CHIEF COMPLAINT: Admitted from home unresponsive and hypotensive s/p
R-VATS/decort [**11-16**] complicated by MRSA empyema.

PRESENT ILLNESS: Mr. [**Known lastname 1617**] is a 58-year-old
gentleman who had a VATS total decortication
of the right lung for chronic and recurrent pleural
effusions, which led to bilateral fibrothoraces. He
suffered a postoperative empyema in the basilar space where
his lung did not fully expand. This was managed by chest tube
drainage and intrapleural and intravenous antibiotics. He was
recommended to undergo a window thoracoplasty for full
debridement of this
empyema cavity and access for wet-to-dry dressing changes,
however, the patient did not want to have this done several
days prior to this acute admission. He presented tonight to an
outside institution with
sepsis. He is now taken to the operating room urgently for
full drainage of the infected space.

MEDICAL HISTORY: Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection
right VATS decortication [**2175-11-17**]
right thoracic window and full surgical debridement [**2175-12-23**]
Trach [**2176-1-4**]

MEDICATION ON ADMISSION: claritin 10', lopressor 12.5'', prilosec 40', calcium,
multivitamins, colace, senna, ditropan 5', asa 81', acidophilus,
levothyroxin 25'

ALLERGIES: Codeine / Zestril

PHYSICAL EXAM: General: intubated and sedated. Opens eyes to name.
HEENT: intubated, sedated. remainder of exam unremarkable.
Neck: no masses, supple.
CV: RRR S1, S2, no murmurs, rub, regurg
Resp; decreased breath sounds at right base, otherwise clear.
Right chest tube in place draining clear yellow fluid.
Abd; soft, distended (baseline), NT, +BS.
Extrem: +[**1-1**] pedal edema bilat. Has chronic LE edema.
Neuro: sedated.

FAMILY HISTORY: Father - PVD
Mother - questionable metastatic ovarian cancer

SOCIAL HISTORY: Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU.
Methicillin susceptible Staphylococcus aureus septicemia,Cardiac arrest,Acute and chronic respiratory failure,Empyema without mention of fistula,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis,Acute kidney failure with lesion of tubular necrosis,Pneumonia due to Pseudomonas,Congestive heart failure, unspecified,Severe sepsis,Infection with drug-resistant microorganisms, unspecified, with multiple drug resistance
Meth susc Staph aur sept,Cardiac arrest,Acute & chronc resp fail,Empyema w/o fistula,Oth lymp unsp xtrndl org,Bact pleur/effus not TB,Ac kidny fail, tubr necr,Pseudomonal pneumonia,CHF NOS,Severe sepsis,Infc mcrg drgrst mult
Admission Date:  [**2175-12-22**]              Discharge Date:   [**2176-1-24**]

Date of Birth:  [**2117-10-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Codeine / Zestril

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Admitted from home unresponsive and hypotensive s/p
R-VATS/decort [**11-16**] complicated by MRSA empyema.

Major Surgical or Invasive Procedure:
[**2175-12-23**] Open thoracostomy and drainage of empyema cavity,
creation of thoracic window, left chest tube placement, right
chest tube placement, flexible bronchoscopy.
Trach placed [**2176-1-4**]


History of Present Illness:
Mr. [**Known lastname 1617**] is a 58-year-old
gentleman who had a VATS total decortication
of the right lung for chronic and recurrent pleural
effusions, which led to bilateral fibrothoraces. He
suffered a postoperative empyema in the basilar space where
his lung did not fully expand. This was managed by chest tube
drainage and intrapleural and intravenous antibiotics. He was
recommended to undergo a window thoracoplasty for full
debridement of this
empyema cavity and access for wet-to-dry dressing changes,
however, the patient did not want to have this done several
days prior to this acute admission. He presented tonight to an
outside institution with
sepsis. He is now taken to the operating room urgently for
full drainage of the infected space.


Past Medical History:
Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection
right VATS decortication [**2175-11-17**]
right thoracic window and full surgical debridement [**2175-12-23**]
Trach [**2176-1-4**]

Social History:
Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU.


Family History:
Father - PVD
Mother - questionable metastatic ovarian cancer

Physical Exam:
General: intubated and sedated. Opens eyes to name.
HEENT: intubated, sedated. remainder of exam unremarkable.
Neck: no masses, supple.
CV: RRR S1, S2, no murmurs, rub, regurg
Resp; decreased breath sounds at right base, otherwise clear.
Right chest tube in place draining clear yellow fluid.
Abd; soft, distended (baseline), NT, +BS.
Extrem: +[**1-1**] pedal edema bilat. Has chronic LE edema.
Neuro: sedated.

Brief Hospital Course:
In brief, patient is a 50-year-old man with a history of large
cell lymphoma, for which he underwent R-CHOP chemotherapy most
recently in [**2175-6-30**]. He has had known bilateral effusions by
his report dating back to [**2158**]. Patient was previously admitted
for a VATS/decortication [**2175-11-17**]. On POD# 13 his chest tube was
noted to be draining pus and his empyema was treated initially
with vanc and zosyn and then later IV and intra-pleural
vancomycin. The pus cultured out MRSA and he was discharged on
[**2175-12-10**] with plans for a 2 wk course of vanco.

[**2175-12-22**] Pt was re-admitted from OSH intubated after developing
hypoxemic respiratory failure. Pt was taken directly to the OR
for open thoracostomy and drainage of empyema cavity, creation
of thoracic window, left chest tube placement, right chest tube
placement, flexible bronchoscopy on [**2175-12-23**] (see operative log
for details).

Events:
Immediately post op: Started on vanco, zosyn, fluc, levo. Right
chest open w/ [**Hospital1 **] dressing changes by thoracic surgery. Remained
sedated requiring pressure control ventilation. Attempts to wean
to PSV unsuccessful-returned to PC and did not tolerate volume
control.

POD#[**3-2**] Tube feeds started. Remains on PC ventilation, / fio2
40% -sats 100%. Lasix gtt started. Wound clean and granulating.
Lasix gtt was started.

[**2176-12-22**] Taken to the operating room for open thoracostomy and
drainage of empyema cavity, creation of thoracic window, left
chest tube placement, right
chest tube placement, and flexible bronchoscopy.

[**2176-12-29**] - Diagnostic therapeutic flexible bronchoscopy was
performed and bronchioalveolar lavage of the lingula was sent.

[**2176-1-1**] -Continued on vanc/zosyn for MRSA + enterococcal empyema
annd pseudomonas empyema.

[**2176-1-4**] Percutaneous tracheostomy.

[**2176-1-14**] Developing consolidation in the right perihilar region
concerning for pneumonia.

[**2176-1-16**] Bronchoscopy with therapeutic aspiration and BAL. Fever,
infiltrate on CXR.

[**2176-1-22**] ventilation with high airway pressures but poor
oxygenation and CO2 retention. Acidotic, given bicarb.
Hemodialyzed [**2176-1-22**], hypotensive and on pressors.

[**2176-1-23**] p.m. code blue - asystolic / PEA, chest compressions +
epi/bicarb

[**2176-1-24**] Multisystem organ failure, ventilator withdrawn per
family request at 12:23am.


Medications on Admission:
claritin 10', lopressor 12.5'', prilosec 40', calcium,
multivitamins, colace, senna, ditropan 5', asa 81', acidophilus,
levothyroxin 25'

Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
s/p R VATS / decortication
s/p thoracic window
large cell lymphoma
+MRSA empyema
ATN renal failure
pseudomonas PNA


Discharge Condition:
deceased

Discharge Instructions:
deceased

Followup Instructions:
n/a


Completed by:[**2176-1-24**]
{'Methicillin susceptible Staphylococcus aureus septicemia,Cardiac arrest,Acute and chronic respiratory failure,Empyema without mention of fistula,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis,Acute kidney failure with lesion of tubular necrosis,Pneumonia due to Pseudomonas,Congestive heart failure, unspecified,Severe sepsis,Infection with drug-resistant microorganisms, unspecified, with multiple drug resistance'}


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: Admitted from home unresponsive and hypotensive s/p
R-VATS/decort [**11-16**] complicated by MRSA empyema.

PRESENT ILLNESS: Mr. [**Known lastname 1617**] is a 58-year-old
gentleman who had a VATS total decortication
of the right lung for chronic and recurrent pleural
effusions, which led to bilateral fibrothoraces. He
suffered a postoperative empyema in the basilar space where
his lung did not fully expand. This was managed by chest tube
drainage and intrapleural and intravenous antibiotics. He was
recommended to undergo a window thoracoplasty for full
debridement of this
empyema cavity and access for wet-to-dry dressing changes,
however, the patient did not want to have this done several
days prior to this acute admission. He presented tonight to an
outside institution with
sepsis. He is now taken to the operating room urgently for
full drainage of the infected space.

MEDICAL HISTORY: Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection
right VATS decortication [**2175-11-17**]
right thoracic window and full surgical debridement [**2175-12-23**]
Trach [**2176-1-4**]

MEDICATION ON ADMISSION: claritin 10', lopressor 12.5'', prilosec 40', calcium,
multivitamins, colace, senna, ditropan 5', asa 81', acidophilus,
levothyroxin 25'

ALLERGIES: Codeine / Zestril

PHYSICAL EXAM: General: intubated and sedated. Opens eyes to name.
HEENT: intubated, sedated. remainder of exam unremarkable.
Neck: no masses, supple.
CV: RRR S1, S2, no murmurs, rub, regurg
Resp; decreased breath sounds at right base, otherwise clear.
Right chest tube in place draining clear yellow fluid.
Abd; soft, distended (baseline), NT, +BS.
Extrem: +[**1-1**] pedal edema bilat. Has chronic LE edema.
Neuro: sedated.

FAMILY HISTORY: Father - PVD
Mother - questionable metastatic ovarian cancer

SOCIAL HISTORY: Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU. 

### Response:
{'Methicillin susceptible Staphylococcus aureus septicemia,Cardiac arrest,Acute and chronic respiratory failure,Empyema without mention of fistula,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis,Acute kidney failure with lesion of tubular necrosis,Pneumonia due to Pseudomonas,Congestive heart failure, unspecified,Severe sepsis,Infection with drug-resistant microorganisms, unspecified, with multiple drug resistance'}
