CHIEF COMPLAINT: Right hip pain

PRESENT ILLNESS: Briefly, patient is a 56 yo M who underwent primary right THA
with Dr. [**Last Name (STitle) **] on [**2143-6-26**]. He initially did well but was seen
in the ER with right hip pain on [**2143-7-5**]. Xrays showed
hardware in good position and he was admitted for pain control
and PT. His pain resolved with medications and returned to
baseline so no further imaging or intervention was performed.
However on [**2143-7-14**], he felt inceasing pain in the right hip
and had to take more oxycodone and tizanidine in setting of
right foot drop, and was admitted to the Medicine service for
worsening right hip pain.

MEDICAL HISTORY: -OA of knees and hips
-low back pain from car accident
-rotator cuff injury in b/l arms in [**2140**] and [**2141**]
-HTN
-hyperlipidemia
-obstructive sleep apnea
-L foot cyst
-colonic polyps
-CAD (microvascular dz) with h/o atypical cp, s/p cath with no
intervention
-depression/anxiety
-DM 2
-GERD
-obesity s/p lap band (lost 60lbs)
-anemia

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Acetaminophen 650 mg PO Q6H
standing dose
2. Acetaminophen-Caff-Butalbital [**11-26**] TAB PO Q6H:PRN headache
3. Aspirin 81 mg PO DAILY
4. Docusate Sodium 100 mg PO BID
5. Enoxaparin Sodium 40 mg SC Q 24H
6. Ferrous Sulfate 325 mg PO DAILY
7. Fluticasone Propionate NASAL 1 SPRY NU DAILY
8. Lansoprazole Oral Disintegrating Tab 15 mg PO DAILY
9. Lisinopril 20 mg PO DAILY
hold for SBP < 110, HR < 60
10. OxycoDONE (Immediate Release)  5-15 mg PO Q4H:PRN Pain
hold for sedation
11. Senna 1 TAB PO BID
12. fenofibrate *NF* 160 mg Oral daily
13. MetFORMIN XR (Glucophage XR) 1500 mg PO QPM
Do Not Crush
14. Metoprolol Succinate XL 25 mg PO DAILY
hold for SBP < 110, HR < 60
15. testosterone cypionate *NF* 200 mg/mL Injection every 2
weeks
16. Vitamin D 50,000 UNIT PO 1X/WEEK ([**Doctor First Name **])
17. Tizanidine 4-8 mg PO HS:PRN pain, spasm

ALLERGIES: Simvastatin / Pravastatin / nuts,peanuts,walnuts / Wheat Flour /
Nifedipine

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
VS - 98.7, 158/86, 84, 22, 100%RA
GENERAL - appears uncomfortable, but in NAD
HEENT - PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, no LD
LUNGS - Lungs are clear to ausculatation bilaterally, moving air
well and symmetrically, resp unlabored, no accessory muscle use

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient is a pastor. He is happily married with a supportive
family. Denies cigarettes and reports rare EtOH.
Hematoma complicating a procedure,Pyogenic arthritis, pelvic region and thigh,Other candidiasis of other specified sites,Acute posthemorrhagic anemia,Body Mass Index 40.0-44.9, adult,Hip joint replacement,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Lesion of sciatic nerve,Other acute postoperative pain,Other acquired deformities of ankle and foot,Phlebitis and thrombophlebitis of superficial vessels of lower extremities,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Thoracic or lumbosacral neuritis or radiculitis, unspecified,Benign essential hypertension,Esophageal reflux,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Tachycardia, unspecified,Penicillins causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Dysthymic disorder,Abnormal involuntary movements,Bariatric surgery status,Personal history of tobacco use
Hematoma complic proc,Pyogen arthritis-pelvis,Candidiasis site NEC,Ac posthemorrhag anemia,BMI 40.0-44.9, adult,Joint replaced hip,Mth sus Stph aur els/NOS,Sciatic nerve lesion,Acute postop pain NEC,Acq ankle-foot def NEC,Superfic phlebitis-leg,Abn react-artif implant,Obstructive sleep apnea,Morbid obesity,DMII oth nt st uncntrld,Osteoarthros NOS-l/leg,Lumbosacral neuritis NOS,Benign hypertension,Esophageal reflux,Elev transaminase/ldh,Tachycardia NOS,Adv eff penicillins,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Dysthymic disorder,Abn involun movement NEC,Bariatric surgery status,History of tobacco use
Admission Date:  [**2143-7-14**]              Discharge Date:   [**2143-8-13**]

Date of Birth:  [**2087-7-8**]             Sex:   M

Service: ORTHOPAEDICS

Allergies:
Simvastatin / Pravastatin / nuts,peanuts,walnuts / Wheat Flour /
Nifedipine

Attending:[**First Name3 (LF) 64**]
Chief Complaint:
Right hip pain

Major Surgical or Invasive Procedure:
Postoperative hematoma within right gluteus medius s/p I&D and
evacuation of hematoma on [**2143-7-17**] by Dr. [**Last Name (STitle) 5322**]
Septic right total hip arthroplasty s/p I&D, explant of all
components, cement spacer placement, and wound vac placement on
[**2143-7-24**] by Dr. [**Last Name (STitle) **]
Multiple I&D and vac changes for septic right total hip
arthroplasty on [**2143-7-25**], [**2143-7-27**], [**2143-7-30**] by Dr. [**Last Name (STitle) **]
I&D, antibiotic spacer exchange and wound closure [**2143-8-1**] by Dr.
[**Last Name (STitle) **]


History of Present Illness:
Briefly, patient is a 56 yo M who underwent primary right THA
with Dr. [**Last Name (STitle) **] on [**2143-6-26**]. He initially did well but was seen
in the ER with right hip pain on [**2143-7-5**]. Xrays showed
hardware in good position and he was admitted for pain control
and PT. His pain resolved with medications and returned to
baseline so no further imaging or intervention was performed.
However on [**2143-7-14**], he felt inceasing pain in the right hip
and had to take more oxycodone and tizanidine in setting of
right foot drop, and was admitted to the Medicine service for
worsening right hip pain.


Past Medical History:
-OA of knees and hips
-low back pain from car accident
-rotator cuff injury in b/l arms in [**2140**] and [**2141**]
-HTN
-hyperlipidemia
-obstructive sleep apnea
-L foot cyst
-colonic polyps
-CAD (microvascular dz) with h/o atypical cp, s/p cath with no
intervention
-depression/anxiety
-DM 2
-GERD
-obesity s/p lap band (lost 60lbs)
-anemia

PSH:
-R HTA on [**2143-6-26**]
-laparoscopic adjustable gastric band [**2142-4-2**]
-R knee arthroscopies x2
-abdominal hernia repair 3 years ago
-parathyroid surgery on [**5-/2143**]
-L hip pins put in when 14 years ago
-carpal tunnel repair on L hand


Social History:
Patient is a pastor. He is happily married with a supportive
family. Denies cigarettes and reports rare EtOH.

Family History:
Noncontributory.

Physical Exam:
ADMISSION PHYSICAL EXAM
VS - 98.7, 158/86, 84, 22, 100%RA
GENERAL - appears uncomfortable, but in NAD
HEENT - PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, no LD
LUNGS - Lungs are clear to ausculatation bilaterally, moving air
well and symmetrically, resp unlabored, no accessory muscle use

HEART - RRR, without murmurs, rubs or gallops
ABDOMEN - NABS, obese, soft/NT/ND, no rebound/guarding
EXTREMITIES - WWP, 2+ PT pulses. R hip scar with surgical
staples, some induration, slight erythema and tender to
palpation, but no pus or warmth. Tenderness to palpation
throughout leg but in particular R hip, calf, and ankle. Unable
to move joint due to pain, but able to wiggle toes. No noticable
increased in swelling in R leg compared to L. Knee flexion and
extension normal. Sensation to soft touch intact
NEURO - awake, A&Ox3, CNs II-XII grossly intact

DISCHARGE PHYSICAL EXAM ***************
Alert, oriented, NAD
Hemodynamically stable and pain well-controlled
Ambulating with a walker, voiding independently
Tolerating a regular diet
Nonlabored breathing, RRR
Abdomen soft NT/ND
Left lower extremity:
Hip incision clean, dry, and intact
Positive GS/FHL/peroneals, no TA/[**Last Name (un) 938**]
SILT T/S/S, decreased DP/SP
2+ DP pulse, WWP

Pertinent Results:
IMAGING:
[**2143-7-14**] ULTRASOUND OF SURGICAL SCAR
IMPRESSION:  No drainable fluid collection deep to the recent
surgical
incision along the right lateral hip.

[**2143-7-14**] R LEG ULTRASOUND
IMPRESSION:  No evidence of right lower extremity DVT.

[**2143-7-14**] R HIP XRAY
IMPRESSION:  Stable postoperative changes.  No acute fracture or
dislocation.

[**2143-7-15**] CT PELVIS AND THIGH
1. Large hematoma centered within the right gluteus medius
extending
inferiorly into the posterolateral aspect of the proximal right
lower
extremity.

2. No CT evidence for underlying soft tissue mass within the
effected
musculature, however follow contrast enhanced MR examination
would provide
further imaging evaluation if clinically warranted.

3. No drainable subcutaneous fluid collection.

4. No retroperitoneal hematoma.

5. Status post right total hip arthroplasty. Surgical hardware
intact with
no evidence for hardware loosening / failure.

6. Status post pinning of a left femoral neck fracture, surgical
pins intact.

7. Heterotopic ossification versus myositis ossificans
anteromedial to the
right hip.

8. Small left [**Hospital Ward Name 4675**] cyst.

[**2143-7-14**] 09:37AM BLOOD WBC-8.5 RBC-2.82* Hgb-7.7* Hct-24.7*
MCV-88 MCH-27.1 MCHC-31.0 RDW-17.2* Plt Ct-795*
[**2143-7-15**] 05:55AM BLOOD WBC-8.0 RBC-2.61* Hgb-7.1* Hct-23.0*
MCV-88 MCH-27.1 MCHC-30.9* RDW-17.8* Plt Ct-692*
[**2143-7-15**] 06:50PM BLOOD Hct-22.8*
[**2143-7-15**] 11:08PM BLOOD Hct-22.5*
[**2143-7-16**] 06:20AM BLOOD WBC-7.6 RBC-2.57* Hgb-6.7* Hct-22.5*
MCV-88 MCH-26.2* MCHC-29.9* RDW-18.1* Plt Ct-621*
[**2143-7-17**] 03:05AM BLOOD Hct-25.3*
[**2143-7-17**] 01:28PM BLOOD WBC-10.1 RBC-3.11* Hgb-8.7*# Hct-27.4*
MCV-88 MCH-28.0 MCHC-31.8 RDW-16.9* Plt Ct-512*
[**2143-7-18**] 06:10AM BLOOD WBC-8.3 RBC-2.78* Hgb-7.7* Hct-23.9*
MCV-86 MCH-27.7 MCHC-32.3 RDW-17.9* Plt Ct-452*
[**2143-7-19**] 06:05AM BLOOD WBC-7.8 RBC-2.72* Hgb-7.8* Hct-23.8*
MCV-87 MCH-28.8 MCHC-32.9 RDW-17.6* Plt Ct-397
[**2143-7-20**] 06:30AM BLOOD WBC-7.4 RBC-2.91* Hgb-8.3* Hct-25.7*
MCV-88 MCH-28.5 MCHC-32.4 RDW-16.8* Plt Ct-408
[**2143-7-21**] 07:35AM BLOOD WBC-7.8 RBC-2.60* Hgb-7.3* Hct-22.9*
MCV-88 MCH-28.0 MCHC-31.9 RDW-17.7* Plt Ct-327
[**2143-7-22**] 05:35AM BLOOD WBC-7.1 RBC-2.52* Hgb-7.1* Hct-22.3*
MCV-88 MCH-28.2 MCHC-31.9 RDW-17.5* Plt Ct-317
[**2143-7-23**] 05:01AM BLOOD WBC-7.4 RBC-2.73* Hgb-7.7* Hct-23.9*
MCV-87 MCH-28.1 MCHC-32.1 RDW-16.6* Plt Ct-342
[**2143-7-24**] 06:05AM BLOOD WBC-10.3 RBC-2.85* Hgb-8.2* Hct-24.9*
MCV-87 MCH-28.7 MCHC-32.9 RDW-16.9* Plt Ct-387
[**2143-7-24**] 07:20PM BLOOD WBC-10.7 RBC-3.16* Hgb-9.0* Hct-27.8*
MCV-88 MCH-28.5 MCHC-32.4 RDW-17.2* Plt Ct-377
[**2143-7-24**] 07:20PM BLOOD WBC-10.7 RBC-3.16* Hgb-9.0* Hct-27.8*
MCV-88 MCH-28.5 MCHC-32.4 RDW-17.2* Plt Ct-377
[**2143-7-24**] 10:04PM BLOOD WBC-14.5* RBC-3.39* Hgb-9.6* Hct-30.4*
MCV-90 MCH-28.2 MCHC-31.5 RDW-16.7* Plt Ct-329
[**2143-7-25**] 07:20AM BLOOD WBC-8.0 RBC-2.26*# Hgb-6.8*# Hct-20.3*#
MCV-90 MCH-30.0 MCHC-33.3 RDW-16.2* Plt Ct-277
[**2143-7-25**] 04:22PM BLOOD WBC-11.6* RBC-2.36* Hgb-7.3* Hct-21.5*
MCV-91 MCH-30.8 MCHC-33.8 RDW-15.8* Plt Ct-232
[**2143-7-25**] 11:43PM BLOOD Hct-21.6*
[**2143-7-26**] 09:13AM BLOOD WBC-9.1 RBC-3.00*# Hgb-8.9* Hct-26.6*
MCV-88 MCH-29.6 MCHC-33.4 RDW-15.7* Plt Ct-227
[**2143-7-26**] 11:48PM BLOOD WBC-6.7 RBC-2.84* Hgb-8.5* Hct-25.1*
MCV-89 MCH-29.8 MCHC-33.6 RDW-15.7* Plt Ct-256
[**2143-7-27**] 11:52AM BLOOD WBC-9.3 RBC-2.97* Hgb-8.8* Hct-27.0*
MCV-91 MCH-29.6 MCHC-32.5 RDW-15.6* Plt Ct-336
[**2143-7-28**] 01:30AM BLOOD WBC-7.9 RBC-2.71* Hgb-8.1* Hct-24.3*
MCV-90 MCH-29.7 MCHC-33.2 RDW-15.8* Plt Ct-336
[**2143-7-29**] 08:53AM BLOOD WBC-6.3 RBC-2.86* Hgb-8.4* Hct-25.7*
MCV-90 MCH-29.3 MCHC-32.7 RDW-15.7* Plt Ct-489*
[**2143-7-30**] 05:54AM BLOOD WBC-7.1 RBC-3.04* Hgb-8.8* Hct-27.4*
MCV-90 MCH-28.9 MCHC-32.2 RDW-15.9* Plt Ct-574*
[**2143-7-30**] 06:19PM BLOOD WBC-8.2 RBC-3.26* Hgb-9.4* Hct-30.0*
MCV-92 MCH-28.8 MCHC-31.2 RDW-15.7* Plt Ct-764*
[**2143-7-31**] 12:00PM BLOOD WBC-8.4 RBC-3.02* Hgb-8.9* Hct-27.5*
MCV-91 MCH-29.4 MCHC-32.3 RDW-15.8* Plt Ct-817*
[**2143-8-2**] 06:18AM BLOOD WBC-7.9 RBC-2.85* Hgb-8.1* Hct-26.0*
MCV-91 MCH-28.3 MCHC-31.0 RDW-15.4 Plt Ct-724*
[**2143-8-3**] 05:20AM BLOOD WBC-6.6 RBC-2.70* Hgb-7.8* Hct-24.7*
MCV-92 MCH-28.8 MCHC-31.4 RDW-15.4 Plt Ct-786*
[**2143-8-4**] 06:20AM BLOOD WBC-7.7 RBC-3.00* Hgb-8.7* Hct-27.0*
MCV-90 MCH-29.1 MCHC-32.3 RDW-15.8* Plt Ct-853*
[**2143-8-5**] 06:15AM BLOOD WBC-8.4 RBC-3.00* Hgb-8.7* Hct-27.0*
MCV-90 MCH-29.1 MCHC-32.5 RDW-16.2* Plt Ct-767*
[**2143-8-6**] 09:25AM BLOOD WBC-6.7 RBC-3.03* Hgb-8.7* Hct-27.3*
MCV-90 MCH-28.7 MCHC-31.9 RDW-16.2* Plt Ct-683*
[**2143-8-12**] 10:55AM BLOOD WBC-4.7 RBC-3.18* Hgb-9.3* Hct-28.6*
MCV-90 MCH-29.2 MCHC-32.4 RDW-15.8* Plt Ct-397
[**2143-7-14**] 09:37AM BLOOD Neuts-76.2* Lymphs-16.7* Monos-4.7
Eos-2.2 Baso-0.2
[**2143-7-16**] 06:20AM BLOOD Neuts-63.8 Lymphs-26.0 Monos-7.5 Eos-2.5
Baso-0.2
[**2143-7-23**] 05:01AM BLOOD Neuts-67 Bands-0 Lymphs-26 Monos-5 Eos-1
Baso-0 Atyps-1* Metas-0 Myelos-0
[**2143-8-3**] 05:20AM BLOOD Neuts-76.1* Lymphs-16.8* Monos-5.6
Eos-1.3 Baso-0.2
[**2143-7-15**] 05:55AM BLOOD ESR-59*
[**2143-7-18**] 06:10AM BLOOD ESR-60*
[**2143-7-23**] 05:01AM BLOOD ESR-98*
[**2143-7-30**] 06:19PM BLOOD ESR-91*
[**2143-8-4**] 06:20AM BLOOD ESR-83*
[**2143-7-14**] 09:37AM BLOOD Glucose-118* UreaN-15 Creat-1.1 Na-140
K-4.9 Cl-105 HCO3-23 AnGap-17
[**2143-7-15**] 05:55AM BLOOD Glucose-107* UreaN-13 Creat-1.1 Na-141
K-4.5 Cl-106 HCO3-25 AnGap-15
[**2143-7-16**] 06:20AM BLOOD Glucose-148* UreaN-16 Creat-1.0 Na-138
K-4.6 Cl-105 HCO3-25 AnGap-13
[**2143-7-17**] 03:05AM BLOOD Glucose-125* UreaN-11 Creat-0.9 Na-142
K-4.2 Cl-107 HCO3-25 AnGap-14
[**2143-7-17**] 01:28PM BLOOD Glucose-184* UreaN-12 Creat-1.2 Na-140
K-4.7 Cl-107 HCO3-28 AnGap-10
[**2143-7-18**] 06:10AM BLOOD Glucose-128* UreaN-10 Creat-1.0 Na-140
K-4.2 Cl-107 HCO3-26 AnGap-11
[**2143-7-19**] 06:05AM BLOOD Glucose-189* UreaN-13 Creat-1.1 Na-140
K-4.2 Cl-106 HCO3-26 AnGap-12
[**2143-7-20**] 06:30AM BLOOD Glucose-220* UreaN-9 Creat-0.9 Na-142
K-4.2 Cl-108 HCO3-25 AnGap-13
[**2143-7-21**] 07:35AM BLOOD Glucose-178* UreaN-8 Creat-0.9 Na-141
K-3.8 Cl-107 HCO3-25 AnGap-13
[**2143-7-22**] 05:35AM BLOOD Glucose-195* UreaN-10 Creat-1.1 Na-138
K-3.8 Cl-105 HCO3-24 AnGap-13
[**2143-7-23**] 05:01AM BLOOD Glucose-199* UreaN-8 Creat-0.9 Na-137
K-3.7 Cl-105 HCO3-25 AnGap-11
[**2143-7-24**] 10:04PM BLOOD Glucose-166* UreaN-10 Creat-1.1 Na-141
K-4.2 Cl-108 HCO3-22 AnGap-15
[**2143-7-25**] 07:20AM BLOOD Glucose-223* UreaN-15 Creat-1.7* Na-135
K-4.2 Cl-104 HCO3-24 AnGap-11
[**2143-7-25**] 04:22PM BLOOD Glucose-154* UreaN-16 Creat-1.8* Na-137
K-3.9 Cl-106 HCO3-23 AnGap-12
[**2143-7-25**] 11:43PM BLOOD Glucose-120* UreaN-11 Creat-1.3* Na-142
K-3.5 Cl-114* HCO3-20* AnGap-12
[**2143-7-26**] 09:13AM BLOOD Glucose-167* UreaN-11 Creat-1.1 Na-139
K-4.2 Cl-107 HCO3-24 AnGap-12
[**2143-7-26**] 11:48PM BLOOD Glucose-162* UreaN-11 Creat-1.0 Na-137
K-4.3 Cl-106 HCO3-25 AnGap-10
[**2143-7-27**] 11:52AM BLOOD Glucose-160* UreaN-8 Creat-0.8 Na-140
K-4.3 Cl-107 HCO3-25 AnGap-12
[**2143-7-28**] 01:30AM BLOOD Glucose-143* UreaN-8 Creat-0.9 Na-137
K-4.6 Cl-103 HCO3-28 AnGap-11
[**2143-7-30**] 05:54AM BLOOD Glucose-131* UreaN-8 Creat-0.8 Na-141
K-4.6 Cl-106
[**2143-7-31**] 12:00PM BLOOD Glucose-143* UreaN-10 Creat-1.0 Na-139
K-4.9 Cl-102 HCO3-28 AnGap-14
[**2143-8-2**] 06:18AM BLOOD Glucose-191* UreaN-10 Creat-0.9 Na-138
K-5.2* Cl-105 HCO3-29 AnGap-9
[**2143-8-6**] 09:25AM BLOOD Glucose-116* UreaN-14 Creat-0.7 Na-143
K-3.9 Cl-113* HCO3-24 AnGap-10
[**2143-8-12**] 10:55AM BLOOD Glucose-184* UreaN-16 Creat-0.8 Na-140
K-4.5 Cl-107 HCO3-26 AnGap-12
[**2143-7-15**] 05:55AM BLOOD CRP-36.7*
[**2143-7-18**] 06:10AM BLOOD CRP-66.4*
[**2143-7-23**] 05:01AM BLOOD CRP-114.5*
[**2143-7-30**] 06:19PM BLOOD CRP-41.6*
[**2143-8-4**] 06:20AM BLOOD CRP-18.6*

TISSUE Cx:

Time Taken Not Noted     Log-In Date/Time: [**2143-7-17**] 12:27 pm
      TISSUE     Site: HIP      RIGHT HIP HEMATOMA.

   GRAM STAIN (Final [**2143-7-17**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   TISSUE (Final [**2143-7-21**]):
      Reported to and read back by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**2143-7-18**] 12:00N.

      STAPH AUREUS COAG +.    RARE GROWTH.
         Staphylococcus species may develop resistance during
prolonged
         therapy with quinolones.   Therefore, isolates that are
initially
         susceptible may become resistant within three to four
days after
         initiation of therapy.  Testing of repeat isolates may
be
         warranted.  Rifampin should not be used alone for
therapy.
         RIFAMPIN REQUESTED BY  DR.[**First Name (STitle) **] ,APARA #[**Numeric Identifier 26977**] [**2143-7-20**].

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------<=0.25 S
ERYTHROMYCIN----------<=0.25 S
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------  0.25 S
OXACILLIN-------------   0.5 S
RIFAMPIN-------------- <=0.5 S
TETRACYCLINE----------   <=1 S
TRIMETHOPRIM/SULFA---- <=0.5 S

   ANAEROBIC CULTURE (Final [**2143-7-21**]):    NO ANAEROBES ISOLATED.


   ACID FAST SMEAR (Final [**2143-7-18**]):
      NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.

   ACID FAST CULTURE (Preliminary):    NO MYCOBACTERIA ISOLATED.


   FUNGAL CULTURE (Final [**2143-7-30**]):    NO FUNGUS ISOLATED.

[**2143-7-25**] 2:55 pm TISSUE      RIGHT HIP DEEP TISSUE #2.

                            **FINAL REPORT [**2143-7-31**]**

   GRAM STAIN (Final [**2143-7-25**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   TISSUE (Final [**2143-7-31**]):
      PROTEUS MIRABILIS.    SPARSE GROWTH.
         IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE #
353-5633K
         [**2143-7-24**].
      [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 16437**].    SPARSE GROWTH.
         Fluconazole REQUESTED BY DR. [**Last Name (STitle) **] #[**Numeric Identifier 61848**] .
         SENT TO [**Hospital1 4534**] FOR SENSITIVITIES [**2143-7-31**].
         Refer to sendout/miscellaneous reporting for results.

   ANAEROBIC CULTURE (Final [**2143-7-29**]):    NO ANAEROBES ISOLATED.


[**2143-7-24**] 5:00 pm TISSUE     Site: HIP      RT HIP GRANULATION.

                            **FINAL REPORT [**2143-8-12**]**

   GRAM STAIN (Final [**2143-7-24**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
      SMEAR REVIEWED; RESULTS CONFIRMED.

   TISSUE (Final [**2143-7-27**]):
      Reported to and read back by DR [**Last Name (STitle) **] [**2143-7-25**] AT 11:10AM.
      PROTEUS MIRABILIS.    MODERATE GROWTH.
         Piperacillin/Tazobactam sensitivity testing performed
by [**First Name8 (NamePattern2) 3077**]
         [**Last Name (NamePattern1) 3060**].

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             PROTEUS MIRABILIS
                             |
AMPICILLIN------------   <=2 S
AMPICILLIN/SULBACTAM--   <=2 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN/TAZO-----       S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S

   ANAEROBIC CULTURE (Final [**2143-7-28**]):    NO ANAEROBES ISOLATED.


   FUNGAL CULTURE (Final [**2143-8-12**]):    NO FUNGUS ISOLATED.

[**2143-7-30**] 4:30 pm TISSUE     Site: HIP      RIGHT HIP # 1.

                            **FINAL REPORT [**2143-8-5**]**

   GRAM STAIN (Final [**2143-7-30**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   TISSUE (Final [**2143-8-2**]):    NO GROWTH.

   ANAEROBIC CULTURE (Final [**2143-8-5**]):    NO GROWTH.

[**2143-8-1**] 4:55 pm TISSUE     Site: HIP      RIGHT HIP #3.

   GRAM STAIN (Final [**2143-8-1**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   TISSUE (Final [**2143-8-4**]):    NO GROWTH.

   ANAEROBIC CULTURE (Final [**2143-8-7**]):    NO GROWTH.

   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.


Brief Hospital Course:
The patient was initially admitted to the Medicine service for
worsening right hip pain. A CT was performed showing a hematoma
in the right gluteal region. The patient also developed
parasthesias and weakness in the sciatic distribution with a
true right foot drop. At that point he was transferred to the
Ortho service with a symptomatic postoperative hematoma. He was
taken to the OR by Dr. [**Last Name (STitle) 5322**] for evacuation of the hematoma on
[**2143-7-17**] at which time cultures were sent. These cultures
ultimately grew MSSA and the patient was started on Nafcillin
and taken back to the OR for I&D, hardware removal, ABX spacer,
and wound VAC on [**2143-7-24**]. These cultures showed proteus in the
tissue and yeast in the fluid so ID recommended switching from
nafcillin to cefepime with initiation of micofungin.  Following
further speciation micofungin discontinued & started on
Voriconazole. After sensitivities returned on yeast,
voriconazole changed to fluconazole. He was found to be bleeding
from the wound and required serial transfusions. Postoperatively
his VAC failed and due to persistent bleeding so he was taken
back to the OR on [**2143-7-25**] for repeat I&D and VAC placement. He
continued to require multiple transfusions and resuscitation and
ultimately was transferred to the Trauma ICU, with transfer to
floor following stabilization.  Patient underwent repeat I&D on
[**2143-7-30**] and interval repeat I&D, antibiotic spacer exchange &
wound closure on [**2143-8-2**].

***************

The patient was admitted to the orthopaedic surgery service and
was taken to the operating room on multiple occasions for the
procedures described above. Please see separately dictated
operative reports for details. In general the patient tolerated
the procedures well but had significant blood loss and
ultimately required multiple transfusions and ICU monitoring. He
received antibiotics as directed by the ID team.

Hospital course was remarkable for the following:

1. ID consult: MSSA growing from [**2143-7-17**] OR tissue specimens.
Initially ID recommended nafcillin 2g IV q4h x 6 weeks. However,
at the time of hardware removal on [**2143-7-24**], OR tissue
specimens grew proteus and OR fluid specimens grew yeast. The
patient was switched to cefepime 2grams Q12H and voriconazole
and finally switch to fluconazole
.
2. PICC placement [**2143-7-22**]

3. Neuro consult for presumed sciatic compression injury and new
foot drop

4. Chronic pain consult for pain management

5. Post op blood loss anemia: Transfused 1 unit PRBCs on
[**2143-7-22**] for Hct 22.3. Transfused 4units PRBCs on [**2143-7-24**] for
Hct of 24.9. Transfused 6 units PRBC and
4 units FFP on [**2143-7-25**] for Hct 20.3. Transferred to the Trauma
ICU for serial Hct checks and further resuscitative management.

6. Calf pain: [**2143-7-22**] RLE US shows no DVT, but evidence of
superficial thrombophlebitis.

The patient's weight-bearing status is weight bearing as
tolerated on the operative extremity with posterior precautions
and bilateral upper extremity support.

Mr [**Known lastname 1356**] is discharged to rehab in stable condition.


Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Acetaminophen 650 mg PO Q6H
standing dose
2. Acetaminophen-Caff-Butalbital [**11-26**] TAB PO Q6H:PRN headache
3. Aspirin 81 mg PO DAILY
4. Docusate Sodium 100 mg PO BID
5. Enoxaparin Sodium 40 mg SC Q 24H
6. Ferrous Sulfate 325 mg PO DAILY
7. Fluticasone Propionate NASAL 1 SPRY NU DAILY
8. Lansoprazole Oral Disintegrating Tab 15 mg PO DAILY
9. Lisinopril 20 mg PO DAILY
hold for SBP < 110, HR < 60
10. OxycoDONE (Immediate Release)  5-15 mg PO Q4H:PRN Pain
hold for sedation
11. Senna 1 TAB PO BID
12. fenofibrate *NF* 160 mg Oral daily
13. MetFORMIN XR (Glucophage XR) 1500 mg PO QPM
Do Not Crush
14. Metoprolol Succinate XL 25 mg PO DAILY
hold for SBP < 110, HR < 60
15. testosterone cypionate *NF* 200 mg/mL Injection every 2
weeks
16. Vitamin D 50,000 UNIT PO 1X/WEEK ([**Doctor First Name **])
17. Tizanidine 4-8 mg PO HS:PRN pain, spasm


Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
standing dose
2. Acetaminophen-Caff-Butalbital [**11-26**] TAB PO Q6H:PRN headache
3. Docusate Sodium 100 mg PO BID
4. Ferrous Sulfate 325 mg PO DAILY
5. Fluticasone Propionate NASAL 1 SPRY NU DAILY
6. Lansoprazole Oral Disintegrating Tab 15 mg PO DAILY
7. Lisinopril 20 mg PO DAILY
hold for SBP < 110, HR < 60
8. MetFORMIN XR (Glucophage XR) 1500 mg PO QPM
Do Not Crush
9. Metoprolol Succinate XL 25 mg PO DAILY
hold for SBP < 110, HR < 60
10. Senna 1 TAB PO BID
11. Tizanidine 4-8 mg PO HS:PRN pain, spasm
12. Vitamin D 50,000 UNIT PO 1X/WEEK ([**Doctor First Name **])
13. fenofibrate *NF* 160 mg Oral daily
14. testosterone cypionate *NF* 200 mg/mL Injection every 2
weeks
15. Aspirin 81 mg PO DAILY
16. Outpatient Lab Work
Check CBC/diff, ESR/CRP, BMP, LFTs
 - Check weekly and fax results to ([**Telephone/Fax (1) 4591**]

17. Aluminum-Magnesium Hydrox.-Simethicone 15-30 ml PO Q6H:PRN
Dyspepsia
18. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation
19. Calcium Carbonate 500 mg PO TID calcium repletion
20. Diazepam 10 mg PO Q6H:PRN pain
please encourage more PRN use if needed, patient only taken 1
tab today and 1 tab yesterday per pharmacy
21. DiphenhydrAMINE 12.5-50 mg PO/IV Q6H:PRN Insomnia/Pruritis
22. Gabapentin 600 mg PO Q6H
23. Insulin SC
      Sliding Scale

Fingerstick QACHS
Insulin SC Sliding Scale using HUM Insulin
24. Milk of Magnesia 30 ml PO BID:PRN Constipation
25. Multivitamins 1 CAP PO DAILY
26. Nortriptyline 25 mg PO HS
27. CefePIME 2 g IV Q8H
28. Morphine Sulfate IR 15-30 mg PO Q4H:PRN pain
29. Morphine SR (MS Contin) 30 mg PO Q12H
RX *morphine 30 mg 1 capsule(s) by mouth every twelve (12) hours
Disp #*60 Capsule Refills:*0
30. Lidocaine 5% Patch 1 PTCH TD DAILY
31. Fluconazole 400 mg PO Q24H
32. Enoxaparin Sodium 40 mg SC DAILY
stop date is [**2143-9-2**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] State

Discharge Diagnosis:
Right hip osteoarthritis s/p total hip arthroplasty [**2143-6-26**]
Postoperative hematoma within right gluteus medius s/p I&D and
evacuation of hematoma on [**2143-7-17**] by Dr. [**Last Name (STitle) 5322**]
Septic right total hip arthroplasty s/p I&D, explant of all
components, cement spacer placement, and wound vac placement on
[**2143-7-24**] by Dr. [**Last Name (STitle) **]
Multiple I&D and vac changes for septic right total hip
arthroplasty on [**2143-7-25**], [**2143-7-27**], [**2143-7-30**], [**2143-8-1**]  by Dr.
[**Last Name (STitle) **]


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
1. Please return to the emergency department or notify your
physician if you experience any of the following: severe pain
not relieved by medication, increased swelling, decreased
sensation, difficulty with movement, fevers greater than 101.5,
shaking chills, increasing redness or drainage from the incision
site, chest pain, shortness of breath or any other concerns.

2. Please follow up with your primary physician regarding this
admission and any new medications and refills.

3. Resume your home medications unless otherwise instructed.

4. You have been given medications for pain control. Please do
not drive, operate heavy machinery, or drink alcohol while
taking these medications. As your pain decreases, take fewer
tablets and increase the time between doses. This medication can
cause constipation, so you should drink plenty of water daily
and take a stool softener (such as colace) as needed to prevent
this side effect.  Call your surgeons office 3 days before you
are out of medication so that it can be refilled.  These
medications cannot be called into your pharmacy and must be
picked up in the clinic or mailed to your house.  Please allow
an extra 2 days if you would like your medication mailed to your
home.

5. You may not drive a car until cleared to do so by your
surgeon.

6. Please keep your wounds clean. You may shower starting five
(5) days after surgery, but no tub baths or swimming for at
least four (4) weeks. No dressing is needed if wound continues
to be non-draining. Any stitches that need to be removed will be
taken out at your follow-up visit.

7. Please call your surgeon's office to schedule or confirm your
follow-up appointment.

8. Please DO NOT take any non-steroidal anti-inflammatory
medications (NSAIDs such as celebrex, ibuprofen, advil, aleve,
motrin, etc).

9. ANTICOAGULATION: Please continue your lovenox for four (4)
weeks to help prevent deep vein thrombosis (blood clots).  If
you were taking aspirin prior to your surgery, it is OK to
continue at your previous dose while taking this medication.
[**Male First Name (un) **] STOCKINGS x 6 WEEKS.

10. WOUND CARE: Please keep your incision clean and dry. It is
okay to shower five days after surgery but no tub baths,
swimming, or submerging your incision until after your four (4)
week checkup. Please place a dry sterile dressing on the wound
each day if there is drainage, otherwise leave it open to air.
Check wound regularly for signs of infection such as redness or
thick yellow drainage. Sutures will be removed at yoru follow-up
visit.

11. VNA (once at home): Home PT/OT, dressing changes as
instructed, wound checks, PICC line assessment, IV infusions.
Weekly labs - CBC/diff, Chem 7, LFTs and send to ID RNs at
[**Telephone/Fax (1) 93513**].

12. ACTIVITY: Weight bearing as tolerated on the operative
extremity.  No strenuous exercise or heavy lifting until follow
up appointment.  Mobilize frequently.
Physical Therapy:
WBAT
Mobilize
Treatments Frequency:
dry, sterile dressing changes daily and as needed for drainage
wound checks
ice
TEDs
**staple removal will be at first follow up appt.**

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 12567**] [**Name12 (NameIs) **], MD (Neurology) Phone:[**Telephone/Fax (1) 1844**]
Date/Time:[**2143-8-12**] 4:00  -  **PLEASE CALL TO RESCHEDULE THIS
APPT FOR END OF [**Month (only) **] OR EARLY [**Month (only) **]**
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 23870**], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2143-9-4**] 11:00

Provider: [**First Name11 (Name Pattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3260**], [**MD Number(3) 3261**]:[**Telephone/Fax (1) 1228**]
Date/Time:[**2143-8-23**] 3:20 - YOU WILL SEE DR [**Last Name (STitle) **] DURING THIS
APPT**



Completed by:[**2143-8-13**]
{'Hematoma complicating a procedure,Pyogenic arthritis, pelvic region and thigh,Other candidiasis of other specified sites,Acute posthemorrhagic anemia,Body Mass Index 40.0-44.9, adult,Hip joint replacement,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Lesion of sciatic nerve,Other acute postoperative pain,Other acquired deformities of ankle and foot,Phlebitis and thrombophlebitis of superficial vessels of lower extremities,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Thoracic or lumbosacral neuritis or radiculitis, unspecified,Benign essential hypertension,Esophageal reflux,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Tachycardia, unspecified,Penicillins causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Dysthymic disorder,Abnormal involuntary movements,Bariatric surgery status,Personal history of tobacco use'}


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: Right hip pain

PRESENT ILLNESS: Briefly, patient is a 56 yo M who underwent primary right THA
with Dr. [**Last Name (STitle) **] on [**2143-6-26**]. He initially did well but was seen
in the ER with right hip pain on [**2143-7-5**]. Xrays showed
hardware in good position and he was admitted for pain control
and PT. His pain resolved with medications and returned to
baseline so no further imaging or intervention was performed.
However on [**2143-7-14**], he felt inceasing pain in the right hip
and had to take more oxycodone and tizanidine in setting of
right foot drop, and was admitted to the Medicine service for
worsening right hip pain.

MEDICAL HISTORY: -OA of knees and hips
-low back pain from car accident
-rotator cuff injury in b/l arms in [**2140**] and [**2141**]
-HTN
-hyperlipidemia
-obstructive sleep apnea
-L foot cyst
-colonic polyps
-CAD (microvascular dz) with h/o atypical cp, s/p cath with no
intervention
-depression/anxiety
-DM 2
-GERD
-obesity s/p lap band (lost 60lbs)
-anemia

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Acetaminophen 650 mg PO Q6H
standing dose
2. Acetaminophen-Caff-Butalbital [**11-26**] TAB PO Q6H:PRN headache
3. Aspirin 81 mg PO DAILY
4. Docusate Sodium 100 mg PO BID
5. Enoxaparin Sodium 40 mg SC Q 24H
6. Ferrous Sulfate 325 mg PO DAILY
7. Fluticasone Propionate NASAL 1 SPRY NU DAILY
8. Lansoprazole Oral Disintegrating Tab 15 mg PO DAILY
9. Lisinopril 20 mg PO DAILY
hold for SBP < 110, HR < 60
10. OxycoDONE (Immediate Release)  5-15 mg PO Q4H:PRN Pain
hold for sedation
11. Senna 1 TAB PO BID
12. fenofibrate *NF* 160 mg Oral daily
13. MetFORMIN XR (Glucophage XR) 1500 mg PO QPM
Do Not Crush
14. Metoprolol Succinate XL 25 mg PO DAILY
hold for SBP < 110, HR < 60
15. testosterone cypionate *NF* 200 mg/mL Injection every 2
weeks
16. Vitamin D 50,000 UNIT PO 1X/WEEK ([**Doctor First Name **])
17. Tizanidine 4-8 mg PO HS:PRN pain, spasm

ALLERGIES: Simvastatin / Pravastatin / nuts,peanuts,walnuts / Wheat Flour /
Nifedipine

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
VS - 98.7, 158/86, 84, 22, 100%RA
GENERAL - appears uncomfortable, but in NAD
HEENT - PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, no LD
LUNGS - Lungs are clear to ausculatation bilaterally, moving air
well and symmetrically, resp unlabored, no accessory muscle use

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient is a pastor. He is happily married with a supportive
family. Denies cigarettes and reports rare EtOH. 

### Response:
{'Hematoma complicating a procedure,Pyogenic arthritis, pelvic region and thigh,Other candidiasis of other specified sites,Acute posthemorrhagic anemia,Body Mass Index 40.0-44.9, adult,Hip joint replacement,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Lesion of sciatic nerve,Other acute postoperative pain,Other acquired deformities of ankle and foot,Phlebitis and thrombophlebitis of superficial vessels of lower extremities,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Thoracic or lumbosacral neuritis or radiculitis, unspecified,Benign essential hypertension,Esophageal reflux,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Tachycardia, unspecified,Penicillins causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Dysthymic disorder,Abnormal involuntary movements,Bariatric surgery status,Personal history of tobacco use'}
