurgitation
appears eccentric and is probably moderate   but is not fully
visualized.

CXR PA/Lat [**2169-9-21**]: The heart is enlarged. Bilateral upper zone
redistribution with effusions is present consistent with known
failure.
There has been little change since the prior chest x-ray of
[**9-17**].


Brief Hospital Course:
Mr. [**Known lastname 21160**] is an 87 year old man with a history of coronary
disease, h/o reported AF on coumadin, type II DM, admitted [**9-11**]
with R intertrochanteric hip fracture.

1) Hip fracture:
Pt was admitted and found to have a R hip fracture.  He
developed an acute anemia thought to be secondary to hematoma.
He was admitted to the MICU for fluid overload and tachycardia.
His INR was reversed with FFP and he was given PRBC transfusion.
 After being cleared by medicine and cardiology, he was brought
to the OR on [**2169-9-15**] for an uncomplicated ORIF.

2) Cardiac:
a) Ischemia:
The patient experienced tachycardia and was noted to have
inferolateral ST changes.  He also had slightly positive cardiac
enzymes.  Cardiology was consulted given the possibility of
active ischemia.  An echo demonstrated apical WMA.  Ultimately,
for preoperative clearence, cardiology referred the patient for
cardiac cath.  Cath demonstrated severe 3-VD and it was
recommended that he only be medically optimized as he is not a
good candidate for percutaneous intervention or bypass surgery.

b) Rhythm: The patient has a reported history of atrial
fibrillation.  He is maintained on coumadin and was therapeutic
on admission.  Given his possible hematoma, his INR was
reversed.  Unfortunately, he developed a difficult to control
tachycardia and required escalating doses of beta-blockade with
poor control in the 100's to 120's.  The rhythm appeared to be
either atrial tachycardia or atypical (ie probably left-sided,
non cavotricuspid isthmus dependent atrial flutter.

Ultimately, the patient was transferred to the general medical
[**Hospital1 **] and had recurrence of the tachycardia.  Dilt and later dig
were added with poor effect.  He was then transferred to the
cardiology service and had improved rate control but still had
a-tach at around 270-300 bpm (atrial rate) with ventricular
rates in the 70-80's.  It was decided to pursue
TEE-cardioversion.  The TEE was negative for clot and
cardioversion was successful after 1 attempt.

The patient was started on Amiodarone.  This began with a 200mg
po loading dose and willc continue at 200mg [**Hospital1 **] x3 days starting
[**9-20**], followed by 200mg daily x7 days, then 100mg daily
thereafter.

c) Pump: Pt has preserved EF on echo, but likely a component of
diastolic dysfunction secondary to poor filling from inadequate
rate control.  He also received a lot of fluid from blood
transfusions early in his course.  He was given boluses of lasix
for diuresis.  His enalapril was held while his beta-blockers
were titrated, this is restarted prior to his discharge.

3) R foot cellulitis:
The patient received vancomycin [**Date range (1) 111024**] (8 days) plus levaquin
500mg x11days.  Given the resolution of his cellulitis and the
interactions with his coumadin, it was felt that did not require
further antibiotics as of [**9-21**].

4) Diabetes: patient's glyburide was held while in-house.  He
can be restarted on return to [**Hospital1 5595**].

7) Code: The patient had DNR paperwork from [**Hospital1 5595**] but on
admission the patient said he wanted to be full code.  His code
status was thus reversed.  This was verified with his cousin,
[**Name (NI) 1494**] [**Name (NI) **] who is also his healtcare proxy.  [**First Name4 (NamePattern1) 1494**] [**Last Name (NamePattern1) **]
[**Telephone/Fax (1) 111025**]

Medications on Admission:
ASA 81
Warfarin (? dose)
Glyburide 5 daily
Tylenol prn
Enalapril 2.5 daily
Toprol XL 75 daily


Discharge Medications:
1. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
2. Morphine 2 mg/mL Syringe Sig: 1-2 mg Injection Q4H (every 4
hours) as needed.
3. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours): Hold for HR<55,SBP<100.
4. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 2 days: 200 [**Hospital1 **] x2 days
200 daily x7 days
then 100mg daily therafter.
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
11. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours).
12. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6-8H (every 6
to 8 hours) as needed.
13. Enalapril Maleate 2.5 mg Tablet Sig: One (1) Tablet PO once
a day.
14. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day.
15. Warfarin 1 mg Tablet Sig: One (1) Tablet PO once a day: Hold
dose [**Date range (1) 3923**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
Primary:
R intertrochanteric hip fracture
Non ST-Segment elevation Myocardial infarction.
3-vessel coronary artery disease
atrial flutter with rapid ventricular response

Secondary
blood loss anemia
post-op blood loss anemia
congestive heart failure

Discharge Condition:
Stable

Discharge Instructions:
Please seek medical attention for fevers > 101.4, for anything
else medically concerning

Followup Instructions:
Please arrange follow up with a cardiologist in [**2-17**] weeks for
CAD and arrhythmia management.
Please follow daily weights
You INR goal [**2-17**] barring contraindications.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2964**] MD, [**MD Number(3) 2965**]
{'Closed fracture of intertrochanteric section of neck of femur,Unspecified fall,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Cellulitis and abscess of foot, except toes,Pressure ulcer, other site,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other persistent mental disorders due to conditions classified elsewhere,Old myocardial infarction'}


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: hip fracture s/p mechanical fall

PRESENT ILLNESS: Mr. [**Known lastname 21160**] is an 87 [**Hospital 100**] Rehab resident with a history of
coronary disease, s/p MI [**2167**], type II diabetes on oral therapy,
dementia, atrial fibrillation on warfarin who fell at his NH
this am and heard a "crack" in his hip - transfered to the [**Hospital1 18**]
ED where he is found to have a externally rotated and
foreshortened Rt LE and a comminuted right intertrochanteric
femur fracture. He was also noted to have a rt foot cellulitis.
He was afebrile on presentation, with a bp of 116/70, but was
soon noted to have a pressure drop to the 70's systolic and Hct
drop 27 to 22. He was guaiac neg. His INR was 2.6. He was given
2 U blood, 4 Units NS, 4 units FFP. His pressure responded well,
but he developed basilar crackles and mild dyspnea. He was noted
to have infero-lateral ST depressions during this episode with
relative tachycardia in the 120's (afib/rvr) - initial Trop T
0.03. Cardiology and Orthopedics were consulted.

MEDICAL HISTORY: CAD s/p MI [**2167**]
Afib on warfarin
Type II diabetes
Dementia

MEDICATION ON ADMISSION: ASA 81
Warfarin (? dose)
Glyburide 5 daily
Tylenol prn
Enalapril 2.5 daily
Toprol XL 75 daily

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 96.3 110 130/70 18 100% 2 lpm NC
HEENT: Pale, EOMI, PERRL, MMM
COR: Tachy, [**Last Name (un) 3526**] [**Last Name (un) 3526**], no mrg
PULM: bibasilar fine, wet rales, otw cta
ABD: diminished bowel sounds, soft, nt, nd
EXT: Rt foot dorsal celllulitis, 2+ edema bilaterally, rt LE
externally rotated and foreshortened
NEURO:fully alert and oriented, moves all four, face symmetric,
gait and station not evaluated

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Former bank teller. Lives at [**Hospital 100**] Rehab. Denies ETOH, tobacco.
Has cousins only still living for family. Makes own medical
decisions. 

### Response:
{'Closed fracture of intertrochanteric section of neck of femur,Unspecified fall,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Cellulitis and abscess of foot, except toes,Pressure ulcer, other site,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other persistent mental disorders due to conditions classified elsewhere,Old myocardial infarction'}
