CHIEF COMPLAINT: perineal infection

PRESENT ILLNESS: HPI: The pt is a 40yM with a history of diabetes who was
transferred from [**Hospital 8641**] Hospital by Mediflight where he
presented with scrotal pain and swelling 2 days after an
incision and drainage of a small scrotal abscess and was found
to have an exam c/w Fournier's Gangrene and subcutaneous gas on
CT. The pt reports that he waited in the ED at [**Location (un) 8641**] for 3
hours in early afternoon where erythema of his scrotum and
swelling progressed to his lower abdominal region. After his
transfer to [**Hospital1 18**], he was noted to be afebrile but over the
course of an hour became diaphoretic and ill appearing. The pt
denies SOB< CP, neurological sx, urinary sx, or GI sx.
PMH: DM, HTN, chronic back pain
PSH: Vasectomy
Med: Atenolol 50", oxycontin 40", ASA 81', Metformin 1000'
All: NKDA
Soc: Live in [**Last Name (un) 53428**], NH. Wife [**Doctor First Name 803**] can be reached at
[**Telephone/Fax (1) 79837**]
Labs: CH 7
129 94 25 306 AGap=18
3.3 20 1.3

MEDICAL HISTORY: DM, HTN, chronic back pain
Vasectomy

MEDICATION ON ADMISSION: Atenolol 50", oxycontin 40", ASA 81', Metformin 1000'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Day of Discharge
Gen: No acute distress
Cards: RRR
Pulm: Lungs clear to Auscultation
Abdomen: soft non-tender
Wound: well-approximated, healing, drains maintaining suction
with clear serosanguinous drainage. Skin graft with 100% take.
Mild maceration/irritation of skin on medial bilateral thighs
secondary to moisture and friction.

FAMILY HISTORY: 

SOCIAL HISTORY: Live in [**Last Name (un) 53428**], NH. Wife [**Doctor First Name 803**] can be reached at
Streptococcal septicemia,Necrotizing fasciitis,Acute respiratory failure,Vascular disorders of male genital organs,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Backache, unspecified,Other chronic pain,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)
Streptococcal septicemia,Necrotizing fasciitis,Acute respiratry failure,Male gen vascul dis NEC,Sepsis,DMII wo cmp nt st uncntr,Hypertension NOS,Backache NOS,Chronic pain NEC,Unilat inguinal hernia
Admission Date:  [**2173-10-1**]              Discharge Date:   [**2173-10-20**]

Date of Birth:  [**2133-4-7**]             Sex:   M

Service: PLASTIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 26411**]
Chief Complaint:
perineal infection

Major Surgical or Invasive Procedure:
[**2173-10-1**] Radical debridement of scrotum, perineum and
abdomen.


History of Present Illness:
HPI: The pt is a 40yM with a history of diabetes who was
transferred from [**Hospital 8641**] Hospital by Mediflight where he
presented with scrotal pain and swelling 2 days after an
incision and drainage of a small scrotal abscess and was found
to have an exam c/w Fournier's Gangrene and subcutaneous gas on
CT. The pt reports that he waited in the ED at [**Location (un) 8641**] for 3
hours in early afternoon where erythema of his scrotum and
swelling progressed to his lower abdominal region. After his
transfer to [**Hospital1 18**], he was noted to be afebrile but over the
course of an hour became diaphoretic and ill appearing. The pt
denies SOB< CP, neurological sx, urinary sx, or GI sx.
PMH: DM, HTN, chronic back pain
PSH: Vasectomy
Med: Atenolol 50", oxycontin 40", ASA 81', Metformin 1000'
All: NKDA
Soc: Live in [**Last Name (un) 53428**], NH. Wife [**Doctor First Name 803**] can be reached at
[**Telephone/Fax (1) 79837**]
Labs: CH 7
129 94 25 306 AGap=18
3.3 20 1.3

CBC- 11.5 / 34.1 / 142

PT: 15.1 PTT: 26.2 INR: 1.3
OSH CT Abd: Scrotal air tracking anteriorly and posteriorly with
additional gas in the buttock
PE:
VS: 100.4 96 100/56 21 94
Diaphoretic
RRR
CTAB
Abdomen soft, NT, NT, erythema tracking to the right inguinal
crease, within marker, crepitus palpable over left inguinal
crease
Phallus circumcised mild, ecchymosis at base
Scrotum the size of grapefruit, ecchymotic, crepitus present,
focal area of dark purple with break in skin in midline, testes
non-palpable
Perineum indurated without crepitus, bleeding from perineal
wound
Anus without crepitus,


Past Medical History:
DM, HTN, chronic back pain
Vasectomy


Social History:
Live in [**Last Name (un) 53428**], NH. Wife [**Doctor First Name 803**] can be reached at


[**Telephone/Fax (1) 79837**]




Physical Exam:
On Day of Discharge
Gen: No acute distress
Cards: RRR
Pulm: Lungs clear to Auscultation
Abdomen: soft non-tender
Wound: well-approximated, healing, drains maintaining suction
with clear serosanguinous drainage. Skin graft with 100% take.
Mild maceration/irritation of skin on medial bilateral thighs
secondary to moisture and friction.

Pertinent Results:
[**2173-9-30**] 10:30PM   NEUTS-89.1* LYMPHS-7.5* MONOS-2.9 EOS-0.5
BASOS-0.1
[**2173-9-30**] 10:30PM   WBC-11.5* RBC-5.24 HGB-11.8* HCT-34.1*
MCV-65* MCH-22.5* MCHC-34.6 RDW-13.9
[**2173-10-1**] 02:30AM   HGB-10.4* calcHCT-31
[**2173-10-1**] 04:25AM   WBC-12.5* RBC-4.21* HGB-9.6* HCT-29.5*
MCV-70* MCH-22.8* MCHC-32.5 RDW-13.5
[**2173-10-1**] 11:18AM URINE  BLOOD-SM NITRITE-NEG PROTEIN-NEG
GLUCOSE-250 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2173-10-1**] 12:47PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG

Brief Hospital Course:
Pt life-flighted to [**Hospital1 18**]. Pt diagnosed with Fournier's
gangrene, taken emergently by Urology to OR from ER for radical
perineal debridement. Please see operative note dictated
separately. Pt transferred to SICU still intubated for IV
insulin, IV antibiotics (Vanc, Zosyn, Clinda), hourly wound
checks, and pressor/ventilator support. POD2 Pt taken back to OR
for re-debridement of wound margins by Gen [**Doctor First Name **] and Urology.
In the SICU, the pt had a relatively uneventful course. see
notes below.
[**9-30**]: transfer from [**Hospital 8641**] Hospital, s/p incision and drainage of
perineal abscess 2 days ago followed by increasing pain and
redness and fever, evaluated today and found to have clinical
and radiological findings c/w Fournier's gangrene. Transferred
to [**Hospital1 18**] for surgical evaluation and treatment. States fevers
and
chills.
[**10-1**]: added clindamycin for antibiotic coverage, minimally
marching erythema, added propofol for sedation. A wound swab
from this day was taken and was + enterococcus. All other
cultures neg.
[**10-2**]: back to OR for some more debridement of right thigh. weaned
off of levo using fluid
[**10-3**]: bronchoscopy was performed
[**10-4**]:NGT placement--TF started. low grade temp. flexiseal placed

[**10-5**]:started insulin gtt for refractory blood sugars in the
setting of chronic wound care, lasix gtt with albumin
[**10-6**]: weaned versed/fent, weaned vent, started diamox, started
precedex to wean to extubation
[**10-7**]: Extubated. Aggitated, responding to haldol prn
[**10-9**]: no acute events, changed to po meds, po lasix, increased
RISS, PCA and oral pain control, d/c'ed insulin gtt

Pt transferred to Urology floor service in stable condition.
Wound care, glycemic control, and continued antibiotics
provided. Pt taken to OR by Plastic Surgery for local flap
closure of debrided area and VAC placement to bolster skin graft
over testicles. The patient did well on the floor. He was kept
on bed rest POD1-5 with strict restrictions against abducting
his legs. In addition, he was continued on IV antibiotics per ID
recommendations. On POD 5 his VAC dressing was taken down and
his skin graft had 100% take. On day of discharge POD 7, the
patient was doing very well. He was Afebrile vital signs stable,
his pain was well controlled with an oral regimen, he had been
cleared for home by Physical therapy, and his drain outputs had
decreased appropriately. Per ID recs, the patient did not
require additional IV antibiotic therapy.

Medications on Admission:
Atenolol 50", oxycontin 40", ASA 81', Metformin 1000'

Discharge Medications:
1. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
2. Zinc Sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
3. Morphine 30 mg Tablet Sustained Release Sig: Two (2) Tablet
Sustained Release PO Q12H (every 12 hours).
Disp:*24 Tablet Sustained Release(s)* Refills:*0*
4. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
5. Alprazolam 0.25 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. Tizanidine 2 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6
hours) as needed.
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
10. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
12. Duricef 500 mg Capsule Sig: One (1) Capsule PO twice a day
for 10 days.
Disp:*20 Capsule(s)* Refills:*0*
13. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Sixteen
(16) units Subcutaneous twice a day: take at breakfast and
Bedtime. Take [**2-28**] dose if not eating. .
Disp:*2 vials* Refills:*2*
14. Diabetic supplies
1/2 cc 30gauge insulin syringes prn

Glucometer testing strips PRN


Discharge Disposition:
Home With Service

Facility:
ROCKINHAM VNA

Discharge Diagnosis:
Fournier's Gangrene

Discharge Condition:
hemodynamically stable, tolerating oral intake, ambulating,
voiding without difficulty, pain controlled on oral regimen


Discharge Instructions:
Return to the ER if:
* If you are vomiting and cannot keep in fluids or your
medications.
* If you have shaking chills, fever greater than 101.5 (F)
degrees or 38 (C) degrees, increased redness, swelling or
discharge from incision, chest pain, shortness of breath, or
anything else that is troubling you.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds as ordered.
* Do not drive or operate heavy machinery while taking any
narcotic pain medication. You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.

Meds
Take all medications as ordered.

Drains
You will have a VNA who will help you with dressing changes and
wound checks as well as drain care. It will be important for you
to keep good records of your drain output and bring the records
with you when you return to clinic.




Followup Instructions:
Please call Dr.[**Name (NI) 29526**] office at ([**Telephone/Fax (1) 26412**] for a
followup appointment in 1 week.

Please call Dr.[**Name (NI) 11306**] office at ([**Telephone/Fax (1) 8791**] for a followup
appointment.

F/u with your PCP regarding your insulin regimen and blood
glucose control



Completed by:[**2173-10-20**]
{'Streptococcal septicemia,Necrotizing fasciitis,Acute respiratory failure,Vascular disorders of male genital organs,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Backache, unspecified,Other chronic pain,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)'}


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: perineal infection

PRESENT ILLNESS: HPI: The pt is a 40yM with a history of diabetes who was
transferred from [**Hospital 8641**] Hospital by Mediflight where he
presented with scrotal pain and swelling 2 days after an
incision and drainage of a small scrotal abscess and was found
to have an exam c/w Fournier's Gangrene and subcutaneous gas on
CT. The pt reports that he waited in the ED at [**Location (un) 8641**] for 3
hours in early afternoon where erythema of his scrotum and
swelling progressed to his lower abdominal region. After his
transfer to [**Hospital1 18**], he was noted to be afebrile but over the
course of an hour became diaphoretic and ill appearing. The pt
denies SOB< CP, neurological sx, urinary sx, or GI sx.
PMH: DM, HTN, chronic back pain
PSH: Vasectomy
Med: Atenolol 50", oxycontin 40", ASA 81', Metformin 1000'
All: NKDA
Soc: Live in [**Last Name (un) 53428**], NH. Wife [**Doctor First Name 803**] can be reached at
[**Telephone/Fax (1) 79837**]
Labs: CH 7
129 94 25 306 AGap=18
3.3 20 1.3

MEDICAL HISTORY: DM, HTN, chronic back pain
Vasectomy

MEDICATION ON ADMISSION: Atenolol 50", oxycontin 40", ASA 81', Metformin 1000'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Day of Discharge
Gen: No acute distress
Cards: RRR
Pulm: Lungs clear to Auscultation
Abdomen: soft non-tender
Wound: well-approximated, healing, drains maintaining suction
with clear serosanguinous drainage. Skin graft with 100% take.
Mild maceration/irritation of skin on medial bilateral thighs
secondary to moisture and friction.

FAMILY HISTORY: 

SOCIAL HISTORY: Live in [**Last Name (un) 53428**], NH. Wife [**Doctor First Name 803**] can be reached at 

### Response:
{'Streptococcal septicemia,Necrotizing fasciitis,Acute respiratory failure,Vascular disorders of male genital organs,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Backache, unspecified,Other chronic pain,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)'}
