CHIEF COMPLAINT: The patient was intubated to protect her
airway, status post mediastinal exploration.

PRESENT ILLNESS: This 73-year-old female with the
below past medical history had lower extremity edema and
visited her primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], on
[**2176-8-1**].  A workup was deferred at that time to evaluate a
1.5 cm thyroid nodule.  This was though possibly to be a
neoplasm, which might have explained a neuropathy that the
patient had which had defied workup with the consideration
that it might be a perineoplastic phenomenon.

MEDICAL HISTORY: 1.  Polycythemia [**Doctor First Name **] times 25 years, followed by Dr. [**Last Name (STitle) **] of
hematology oncology:  Her baseline CBC included a white blood
cell count of 40,000, hemoglobin of 13, hematocrit of 38 and
platelet count of 700,000.
2.  Hypo.
3.  Hip fracture with two arthroplasties.
4.  Perioperative myocardial infarction and cerebrovascular
accident at [**Hospital6 1129**], thought related
to high hematocrit and leukocytes earlier this year at the
time of her second hip arthroplasty.
5.  Polyneuropathy with a negative workup.
6.  Status post clipping of cerebral aneurysm in [**2174-1-17**].

MEDICATION ON ADMISSION: 

ALLERGIES: The patient had allergies to codeine, Demerol and
possibly contrast, but she received a CT scan without
difficulty at the other hospital.

PHYSICAL EXAM: 

FAMILY HISTORY: The family history was noncontributory.

SOCIAL HISTORY: The patient quit smoking 44 years ago.  She
drank rare alcohol.  The daughter is closely involved with
the patient's care; her name is [**Name (NI) 24592**] [**Name (NI) 1968**], [**First Name3 (LF) **] intensive
care unit nurse [**First Name (Titles) **] [**Hospital1 69**].  The
patient also has a son, who is an anesthesiologist.  She has
been engaged for several years.
Hematoma complicating a procedure,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Other pulmonary embolism and infarction,Other specified conduction disorders,Bacteremia,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Polycythemia vera
Hematoma complic proc,Other pulmonary insuff,CHF NOS,Pulm embol/infarct NEC,Conduction disorder NEC,Bacteremia,Food/vomit pneumonitis,Acute kidney failure NOS,Polycythemia vera
Admission Date:  [**2176-8-7**]       Discharge Date:  [**2176-9-6**]

Date of Birth:   [**2103-6-17**]       Sex:  F

Service:

CHIEF COMPLAINT:  The patient was intubated to protect her
airway, status post mediastinal exploration.

HISTORY OF PRESENT ILLNESS:  This 73-year-old female with the
below past medical history had lower extremity edema and
visited her primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], on
[**2176-8-1**].  A workup was deferred at that time to evaluate a
1.5 cm thyroid nodule.  This was though possibly to be a
neoplasm, which might have explained a neuropathy that the
patient had which had defied workup with the consideration
that it might be a perineoplastic phenomenon.

On [**2176-8-5**], the patient had a fine needle aspiration of the
nodule, which eventually showed a solid 3.4 x 2.2 x 1.9 cm
mass, not a multinodular goiter but simply a hyperplastic
nodule.  However, the patient had a resultant mediastinal
hematoma with respiratory distress which was first noticed at
home post procedure.  The patient returned to the [**Hospital1 **]
emergency room and was intubated in the emergency room for
airway protection.  A CT scan showed that she had airway
stenosis distal to the endotracheal tube, so she was sent to
the operating room for mediastinal exploration.  At that
time, 350 cc of blood were drained and an additional 500 cc
of blood were lost.  She sustained a 3.5 gm hemoglobin drop
from 11.9 to 8.4.

The patient was doing well on a T-piece trial on 35% face
mask after her original intubation.  However, after receiving
blood and fluids, the patient had respiratory distress.  She
was given further mechanical ventilatory support and was
transferred to [**Hospital1 69**] for
further management of airway problems.  [**Name (NI) **] laboratory data
before transfer were notable for a white blood cell count of
65,400 and a platelet count of 847,000.

PAST MEDICAL HISTORY:
1.  Polycythemia [**Doctor First Name **] times 25 years, followed by Dr. [**Last Name (STitle) **] of
hematology oncology:  Her baseline CBC included a white blood
cell count of 40,000, hemoglobin of 13, hematocrit of 38 and
platelet count of 700,000.
2.  Hypo.
3.  Hip fracture with two arthroplasties.
4.  Perioperative myocardial infarction and cerebrovascular
accident at [**Hospital6 1129**], thought related
to high hematocrit and leukocytes earlier this year at the
time of her second hip arthroplasty.
5.  Polyneuropathy with a negative workup.
6.  Status post clipping of cerebral aneurysm in [**2174-1-17**].

SOCIAL HISTORY:  The patient quit smoking 44 years ago.  She
drank rare alcohol.  The daughter is closely involved with
the patient's care; her name is [**Name (NI) 24592**] [**Name (NI) 1968**], [**First Name3 (LF) **] intensive
care unit nurse [**First Name (Titles) **] [**Hospital1 69**].  The
patient also has a son, who is an anesthesiologist.  She has
been engaged for several years.

FAMILY HISTORY:  The family history was noncontributory.

ALLERGIES:  The patient had allergies to codeine, Demerol and
possibly contrast, but she received a CT scan without
difficulty at the other hospital.

LABORATORY DATA:  On admission, the patient had a white blood
cell count of 43,700 with a hemoglobin of 8.2, hematocrit of
24.8 and platelet count of 579,000 with an MCV of 85.
Prothrombin time was 26.6 and INR was 1.3.  There was a
sodium of 142, potassium of 4, chloride of 105, bicarbonate
of 22, BUN of 28, creatinine of 1.2 and glucose of 129.  CK
was 305.  Albumin was 3.4.  Calcium was 8.1, phosphate was
4.8 and magnesium was 1.6.  Uric acid was 8.6.  Fine needle
aspiration original results showed insufficient cellular
material for analysis.

RADIOLOGY DATA:  A portable chest x-ray dated [**2176-8-21**] showed
the nasogastric tube to be in good position with a left sided
PICC line at the superior vena cava.  The heart size was
stable with slight upper zone redistribution, right basilar
atelectasis and the left costophrenic angle off the film.
The lungs were otherwise clear with mild congestive heart
failure.  On [**2176-9-3**], a chest x-ray showed further
improvement since [**2176-8-28**] in infiltrates with no new
abnormalities, the nasogastric tube in place and the PICC at
the right atrial and superior vena cava junction.  On
[**2176-9-6**], the chest x-ray showed mild pulmonary edema.

A head CT scan dated [**2176-8-14**] showed an aneurysm to be
present with a hypodense left frontal lobe, consistent with
encephalomalacia, a low density of the right periventricular
region and no acute processes or bleed.  A chest CT scan
dated [**2176-8-14**] showed bilateral effusions with atelectasis,
peripheral right upper lobe and lingular pulmonary embolisms,
neck hematoma which was not compressive and mediastinal
drains in place and interval enlargement of the hematoma.

CARDIAC STUDIES:  An echocardiogram of [**2176-8-8**] showed
marked left atrial enlargement, moderate right atrial
enlargement, septum bowed to the right atrium, no atrioseptal
defect, a left ventricular ejection fraction of greater than
55%, normal size, right ventricular volume and pressure
overload, moderate right dilation, mild aortic stenosis,
trace aortic regurgitation, 1 to 2+ mitral regurgitation, 3+
tricuspid regurgitation, mild pulmonic regurgitation, trivial
effusion; from the prior study, this noted new tricuspid
regurgitation and moderate to severe pulmonary hypertension.

HOSPITAL COURSE:
1.  PULMONARY:  The patient was continued on assist-control
ventilation and later weaned to pressure support ventilation.
A CT scan was performed to follow the neck hematoma with the
cardiothoracic surgery service following and this showed that
it was relatively stable.  Solu-Medrol was given for tracheal
edema.  A CT scan of the neck performed on [**2176-8-11**] showed a
noncompressive hematoma.  A ventilation perfusion scan was
performed on [**2176-8-12**] after the pulmonary hypertension noted
on echocardiogram was evaluated and this showed moderate
probability for pulmonary embolus, which was felt very
suggestive, given her history of polycythemia [**Doctor First Name **].  A CT
angiography was performed on [**2176-8-14**], which was positive
for peripheral pulmonary embolus and the patient was then
anticoagulated.

On [**2176-8-15**], the patient was extubated in the operating room
with the assistant of the high risk airway team.  Since then,
she was placed on face mask oxygen with humidification.  On
[**2176-8-17**] or [**2176-8-18**], the last [**Location (un) 1661**]-[**Location (un) 1662**] drain in the
neck wound was removed.  On [**2176-8-18**], the patient desaturated
to 88%, but recovered with supplemental oxygen.  She
continued on face mask oxygen.  She reported some shortness
of breath when her oxygen briefly slipped off on [**2176-8-26**].
Vigorous chest physical therapy and incentive spirometry were
provided.

On [**2176-8-27**] and [**2176-8-28**], decreased subjective shortness of
breath and fewer secretions were noted.  On [**2176-8-28**], the
chest x-ray looked substantially improved.  The patient felt
that her shortness of breath might have just been anxiety.
Ativan p.r.n. was given for this.  Antibiotics were
discontinued on [**2176-9-4**].  Thereafter, the patient remained
stable.  She had a slight desaturation to the low 90s on
[**2176-9-6**], but was mouth breathing at the time and not taking
her nasal cannula oxygen.  A chest x-ray showed mild
pulmonary edema, thought to be related to fluids given at the
time of her PEG placement and she was given 20 mg of Lasix.
She was saturating well and was comfortable at the time of
discharge.

2.  CARDIOVASCULAR:  For her coronary artery disease, beta
blockade was titrated up slowly and her cholesterol was
checked.  Aspirin was held for a question of platelet
dysfunction with the polycythemia [**Doctor First Name **].  The patient had an
echocardiogram on [**2176-8-8**], which showed pulmonary
hypertension with a gradient of greater than 66 and tricuspid
regurgitation with an ejection fraction of greater than 55%.
Hypertension became an issue after earlier stable blood
pressures, at some points even needing intravenous fluids for
low blood pressures.  As her blood pressure rose, eventually
Norvasc, Captopril and Lopressor were titrated up to provide
control.  The cardiology service thought that her high blood
pressure might be related to her pulmonary hypertension as
well.

The patient had two episodes of paroxysmal supraventricular
tachycardia on [**2176-8-19**] and [**2176-8-20**] with lowering of her
blood pressure with the first episode.  The cardiology
service was reconsulted on [**2176-8-19**] and they felt that the
problem was either atrioventricular nodal reentrant
tachycardia or atrial fibrillation and amiodarone was
initiated at loading doses with caution, given her history of
contrast allergy and thyroid issues.  No recurrence was noted
by [**2176-8-27**] and telemetry was discontinued on [**2176-8-28**].
The patient had no further events.  The amiodarone is
scheduled to go to 200 mg q.d. on [**2176-9-12**], although the
patient has been discharged on 200 mg b.i.d.

3.  INFECTIOUS DISEASE:  The patient was treated with
levofloxacin and Flagyl for 14 days for community-acquired
pneumonia starting on [**2176-8-8**].  This was changed to
vancomycin on [**2176-8-16**] for Methicillin resistant
Staphylococcus aureus positive sputum and positive blood
cultures with gram positive cocci, originally to complete a
ten day course.  The infectious disease service followed the
patient on the consultant service starting on [**2176-8-17**] and
felt that the pneumonia diagnosis was not entirely secure.  A
subclavian central line was pulled for positive cultures on
[**2176-8-17**] after a triple lumen catheter was placed to replace
it.

The infectious disease service's recommendations included
tapering the steroids, checking the Clostridium difficile,
giving vancomycin for at least ten to 14 days given the areas
that she might seed with bacteria, including her neck and hip
hardware, and checking fungal cultures for any spikes.  On
[**2176-8-22**], they added obtaining an herpes simplex virus
culture of a forearm lesion, which they felt was vesicular
and possibly consistent with herpes simplex virus; this was
negative.

On [**2176-8-25**], the patient had levofloxacin and Flagyl
reinitiated for a new infiltrate on chest x-ray, which was
originally only done for nasogastric tube placement.
However, the patient was afebrile and had an uninterpretable
white blood cell count, given that she had a history of
polycythemia [**Doctor First Name **].  Vancomycin was stopped on [**2176-8-26**] and
the patient was afebrile thereafter.  No changes were made to
her antibiotics after this time with her antibiotic course of
levofloxacin and Flagyl completed on [**2176-9-3**].  After a
positive urinalysis, the Foley catheter was discontinued on
[**2176-8-29**].  It was then reinserted for failure to void and
was removed as of [**2176-9-4**].  The patient was originally
thought to be having low grade temperatures, but it was later
found out that these were rectal temperatures and were
therefore one degree higher than the actual body temperature.

4.  HEME:  The patient was initially treated with hydroxyurea
and anagrelide for her polycythemia [**Doctor First Name **].  She was also
transfused with three units of packed red blood cells early
in her course to obtain a goal hematocrit of 30.  Anagrelide
was changed to b.i.d. on [**2176-8-11**].  A hypercoagulability
panel was sent for her pulmonary embolus history and heparin
was started on [**2176-8-16**].  On [**2176-8-21**], the hydroxyurea and
anagrelide were stopped.  Coumadin was begun on [**2176-8-22**] for
her pulmonary embolus.  This was increased on [**2176-8-26**] for
failure of her INR to increase.

The patient then required another unit of packed red blood
cells and the hematology service was reconsulted and felt
that she might be in the spent phase of polycythemia [**Doctor First Name **]
with myelofibrosis.  However, hemolysis laboratory studies
were sent on [**2176-8-26**] in an effort to explain her low
increase in hematocrit after transfusion and stool was guaiac
tested repeatedly.

On [**2176-8-27**], her LDH was noted to be elevated, but was not
significant given her history of polycythemia [**Doctor First Name **].  However,
her haptoglobin was less than 20 and a delayed transfusion
reaction workup was sent.  This was discussed with her
hematologist, Dr. [**Last Name (STitle) **], who thought that the patient might
have myelofibrosis and was therefore having a difficult time
recovering from the marrow-suppressive effects of her
polycythemia [**Doctor First Name **] medications.  He felt that there was no
need to act regarding hemolysis and said that the
schistocytes on peripheral smear probably represented the
effects of her myelofibrosis.  The hematocrit remained stable
thereafter.

Further contact with the blood bank indicated that no
transfusion reaction occurred and her schistocytes and her
anemia were attributed solely to polycythemia [**Doctor First Name **].  On
[**2176-8-29**], we considered getting a right upper quadrant
ultrasound to explain asymmetric edema of the right upper
extremity, but this was thought to be due mediastinal
hematoma per the medical intensive care unit team and was
improving and, further, would not have changed her management
because she was already anticoagulated.  Therefore, this was
deferred.

The patient's Coumadin was increased to 7.5 and then
decreased to 5 after a good INR was obtained.  Heparin was
discontinued.  On [**2176-9-2**], a decision was made to hold the
polycythemia [**Doctor First Name **] medications despite her increasing platelet
count to 500,000 or greater because of her low hematocrit.
Coumadin was discontinued for PEG placement and she was given
vitamin K to decrease her INR.  She was covered with heparin
in the meantime.  After PEG tube placement, heparin was
restarted with Coumadin.  On the day of discharge, her INR
was 1.5.  She will need to be covered with Lovenox until her
Coumadin is therapeutic.

5.  FLUID, ELECTROLYTES AND NUTRITION:  Tube feeds were
started and titrated up.  Intravenous fluids were stopped on
[**2176-8-10**] because the patient had a large positive balance.
Electrolytes were repleted p.r.n.  A subclavian central line
was placed on [**2176-8-7**] and discontinued, as per the
infectious disease section above, after she had positive
blood cultures.  A PICC line was placed on [**2176-8-21**].  The
patient was bolused for several liters on [**2176-8-26**] because
she had a low urine output.  This increased in response and
increased free water flushes were given thereafter.  Tube
feeds were restarted after her PEG tube was placed and, at
the time of discharge, are being tolerated well by the
patient.

6.  GASTROINTESTINAL:  After the endotracheal tube was
removed, the patient had a swallowing study on [**2176-8-21**],
which she failed.  Therefore, her nasogastric tube was kept
to give medications and nutrition.  The patient was given
Reglan as well to prove gastric motility.  The dysphagia team
followed the patient until she was ready for repeat swallow
with video study, which was done on [**2176-8-27**] and showed
residual pharyngeal material which she later aspirated.
Plans were therefore to keep her nasogastric tube and to
retry later.

Diarrhea developed and Clostridium difficile was checked
repeatedly and remained negative.  The diarrhea resolved
after her Colace was discontinued.  However, it might also
have been because Flagyl was coincidentally started for
pneumonia at the same time.  Promote with Fiber tube feeds
were felt to be ideal for her because it contained fiber but
not lactose.  Baseline liver function tests were checked,
given her amiodarone loading.

On [**2176-8-29**], the patient had persistent dysphagia and
gastrointestinal was consulted for a PEG tube.  However,
because the patient had a nasogastric tube, the
interventional radiology service was consulted on [**9-17**] the PEG tube so that the patient could avoid
endoscopy.  The PEG tube was completed on [**2176-9-4**] by the
interventional radiology service without complications.

7.  ENDOCRINE:  Thyroid medications were given.  On [**2176-8-19**],
the endocrine team saw her for a question of endocrine
contribution to her paroxysmal supraventricular tachycardia.
They did not think that her amiodarone would cause
hypothyroidism.

8.  RENAL:  Mild acute renal failure at admission with a
creatinine of 1.2 resolved.  She had decreased urine output
noted on [**2176-8-25**] and she was bolused for a total of 500 cc
of normal saline.  On [**2176-8-26**], the patient had decreased
but acceptable urine output and a stable creatinine which had
stayed stable since the Foley catheter was discontinued.  The
patient was incontinent, so at discharge the plan was to
restart Ditropan and see if she could regain control.

9.  MUSCULOSKELETAL:  The patient was seen by the physical
therapy service.  She was followed with variable interest in
her physical therapy.  Chest physical therapy was added to
help with secretion management.  Occupational therapy was
added on [**2176-9-4**].  An improved neurological function was
noticed by the time of discharge with increased mobility of
the right lower extremity and good function of the right
upper extremity.

10.  NEUROLOGY:  The patient's old cerebrovascular accident,
old aneurysm clipping and old polyneuropathy were stable.
Psychiatry saw the patient for depression and irritability
and thought a frontal lobe syndrome might be active.  This
was hard to interpret, given the lack of records at the time
of her cerebrovascular accident at [**Hospital6 1130**].  Their recommendations were to use Risperdal p.r.n.
for agitation.  A repeat CT scan on [**2176-8-28**] showed no
changes to the left frontal encephalomalacia and right
periventricular low attenuation areas.  This was performed
because the patient had a rather dense right hemiparesis
which was out of proportion to her weakness before being sent
to the medical intensive care unit.

Thereafter, the patient had improved right upper extremity
activity.  However, the neurology service was consulted for
their opinion whether a silent cerebrovascular accident
versus exacerbated old cerebrovascular accident might be
responsible.  They felt that [**Last Name **] problem was primarily
neuropathic, as her hemiparesis was flaccid.

Electromyograms were performed on [**2176-8-31**].  The initial
read showed no demyelinating.  However, they could not do a
myelogram and the procedure was terminated early because of
patient discomfort and her right side was not checked.  Only
the left upper extremity was done.  A nerve biopsy was
considered, however, because it was unlikely that we would
find a treatable cause of neuropathy and wanted to avoid the
risk to the patient of the wound.  This was deferred.  This
may be pursued if she fails to improve at rehabilitation.  At
the time of discharge, the patient had improving function of
her right sided weakness.

11.  PROPHYLAXIS:  Prophylaxis was with Prevacid and
pneumoboots and then heparin after her PEG was secured.
Coumadin was added for pulmonary embolus.  Prevacid was later
changed to Protonix, as this was less deliriogenic; however,
it was changed back to Prevacid because Protonix could not be
crushed.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Full code.

DISCHARGE MEDICATIONS:
Zantac 150 mg by PEG b.i.d.
Captopril 50 mg by PEG t.i.d.
Colace 100 mg by PEG b.i.d.
Synthroid 150 mcg by PEG q.d.
Lopressor 100 mg by PEG t.i.d.
Vitamin C 500 mg by PEG b.i.d.
Zinc sulfate 220 MG by PEG q.d.
Reglan 10 mg by PEG every six hours.
Miconazole cream to groin p.r.n.
Serzone 50 mg p.o. q.a.m. and 100 mg p.o. h.s.
Risperdal 0.5 mg by PEG t.i.d. p.r.n. for agitation.
Ativan 0.5 to 1 mg by PEG t.i.d. p.r.n. for anxiety.
Senna two tablets by PEG q.d. p.r.n.
Tylenol 650 mg by PEG every four to six hours p.r.n.
Hydralazine 10 mg intravenous every four to six hours p.r.n.
for hypertension.
Milk of Magnesia 15 to 30 cc by PEG every six hours p.r.n.
Ditropan 5 mg p.o. b.i.d.
Promote with Fiber 65 cc/hour.
Amiodarone 200 mg b.i.d. to change to 200 mg q.d. on
[**2176-9-12**].
Coumadin 5 mg p.o. h.s. with monitoring of INR and dose
adjustment.
Lovenox 65 mg subcutaneous b.i.d. until INR is 2.3, then
discontinued.

DRESSING CHANGES TO LEFT WRIST:  Cleanse with normal saline,
apply a thin layer of DuoDerm, a moist dressing with normal
saline, a dry sterile dressing and then Kling wrap without
tape, as the patient had tape injuries in the past; perform
dressing changes b.i.d.

DISCHARGE DIAGNOSES:
1.  Neck hematoma secondary to thyroid hemorrhage, requiring
intubation.
2.  Resultant pneumonia, possibly with Methicillin resistant
Staphylococcus aureus.
3.  Methicillin resistant Staphylococcus aureus bacteremia
while in the medical intensive care unit.
[**Unit Number **].  Exacerbation of chronic neuropathy.
5.  Status post PEG.
6.  See also the Past Medical History.

FOLLOW UP:  The patient is to follow up with Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **], who will see her at rehabilitation.




                            [**First Name11 (Name Pattern1) 198**] [**Last Name (NamePattern4) 199**], M.D.  [**MD Number(1) 200**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36

D:  [**2176-9-6**]  18:17
T:  [**2176-9-6**]  20:39
JOB#:  [**Job Number 42263**]
{'Hematoma complicating a procedure,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Other pulmonary embolism and infarction,Other specified conduction disorders,Bacteremia,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Polycythemia vera'}


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: The patient was intubated to protect her
airway, status post mediastinal exploration.

PRESENT ILLNESS: This 73-year-old female with the
below past medical history had lower extremity edema and
visited her primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], on
[**2176-8-1**].  A workup was deferred at that time to evaluate a
1.5 cm thyroid nodule.  This was though possibly to be a
neoplasm, which might have explained a neuropathy that the
patient had which had defied workup with the consideration
that it might be a perineoplastic phenomenon.

MEDICAL HISTORY: 1.  Polycythemia [**Doctor First Name **] times 25 years, followed by Dr. [**Last Name (STitle) **] of
hematology oncology:  Her baseline CBC included a white blood
cell count of 40,000, hemoglobin of 13, hematocrit of 38 and
platelet count of 700,000.
2.  Hypo.
3.  Hip fracture with two arthroplasties.
4.  Perioperative myocardial infarction and cerebrovascular
accident at [**Hospital6 1129**], thought related
to high hematocrit and leukocytes earlier this year at the
time of her second hip arthroplasty.
5.  Polyneuropathy with a negative workup.
6.  Status post clipping of cerebral aneurysm in [**2174-1-17**].

MEDICATION ON ADMISSION: 

ALLERGIES: The patient had allergies to codeine, Demerol and
possibly contrast, but she received a CT scan without
difficulty at the other hospital.

PHYSICAL EXAM: 

FAMILY HISTORY: The family history was noncontributory.

SOCIAL HISTORY: The patient quit smoking 44 years ago.  She
drank rare alcohol.  The daughter is closely involved with
the patient's care; her name is [**Name (NI) 24592**] [**Name (NI) 1968**], [**First Name3 (LF) **] intensive
care unit nurse [**First Name (Titles) **] [**Hospital1 69**].  The
patient also has a son, who is an anesthesiologist.  She has
been engaged for several years. 

### Response:
{'Hematoma complicating a procedure,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Other pulmonary embolism and infarction,Other specified conduction disorders,Bacteremia,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Polycythemia vera'}
