CHIEF COMPLAINT: 72 year old male admitted on [**2122-7-12**] with right iliac stent
artery aneurysm with a cheif complaint of back pain and mild
shortness of breath.

PRESENT ILLNESS: The pt is a 72 year old male s/p AAA orininally presented on
[**2122-5-19**] for SOB, and a CTA of the A/P at that time demonstrated
a RCI aneurysm.  Pt was instructed to follow up at a later date,
as this was not deemed an emergent issue.  On [**2122-6-11**], he
presented for a CAT and IV fluids for his RI.  He was then
discharged and told to follow up with Dr. [**Last Name (STitle) **].  On [**2122-7-12**],
the pt arrived to have his RCI aneurysm endvascularly repaired.

MEDICAL HISTORY: AAA repair
COPD
CAD
anemia
HTN
CRI
CHF
chronic UTI
dementia
depression

MEDICATION ON ADMISSION: FS Jevity
Tylenol 325'
Lipitor
ASA
Lopressor 6.25''
Protonix
SQ heparin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: cachectic male
HEENT:  PERRLA, EOMI
Lungs: rhonchi b/l bases
Cardiac: RRR, no murmurs
Abd: PEG tube site clean, slightly distended, soft, nontender
Ext: No C/C/E
Neuro: AxOx3
Palp PT bil

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Spanish speaking, lives in a nursing home, ex-smoker and alcohol
user.
Aneurysm of iliac artery,Pneumonia due to Pseudomonas,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Personal history of other specified urinary system disorders,Anemia, unspecified,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other persistent mental disorders due to conditions classified elsewhere,Depressive disorder, not elsewhere classified,Gastrostomy status,Delirium due to conditions classified elsewhere,Hypotension, unspecified,Constipation, unspecified
Iliac artery aneurysm,Pseudomonal pneumonia,Obs chr bronc w(ac) exac,CHF NOS,Crnry athrscl natve vssl,Prsn hst ot spf urn dsrd,Anemia NOS,Hypertension NOS,Renal & ureteral dis NOS,Mental disor NEC oth dis,Depressive disorder NEC,Gastrostomy status,Delirium d/t other cond,Hypotension NOS,Constipation NOS
Name:  [**Known lastname 11072**],[**Known firstname 11073**]                  Unit No:   [**Numeric Identifier 11074**]

Admission Date:  [**2122-7-12**]              Discharge Date:   [**2122-8-7**]

Date of Birth:  [**2049-10-4**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 107**]
Addendum:
See the brief hospital course below for the addendum.

Brief Hospital Course:
#1.  leukocytosis:  Pt transferred to the medicine service on
[**8-4**] for w/u of persistent leukocytosis.  He had been afebrile,
completed a 10 day course of Zosyn for pseudomonas pneumonia,
and had been on steroids for a COPD flare from [**Date range (1) 11075**].  His
WBC increased from 6.8 on [**7-25**] and peaked to 22 on [**7-31**].  CXR,
blood cultures, PPD, TTE all negative.  ESR was elevated; WBC
trending down from 22 - last checked on [**8-6**] with result of
14.1.  Infectious disease service was consulted, and they
recommended testing for C. diff given that they did not find
other sources of infection.  C. diff was tested once during pt's
hospitalization -- negative and pt w/out diarrhea.  Plan to test
at the rehab facility.
.
#2.  SOB:  On [**8-4**], pt had episode of SOB/tachypnea/tachycardia
with hypotension that responded with a fluid bolus, nebs and
suction.  Although pt had been on SC heparin during his
admission, ruled out PE with a CXR and CTA.  EKG and cardiac
enzymes were also negative.  He has had several similar episodes
in the SICU but had not been worked up for PE.  It is most
likely that these have been COPD flares that are responsive to
neb treatments.  Would continue to provide supplemental O2,
chest PT, suction, and nebs.
.
#3.  CAD:  Please refer to issue #2 above - given his history of
CAD, we checked his cardiac enzymes, ECHO, and EKG.  All were
negative, and we made no changes to the current cardiac meds.


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*2*
4. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 * Refills:*2*
6. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One
(1)  PO DAILY (Daily): G TUBE DAILY.
Disp:*30 * Refills:*2*
7. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
8. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for shortness of breath or
wheezing.
Disp:*1 * Refills:*2*
9. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for shortness of breath or
wheezing.
Disp:*1 * Refills:*2*
10. Haloperidol Lactate 5 mg/mL Solution Sig: One (1)  Injection
[**Hospital1 **] (2 times a day) as needed for delirium.
Disp:*30 * Refills:*2*
11. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
Disp:*1 * Refills:*2*
12. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
13. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
 Injection TID (3 times a day).
Disp:*30 * Refills:*2*
14. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): Please adhere to the insulin
sliding scale.
Disp:*1 mL* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 474**]- [**Location (un) 164**]

Discharge Diagnosis:
Primary:
AAA repair
Pseudomonas pneumonia
COPD exacerbation
leukcocytosis
Secondary:
CAD
anemia
HTN
CRI
CHF
chronic UTI
dementia
depression


Discharge Condition:
Good

Discharge Instructions:
Please make sure to see Dr. [**Last Name (STitle) **] within the week at [**Hospital 11076**].

Notify Dr. [**Last Name (STitle) **] with fever, worsening shortness of breath,
chest pain, persistent diarrhea, green or bloody sputum,
dizziness, back pain, or bleeding from your groin.

Followup Instructions:
Please see Dr. [**Last Name (STitle) **] in the upcoming week at [**Hospital3 474**].


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 108**] MD [**MD Number(1) 109**]

Completed by:[**2122-8-7**]

Admission Date:  [**2122-7-12**]              Discharge Date:   [**2122-8-7**]

Date of Birth:  [**2049-10-4**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1190**]
Chief Complaint:
72 year old male admitted on [**2122-7-12**] with right iliac stent
artery aneurysm with a cheif complaint of back pain and mild
shortness of breath.

Major Surgical or Invasive Procedure:
[**2122-7-13**]- Endovascular stent graft repair of right common iliac
artery with extender stend into external iliac artery and
hypogastric artery embolization.

History of Present Illness:
The pt is a 72 year old male s/p AAA orininally presented on
[**2122-5-19**] for SOB, and a CTA of the A/P at that time demonstrated
a RCI aneurysm.  Pt was instructed to follow up at a later date,
as this was not deemed an emergent issue.  On [**2122-6-11**], he
presented for a CAT and IV fluids for his RI.  He was then
discharged and told to follow up with Dr. [**Last Name (STitle) **].  On [**2122-7-12**],
the pt arrived to have his RCI aneurysm endvascularly repaired.

Past Medical History:
AAA repair
COPD
CAD
anemia
HTN
CRI
CHF
chronic UTI
dementia
depression


Social History:
Spanish speaking, lives in a nursing home, ex-smoker and alcohol
user.

Family History:
noncontributory

Physical Exam:
Gen: cachectic male
HEENT:  PERRLA, EOMI
Lungs: rhonchi b/l bases
Cardiac: RRR, no murmurs
Abd: PEG tube site clean, slightly distended, soft, nontender
Ext: No C/C/E
Neuro: AxOx3
Palp PT bil

Pertinent Results:
[**2122-8-6**]

WBC-13.4* RBC-3.59* Hgb-10.2* Hct-32.2* MCV-90 MCH-28.3
MCHC-31.6 RDW-17.1* Plt Ct-219

[**2122-8-5**]

Neuts-75.9* Lymphs-16.6* Monos-5.0 Eos-2.2 Baso-0.3

[**2122-7-31**]

PT-13.4* PTT-32.4 INR(PT)-1.2

[**2122-8-6**]

Glucose-156* UreaN-48* Creat-1.2 Na-140 K-4.6 Cl-100 HCO3-30*
AnGap-15

[**2122-8-6**]

Calcium-10.3* Phos-4.3 Mg-2.1

[**2122-7-13**]

CHEST (PORTABLE AP); -59 DISTINCT PROCEDURAL SERVIC

Reason: Locate central and r/o pneumo

AP SUPINE CHEST: Comparison to AP upright chest of 8 hours
prior. There has been interval intubation with the ETT tip 5 cm
above the carina. Right IJ line seen with its tip distal SVC. No
pneumothorax is identified, though limited assessment due to
severe emphysema and overlying tubes. Severe upper lobe bullous
emphysema. There remains bibasilar opacities, which may be
secondary to chronic emphysema, however, it is difficult to
exclude an element of mild CHF/volume overload superimposed on
background emphysematous changes. No pneumonia is seen. There is
a persisting left retrocardiac opacity, which is unchanged
dating back to multiple prior chest x-rays.

IMPRESSION:
1) ETT and right IJ in satisfactory position; no pneumothorax
identified, though limited assessment due to emphysema and
overlying tubes.
2) Equivocal mild CHF/volume overload superimposed on background
emphysema. No new pneumonia. Unchanged appearance of left
retrocardiac opacity. Follow-up again recommended to ensure
resolution is recommended.


ECHO

MEASUREMENTS:
Left Atrium - Long Axis Dimension: *4.1 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: *5.5 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: 4.8 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: 1.1 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: 1.0 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 4.0 cm (nl <= 5.6 cm)
Left Ventricle - Ejection Fraction: 50% to 60% (nl >=55%)
Aorta - Valve Level: 3.1 cm (nl <= 3.6 cm)
Aorta - Ascending: *3.5 cm (nl <= 3.4 cm)
Aortic Valve - Peak Velocity: 1.0 m/sec (nl <= 2.0 m/sec)
Mitral Valve - E Wave: 0.5 m/sec
Mitral Valve - A Wave: 1.0 m/sec
Mitral Valve - E/A Ratio: 0.50
Mitral Valve - E Wave Deceleration Time: 252 msec
TR Gradient (+ RA = PASP): <= 25 mm Hg (nl <= 25 mm Hg)

Findings:

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Suboptimal technical quality, a focal LV wall motion abnormality
cannot be fully excluded. Overall normal LVEF (>55%). No resting
LVOT gradient.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No masses or vegetations on aortic valve.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No mass or
vegetation on mitral valve. Trivial MR. LV inflow pattern c/w
impaired relaxation.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR. Normal PA systolic pressure.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.


Conclusions:
Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Due to suboptimal technical
quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic
function is probably normal. Right ventricular chamber size and
free wall
motion are normal. The aortic valve leaflets (3) are mildly
thickened but
aortic stenosis is not present. No masses or vegetations are
seen on the
aortic valve. The mitral valve leaflets are mildly thickened. No
mass or
vegetation is seen on the mitral valve. Trivial mitral
regurgitation is seen. The left ventricular inflow pattern
suggests impaired relaxation. The estimated pulmonary artery
systolic pressure is normal. There is no
pericardial effusion.

Compared with the findings of the prior study (tape reviewed) of
[**2122-7-14**], there  is probably no change.

IMPRESSION: No valvular vegetations seen. If clinically
indicated, a TEE would better to exclude a small valve
vegetation.


[**2122-8-5**]

CTA CHEST W&W/O C &RECONS; CT 100CC NON IONIC CONTRAST

Reason: SOB

PROCEDURE: CT of the chest.

INDICATION: Tachycardic and tachypnic with shortness of breath.

TECHNIQUE: Multidetector noncontrast low-dose images of the
chest, and contrast-enhanced images of the chest following rapid
bolus administration of 100 cc of IV Optiray were performed.
Images are reformatted in the sagittal and coronal planes.

IV CONTRAST: Nonionic IV Optiray contrast was used for rapid
bolus administration.

CT OF THE CHEST WITH AND WITHOUT CONTRAST: There is severe
emphysematous change throughout the lungs, with marked bullous
formation in the upper lobes as well as anteriorly towards the
lung bases. No pulmonary embolism is identified. There are no
areas of consolidation. There are no pleural effusions. There is
a focal 1.2 cm opacity seen in the periphery of the lingula, not
seen on prior study of [**2122-5-11**]. The aorta is markedly
tortuous, and is seen to have mass effect on the left atrium as
before, which might compromise venous return. There is mild
dilatation of both main pulmonary arteries indicative of
pulmonary hypertension. The right pulmonary artery measures 2.5
cm, and the left 2.2 cm. There is no pneumothorax. No
pericardial effusion. Within the imaged portions of the upper
abdomen, no abnormalities are identified.

Bone windows show no suspicious lesions.

Some secretions are noted within the trachea and right main stem
bronchus.

MULTIPLANAR REFORMATTED IMAGES: Images reformatted in the
sagittal and coronal planes show no evidence of pulmonary
embolism. No aortic aneurysm or dissection identified.

IMPRESSION:
1. No pulmonary embolism identified.
2. Severe emphysema with marked bullous changes particularly at
the upper lobes and in the lower thorax anteriorly.
3. Focal 1.2 cm opacity in the periphery of the left lingula,
not seen previously. While this may represent atelectasis or an
inflammatory opacity, short-term followup in one to two months
is recommended to ensure stability or resolution.

[**2122-7-17**]

SPUTUM     Site: ENDOTRACHEAL

Source: Endotracheal.

GRAM STAIN (Final [**2122-7-17**]):
      >25 PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE ROD(S).
      4+   (>10 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

RESPIRATORY CULTURE (Final [**2122-7-19**]):
MODERATE GROWTH OROPHARYNGEAL FLORA.
PSEUDOMONAS AERUGINOSA.    MODERATE GROWTH.

SENSITIVITIES: MIC expressed in MCG/ML

_________________________________________________________
                             PSEUDOMONAS AERUGINOSA
                             |
CEFEPIME--------------     8 S
CEFTAZIDIME-----------    16 I
CIPROFLOXACIN---------     2 I
GENTAMICIN------------   <=1 S
IMIPENEM--------------     2 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN----------       R
PIPERACILLIN/TAZO-----    16 S
TOBRAMYCIN------------   <=1 S

ACID FAST SMEAR (Final [**2122-7-20**]):
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.





Brief Hospital Course:
The patient was admitted on [**2122-7-12**]

PCP followed patient while in hospital

The patient is an elderly male who underwent treatment of a
ruptured aortic aneurysm at an outside hospital. He recovered,
but was left with a greater than 6 cm
right common iliac artery aneurysm. Although the aneurysm was
very large and the iliac artery proximal and distal was very
tortuous, there appeared to be a suitable proximal and distal
cuff zone for endovascular repair.

Pt pre-op'd cleared for surgery.

[**2122-7-13**]

Pt underwent a endovascular stent graft repair of right common
iliac artery aneurysm.
extender stent graft into external iliac artery and embolization
of right hypogastric artery.He tolerated the procedure well.
There were no complications. He was transfered to the PACU in
stable condition.

[**2122-7-14**]

Pt remained in PACU overnight. He was extubated this day. He was
also diuresed post procedure.

Pt had to reintubated for failed extubation. Pt has a history of
 02 dependent COPD / aspiration pna. When extubated pt dropped
his o2 sats and had labored breathing.

[**2122-7-15**] - [**2122-7-27**]

Pt transfered to SICU.

Pt CRI/CHF remained stable.

Pt on CPAP/PS. recieved inhalers. Tube feeds through PEG, foley
remained, hct stable, SSI, lines remained in place. Pt
experienced low grade temps. Yellow secretions. Required no BP
control. Pt experienced low grade temps.

Pt pan cx'd. Found to have increase WBC.

Pt given zosyn for pna. Also pt started on Vancomycin for pos
blood cx.

Pt weaned to BIPAP. While in the SICU pt [**Last Name **] problem was the
inability extubate. He recieve Antibiotics for PNA. He
experienced some minor dementia. This was thought to be due sun
downing. Pt also reqiured a variety of IV medications for BP
support

Steroids were started for COPD flare. Pt extubated

[**2122-7-28**] - [**2122-7-30**]

Pt transfered to the VICU in stable condition.

Zosyn was Dc'd / Vancomycin Dc'd.
Steroids were tapered
CVL dc'd. Pt still required some diuresis.

[**2122-7-31**] -[**2122-8-3**]

Foley [**Name (NI) **]
PT WBC remained elevated. A CT scan was obtained. This was
negative.

[**2122-8-4**]

Pt transfered to Medicine for on going leukocytosis.


Medications on Admission:
FS Jevity
Tylenol 325'
Lipitor
ASA
Lopressor 6.25''
Protonix
SQ heparin

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 537**]- [**Location (un) 538**]

Discharge Diagnosis:
Right common iliac artery aneurysm
CRI
CHF
PNA

Discharge Condition:
Stable

Discharge Instructions:
Follow-up with Dr [**Last Name (STitle) 3407**] in two weeks. Please call [**Telephone/Fax (1) 1241**].


Completed by:[**2122-8-7**]
{'Aneurysm of iliac artery,Pneumonia due to Pseudomonas,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Personal history of other specified urinary system disorders,Anemia, unspecified,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other persistent mental disorders due to conditions classified elsewhere,Depressive disorder, not elsewhere classified,Gastrostomy status,Delirium due to conditions classified elsewhere,Hypotension, unspecified,Constipation, unspecified'}


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: 72 year old male admitted on [**2122-7-12**] with right iliac stent
artery aneurysm with a cheif complaint of back pain and mild
shortness of breath.

PRESENT ILLNESS: The pt is a 72 year old male s/p AAA orininally presented on
[**2122-5-19**] for SOB, and a CTA of the A/P at that time demonstrated
a RCI aneurysm.  Pt was instructed to follow up at a later date,
as this was not deemed an emergent issue.  On [**2122-6-11**], he
presented for a CAT and IV fluids for his RI.  He was then
discharged and told to follow up with Dr. [**Last Name (STitle) **].  On [**2122-7-12**],
the pt arrived to have his RCI aneurysm endvascularly repaired.

MEDICAL HISTORY: AAA repair
COPD
CAD
anemia
HTN
CRI
CHF
chronic UTI
dementia
depression

MEDICATION ON ADMISSION: FS Jevity
Tylenol 325'
Lipitor
ASA
Lopressor 6.25''
Protonix
SQ heparin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: cachectic male
HEENT:  PERRLA, EOMI
Lungs: rhonchi b/l bases
Cardiac: RRR, no murmurs
Abd: PEG tube site clean, slightly distended, soft, nontender
Ext: No C/C/E
Neuro: AxOx3
Palp PT bil

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Spanish speaking, lives in a nursing home, ex-smoker and alcohol
user. 

### Response:
{'Aneurysm of iliac artery,Pneumonia due to Pseudomonas,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Personal history of other specified urinary system disorders,Anemia, unspecified,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Other persistent mental disorders due to conditions classified elsewhere,Depressive disorder, not elsewhere classified,Gastrostomy status,Delirium due to conditions classified elsewhere,Hypotension, unspecified,Constipation, unspecified'}
