CHIEF COMPLAINT: bilateral foot pain and swelling

PRESENT ILLNESS: Mr. [**Known lastname 66333**] is a 46-year-old man who claims to have been
trimming tree branches while barefoot and fell out of the tree
into a thorn [**Last Name (un) **]. He sustained multiple abrasions and then went
with a friend to use cocaine, after which he felt bilateral foot
pain and walked to [**Hospital 1474**] Hospital for evaluation. His aunt,
with whom he lives, describes finding him in the garage, wrapped
only in a blanket, near a pile of broken glass. He had scratches
all over his body and complained of foot pain, so she took him
to [**Hospital 1474**] Hospital.

MEDICAL HISTORY: bipolar disorder
multiple inpatient psychiatric admissions
self-inflicted stab wound to chest requiring emergent sternotomy

MEDICATION ON ADMISSION: depakote (although blood levels extremely low)

ALLERGIES: Lithium

PHYSICAL EXAM: 98.9  95  172/124  20  95%RA
A&Ox3
agitated, uncomfortable
sick-appearing
HEENT: PERRL, EOMI. minor scratches on face
chest: multiple abrasions. CTAB. Midsternal wound healed.
CV RRR
abd: multiple abrasions including on genitals. NTND, soft, +BS
UE: multiple scratches b/l arms concentrated at dorsal/volar
forearms. Erythema b/l hands R>L. SILT M/R/U/A. +TTP throughout
R hand. Necrotic R small digit tip.
LE: multiple scratches b/l LE extending from upper inner thighs
to feet. All leg compartments soft but b/l feet significantly
more tense. Weeping excoriations L foot. Able to express small
amount of pus from excoriation plantar foot. Erythema extending
just distal to knees b/l. 2+ DP pulses. Great and 2nd toes cold
and dusky bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: +MJ, +cocaine
2 year h/o cigarette smoking
lives with aunt, unemployed
Acute kidney failure, unspecified,Rhabdomyolysis,Cocaine abuse, unspecified,Cellulitis and abscess of leg, except foot,Gangrene,Bipolar I disorder, most recent episode (or current) unspecified,Other accidental fall from one level to another,Abrasion or friction burn of other, multiple, and unspecified sites, infected,Frostbite of hand,Accident due to excessive cold due to weather conditions
Acute kidney failure NOS,Rhabdomyolysis,Cocaine abuse-unspec,Cellulitis of leg,Gangrene,Bipolor I current NOS,Fall-1 level to oth NEC,Abrasion NEC-infected,Frostbite of hand,Excessive cold: weather
Admission Date:  [**2184-3-5**]              Discharge Date:   [**2184-3-9**]

Date of Birth:  [**2138-2-26**]             Sex:   M

Service: SURGERY

Allergies:
Lithium

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
bilateral foot pain and swelling

Major Surgical or Invasive Procedure:
none on this admission


History of Present Illness:
Mr. [**Known lastname 66333**] is a 46-year-old man who claims to have been
trimming tree branches while barefoot and fell out of the tree
into a thorn [**Last Name (un) **]. He sustained multiple abrasions and then went
with a friend to use cocaine, after which he felt bilateral foot
pain and walked to [**Hospital 1474**] Hospital for evaluation. His aunt,
with whom he lives, describes finding him in the garage, wrapped
only in a blanket, near a pile of broken glass. He had scratches
all over his body and complained of foot pain, so she took him
to [**Hospital 1474**] Hospital.

Past Medical History:
bipolar disorder
multiple inpatient psychiatric admissions
self-inflicted stab wound to chest requiring emergent sternotomy

Social History:
+MJ, +cocaine
2 year h/o cigarette smoking
lives with aunt, unemployed

Family History:
NC

Physical Exam:
98.9  95  172/124  20  95%RA
A&Ox3
agitated, uncomfortable
sick-appearing
HEENT: PERRL, EOMI. minor scratches on face
chest: multiple abrasions. CTAB. Midsternal wound healed.
CV RRR
abd: multiple abrasions including on genitals. NTND, soft, +BS
UE: multiple scratches b/l arms concentrated at dorsal/volar
forearms. Erythema b/l hands R>L. SILT M/R/U/A. +TTP throughout
R hand. Necrotic R small digit tip.
LE: multiple scratches b/l LE extending from upper inner thighs
to feet. All leg compartments soft but b/l feet significantly
more tense. Weeping excoriations L foot. Able to express small
amount of pus from excoriation plantar foot. Erythema extending
just distal to knees b/l. 2+ DP pulses. Great and 2nd toes cold
and dusky bilaterally

Pertinent Results:
[**2184-3-5**] 11:45AM   WBC-14.3* RBC-4.52* HGB-13.8* HCT-38.3*
MCV-85 MCH-30.5 MCHC-36.0* RDW-13.9
[**2184-3-5**] 11:45AM   NEUTS-78.9* BANDS-0 LYMPHS-17.4* MONOS-3.4
EOS-0.1 BASOS-0.2
[**2184-3-5**] 11:45AM   PT-13.4* PTT-26.7 INR(PT)-1.1
[**2184-3-5**] 11:45AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2184-3-5**] 11:45AM   GLUCOSE-114* UREA N-51* CREAT-2.1* SODIUM-135
POTASSIUM-5.9* CHLORIDE-102 TOTAL CO2-23 ANION GAP-16
[**2184-3-5**] 11:45AM   CALCIUM-8.2* PHOSPHATE-4.1 MAGNESIUM-2.4
[**2184-3-5**] 11:45AM   CK(CPK)-[**Numeric Identifier 11094**]*
[**2184-3-5**] 02:32PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-POS
cocaine-POS amphetmn-NEG mthdone-NEG
[**2184-3-5**] 09:18PM   WBC-11.4* RBC-4.37* HGB-13.2* HCT-37.1*
MCV-85 MCH-30.2 MCHC-35.6* RDW-13.8

[**2183-3-9**]: WBC=8.0, Cr=0.9, CK=794

Brief Hospital Course:
Pt was evaluated by multiple services in the ED. He was admitted
to the trauma ICU with a presumed diagnosis of rhabdomyolysis,
acute renal failure, and cellulitis. He was started on
aggressive hydration and his CK and renal assays normalized. ID
was consulted and he received IV Vancomycin/Zosyn for 5 days. He
was maintained on a 1:1 sitter throughout his hospitalization.
He was followed by multiple surgical services but no surgical
intervention was deemed necessary. He was initially somnolent
but his mental status gradually improved. The erythema, edema,
and tenderness to palpation of his extremities gradually
improved with elevation and antibiotics. His lower extremities
were wrapped in compressive dressings with good resolution of
the edema. On hospital day 2 he was improving. He was
transferred to the surgical floor. Psychiatry was consulted
given his extensive psychiatric history.  On hospital day 3 he
was advanced to a regular diet and was able to ambulate. Per ID,
a hepatitis panel and HIV test were sent. All hepatitis tests
were negative. The HIV test was still pending at the time of
discharge and will need to be followed as an outpatient. By
hospital day 5 the patient was greatly improved and stable for
discharge. He had stable necrotic tips of the first and 2nd
digits of each foot as well as the small digit of the right hand
on discharge. He will follow-up with Podiatry and Plastic
Surgery for these. Psychiatry agreed that he was stable for
discharge to home. He will follow-up with the TriCity Mental
Health Clinic on Friday. It is possible that he will need
vascular surgery intervention at a later date, although at this
point he has only single digit necrosis on his hands and feet
and bilaterally palpable pulses at his feet. His blood pressure
was also elevated throughout this admission, althought he was
asymptomatic. He was started on Metoprolol 25mg PO BID, which he
will continue at home. He was given the information for the
[**Hospital3 **] internal medicine group and he will
follow-up with his new primary care doctor regarding this issue.

Medications on Admission:
depakote (although blood levels extremely low)

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 2 weeks: take while taking narcotic pain
medication.
Disp:*28 Capsule(s)* Refills:*0*
2. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain for 1 weeks.
Disp:*25 Tablet(s)* Refills:*0*
3. Divalproex 500 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO at bedtime.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
rhabdomyolysis
acute renal failure
cellulitis
frostbite
bipolar disorder


Discharge Condition:
stable


Discharge Instructions:
You may resume your usual diet and activities as you feel able.
When you are sitting or lying down you should keep your feet
elevated above the level of your heart. You should keep all
scratches and skin breaks clean and dry, do not scratch or pick
at the scabs. You should not drive while taking pain
medications.

Keep all follow-up appointments.

Call your doctor or go to the ER if you experience:
-chest pain or shortness of breath
-fevers or chills
-increased pain, redness, or drainage from your hands or feet
-anything else that concerns you

Followup Instructions:
Follow-up with the TriCity Mental Health clinic on [**2-8**] at 3pm.

Follow-up with Podiatry in 2 weeks. Call ([**Telephone/Fax (1) 21608**] to
schedule your appointment.

Follow-up with Plastic Surgery Hand Clinic in [**2-2**] weeks. Call
[**Telephone/Fax (1) 4652**] to schedule your appointment, appointments are
Tuesdays only.

Follow-up with [**Hospital3 **] to get a new primary care
doctor. They are located in the [**Hospital Ward Name 23**] Atrium ([**Location (un) **]) on
the [**Hospital Ward Name 516**]. Call ([**Telephone/Fax (1) 56960**] to schedule your
appointment. An HIV test was sent on this admission. You can get
the results from your new primary care doctor. In addition, your
blood pressure was elevated throughout this admission. A new
medication, metoprolol, was started which you should take every
day. You should have your blood pressure followed as an
outpatient.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]
{'Acute kidney failure, unspecified,Rhabdomyolysis,Cocaine abuse, unspecified,Cellulitis and abscess of leg, except foot,Gangrene,Bipolar I disorder, most recent episode (or current) unspecified,Other accidental fall from one level to another,Abrasion or friction burn of other, multiple, and unspecified sites, infected,Frostbite of hand,Accident due to excessive cold due to weather conditions'}


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: bilateral foot pain and swelling

PRESENT ILLNESS: Mr. [**Known lastname 66333**] is a 46-year-old man who claims to have been
trimming tree branches while barefoot and fell out of the tree
into a thorn [**Last Name (un) **]. He sustained multiple abrasions and then went
with a friend to use cocaine, after which he felt bilateral foot
pain and walked to [**Hospital 1474**] Hospital for evaluation. His aunt,
with whom he lives, describes finding him in the garage, wrapped
only in a blanket, near a pile of broken glass. He had scratches
all over his body and complained of foot pain, so she took him
to [**Hospital 1474**] Hospital.

MEDICAL HISTORY: bipolar disorder
multiple inpatient psychiatric admissions
self-inflicted stab wound to chest requiring emergent sternotomy

MEDICATION ON ADMISSION: depakote (although blood levels extremely low)

ALLERGIES: Lithium

PHYSICAL EXAM: 98.9  95  172/124  20  95%RA
A&Ox3
agitated, uncomfortable
sick-appearing
HEENT: PERRL, EOMI. minor scratches on face
chest: multiple abrasions. CTAB. Midsternal wound healed.
CV RRR
abd: multiple abrasions including on genitals. NTND, soft, +BS
UE: multiple scratches b/l arms concentrated at dorsal/volar
forearms. Erythema b/l hands R>L. SILT M/R/U/A. +TTP throughout
R hand. Necrotic R small digit tip.
LE: multiple scratches b/l LE extending from upper inner thighs
to feet. All leg compartments soft but b/l feet significantly
more tense. Weeping excoriations L foot. Able to express small
amount of pus from excoriation plantar foot. Erythema extending
just distal to knees b/l. 2+ DP pulses. Great and 2nd toes cold
and dusky bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: +MJ, +cocaine
2 year h/o cigarette smoking
lives with aunt, unemployed 

### Response:
{'Acute kidney failure, unspecified,Rhabdomyolysis,Cocaine abuse, unspecified,Cellulitis and abscess of leg, except foot,Gangrene,Bipolar I disorder, most recent episode (or current) unspecified,Other accidental fall from one level to another,Abrasion or friction burn of other, multiple, and unspecified sites, infected,Frostbite of hand,Accident due to excessive cold due to weather conditions'}
