CHIEF COMPLAINT: Left carotid stenosis.

PRESENT ILLNESS: This is a 78 year-old gentleman
who was initially evaluated for carotid stenosis for
potential carotid stenosis for potential carotid stenting but
he was not a candidate for stenting. He would require a left
carotid endarterectomy. The patient is now admitted for a
left carotid endarterectomy. The patient's previous history
is significant for a parietal stroke in [**Month (only) 216**] of this year
from which he fully recovered.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: Xanax 1 mg at bedtime, Lasix 40 mg
daily, Coreg 3.125 mg b.i.d., Bilan 80 mg q.d., Coumadin 5 mg
q.d. which had been held for 4 days.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married and lives with his
wife. [**Name (NI) **] admits to 3 drinks per day and is a former tobacco
user. Has not smoked since [**2126**].
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Iatrogenic cerebrovascular infarction or hemorrhage,Intracerebral hemorrhage,Atrial fibrillation,Pneumonia due to Pseudomonas,Pneumonitis due to inhalation of food or vomitus,Iatrogenic pulmonary embolism and infarction,Thrombocytopenia, unspecified,Hematoma complicating a procedure,Chronic airway obstruction, not elsewhere classified,Intestinal infection due to Clostridium difficile
Ocl crtd art wo infrct,Iatrogen CV infarc/hmrhg,Intracerebral hemorrhage,Atrial fibrillation,Pseudomonal pneumonia,Food/vomit pneumonitis,Iatrogen pulm emb/infarc,Thrombocytopenia NOS,Hematoma complic proc,Chr airway obstruct NEC,Int inf clstrdium dfcile
Unit No:  [**Numeric Identifier 63236**]
Admission Date: [**2136-10-2**]
Discharge Date: [**2136-10-25**]
Date of Birth:  [**2057-11-28**]
Sex:  M
Service:  VSU


CHIEF COMPLAINT:  Left carotid stenosis.

HISTORY OF PRESENT ILLNESS:  This is a 78 year-old gentleman
who was initially evaluated for carotid stenosis for
potential carotid stenosis for potential carotid stenting but
he was not a candidate for stenting. He would require a left
carotid endarterectomy. The patient is now admitted for a
left carotid endarterectomy. The patient's previous history
is significant for a parietal stroke in [**Month (only) 216**] of this year
from which he fully recovered.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Xanax 1 mg at bedtime, Lasix 40 mg
daily, Coreg 3.125 mg b.i.d., Bilan 80 mg q.d., Coumadin 5 mg
q.d. which had been held for 4 days.

PAST ILLNESSES:  Includes left parietal cerebrovascular
accident in [**2136-8-20**], a history of chronic atrial
fibrillation, anticoagulated. History of coronary artery
disease, status post coronary angioplasty of the right
coronary artery in [**2134**], history of congestive heart failure
compensated in [**2135**]. History of type 2 diabetes. History of
left vocal cord cancer, status post resection in [**2133-8-20**], History of squamous cell carcinoma of the left thorax
and leg, status post excision, history of Factory D Leiden
deficiency. History of hypertension.

SOCIAL HISTORY:  The patient is married and lives with his
wife. [**Name (NI) **] admits to 3 drinks per day and is a former tobacco
user. Has not smoked since [**2126**].

PHYSICAL EXAMINATION:  Vital signs: Blood pressure 122/59,
heart rate 80, respirations 16, O2 saturation 95% on room
air. General appearance: This is a white male in no acute
distress and oriented x3. Head, eyes, ears, nose and throat
examination was remarkable for left carotid bruit. Heart is
irregular-irregular rhythm with a I/VI systolic ejection
murmur. Lungs are clear to auscultation bilaterally.
Neurological examination is intact.

HOSPITAL COURSE:  The patient was admitted to the
preoperative holding area on [**2136-10-2**]. He underwent
a left carotid endarterectomy without complication and was
transferred to the post anesthesia care unit in stable
condition. Patient developed atrial fibrillation and
bradycardia requiring Neo-Synephrine support. His rule out
was negative. The patient developed on [**2136-10-4**] at
about 3 A.M. in the morning mental status changes associated
with hypoxia with a pCO2 of 80 and CO2 of 67. The chest x-ray
showed possible [**Location (un) 22533**] hump. The patient was begun on IV
heparin. CTA was obtained which showed a left lower lobe
pulmonary embolus. Patient became aphasic with right sided
flaccidness. The heparin was discontinued. CTA of the head
was obtained which showed a large hemorrhagic stroke. He was
given 2 units of fresh frozen plasma and a unit of platelets.
He required Neo-Synephrine and dobutamine for blood pressure
control. Neurosurgery was consulted. The patient was begun on
a Dilantin load and he underwent on [**10-5**] a left
parietal frontal craniotomy with evacuation of hemorrhage.
Intraoperatively the patient experienced asystole but  was
resuscitated. Inferior vena cava filter was placed. Because
of history of atrial fibrillation the patient was admitted to
the thoracic Intensive Care Unit for continued care. The
patient continued on a prednisone taper. He developed
transient thrombocytopenia. His heparin dependent antibodies
were negative. EPS was consulted secondary to the patient's
atrial fibrillation and bradycardia. They felt that a
pacemaker was not indicated at this time although external
pacemaker leads were applied. A nasogastric tube was placed
on [**10-6**] and tube feeds were begun. The patient was
noted to have a left neck hematoma which was stable. A
[**10-7**] a CPAP was tried. The patient failed. The
patient was begun on Zosyn for gram negative rods in his
sputum culture and a right lower lobe infiltrate on chest x-
ray. White count at that time was 7.4. Levofloxacin was added
on [**10-9**] to his Zosyn for broader pseudomonas coverage
in his sputum. On [**10-10**] the patient was finally
extubated. A swallowing study was done at the bedside. The
patient did show signs of aspiration with delayed swallowing.
The study was terminated because of concern for respiratory
compromise and the patient remained n.p.o. on tube feeds. On
[**10-11**] the patient self discontinued his tube feed and
his arterial line. The Dobhoff was replaced. IV
heparinization was started slowly. On [**10-13**] the
patient was transferred to the vascular Intensive Care Unit
for continued monitoring and care. Physical therapy and
occupational therapy evaluations were begun. On [**10-15**]
the patient desaturated to an O2 of 59%. He was transferred
to the Intensive Care Unit. He required IV Lasix and
Lopressor for rate control. And nebulizers and aggressive
pulmonary care. On [**10-16**] patient remained in the
Intensive Care Unit. Stool for C difficile was sent and
patient's stool was positive and patient was started on
[**Month (only) 63237**]. On [**10-17**] a repeat swallow was attempted but
held secondary to the patient being n.p.o. for a PEG
placement.

On [**9-21**] the patient underwent endoscopic percutaneous
gastric tube placement. The patient continued to do well,
tolerated his tube feeds. On [**10-21**] patient was
transferred to the vascular intensive care unit for continued
monitoring and care. On [**2136-10-23**] physical therapy
continued to work with the patient. IV heparin and
Coumadinization conversion was continued. Renal screening was
begun. The patient will be discharged to rehabilitation when
he is in a steady therapeutic INR state of 2 to 3.0. The
patient will follow up with Dr. [**Last Name (STitle) **] as directed post
discharge from rehabilitation. He should follow up with his
primary care physician.

MEDICATIONS AT TIME OF DISCHARGE:  Artificial tear ointment
.1% p.r.n. as needed, eye drops 1.4/0.6% 1 to 2 drops o.u.
p.r.n., econazole nitrate 2% powder to effected area p.r.n.,
aspirin 81 mg, alrestatin 20 mg q.d., albuterol sulfate
solution inhaled q 6 hours as needed, Lasix 40 mg q.d.,
Valsartan 80 mg q.d., rosiglitazone 4 mg daily, alprazolam 1
mg at bedtime, Carbatrol 3.125 mg b.i.d., vitamin E capsule 1
daily, Ventolin 200 mg t.i.d., warfarin 5 mg at h.s. for a
goal INR of 2.0 to 3.0. Regular Humulin insulin q 6 hours as
follows: Glucoses less than 120, no insulin; 121 to 140 - 4
units; 141 to 160 - 7 units; 161 to 180 - 10 units; 181 to
200 - 13 units; 201 to 220 - 16 units; 221 to 140 - 19 units;
241 to 260 - 22 units; 261 to 280 - 25 units; 281 to 300 - 28
units; 301 to 320 - 31 units; greater than 320 - notify
physician. [**Name Initial (NameIs) 63237**] 500 mg t.i.d. for a total of 7 more days.

DISCHARGE DIAGNOSES:  Carotid artery stenosis, left with
known parietal cerebrovascular accident in [**2136-8-20**].
Postoperative atrial fibrillation, bradycardia requiring
vasopressor support, resolved.
Postoperative hypoxia with mental status changes.
Pulmonary embolus of the left lower lobe on [**2136-10-4**].
Left parietal frontal hemorrhagic stroke on [**2136-10-4**].
Postoperative thrombocytopenia, transient with negative HIT
panel.
Postoperative pseudomonas pneumonia, treated.
Postoperative aspiration by evaluation.
Postoperative left neck hematoma, stable.

SURGERIES:  Included left carotid endarterectomy on [**2136-10-2**].
Left parietal frontal craniotomy with evacuation of
hemorrhage on [**2136-10-4**].
Endoscopic PEG placement on [**2136-10-18**].

Patient's INRs should be monitored closely while he remains
on [**Year (4 digits) 63237**]. Goal INR is 2.0 to 3.0. Coumadin dosing should be
adjusted accordingly. Patient should follow up with Dr.
[**Last Name (STitle) **] post rehabilitation. Patient will continue on
his tube feeds of Respalor full strength with a goal rate of
60 cc per hour. Residual should be checked q 4 hours and held
if residual greater than 100 cc. Patient will remain strict
n.p.o. All medications should be given through nasogastric
tube. Patient should be evaluated at rehabilitation as he
neurologically progresses for possibility of reinstituting
oral feeds.

Patient's activity level is bed rest to chair.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(2) 6039**]

Dictated By:[**Last Name (NamePattern1) 2382**]
MEDQUIST36
D:  [**2136-10-23**] 12:01:42
T:  [**2136-10-23**] 13:41:24
Job#:  [**Job Number 63238**]





Name:  [**Known lastname 193**],[**Known firstname 33**]                  Unit No:   [**Numeric Identifier 11201**]

Admission Date:  [**2136-10-2**]              Discharge Date:   [**2136-10-29**]

Date of Birth:  [**2057-11-28**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 726**]
Addendum:
[**2136-10-29**] Patient remained in hospital perfamily request and
discussion with Dr. [**Last Name (STitle) **]. He has conmpleted his
antibiotics course.Will d/c on 7.5 coumadin qHs. Continue to
moniter inr.dialy until patient in steady thearpeutic state.
goal 2.0-3.0. Patient can followup with Dr. [**Last Name (STitle) **] when
d/c'd from rehab. call for appointment [**Telephone/Fax (1) 11071**]

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 41**] - [**Location (un) 42**]

                             [**First Name11 (Name Pattern1) 168**] [**Last Name (NamePattern4) 730**] MD [**MD Number(2) 731**]

Completed by:[**2136-10-29**]
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Iatrogenic cerebrovascular infarction or hemorrhage,Intracerebral hemorrhage,Atrial fibrillation,Pneumonia due to Pseudomonas,Pneumonitis due to inhalation of food or vomitus,Iatrogenic pulmonary embolism and infarction,Thrombocytopenia, unspecified,Hematoma complicating a procedure,Chronic airway obstruction, not elsewhere classified,Intestinal infection due to Clostridium difficile'}


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: Left carotid stenosis.

PRESENT ILLNESS: This is a 78 year-old gentleman
who was initially evaluated for carotid stenosis for
potential carotid stenosis for potential carotid stenting but
he was not a candidate for stenting. He would require a left
carotid endarterectomy. The patient is now admitted for a
left carotid endarterectomy. The patient's previous history
is significant for a parietal stroke in [**Month (only) 216**] of this year
from which he fully recovered.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: Xanax 1 mg at bedtime, Lasix 40 mg
daily, Coreg 3.125 mg b.i.d., Bilan 80 mg q.d., Coumadin 5 mg
q.d. which had been held for 4 days.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married and lives with his
wife. [**Name (NI) **] admits to 3 drinks per day and is a former tobacco
user. Has not smoked since [**2126**]. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Iatrogenic cerebrovascular infarction or hemorrhage,Intracerebral hemorrhage,Atrial fibrillation,Pneumonia due to Pseudomonas,Pneumonitis due to inhalation of food or vomitus,Iatrogenic pulmonary embolism and infarction,Thrombocytopenia, unspecified,Hematoma complicating a procedure,Chronic airway obstruction, not elsewhere classified,Intestinal infection due to Clostridium difficile'}
