CHIEF COMPLAINT: dyspnea, chest and back pain

PRESENT ILLNESS: 58 yo F presented to [**Hospital 61989**] Hospital with chest and back pain
and SOB. BP > 200. CT showed Type B dissection, started on
nitroprusside gtt, transferred to [**Hospital1 18**] for further eval.

MEDICAL HISTORY: cushings syndrome, AVR/ascending aorta [**2143**], pulmonary AVM
repair [**2143**], COPD, GERD, h/o splenic lac c/b cardiac arrest and
anoxic brain injury, bilat adrenalectomy

MEDICATION ON ADMISSION: atrovent, metoprolol, prednisone

ALLERGIES: Codeine / Talwin / Nafcillin

PHYSICAL EXAM: 37.0 54 132/74 19 97% NRB
NAD
Dobhoff in place and functioning.
RRR, no M/R/G
CTAB
Abdomen soft/NT/ND
Palpable pedal pulses, no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: unknown.
Dissection of aorta, thoracic,Other complications due to other vascular device, implant, and graft,Hematoma complicating a procedure,Unspecified pleural effusion,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Anemia, unspecified,Other diseases of trachea and bronchus,Esophageal reflux
Dsct of thoracic aorta,Comp-oth vasc dev/graft,Hematoma complic proc,Pleural effusion NOS,Surg compl-urinary tract,Urin tract infection NOS,Proteus infection NOS,Chr airway obstruct NEC,Atrial fibrillation,Anemia NOS,Trachea & bronch dis NEC,Esophageal reflux
Admission Date:  [**2150-10-26**]              Discharge Date:   [**2150-11-11**]

Date of Birth:  [**2092-3-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Talwin / Nafcillin

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
dyspnea, chest and back pain

Major Surgical or Invasive Procedure:
s/p thoracoabdominal stent graft for ruptured thoracic
aneurysm/dissection [**10-26**], coiling of L subclavian [**10-27**], s/p
tracheal stent [**10-30**]; tracheostomy [**11-4**]


History of Present Illness:
58 yo F presented to [**Hospital 61989**] Hospital with chest and back pain
and SOB. BP > 200. CT showed Type B dissection, started on
nitroprusside gtt, transferred to [**Hospital1 18**] for further eval.

Past Medical History:
cushings syndrome, AVR/ascending aorta [**2143**], pulmonary AVM
repair [**2143**], COPD, GERD, h/o splenic lac c/b cardiac arrest and
anoxic brain injury, bilat adrenalectomy

Social History:
unknown.

Family History:
NC

Physical Exam:
37.0 54 132/74 19 97% NRB
NAD
Dobhoff in place and functioning.
RRR, no M/R/G
CTAB
Abdomen soft/NT/ND
Palpable pedal pulses, no edema


Pertinent Results:
[**2150-11-11**] 03:08AM BLOOD WBC-17.2* RBC-3.20* Hgb-9.3* Hct-28.6*
MCV-89 MCH-29.1 MCHC-32.6 RDW-17.9* Plt Ct-1734*
[**2150-11-9**] 04:15AM BLOOD WBC-25.0* RBC-3.15* Hgb-9.1* Hct-28.5*
MCV-90 MCH-29.0 MCHC-32.1 RDW-17.5* Plt Ct-1782*
[**2150-10-26**] 04:30PM BLOOD WBC-12.2* RBC-3.97* Hgb-12.2 Hct-37.2
MCV-94 MCH-30.8 MCHC-32.8 RDW-15.7* Plt Ct-346
[**2150-11-11**] 05:38AM BLOOD PT-16.2* PTT-41.4* INR(PT)-1.4*
[**2150-11-11**] 03:08AM BLOOD Plt Ct-1734*
[**2150-11-10**] 05:42AM BLOOD Plt Ct-1846*
[**2150-11-8**] 02:23AM BLOOD Plt Ct-1276*
[**2150-11-5**] 02:55AM BLOOD Plt Ct-863*
[**2150-10-26**] 04:30PM BLOOD PT-35.0* PTT-27.1 INR(PT)-3.8*
[**2150-11-11**] 03:08AM BLOOD Glucose-173* UreaN-13 Creat-0.4 Na-135
K-4.4 Cl-100 HCO3-25 AnGap-14
[**2150-10-26**] 04:30PM BLOOD UreaN-17 Creat-0.6
[**2150-11-8**] 02:23AM BLOOD ALT-31 AST-49* AlkPhos-299* Amylase-68
TotBili-0.5
[**2150-10-26**] 04:30PM BLOOD ALT-19 AST-19 LD(LDH)-222 CK(CPK)-42
AlkPhos-91 Amylase-87 TotBili-0.7
[**2150-11-11**] 03:08AM BLOOD Mg-2.3
[**2150-10-26**] 04:30PM BLOOD Albumin-3.4 Calcium-8.9 Phos-3.1 Mg-2.0
[**2150-11-11**] 05:38AM BLOOD Vanco-12.1
[**2150-11-3**] 05:10PM BLOOD Vanco-30.0*
[**2150-11-2**] 12:13PM BLOOD Type-ART Temp-36.9 Rates-/23 Tidal V-414
PEEP-5 FiO2-40 pO2-109* pCO2-37 pH-7.37 calTCO2-22 Base XS--3
Intubat-INTUBATED Vent-SPONTANEOU
[**2150-10-26**] 06:46PM BLOOD Type-ART pO2-441* pCO2-38 pH-7.36
calTCO2-22 Base XS--3
[**2150-11-1**] 11:41AM BLOOD Glucose-115* K-3.7
[**2150-10-26**] 04:56PM BLOOD Glucose-117* Lactate-2.8* Na-144 K-3.5
Cl-103 calHCO3-27
[**2150-11-1**] 11:41AM BLOOD O2 Sat-98

Brief Hospital Course:
She was taken to the operating room emergently on [**10-26**] where she
underwent endovascular stent placement of descending thoracic
aorta vioa a retroperitoneal approach. She was extubated the
morning of POD #1 but was reintubated one hour later for
respiratory distress and stridor. Her left subclavian was coiled
for endoleak. She was given stress dose steroids. She was seen
by thoracic surgery for widened mediatinum and small left
pleural effusion post op. Bronchoscopy on [**10-29**] showed narrowing
of distal trachea and B/L mainstem bronchi from compression from
mediatinal hematoma. On [**10-30**] she underwent right thoracentesis
for 450 cc, rigid bronch/flexible bronchoscopy and Y stent
placement with IP on [**10-30**]. She was again extubated and
reintubated for respiratory distress on [**10-30**]. She was seen by
infectious diseases for 2-3 days of fevers. She grew gram +
cocci in blood cultures and proteus in her urine and was started
on vanocmycin and aztreonam and will need to complete a four
week course. On [**11-2**] she was bronched and extubated again, but
was reintubated shortly after for respiratory distress. On [**11-4**]
she underwent tracheostomy. Her health care proxy refused
placement of PEG. She was difficult to sedate and was tried on
Remifentanil, then thorazine with no resolution. Neurology and
psychistry was consulted.  Recommendations were to continue
Thorazine,  in combination with low dose Haldol 2mg TID.  All
other sedation was discontinued.  Weaned off ventilator to
trach-mask on [**11-10**].  Pt tolerated this well.  Heparin drip
continued as INR did not become therapeutic.  Vancomycin trough
was low at 12 on [**11-11**] and so dose was increased to 1250 [**Hospital1 **].
She was ready for discharge for rehab on [**11-11**] and placement was
secured.

Medications on Admission:
atrovent, metoprolol, prednisone

Discharge Medications:
1. Docusate Sodium 100 mg Capsule [**Month/Year (2) **]: One (1) Capsule PO BID (2
times a day).
2. Atorvastatin 10 mg Tablet [**Month/Year (2) **]: One (1) Tablet PO DAILY
(Daily).
3. Aspirin 325 mg Tablet [**Month/Year (2) **]: One (1) Tablet PO DAILY (Daily).
4. Prednisone 5 mg Tablet [**Month/Year (2) **]: 1.5 Tablets PO DAILY (Daily).
5. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol [**Month/Year (2) **]: Two
(2) Puff Inhalation Q4H (every 4 hours).
6. Fluticasone 110 mcg/Actuation Aerosol [**Month/Year (2) **]: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
7. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
8. Warfarin 1 mg Tablet [**Last Name (STitle) **]: as dirercted Tablet PO DAILY
(Daily): target INR 2.5-3.
9. Haloperidol 1 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO TID (3 times a
day).
10. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: Three (3) Tablet PO
TID (3 times a day).
11. Warfarin 2.5 mg Tablet [**Last Name (STitle) **]: Three (3) Tablet PO ONCE (Once)
for 1 doses.
12. Aztreonam 1 gram Recon Soln [**Last Name (STitle) **]: One (1) gm Injection Q8H
(every 8 hours) for 4 weeks.
13. Lorazepam 2 mg/mL Syringe [**Last Name (STitle) **]: 0.5 mg Injection Q4H (every 4
hours) as needed.
14. Chlorpromazine 25 mg/mL Solution [**Last Name (STitle) **]: Twenty Five (25) mg
Injection Q6H (every 6 hours) as needed.
15. Heparin (Porcine) in D5W 100 unit/mL Parenteral Solution
[**Last Name (STitle) **]: 1400 (1400) units/hr Intravenous ASDIR (AS DIRECTED): goal
ptt 60.
16. Vancomycin 1,000 mg Recon Soln [**Last Name (STitle) **]: 1250 (1250) mg
Intravenous Q 12H (Every 12 Hours) for 4 weeks.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Type B Dissection
PMH: s/p AVR(mech),COPD, GERD, h/o splenic lac c/b cardiac
arrest and anoxic brain injury, [**Location (un) 3484**]
PSH: ?MVR, bilat adrenalectomy, asc Ao repair [**2143**]


Discharge Condition:
Stable.


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.

IMPORTANT:  REGARDING COUMADIN: patient has a mechanical valve
and therefore needs to be anticoagulated with heparin drip until
therapeutic INR acheived between 2.5 - 3.0.  Dosing should be
given in response to daily levels and adjusted accordingly.
Dosing as dicated on discharge medication section should
therefore serve as a guideline and not a strict dosage.

Followup Instructions:
Dr. [**Last Name (STitle) 914**] 4 weeks
Dr. [**Last Name (STitle) **] after discharge from rehab
Dr. [**Last Name (STitle) **] (IP) 4 weeks
{'Dissection of aorta, thoracic,Other complications due to other vascular device, implant, and graft,Hematoma complicating a procedure,Unspecified pleural effusion,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Anemia, unspecified,Other diseases of trachea and bronchus,Esophageal reflux'}


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: dyspnea, chest and back pain

PRESENT ILLNESS: 58 yo F presented to [**Hospital 61989**] Hospital with chest and back pain
and SOB. BP > 200. CT showed Type B dissection, started on
nitroprusside gtt, transferred to [**Hospital1 18**] for further eval.

MEDICAL HISTORY: cushings syndrome, AVR/ascending aorta [**2143**], pulmonary AVM
repair [**2143**], COPD, GERD, h/o splenic lac c/b cardiac arrest and
anoxic brain injury, bilat adrenalectomy

MEDICATION ON ADMISSION: atrovent, metoprolol, prednisone

ALLERGIES: Codeine / Talwin / Nafcillin

PHYSICAL EXAM: 37.0 54 132/74 19 97% NRB
NAD
Dobhoff in place and functioning.
RRR, no M/R/G
CTAB
Abdomen soft/NT/ND
Palpable pedal pulses, no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: unknown. 

### Response:
{'Dissection of aorta, thoracic,Other complications due to other vascular device, implant, and graft,Hematoma complicating a procedure,Unspecified pleural effusion,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Anemia, unspecified,Other diseases of trachea and bronchus,Esophageal reflux'}
