CHIEF COMPLAINT: Pt returns for completeion of coiling of pcomm aneurysm

PRESENT ILLNESS: 69 year old white female who suffered rupture of left pcomm
aneurysm in [**2139-1-27**].  Her initial presentation was
complicated by pulseless VTAC from which she was resuscitated.
She ultimately required tracheostomy, peg placment, VPS
placment, left sided chest tube for spontaneous left
pneumothorax and Left MCA infarct.  She was discharged to rehab
and returns today for completion of coiling of left pcomm
aneurysm.

MEDICAL HISTORY: HTN
Hyperlipidemia
pulseless VTACH responded to ACLS
SAH
VPS
trach
PEG
Left MCA infarct
cerebral vasospasm
left pcomm aneurysm
IVH
left spontaneous Pneumothorax

MEDICATION ON ADMISSION: Medications on Admission same as discharge medications

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Patient has a Trach and PEG
Is arousable and mouths words appropriately
Is oriented to self and date and directable to location
Pupils: right is surgical and 5mm , left 3mm rective
Motor strenth, slight weakness in right grip [**3-3**] otherwise [**4-2**]
througout.

FAMILY HISTORY: unknown

SOCIAL HISTORY: Married was living with husband at home until sah.  Most
recently at a rehab facility
Cerebral aneurysm, nonruptured,Hypovolemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Attention to tracheostomy,Gastrostomy status
Nonrupt cerebral aneurym,Hypovolemia,Hypertension NOS,Hyperlipidemia NEC/NOS,Atten to tracheostomy,Gastrostomy status
Admission Date:  [**2139-4-14**]              Discharge Date:   [**2139-4-16**]

Date of Birth:  [**2069-6-25**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Pt returns for completeion of coiling of pcomm aneurysm

Major Surgical or Invasive Procedure:
[**2139-4-14**] CEREBRAL ANGIOGRAM WITH COILING OF PCOMM ANEURYSM


History of Present Illness:
69 year old white female who suffered rupture of left pcomm
aneurysm in [**2139-1-27**].  Her initial presentation was
complicated by pulseless VTAC from which she was resuscitated.
She ultimately required tracheostomy, peg placment, VPS
placment, left sided chest tube for spontaneous left
pneumothorax and Left MCA infarct.  She was discharged to rehab
and returns today for completion of coiling of left pcomm
aneurysm.

Past Medical History:
HTN
Hyperlipidemia
pulseless VTACH responded to ACLS
SAH
VPS
trach
PEG
Left MCA infarct
cerebral vasospasm
left pcomm aneurysm
IVH
left spontaneous Pneumothorax

Social History:
Married was living with husband at home until sah.  Most
recently at a rehab facility

Family History:
unknown

Physical Exam:
Patient has a Trach and PEG
Is arousable and mouths words appropriately
Is oriented to self and date and directable to location
Pupils: right is surgical and 5mm , left 3mm rective
Motor strenth, slight weakness in right grip [**3-3**] otherwise [**4-2**]
througout.

Pertinent Results:
[**2139-4-14**] 03:37PM   GLUCOSE-121* LACTATE-1.4 NA+-139 K+-3.6
CL--107
[**2139-4-14**] 06:25PM   WBC-6.7 RBC-3.92* HGB-11.3* HCT-32.5* MCV-83
MCH-28.9 MCHC-34.9 RDW-14.5

Brief Hospital Course:
Pt was admitted through the same day surgery department for the
proposed procedure.  She underwent the procedure without
complication and ws transferred to the ICU. She was taken off
the ventilator in the evening and resumbed independant
respirations.  Tube feeds were restarted and advanced to goal.
On post procedure day one the patient remained clinically stable
and was clear for return back to rehab.

Medications on Admission:
Medications on Admission same as discharge medications

Discharge Medications:
1. acetaminophen 325 mg Tablet [**Month/Day/Year **]: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain fever.
2. heparin (porcine) 5,000 unit/mL Solution [**Month/Day/Year **]: One (1)
Injection TID (3 times a day).
3. oxycodone-acetaminophen 5-325 mg Tablet [**Month/Day/Year **]: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain .
4. miconazole nitrate 2 % Cream [**Month/Day/Year **]: One (1) Appl Topical Q 8H
(Every 8 Hours).
5. metoprolol tartrate 25 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO BID
(2 times a day).
6. aspirin 325 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO DAILY (Daily).
7. olanzapine 2.5 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO HS (at
bedtime).
8. docusate sodium 50 mg/5 mL Liquid [**Month/Day/Year **]: One (1)  PO BID (2
times a day).
9. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
10. bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Last Name (STitle) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
11. Keppra 500 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO twice a day.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
LEFT PCOMM ANEURYSM


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
Angiogram with Embolization and/or Stent placement
Medications:
Take Aspirin 325mg (enteric coated) once daily.
Continue all other medications you were taking before surgery,
unless otherwise directed
You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
When you go home, you may walk and go up and down stairs.
You may shower (let the soapy water run over groin incision,
rinse and pat dry)
Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
No heavy lifting, pushing or pulling (greater than 5 lbs) for 1
week (to allow groin puncture to heal).
After 1 week, you may resume sexual activity.
After 1 week, gradually increase your activities and distance
walked as you can tolerate.
No driving until you are no longer taking pain medications

What to report to office:
Changes in vision (loss of vision, blurring, double vision, half
vision)
Slurring of speech or difficulty finding correct words to use
Severe headache or worsening headache not controlled by pain
medication
A sudden change in the ability to move or use your arm or leg or
the ability to feel your arm or leg
Trouble swallowing, breathing, or talking
Numbness, coldness or pain in lower extremities
Temperature greater than 101.5F for 24 hours
New or increased drainage from incision or white, yellow or
green drainage from incisions
Bleeding from groin puncture site

*SUDDEN, SEVERE BLEEDING OR SWELLING
(Groin puncture site)
Lie down, keep leg straight and have someone apply firm pressure
to area for 10 minutes. If bleeding stops, call our office. If
bleeding does not stop, call 911 for transfer to closest
Emergency Room!

Followup Instructions:
-YOU WILL NEED TO SEE DR [**First Name (STitle) **] IN THE OFFICE IN 3 months
PLEASE CALL [**Telephone/Fax (3) **] FOR AN APPOINTMENT
- YOU WILL NEED AN MRI/MRA WITH 'DR [**First Name (STitle) **] PROTOCOL' ON THAT
APPOINTMENT DAY



Completed by:[**2139-4-15**]

Name:  [**Known lastname 10592**],[**Known firstname **]                 Unit No:   [**Numeric Identifier 14275**]

Admission Date:  [**2139-4-14**]              Discharge Date:   [**2139-4-16**]

Date of Birth:  [**2069-6-25**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 40**]
Addendum:
Patient was unable to leave BICMC as planned on [**4-15**] due to bed
inavalibility at the rehab. She is being discharged on [**4-16**]
without any interveral change.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 49**] - [**Location (un) 50**]

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 43**] MD [**MD Number(2) 44**]

Completed by:[**2139-4-16**]
{'Cerebral aneurysm, nonruptured,Hypovolemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Attention to tracheostomy,Gastrostomy status'}


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: Pt returns for completeion of coiling of pcomm aneurysm

PRESENT ILLNESS: 69 year old white female who suffered rupture of left pcomm
aneurysm in [**2139-1-27**].  Her initial presentation was
complicated by pulseless VTAC from which she was resuscitated.
She ultimately required tracheostomy, peg placment, VPS
placment, left sided chest tube for spontaneous left
pneumothorax and Left MCA infarct.  She was discharged to rehab
and returns today for completion of coiling of left pcomm
aneurysm.

MEDICAL HISTORY: HTN
Hyperlipidemia
pulseless VTACH responded to ACLS
SAH
VPS
trach
PEG
Left MCA infarct
cerebral vasospasm
left pcomm aneurysm
IVH
left spontaneous Pneumothorax

MEDICATION ON ADMISSION: Medications on Admission same as discharge medications

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Patient has a Trach and PEG
Is arousable and mouths words appropriately
Is oriented to self and date and directable to location
Pupils: right is surgical and 5mm , left 3mm rective
Motor strenth, slight weakness in right grip [**3-3**] otherwise [**4-2**]
througout.

FAMILY HISTORY: unknown

SOCIAL HISTORY: Married was living with husband at home until sah.  Most
recently at a rehab facility 

### Response:
{'Cerebral aneurysm, nonruptured,Hypovolemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Attention to tracheostomy,Gastrostomy status'}
