CHIEF COMPLAINT: Thoracic myelopathy, stenosis

PRESENT ILLNESS: see admit H&P

MEDICAL HISTORY: see admit H&P

MEDICATION ON ADMISSION: see admit H&P

ALLERGIES: Latex / Penicillins / Dilaudid

PHYSICAL EXAM: see admit H&P

FAMILY HISTORY: see admit H&P

SOCIAL HISTORY: see admit H&P
Spondylosis with myelopathy, thoracic region,Foreign body in main bronchus,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Disorders of meninges, not elsewhere classified,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other acute postoperative pain,Personal history of malignant neoplasm of bone
Spond compr thor sp cord,Foreign body bronchus,Long-term use anticoagul,Hx-ven thrombosis/embols,Disorder of meninges NEC,Resp obstr-inhal obj NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Acute postop pain NEC,Hx of bone malignancy
Admission Date:  [**2197-9-4**]              Discharge Date:   [**2197-9-15**]

Date of Birth:  [**2152-1-30**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Latex / Penicillins / Dilaudid

Attending:[**Doctor Last Name 1350**]
Chief Complaint:
Thoracic myelopathy, stenosis

Major Surgical or Invasive Procedure:
1. Anterior T9/10 decompression and interbody cage via
thoracotomy
2. Posterior spinal fusion T9/10


History of Present Illness:
see admit H&P

Past Medical History:
see admit H&P

Social History:
see admit H&P

Family History:
see admit H&P

Physical Exam:
see admit H&P

Pertinent Results:
[**2197-9-4**] 07:15PM   HCT-28.8*
[**2197-9-4**] 01:49PM   GLUCOSE-160* UREA N-7 CREAT-0.8 SODIUM-141
POTASSIUM-4.2 CHLORIDE-107 TOTAL CO2-24 ANION GAP-14
[**2197-9-4**] 01:49PM   estGFR-Using this
[**2197-9-4**] 01:49PM   CALCIUM-8.8 PHOSPHATE-5.9* MAGNESIUM-1.6
[**2197-9-4**] 01:49PM   WBC-17.2* RBC-3.54* HGB-9.6* HCT-27.6*
MCV-78* MCH-27.2 MCHC-34.8 RDW-15.6*
[**2197-9-4**] 01:49PM   PLT COUNT-329
[**2197-9-4**] 12:08PM   GLUCOSE-108* LACTATE-2.5* NA+-137 K+-4.1
CL--105
[**2197-9-4**] 12:08PM   TYPE-ART PO2-126* PCO2-44 PH-7.36 TOTAL
CO2-26 BASE XS-0 INTUBATED-INTUBATED
[**2197-9-4**] 12:08PM   HGB-10.5* calcHCT-32
[**2197-9-4**] 12:08PM   freeCa-1.16
[**2197-9-4**] 11:07AM   TYPE-ART PO2-96 PCO2-41 PH-7.33* TOTAL CO2-23
BASE XS--4 INTUBATED-INTUBATED
[**2197-9-4**] 11:07AM   GLUCOSE-121* LACTATE-3.0* NA+-138 K+-4.2
CL--106
[**2197-9-4**] 11:07AM   HGB-11.7* calcHCT-35
[**2197-9-4**] 11:07AM   freeCa-1.24
[**2197-9-4**] 09:40AM   TYPE-ART PO2-88 PCO2-43 PH-7.31* TOTAL CO2-23
BASE XS--4 INTUBATED-INTUBATED
[**2197-9-4**] 09:40AM   GLUCOSE-128* LACTATE-2.9* NA+-140 K+-3.5
CL--111
[**2197-9-4**] 09:40AM   HGB-11.0* calcHCT-33 O2 SAT-95
[**2197-9-4**] 09:40AM   freeCa-1.05*
[**2197-9-4**] 07:00AM   PT-11.4 INR(PT)-0.9

Brief Hospital Course:
Patient was admitted for the above mentioned procedures.  These
were performed as planned and tolerated well by the patient.

Post-operatively, pain was controlled with IV medications.  The
chest tube for thoracotomy was managed by CT surgery.  PT was
consulted for assistance with patient's care.  After discussing
with hematology, subQ heparin was initiated on post-op day 2
after the 2nd procedure and daily coumadin with daily INR
monitoring was initiated.

Post-operatively, patient had increasing problems with pain
control and with respiratory function.  Diagnosis of mucus plug
was made, and patient was transferred to the ICU for more
aggressive pain control and for management of the respiratory
insufficiency.  Intubation was required.  Patient's respiratory
status rapidly improved and she was successfully extubated.
Mucolytics aided improvement of respiratory status.  Acute pain
service transitioned the patient successfully to PO pain
control, discontinuing IV ketamine.

Given patient's improvement, she returned to the floor.  She
continued to convalesce successfully, progressing with PT and
with excellent pulmonary function off of supplemental O2.
Coumadin reached therapeutic range and subQ heparin was
discontinued.  Chest tube was removed as deemed appropriate by
CT surgery.  Chest XR also improved and no further interventions
were recommended.  Incisions maintained excellent apperaance
throughout hospitalization.

Given the patient's excellent progress, adequate pain control on
PO meds, and having passed PT, she was deemed stable for
discharge home.

Medications on Admission:
see admit H&P

Discharge Medications:
1. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
4. glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. alprazolam 0.25 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) as needed for anxiety.
6. gabapentin 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
[**Month/Day/Year **]:*90 Capsule(s)* Refills:*2*
7. famotidine 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
[**Month/Day/Year **]:*80 Tablet(s)* Refills:*0*
9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
11. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO QID (4 times a day) as needed for
dyspepsia.
12. warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
target INR [**1-11**], drug to be followed by primary care physician.
[**Name Initial (NameIs) **]:*30 Tablet(s)* Refills:*2*
13. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as
needed for pain.
14. guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed for cough.
15. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical QID
(4 times a day) as needed for rash.
16. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
17. OxyContin 10 mg Tablet Sustained Release 12 hr Sig: Two (2)
Tablet Sustained Release 12 hr PO twice a day for 3 weeks: 20 mg
[**Hospital1 **] X 1 week, then 10 mg [**Hospital1 **] X 1 week, then 10 mg QHS X 1 week,
then stop.
[**Hospital1 **]:*50 Tablet Sustained Release 12 hr(s)* Refills:*0*


Discharge Disposition:
Home with Service

Discharge Diagnosis:
1. Thoracic myelopathy and stenosis T9/10
2. h/o arterial thrombosis
3. Post-operative bronchial mucus plug


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
1. No bending, twisting, lifting, pushing, pulling
2. Continue PT exercises, ambulate as much as tolerated.
3. Continue cough and deep breathing
4. Keep incisions clean and dry, may shower - change dressing
afterwards.
5. Do not submerge incisions (no baths, pools, etc.)
Physical Therapy:
1. Continue to advance mobility
2. No bending, twisting, lifting, pushing, pulling.
Treatments Frequency:
1. Daily dressing change until dry for 24 hours, then may leave
open to air.
2. [**Month (only) 116**] shower, change dressing afterwards

Followup Instructions:
Keep scheduled appointment with Dr. [**Last Name (STitle) 1007**].

Schedule follow-up with Dr. [**Last Name (STitle) 3060**] in Hematology for further
recommendations regarding coumadin therapy.

Call your primary physician for instructions on coumadin
monitoring.



Completed by:[**2197-9-14**]
{'Spondylosis with myelopathy, thoracic region,Foreign body in main bronchus,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Disorders of meninges, not elsewhere classified,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other acute postoperative pain,Personal history of malignant neoplasm of bone'}


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: Thoracic myelopathy, stenosis

PRESENT ILLNESS: see admit H&P

MEDICAL HISTORY: see admit H&P

MEDICATION ON ADMISSION: see admit H&P

ALLERGIES: Latex / Penicillins / Dilaudid

PHYSICAL EXAM: see admit H&P

FAMILY HISTORY: see admit H&P

SOCIAL HISTORY: see admit H&P 

### Response:
{'Spondylosis with myelopathy, thoracic region,Foreign body in main bronchus,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Disorders of meninges, not elsewhere classified,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other acute postoperative pain,Personal history of malignant neoplasm of bone'}
