CHIEF COMPLAINT: CC:[**CC Contact Info 15218**]
Major Surgical or Invasive Procedure:
None.

PRESENT ILLNESS: HPI: 81M w/recent subdural hematoma s/p evacuation in [**3-30**], CHF,

MEDICAL HISTORY: 1. CHF: [**2-27**] echo: mild symm LVH, EF 55% but likely
overestimation with degree of MR
2.  3+ mitral regurgitation
3. Atrial fibrillation
4. Ascending aortic aneurysm- [**11-27**] CTA: 5.7 x 5.4 cm stable
(pt. currently not interested in surgery)
5. DM2
6. Gout
7. Inflammatory Colitis (?)on chronic sulfasalazine.  No prior
surgeries or recent flares.
8. Hypertension
9. GERD
10. h/o Asbestosis
11. Recent B12 and Fe def. anemia
12. ?progressive dementia

MEDICATION ON ADMISSION: 1. Ferrous Sulfate 325 PO DAILY
2. Docusate Sodium 100 mg PO BID
3. Furosemide 40 mg PO DAILY
4. Levetiracetam 250 mg PO QAM
5. Levetiracetam 250 mg PO HS
6. Citalopram 10 mg PO DAILY
7. Ascorbic Acid 250 mg PO DAILY
8. Vancomycin 500 mg IV q24h
9. Levothyroxine 25 mcg PO DAILY
10. Metoprolol Tartrate 50 mg PO BID
11. Lisinopril 5 mg PO once a day.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 96.9 HR 109/41 HR 71 R 19 98% 3L
Gen: NAD, A&O X  2
Skin: no rash
HEENT: EOMI, PERRL, O/P clear
Neck: supple, no LAD
CV: RRR nl s1 s2 2/6 sem at llsb
Pulm: CTAB
Abd: soft, NT, ND +BS
Ext: cachetic, no edema
Neuro: A&O X [**1-27**], moves all 4, sensation intact to LT, 2+ DTR at
[**Name2 (NI) 15219**] b/l, [**Last Name (un) **] down b/l

FAMILY HISTORY: no Alzhemer's or Parkinson's

SOCIAL HISTORY: Married, lives with wife, no prior [**Name (NI) **]/ETOH. Worked as a
salesman. h/o asbestosis exposure when in the service
(?shipyards).
Cheyne-Stokes respiration,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Unspecified sleep apnea,Atrial fibrillation,Abdominal aneurysm without mention of rupture,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Cheyne-stokes respiratn,CHF NOS,Chronic kidney dis NOS,Sleep apnea NOS,Atrial fibrillation,Abdom aortic aneurysm,DMII wo cmp nt st uncntr
Admission Date:  [**2119-5-26**]              Discharge Date:   [**2119-5-27**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
CC:[**CC Contact Info 15218**]
Major Surgical or Invasive Procedure:
None.


History of Present Illness:
HPI: 81M w/recent subdural hematoma s/p evacuation in [**3-30**], CHF,

Afib, aortic aneurysm, recently ([**4-29**]) admission to [**Hospital Unit Name 153**] for
altered
mental status and hypoxia ([**2039-5-11**]) found to have RML MRSA PNA
plus CHF with intubation. Sent to ED for evaluation for
somnolence, and apnea from [**Hospital1 599**] at [**Location (un) 55**]. This am pt's
RR fluctuated from 24/min to periods of 30-40 sec apneic
episodes with O2 sats ranging from 88-94% on RA.  In the ED,
found to be somnolent but arouseable and able to eat and answer
questions.  Weight is stable at 126 lbs on lasix 40 mg PO daily.
 His Vancomycin course is due to end [**5-27**].  Dose is 500 mg IV
q24h due to high troughs.  In ED afebrile, BP 110/70 P 80 O2 97%
RA.
.
Also in his hospitalization in [**3-30**] at [**Hospital1 18**] he was found to
have an Enterobacter UTI and a LLL pneumonia (treated with
Levoflox).
.
Pt denies any complaints at this time. Endorses feeling confused
this morning and reports that sometimes he "loses days" and that
bothers him.
.
ROS: Denies CP, SOB, orthop, PND, palpitations, cough, fevers,
new weaknesses, changes in sensation or vision, nausea,
vomiting, diarrhea, abdominal pain, hematuria, dysuria, blood in
the stools.

Past Medical History:
1. CHF: [**2-27**] echo: mild symm LVH, EF 55% but likely
overestimation with degree of MR
2.  3+ mitral regurgitation
3. Atrial fibrillation
4. Ascending aortic aneurysm- [**11-27**] CTA: 5.7 x 5.4 cm stable
(pt. currently not interested in surgery)
5. DM2
6. Gout
7. Inflammatory Colitis (?)on chronic sulfasalazine.  No prior
surgeries or recent flares.
8. Hypertension
9. GERD
10. h/o Asbestosis
11. Recent B12 and Fe def. anemia
12. ?progressive dementia

Social History:
Married, lives with wife, no prior [**Name (NI) **]/ETOH. Worked as a
salesman. h/o asbestosis exposure when in the service
(?shipyards).


Family History:
no Alzhemer's or Parkinson's

Physical Exam:
VS: T 96.9 HR 109/41 HR 71 R 19 98% 3L
Gen: NAD, A&O X  2
Skin: no rash
HEENT: EOMI, PERRL, O/P clear
Neck: supple, no LAD
CV: RRR nl s1 s2 2/6 sem at llsb
Pulm: CTAB
Abd: soft, NT, ND +BS
Ext: cachetic, no edema
Neuro: A&O X [**1-27**], moves all 4, sensation intact to LT, 2+ DTR at
[**Name2 (NI) 15219**] b/l, [**Last Name (un) **] down b/l


Pertinent Results:
Studies:
[**5-26**]: CT Head: no intracranial hemorrhage, unchanged hypodense
fluid collection subdural R frontal lobe.
[**5-26**]: CXR: no new infiltrate


Brief Hospital Course:
A/P:  81M w/recent subdural hematoma s/p evacuation in [**3-30**],
CHF,
Afib, aortic aneurysm, recent MRSA PNA and CHF flare now
admitted with somnolence and periods of apnea.
.
# Somnolence: Now seems to be resolved. Pt's family noted him to
be unresponsive, or minimally responsive this morning. DDx
includes infection, hypercarbia, extension of subdural hematoma.
UA, CXR clear, ABG without hypercarbia, CT head OK. ?Worsening
of baseline dementia vs. post-ictal from seizure? Likely
secondary to severe sleep apnea and daytime sleepiness.
.
# Apnea: Unclear if this is new, or newly recognized.  Pt has
characteristic findings of [**Last Name (un) 6055**]-[**Doctor Last Name **] breathing.  Will need
outpt sleep study for titration of CPAP if necessary.  Pt
reports that he would not want CPAP, can be discussed with PCP.
.
# hx CHF: Currently euvolemic, no evidence of CHF flare.
last echo ([**2119-4-3**]) w/EF >55%, 2+ MR, mod AR.
-- Continue home doses of lasix, BB, ACE-I
.
# PNA: Hx MRSA PNA during last admission.
- CXR shows resolving infiltrate.
- No leukocytosis or febrile episodes. Last thoracocentesis in
[**4-29**] showed transudative fluid c/w CHF exacerbation
- Recent sputum grew MRSA ([**5-12**] & [**5-14**]), sensitive to vanco. 10
day course to end [**5-27**].
.
# Subdural hematoma:
- No change on today's head CT
- On Keppra for seizure prophylaxis post-craniotomy (to be
continued  until out-pt neurology or neurosurgical follow-up).
.
# AAA: ascending; measured >5cm in [**11-27**] & pt refused surgical
intervention at that time.
.
# CRI:  (baseline creatinine 1.2-1.6) Today 1.1.
.
# Paroxysmal Afib:
-- continue metoprolol for rate control
-- No anticoagulation with warfarin given recent subdural
hematoma and h/o frequent falls.
.
# DM2:
-- RISS
-- Diabetic diet.
.
# Anemia: iron studies most c/w chronic dz (ferritin 86). Hct
stable. Cont ferrous sulfate.  Guaiac all stools.
.
# Hypothyroidism: clinically euthyroid. Continue synthroid.
.
# Depression: remained stable. Continue celexa.
.
# FEN: PO diet, monitor lytes, replete prn.
# Prophylaxis: protonix and pneumoboots. bowel regimen.
# Communication: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (daughter) [**Telephone/Fax (5) **] 248

2146
# Code: DNR/I, confirmed with pt and last d/c summary
# Dispo: back to rehab.

Medications on Admission:
1. Ferrous Sulfate 325 PO DAILY
2. Docusate Sodium 100 mg PO BID
3. Furosemide 40 mg PO DAILY
4. Levetiracetam 250 mg PO QAM
5. Levetiracetam 250 mg PO HS
6. Citalopram 10 mg PO DAILY
7. Ascorbic Acid 250 mg PO DAILY
8. Vancomycin 500 mg IV q24h
9. Levothyroxine 25 mcg PO DAILY
10. Metoprolol Tartrate 50 mg PO BID
11. Lisinopril 5 mg PO once a day.

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
3. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Levetiracetam 250 mg Tablet Sig: One (1) Tablet PO QAM (once
a day (in the morning)).
6. Levetiracetam 250 mg Tablet Sig: One (1) Tablet PO QHS (once
a day (at bedtime)).
7. Citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
8. Ascorbic Acid 250 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO DAILY (Daily).
9. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1)
Intravenous  Q 12H (Every 12 Hours) for 1 doses: pt has one dose
left in his course for [**5-27**] evening.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
[**Last Name (un) 6055**]-[**Doctor Last Name **] breathing pattern
Sleep Apnea
CHF
Resolving MRSA PNA.


Discharge Condition:
Stable.


Discharge Instructions:
Call your primary care physician or return to the emergency room
if you have shortness of breath, chest pain, or any other
symptom that bothers you.

Followup Instructions:
Please call [**Hospital1 18**] Sleep Lab for a sleep study [**Telephone/Fax (1) 15220**].
Please call your primary care physician for an appointment at
[**Telephone/Fax (1) 3070**].
{'Cheyne-Stokes respiration,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Unspecified sleep apnea,Atrial fibrillation,Abdominal aneurysm without mention of rupture,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: CC:[**CC Contact Info 15218**]
Major Surgical or Invasive Procedure:
None.

PRESENT ILLNESS: HPI: 81M w/recent subdural hematoma s/p evacuation in [**3-30**], CHF,

MEDICAL HISTORY: 1. CHF: [**2-27**] echo: mild symm LVH, EF 55% but likely
overestimation with degree of MR
2.  3+ mitral regurgitation
3. Atrial fibrillation
4. Ascending aortic aneurysm- [**11-27**] CTA: 5.7 x 5.4 cm stable
(pt. currently not interested in surgery)
5. DM2
6. Gout
7. Inflammatory Colitis (?)on chronic sulfasalazine.  No prior
surgeries or recent flares.
8. Hypertension
9. GERD
10. h/o Asbestosis
11. Recent B12 and Fe def. anemia
12. ?progressive dementia

MEDICATION ON ADMISSION: 1. Ferrous Sulfate 325 PO DAILY
2. Docusate Sodium 100 mg PO BID
3. Furosemide 40 mg PO DAILY
4. Levetiracetam 250 mg PO QAM
5. Levetiracetam 250 mg PO HS
6. Citalopram 10 mg PO DAILY
7. Ascorbic Acid 250 mg PO DAILY
8. Vancomycin 500 mg IV q24h
9. Levothyroxine 25 mcg PO DAILY
10. Metoprolol Tartrate 50 mg PO BID
11. Lisinopril 5 mg PO once a day.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 96.9 HR 109/41 HR 71 R 19 98% 3L
Gen: NAD, A&O X  2
Skin: no rash
HEENT: EOMI, PERRL, O/P clear
Neck: supple, no LAD
CV: RRR nl s1 s2 2/6 sem at llsb
Pulm: CTAB
Abd: soft, NT, ND +BS
Ext: cachetic, no edema
Neuro: A&O X [**1-27**], moves all 4, sensation intact to LT, 2+ DTR at
[**Name2 (NI) 15219**] b/l, [**Last Name (un) **] down b/l

FAMILY HISTORY: no Alzhemer's or Parkinson's

SOCIAL HISTORY: Married, lives with wife, no prior [**Name (NI) **]/ETOH. Worked as a
salesman. h/o asbestosis exposure when in the service
(?shipyards). 

### Response:
{'Cheyne-Stokes respiration,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Unspecified sleep apnea,Atrial fibrillation,Abdominal aneurysm without mention of rupture,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
