CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 1968**] is a 66 year-old
gentleman with an extensive past medical history as mentioned
above who is admitted to the hospital for operative
management for an expanding tension pneumothorax on the right
side.  He was admitted on [**2151-8-31**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Spontaneous tension pneumothorax,Other emphysema,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Postinflammatory pulmonary fibrosis,Atrial fibrillation,Other chronic pulmonary heart diseases
Spont tens pneumothorax,Emphysema NEC,Cholelith w ac cholecyst,Postinflam pulm fibrosis,Atrial fibrillation,Chr pulmon heart dis NEC
Admission Date:  [**2151-8-1**]       Discharge Date:  [**2151-8-31**]

Date of Birth:   [**2084-12-14**]       Sex:  M

Service:  THORACIC SURGERY

ADMISSION DIAGNOSES:
1.  Spontaneous pneumothorax.
2.  Emphysema.
3.  History of supraventricular tachycardia.
4.  Pulmonary hypertension.
5.  Spinal stenosis.
6.  Interstitial lung disease.
7.  History of steroid induced psychosis.

DISCHARGE DIAGNOSES:
1.  Spontaneous pneumothorax status post V.A.T.S., status
post pleurodesis, status post decortication.
2.  Biliary sepsis status post open cholecystectomy, status
post percutaneous cholecystomy.
3.  Interstitial lung disease.
4.  Emphysema.
5.  Multifocal atrial fibrillation.
6.  Pulmonary hypertension.
7.  Spinal stenosis.
8.  History of syphilis.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 1968**] is a 66 year-old
gentleman with an extensive past medical history as mentioned
above who is admitted to the hospital for operative
management for an expanding tension pneumothorax on the right
side.  He was admitted on [**2151-8-31**].

PHYSICAL EXAMINATION:  On initial was his temperature was
97.9.  Pulse 96 with a blood pressure of 99/42.  Respiratory
rate 20.  Sating 96% on 3 liters.  He did not appear to be in
acute distress, but he did have notably decreased breath
sounds bilaterally.  His heart was regular rate and rhythm.
His abdomen was soft and flat.  Extremities were warm.  There
was no edema present.

ADMISSION LABORATORIES:  Admission white count was 12.3 with
a hematocrit of 42.8.  His BUN and creatinine at the time of
admission were 46 and 1.5 respectively.  His K initially was
5.6 at the time of admission and was subsequently corrected.

HOSPITAL COURSE:  After the patient was admitted he planned
to undergo a V.A.T.S. procedure, but on the morning of
surgery the patient's pneumothorax began enlarging and became
somewhat hemodynamic compromise and was taken urgently to the
Operating Room where he underwent thoracoscopic decortication
and thoracotomy with pleurodesis.  Postoperatively, the
patient became tachycardic and hypotensive with diminish in
urine output and was taken to the Intensive Care Unit and
treated for what was presumed to be hypovolemia.
Subsequently while on the floor the patient's blood pressures
remained in the 70s/40s, 80s/50s and it was determined that
this was likely the patient's baseline after extensive
attempts to manipulate the blood pressure with fluids and
diuresis, etc.  Notably early on in the [**Hospital 228**] hospital
course he seemed to be going through an addisonian crisis and
has only subsequently learned that the patient had been
taking chronic steroids.  This was not known by the patient
and he did not provide this in his admission history.  After
the patient's chronic doses of steroids were restarted the
patient's electrolyte abnormalities and fluid problems
somewhat improved after the patient was transferred to the
floor he continued to remain with his blood pressures in the
80s/40s and repeatedly underwent episodes which were
initially thought to be atrial fibrillation, which were
treated with intravenous Metoprolol, but were subsequently
determined to be multifocal atrial tachycardia.
Approximately one and a half weeks postoperatively after the
patient's V.A.T.S. he developed a notable erythema over the
abdomen over the right lateral aspect of the back.  This was
accompanied by belly pain, which progressively worsened.
General surgery was consulted.

Laboratory tests were drawn including liver function tests
and ultrasound of the gallbladder.  Ultrasound of the
gallbladder did not show an acute problem with
cholelithiasis.  There was some inflammation noted.  He had
some dilatation noted.  The patient had a percutaneous
cholecystostomy on [**2151-8-14**] in order for drainage as he
was a poor operative candidate fore a cholecystectomy.
Subsequent to this the patient's symptoms were not relieved
and he remained febrile, tachycardic and appeared somewhat
septic.  He was taken urgently to the Operating Room on [**2151-8-16**] for an open cholecystectomy at which time a
gangrenous gallbladder was found with clotted blood.  He was
subsequently cared for in the Intensive Care Unit for his
inability to maintain blood pressures over 70 systolic and
repeated episodes of his atrial tachycardia.
Electrophysiology was also consulted to see the patient and
they were in assistance in somewhat managing this rhythm.  It
is determined that the patient's blood pressure would be fine
if he was maintained at his baseline rate and he should be
given Toprol XL for control of this tachycardia and otherwise
there were no operative interventions for alleviation of this
arrhythmia.

Due to the patient's extensive time in Intensive Care Unit
and lack of mobility he became quite debilitated.  The last
week of his hospitalization was dedicated to providing the
patient with increasing strength and he was given
hyperalimentation where he was given nutritional supplements
through tube feeds in order for him to improve his body
weight and also he was given aggressive physical therapy.  It
was noted that he had bilateral lower extremity weakness,
which was somewhat out or proportion to his upper extremity
weakness and given this with occasional episodes of
incontinence the patient was having neurology was consulted
and the patient had an MRI of the spine in order to evaluate
for a compressing lesion or cauda equina syndrome.  This
turned out to be negative.  Attempts at rehabilitating the
patient while in the hospital were extremely difficult as the
patient at present is unable to stand even with assistance,
but his weight is improving and he is able to take excellent
po intake.  Neurology was consulted for this weakness and
also suggested that the patient might have a steroid induced
myopathy and/or alcohol induced myopathy as he ___________
supplementing thiamine and folate and electrolytes, this was
all done and neurology would like to see the patient in
outpatient follow up and he should be scheduled for an EMG to
evaluate his lower extremity weakness as an outpatient.
Essentially at the time of discharge the patient is medically
stable.  His normal blood pressure does run in the 80s/40s
and at times 70s/40s although the patient has no mental
status changes with this and does not experience any symptoms
of dizziness or shortness of breath with these episodes.  He
is in normal sinus rhythm currently, although he periodically
does revert to his multifocal atrial tachycardia, which has
been greatly reduced with the addition of Toprol XL, but is
rate controlled when necessary with intravenous Lopressor.
Otherwise in terms of respiratory status he continues to have
his emphysema and interstitial lung disease for which he is
on chronic steroids on which he should be maintained as per
his primary care physician, [**Name10 (NameIs) **] there is no evidence of
pneumonia or volume overload.

In terms of his cardiac status as mentioned previously aside
from this tachycardia he had a repeated evaluations for acute
myocardial infarction during episodes of his arrhythmia and
nothing conclusive was ever noted.  No note of acute ischemia
was found on his electrocardiograms.  From a gastrointestinal
standpoint the patient is taking adequate po intake without
difficulty.  He occasionally does have some rectal
incontinence, but this may be secondary to an inability to
ambulate to the bathroom according to the patient.  In terms
of his renal status, the patient is renally stable.  His BUN
and creatinine have been fine and he has been making good
urine.  At present the patient has no evidence of any sort of
infection.  All blood cultures drawn throughout this hospital
especially during the period of his biliary sepsis were not
notable and he did receive multiple courses of antibiotics
during those episodes.  Hematologically, his hematocrit is
stable.  Neurologically the patient is stable.  As noted the
patient is neurologically stable, but does need an outpatient
neurological evaluation for which he has been instructed and
given the phone numbers to attend.

Otherwise at the time of discharge the patient's laboratories
included white count of 10.4, hematocrit stable at 32.7.  The
patient's final urinalysis at the time of discharge showed no
evidence of urinary tract infection.  His sodium was 133 with
a K of 4.2 with serum bicarb of 99 and 29 respectively.  His
BUN and creatinine were 39 and 0.7.  His glucose was 139.

DISCHARGE MEDICATIONS:
1.  Toprol XL 75 mg po q day.
2.  Magnesium oxide 140 mg po q.d.
3.  Folate 1 mg po q.d.
4.  Thiamine 100 mg po q.d.
5.  Lasix 40 mg po b.i.d.
6.  Potassium chloride 20 milliequivalents po b.i.d.
7.  Prednisone 50 mg po q.d.
8.  Protonix 40 mg po q.d.
9.  Albuterol inhaler one to two inhalations b.i.d. prn.
10.  Combivent inhaler one to two inhalations b.i.d. prn.
11.  Combivent one to two puffs b.i.d.

DISCHARGE CONDITION:  Good.  He is discharged to an extended
care facility for rehabilitation.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3351**], M.D.  [**MD Number(1) 3352**]

Dictated By:[**Last Name (NamePattern1) 101471**]
MEDQUIST36

D:  [**2151-8-31**]  10:53
T:  [**2151-8-31**]  11:07
JOB#:  [**Job Number 101472**]
{'Spontaneous tension pneumothorax,Other emphysema,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Postinflammatory pulmonary fibrosis,Atrial fibrillation,Other chronic pulmonary heart diseases'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname 1968**] is a 66 year-old
gentleman with an extensive past medical history as mentioned
above who is admitted to the hospital for operative
management for an expanding tension pneumothorax on the right
side.  He was admitted on [**2151-8-31**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Spontaneous tension pneumothorax,Other emphysema,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Postinflammatory pulmonary fibrosis,Atrial fibrillation,Other chronic pulmonary heart diseases'}
