CHIEF COMPLAINT: Seizures

PRESENT ILLNESS: Mr. [**Known lastname 89987**] is a 54 year old gentleman with a PMH significant
for polysubstance abuse, CAD s/p PCI, and seizure disorder
admitted for possible seizures.  Per report, the patient was
noted today to have chest pain clutching his chest. At that
time, EMS was called with report of seizure activity. He
received 2 mg IM ativan in EMS without resolution of seizure
activity.
.
In the [**Hospital1 18**] ED, initial VS 99.8 70 156/113 100% AC 500x14, 10,
1.0 with ABG 7.34/48/165. The patient had a urine tox screen
positive for amphetamines and had a negative CTA chest and
NCHCT.  [**Hospital1 878**] evaluation in the ED was non-localizing, and
the patient was admitted to the MICU for further management.
.
The patient was initially admitted to [**Hospital3 3583**] on [**2-21**]
for SI and depression. At that time, the admission note states
that he had recently been discharged from [**Hospital **] Hospital 2
weeks prior for depression, and that he has a history of abuse
of pain medications. In addition, the patient has a history of
suicide attempts via OD and car crash. His Daughter states that
he has a history of addiction to morphine, hydromorphone, and
valium due to his chronic pain, and that he has been admitted to
an inpatient substance abuse facility since [**2-21**].
.
Currently, the patient is intubated, and sedated.

MEDICAL HISTORY: HTN
HLD
CAD s/p PCI
Depression
Polysubstance abuse on suboxone
Left parietal tumor
Seizure disorder - has not had a seizure in 5 years.
Neck and back pain s/p C5-7 fusion

MEDICATION ON ADMISSION: Pharmacy: [**Telephone/Fax (1) 89639**], last filled there [**2171-2-20**]
- coreg 25mg po bid
- valproate ER 500mg 2 tabs [**Hospital1 **]
- fluoxetine 40mg daily
- hctz 25mg daily
- hydral 100 tid
- imdur 30 daily
- crestor 40mg daily
- lisinopril 40 daily
- Amlodipine 5 daily
- plavix 75 mg daily
- Remeron 45mg qhs
- valium 5mg tab, [**12-2**] tid:prn
- fiorect-codeine 50-325 APAP-40mg caffeine-30mg codeine
- dilaudid 4mg tid:prn pain
- morphine sulfate ER 30mg [**Hospital1 **]
- fentanyl patch filled 50mcg [**2171-1-8**]

ALLERGIES: Gentamicin / Seroquel / Latex

PHYSICAL EXAM: ADMISSION:
VS: 98.1 54 147/88 100%AC 500x16, 10, 1.0
Gen: Intubated, sedated
HEENT: ETT in place
CV: Nl S1+S2, no m/r/g
Pulm: CTAB
Abd: S/ND +bs
Ext: No c/c/e.
Neuro: pupils 2->1 mm bilaterally. 1+ biceps, brachioradialis,
patellear reflexes bilaterally. No evidence of rigidity or
clonus. Downgoing toes bilaterally.
.
DISCHARGE:
VS:  98.8 98.6 122/88 109-162/75-100 70 62-76 18 95%RA
8H 60/750
24H 480/675+ not saved, +BMx1
Gen: awake, alert, appears fatigued, NAD
HEENT: NCAT, EOMI, right eye deviated to right, dry MM, no
scleral icterus, OP clear
CVS: RRR, nl S1 S2, no m/r/g
Pulm: no use access mm of breathing, CTAB without wheezes or
crackles
Abd: +BS, soft, NTND
Ext: warm, dry, no [**Location (un) **], slight erythema and edema of RUE around
PICC site, slight tenderness to palpation
Neuro: A&Ox3, awake, alert, 4/5 strength RUE, though difficult
to assess if related to effort, gait not assessed

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with daughter. [**Name (NI) 1139**] - 1 ppd x5 years. EtOH - none per
daughter. [**Name (NI) **] illicit or herbal drugse except for pain medication
addiction.
Epilepsy, unspecified, with intractable epilepsy,Acidosis,Cheyne-Stokes respiration,Fever, unspecified,Combinations of opioid type drug with any other drug dependence, unspecified,Other and unspecified infection due to central venous catheter,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other chronic pain,Percutaneous transluminal coronary angioplasty status,Bipolar disorder, unspecified,Iron deficiency anemia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Arthrodesis status,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Tobacco use disorder,Spinal stenosis in cervical region
Epilepsy NOS w intr epil,Acidosis,Cheyne-stokes respiratn,Fever NOS,Opioid/other dep-unspec,Oth/uns inf-cen ven cath,Phlbts sprfc vn up extrm,Chronic pain NEC,Status-post ptca,Bipolar disorder NOS,Iron defic anemia NOS,Hyperlipidemia NEC/NOS,Hypertension NOS,Arthrodesis status,Abn react-procedure NEC,Tobacco use disorder,Cervical spinal stenosis
Admission Date:  [**2171-3-1**]              Discharge Date:   [**2171-3-8**]

Date of Birth:  [**2118-9-11**]             Sex:   M

Service: MEDICINE

Allergies:
Gentamicin / Seroquel / Latex

Attending:[**First Name3 (LF) 2758**]
Chief Complaint:
Seizures

Major Surgical or Invasive Procedure:
Endotracheal intubation

History of Present Illness:
Mr. [**Known lastname 89987**] is a 54 year old gentleman with a PMH significant
for polysubstance abuse, CAD s/p PCI, and seizure disorder
admitted for possible seizures.  Per report, the patient was
noted today to have chest pain clutching his chest. At that
time, EMS was called with report of seizure activity. He
received 2 mg IM ativan in EMS without resolution of seizure
activity.
.
In the [**Hospital1 18**] ED, initial VS 99.8 70 156/113 100% AC 500x14, 10,
1.0 with ABG 7.34/48/165. The patient had a urine tox screen
positive for amphetamines and had a negative CTA chest and
NCHCT.  [**Hospital1 878**] evaluation in the ED was non-localizing, and
the patient was admitted to the MICU for further management.
.
The patient was initially admitted to [**Hospital3 3583**] on [**2-21**]
for SI and depression. At that time, the admission note states
that he had recently been discharged from [**Hospital **] Hospital 2
weeks prior for depression, and that he has a history of abuse
of pain medications. In addition, the patient has a history of
suicide attempts via OD and car crash. His Daughter states that
he has a history of addiction to morphine, hydromorphone, and
valium due to his chronic pain, and that he has been admitted to
an inpatient substance abuse facility since [**2-21**].
.
Currently, the patient is intubated, and sedated.

Past Medical History:
HTN
HLD
CAD s/p PCI
Depression
Polysubstance abuse on suboxone
Left parietal tumor
Seizure disorder - has not had a seizure in 5 years.
Neck and back pain s/p C5-7 fusion

Social History:
Lives with daughter. [**Name (NI) 1139**] - 1 ppd x5 years. EtOH - none per
daughter. [**Name (NI) **] illicit or herbal drugse except for pain medication
addiction.

Family History:
non-contributory

Physical Exam:
ADMISSION:
VS: 98.1 54 147/88 100%AC 500x16, 10, 1.0
Gen: Intubated, sedated
HEENT: ETT in place
CV: Nl S1+S2, no m/r/g
Pulm: CTAB
Abd: S/ND +bs
Ext: No c/c/e.
Neuro: pupils 2->1 mm bilaterally. 1+ biceps, brachioradialis,
patellear reflexes bilaterally. No evidence of rigidity or
clonus. Downgoing toes bilaterally.
.
DISCHARGE:
VS:  98.8 98.6 122/88 109-162/75-100 70 62-76 18 95%RA
8H 60/750
24H 480/675+ not saved, +BMx1
Gen: awake, alert, appears fatigued, NAD
HEENT: NCAT, EOMI, right eye deviated to right, dry MM, no
scleral icterus, OP clear
CVS: RRR, nl S1 S2, no m/r/g
Pulm: no use access mm of breathing, CTAB without wheezes or
crackles
Abd: +BS, soft, NTND
Ext: warm, dry, no [**Location (un) **], slight erythema and edema of RUE around
PICC site, slight tenderness to palpation
Neuro: A&Ox3, awake, alert, 4/5 strength RUE, though difficult
to assess if related to effort, gait not assessed


Pertinent Results:
ADMISSION LABS:
[**2171-3-1**] 03:28PM BLOOD WBC-5.6 RBC-4.42* Hgb-14.2 Hct-39.3*
MCV-89 MCH-32.2* MCHC-36.2* RDW-13.4 Plt Ct-305
[**2171-3-1**] 03:28PM BLOOD Neuts-66.8 Lymphs-26.7 Monos-4.9 Eos-1.2
Baso-0.4
[**2171-3-1**] 03:28PM BLOOD PT-14.4* PTT-29.5 INR(PT)-1.2*
[**2171-3-1**] 03:28PM BLOOD Glucose-118* UreaN-23* Creat-0.9 Na-142
K-4.2 Cl-104 HCO3-28 AnGap-14
[**2171-3-2**] 04:39AM BLOOD Glucose-82 UreaN-18 Creat-0.6 Na-143
K-3.3 Cl-110* HCO3-23 AnGap-13
[**2171-3-1**] 03:28PM BLOOD ALT-14 AST-13 AlkPhos-49 TotBili-0.4
[**2171-3-1**] 03:28PM BLOOD Lipase-25
[**2171-3-1**] 03:28PM BLOOD cTropnT-<0.01
[**2171-3-1**] 11:34PM BLOOD CK-MB-3 cTropnT-<0.01
[**2171-3-2**] 04:39AM BLOOD CK-MB-3 cTropnT-<0.01
[**2171-3-1**] 03:28PM BLOOD Albumin-4.4 Calcium-10.0 Phos-3.7 Mg-2.0
[**2171-3-1**] 03:28PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-POS Barbitr-NEG Tricycl-NEG
[**2171-3-1**] 03:28PM BLOOD Valproa-106*

.
PERTINENT LABS:
[**2171-3-6**] 01:35AM BLOOD CK-MB-2 cTropnT-<0.01
[**2171-3-6**] 04:49AM BLOOD calTIBC-254* VitB12-1163* Folate-6.6
Ferritn-116 TRF-195*
[**2171-3-2**] 04:39AM BLOOD Valproa-89
[**2171-3-2**] 04:40PM BLOOD Phenyto-7.5*
[**2171-3-3**] 02:19AM BLOOD Phenyto-6.0*
[**2171-3-4**] 03:28AM BLOOD Phenyto-5.7*
[**2171-3-4**] 11:47PM BLOOD Phenyto-10.9 Valproa-92
.
DISCHARGE LABS:
[**2171-3-8**] 05:25AM BLOOD WBC-4.4 RBC-3.75* Hgb-11.8* Hct-32.9*
MCV-88 MCH-31.4 MCHC-35.7* RDW-13.5 Plt Ct-258
[**2171-3-8**] 05:25AM BLOOD Glucose-93 UreaN-15 Creat-0.6 Na-142
K-3.5 Cl-108 HCO3-26 AnGap-12

.
MICRO:
BCx [**2171-3-4**]:
[**2171-3-4**] 9:12 pm BLOOD CULTURE      Source: Line-PICC.

   Blood Culture, Routine (Preliminary):
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.
         Isolated from only one set in the previous five days.
         SENSITIVITIES PERFORMED ON REQUEST..

   Anaerobic Bottle Gram Stain (Final [**2171-3-5**]):
      GRAM POSITIVE COCCI IN CLUSTERS.
      Reported to and read back by [**Doctor First Name **] BEAVER AT 8PM ON
[**2171-3-5**].

   Aerobic Bottle Gram Stain (Final [**2171-3-7**]):
      GRAM POSITIVE COCCI.
      IN CLUSTERS.
.
Blood Cx [**2171-3-1**]: no growth
Blood Cx [**3-5**], [**3-6**], [**3-7**]: pending
.
STUDIES:
ECG: Sinus with 1:1 conduction, bradycardic. NA-NI. No acute
ST-T wave changes.
.
CTA: No PE/dissection. no fx identified. cervical anterior
fusion hardware not visualized.
.
CTH: no ich. no acute process.
CXR:
1. Endotracheal tube in appropriate position. Nasogastric tube
coursing below the level of the diaphragm, inferior aspect not
included.
2. Clear lungs
.
C-spine [**2171-3-5**]:
FINDINGS: C1 through the mid-body of C6 are visualized. There is

preservation of the cervical lordosis. There has been prior
anterior fusion at C5 through C7 with metallic plate and two
sets of screws. There is loss of disc height at C4-C5, but the
remainder of the disc spaces are preserved.
There is no fracture or spondylolisthesis between flexion and
extension.
There is no prevertebral soft tissue edema. Visualized lung
apices are clear. A right-sided central venous catheter is
incompletely evaluated.
.
MRI [**2171-3-6**]:
IMPRESSION:
1. Status post spinal fusion from C5 to C7.
2. Moderate severe spinal stenosis at C4-5 level above the level
of fusion
due to disc osteophyte and thickening of the ligaments with
indentation on the spinal cord without abnormal signal seen
within the spinal cord. Severe left-sided and moderate-to-severe
right-sided foraminal narrowing is seen at this level.
3. Degenerative changes at other levels as described above.
4. No evidence of epidural abscess, discitis or osteomyelitis.
.
RUE U/S [**2171-3-7**]:
IMPRESSION: Occlusive thrombus seen within the right cephalic
vein, which is a superficial vein. No thrombus is seen within
any of the deep veins of the right arm. Note is made of a PICC
line in one of the two brachial veins.


Brief Hospital Course:
HOSPITAL COURSE:
Mr. [**Known lastname 89987**] is a 54 year old gentleman with a PMH significant
for polysubstance abuse, CAD s/p PCI, and seizure disorder
admitted for possible seizures. Pt was intubated in the ED for
airway protection. Pt was monitored in the ICU and was followed
closely by [**Known lastname 878**] who did not see EEG activity consistent
with seizures. He was extubated and transferred to the medical
floors for further management. He had some right arm and neck
pain, and MRI showed spinal stenosis. He had fevers, but no
source of infection. One blood culture grew CONS and was
initially started on Vancomycin which was discontinued. Pt was
evaluated by Psychiatry and he did not meet inpatient criteria
for follo-up. Pt was discharged with Psychiatric follow-up, and
continued on home medications.
Pt was discharged with the ride to assist with getting to
appointments.
.
ACTIVE ISSUES:
# Seizure-like activity: He was followed by [**Known lastname **] and
monitored on 24-hour EEG monitoring. He did have several
episodes of myclonic jerking that were not associated with any
EEG evidence of seizures. The EEG was negative over several days
but did show epileptiform activity consistent with history of
epilepsy. In the setting of medication non-compliance he may
have had a seizure prior to admission. He did have urine
toxicology positive for amphetamines and toxicology was
consulted but they did not feel that his presentation was
concerning for amphetamine overdose. MRI brain was negative.
Initially, was loaded on dilantin and was also started on
depakote. When his depakote level was therapeutic, the dilantin
was stopped and he was continued on his home depakote dose. He
was transferred to the medicine floors and had no further
seizure-like activity. He was continued on his home dose of
Depakote and instructed to follow-up with [**Known lastname 878**] as an
outpatient.
.
# Chest pain: Patient has a history of CAD s/p PCI. Per report,
was complaining of chest pain this afternoon at rehab. ACS was
ruled out with serial cardiac biomarkers and repeat ECG.
Carvedilol, ASA, plavix, and statin were restarted when began to
take POs. On the medicine floors, he had an episode of chest
pain, though ECG was unchanged and cardiac markers were again
negative. Pt was hypertensive at the time, and his chest pain
improved as his BP was better controlled.
.
# Respiratory: Patient underwent RSI in the ED for airway
protection in the setting of possible seizures. He was extubated
without complications.
.
# FEVER: Fevers in ICU, though no clear source. Pt had 1 bottle
growing GPC's, and was speciated to coag negative staph, likekly
contaminate. Started on Vancomycin initially, and then
discontinued once speciated as CONS. Pt defervesced and had no
fevers for 48hrs prior to discharge.
.
# SUBSTANCE ABUSE: Positive for amphetamines on admission. Pt
has long-history of substance abuse, and was taking narcotics
prior to admission at [**Hospital1 1680**]. At [**Hospital1 1680**] he was in treatment for
detox. Pt was given fentanyl for concern for withdrawal in ICU.
On the floors, narcotics were held. Psych was consulted, and pt
decided he wanted to go home and was enthusiastic about
attending AA.
He was set up with the ride to help with getting rides to
meetings and oupatient psychiatry.
Pt was counseled on avoidance of narcotics and valium.
.
# Depression: Continued on Fluoxetine in MICU. Remeron was
restarted on the floors. Pt was evaluated by Psychiatry, and
recommended continuing Fluoxetine and Remeron. Pt to follow-up
closely with psychiatry. As above, SW consulted for issues as
outlined above, pt reports unable to make it to previous appts
given difficulty with rides.
.
# Right upper extremity weakness, neck pain: Exam inconsistent
as reportedly able to perform tasks without weakness. MRI
demonstrated severe spinal stenosis, which may have been
contributing to his pain and some right upper arm weakness. Per
[**Hospital1 **] this is a chronic condition and recommended outpatient
follow-up with Spine.
.
# Anemia: Normocytic. Stable since admission. Vitamin B12,
folate normal. Fe on low end of normal, ferritin not elevated,
with low transferrin saturation suggestive of iron deficiency.
Hct was stable and he had no symptoms or signs of bleeding.
Started on iron supplementation. He was instructed to follow-up
with his PCP for further management to have appropriate colon
cancer screening with colonoscopy.
.
# Superficial thrombophlebitis: Pt had some right arm swelling
at site of PICC, found to have thrombosis of superficial vein.
PICC removed, pt treated symptomatically.
.
# HTN: Antihypertensives were initially held in the MICU. On the
floors he was hypertensive, and home medications were restarted:
HCTZ 25 mg daily, Hydralazine 100 mg po tid, Amlodipine 5mg
daily, and Lisinopril 40mg daily. Pt's BP better controlled
after starting home meds.
.
# HLD: Pt was discharged on home dose of Crestor.
.
TRANSITIONAL CARE:
1. CODE: FULL
2. FOLLOW-UP
- PCP
[**Name Initial (PRE) **] [**Name10 (NameIs) **]
[**Name Initial (NameIs) **] PSYCHIATRY
- SPINE
3. Contact: [**Name (NI) 13788**] [**Name (NI) 89987**] ([**Telephone/Fax (1) 89988**] (daughter)
4. MEDICAL MANAGEMENT:
- START Aspirin 81mg, Colace, Ferrous sulfate, potassium for
hypokalemia here with labs to be checked as outpatient on
discharge
- Counseled on avoiding all illicits
5. Barrier to rehospitalization: history of substance abuse,
concern for non-compliance with follow-up
6. Needs outpatient screening colonoscopy for concern of
iron-deficiency anemia.

Medications on Admission:
Pharmacy: [**Telephone/Fax (1) 89639**], last filled there [**2171-2-20**]
- coreg 25mg po bid
- valproate ER 500mg 2 tabs [**Hospital1 **]
- fluoxetine 40mg daily
- hctz 25mg daily
- hydral 100 tid
- imdur 30 daily
- crestor 40mg daily
- lisinopril 40 daily
- Amlodipine 5 daily
- plavix 75 mg daily
- Remeron 45mg qhs
- valium 5mg tab, [**12-2**] tid:prn
- fiorect-codeine 50-325 APAP-40mg caffeine-30mg codeine
- dilaudid 4mg tid:prn pain
- morphine sulfate ER 30mg [**Hospital1 **]
- fentanyl patch filled 50mcg [**2171-1-8**]

Discharge Medications:
1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Crestor 40 mg Tablet Sig: One (1) Tablet PO once a day.
3. fluoxetine 40 mg Capsule Sig: One (1) Capsule PO once a day.

4. carvedilol 25 mg Tablet Sig: One (1) Tablet PO twice a day.
5. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
6. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
7. hydralazine 100 mg Tablet Sig: One (1) Tablet PO three times
a day.
8. divalproex 500 mg Tablet Extended Release 24 hr Sig: Two (2)
Tablet Extended Release 24 hr PO BID (2 times a day).
9. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
11. mirtazapine 45 mg Tablet Sig: One (1) Tablet PO at bedtime.

12. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
Disp:*30 Tablet, Chewable(s)* Refills:*2*
13. docusate sodium 100 mg Tablet Sig: One (1) Tablet PO twice a
day as needed for constipation.
Disp:*60 Tablet(s)* Refills:*0*
14. ferrous sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
15. Outpatient Physical Therapy
Please evaluate and treat.
16. Outpatient Lab Work
Please have chem 7 for electrolytes, BUN/Cr checked on [**2171-3-12**]
and bring or fax results to primary care doctor, Dr. [**Last Name (STitle) 80583**], at
[**Telephone/Fax (1) 89989**].
17. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day.
Disp:*30 Tablet, ER Particles/Crystals(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnoses:
1. Seizure like activity
2. Fevers
3. Substance abuse
4. Anemia
5. Chest pain
Secondary Diagnoses:
1. Depression
2. Anemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname 89987**],

You were admitted to the hospital for seizure like activity. You
were observed closely in the ICU and required intubation. You
were evaluated by [**Known lastname **] and EEG was done, but showed no
seizures. You also had fevers and were initially started on
antibiotics, however, this was discontinued as there was no
infection in the blood. You had chest pain, but the cardiac
enzymes were normal and ECG was normal. You had some neck pain
and right upper arm weakness, and MRI showed some cervical spine
narrowing. You should follow-up with spine specialists for this.
You also had a small blood clot in one of your veins. You should
use warm packs for this to help with the discomfort.
You were evaluated by the physical therapists, who recommended
outpatient physical therapy.

The following medications were changed during this admission:
- STOP Dilaudid, Morphine, Valium, Vistaril, Fiorcet-Codeine,
and Fentanyl
*** You had prescriptions for these medications prior to
admission at [**Hospital1 1680**]. DO not take these medications.

- START Aspirin 81mg by mouth daily
- START Ferrous sulfate 325mg by mouth daily
- START Docusate sodium 100mg by mouth twice daily
**The ferrous sulfate (iron) can cause some constipation. The
Docusate is a stool softener that will help you have bowel
movements.
- START Potassium chloride tablets 20mEQ by mouth daily
**Your potassium levels were low here. This medication is to
help replace your potassium. Please discuss this with your
primary care doctor. You should have your labs checked at your
appointment with her on Tuesday of next week ([**2171-3-12**], see
below) to make sure that your potassium levels are normal.

Please continue all other medications you were on prior to this
admission.

It is important that you avoid ALL illicit drugs. These can be
very harmful and even life-threatening to your health.

It is very important that you make it to all your appointments.
We tried to arrange for the Ride for you. However, you will need
to re-apply when you are discharged. In the mean time, please do
make it to your appointments. This is very important for your
long-term health.

You were found to have anemia here. Your iron was on the low
normal range. We saw no evidence of bleeding here. However, you
should discuss with your PCP further workup such as
age-appropriate colon cancer screening with colonoscopy.

Followup Instructions:
Please follow-up with the following appts:

Name: [**Last Name (LF) **],[**First Name3 (LF) **]
Location: ROUTE 44 MEDICAL
Address: 106 ROUTE 44, [**Location (un) **],[**Numeric Identifier 89990**]
Phone: [**Telephone/Fax (1) 89991**]
Appt: [**3-12**] at 11:45am
***NOTE-At this appt please discuss with Dr [**Last Name (STitle) 80583**] obtaining a
psychiatrist for medication managemenet and counseling needs

Department: [**Last Name (STitle) **]
When: WEDNESDAY [**2171-3-13**] at 2:00 PM
With: [**First Name11 (Name Pattern1) 3292**] [**Last Name (NamePattern1) 3293**], MD [**Telephone/Fax (1) 3294**]
Building: Ks [**Hospital Ward Name 860**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) 1951**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: SPINE CENTER
When: THURSDAY [**2171-3-28**] at 10:00 AM
With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 3736**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2171-3-8**]
{'Epilepsy, unspecified, with intractable epilepsy,Acidosis,Cheyne-Stokes respiration,Fever, unspecified,Combinations of opioid type drug with any other drug dependence, unspecified,Other and unspecified infection due to central venous catheter,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other chronic pain,Percutaneous transluminal coronary angioplasty status,Bipolar disorder, unspecified,Iron deficiency anemia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Arthrodesis status,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Tobacco use disorder,Spinal stenosis in cervical region'}


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: Seizures

PRESENT ILLNESS: Mr. [**Known lastname 89987**] is a 54 year old gentleman with a PMH significant
for polysubstance abuse, CAD s/p PCI, and seizure disorder
admitted for possible seizures.  Per report, the patient was
noted today to have chest pain clutching his chest. At that
time, EMS was called with report of seizure activity. He
received 2 mg IM ativan in EMS without resolution of seizure
activity.
.
In the [**Hospital1 18**] ED, initial VS 99.8 70 156/113 100% AC 500x14, 10,
1.0 with ABG 7.34/48/165. The patient had a urine tox screen
positive for amphetamines and had a negative CTA chest and
NCHCT.  [**Hospital1 878**] evaluation in the ED was non-localizing, and
the patient was admitted to the MICU for further management.
.
The patient was initially admitted to [**Hospital3 3583**] on [**2-21**]
for SI and depression. At that time, the admission note states
that he had recently been discharged from [**Hospital **] Hospital 2
weeks prior for depression, and that he has a history of abuse
of pain medications. In addition, the patient has a history of
suicide attempts via OD and car crash. His Daughter states that
he has a history of addiction to morphine, hydromorphone, and
valium due to his chronic pain, and that he has been admitted to
an inpatient substance abuse facility since [**2-21**].
.
Currently, the patient is intubated, and sedated.

MEDICAL HISTORY: HTN
HLD
CAD s/p PCI
Depression
Polysubstance abuse on suboxone
Left parietal tumor
Seizure disorder - has not had a seizure in 5 years.
Neck and back pain s/p C5-7 fusion

MEDICATION ON ADMISSION: Pharmacy: [**Telephone/Fax (1) 89639**], last filled there [**2171-2-20**]
- coreg 25mg po bid
- valproate ER 500mg 2 tabs [**Hospital1 **]
- fluoxetine 40mg daily
- hctz 25mg daily
- hydral 100 tid
- imdur 30 daily
- crestor 40mg daily
- lisinopril 40 daily
- Amlodipine 5 daily
- plavix 75 mg daily
- Remeron 45mg qhs
- valium 5mg tab, [**12-2**] tid:prn
- fiorect-codeine 50-325 APAP-40mg caffeine-30mg codeine
- dilaudid 4mg tid:prn pain
- morphine sulfate ER 30mg [**Hospital1 **]
- fentanyl patch filled 50mcg [**2171-1-8**]

ALLERGIES: Gentamicin / Seroquel / Latex

PHYSICAL EXAM: ADMISSION:
VS: 98.1 54 147/88 100%AC 500x16, 10, 1.0
Gen: Intubated, sedated
HEENT: ETT in place
CV: Nl S1+S2, no m/r/g
Pulm: CTAB
Abd: S/ND +bs
Ext: No c/c/e.
Neuro: pupils 2->1 mm bilaterally. 1+ biceps, brachioradialis,
patellear reflexes bilaterally. No evidence of rigidity or
clonus. Downgoing toes bilaterally.
.
DISCHARGE:
VS:  98.8 98.6 122/88 109-162/75-100 70 62-76 18 95%RA
8H 60/750
24H 480/675+ not saved, +BMx1
Gen: awake, alert, appears fatigued, NAD
HEENT: NCAT, EOMI, right eye deviated to right, dry MM, no
scleral icterus, OP clear
CVS: RRR, nl S1 S2, no m/r/g
Pulm: no use access mm of breathing, CTAB without wheezes or
crackles
Abd: +BS, soft, NTND
Ext: warm, dry, no [**Location (un) **], slight erythema and edema of RUE around
PICC site, slight tenderness to palpation
Neuro: A&Ox3, awake, alert, 4/5 strength RUE, though difficult
to assess if related to effort, gait not assessed

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with daughter. [**Name (NI) 1139**] - 1 ppd x5 years. EtOH - none per
daughter. [**Name (NI) **] illicit or herbal drugse except for pain medication
addiction. 

### Response:
{'Epilepsy, unspecified, with intractable epilepsy,Acidosis,Cheyne-Stokes respiration,Fever, unspecified,Combinations of opioid type drug with any other drug dependence, unspecified,Other and unspecified infection due to central venous catheter,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other chronic pain,Percutaneous transluminal coronary angioplasty status,Bipolar disorder, unspecified,Iron deficiency anemia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Arthrodesis status,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Tobacco use disorder,Spinal stenosis in cervical region'}
