CHIEF COMPLAINT: Wound infection

PRESENT ILLNESS: 60 y/o male status post liver transplant.  Subsequent to his
liver transplant, he developed a mycobacterial infection of the
skin.  Despite aggressive
attempts at antibiotics and local debridement, he was not able
to clear his mycobacterial infection.  After consultation with
multiple providers including hernia experts and infectious
disease, it was elected to take him back to
the operating room to completely clean out his anterior
abdominal wound, place a mesh, and close the wound.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
- metabolic bone disease
- hepatitis C cirrhosis s/p OLT [**2-14**] c/b poor wound healing, as
below.
- interstitial lung disease - dx 2y ago, no pulmonary follow-up,
does not use home inhalers presently.
- GERD
- chronic pain - abdominal and B LE (neuropathy)
- chronic BLE edema
- psoriasis
- DM2 - dx over past year, on insulin.
- h/o B LE burns [**2-7**] trauma in fire.
.
- denies CVA, CAD, HTN, CKD, PE/DVT, malignancy.
.
PAST SURGICAL/PROCEDURAL HISTORY
[**2138**] RFA of liver lesion
[**2132**] lung biopsy
[**2131**] Extensive burns&#[**Numeric Identifier 25684**];skin graft surgeries
[**2140-2-28**] liver transplant with repair of chronic diaphragmatic
hernia.
[**2140-3-1**] Exploratory laparotomy, repair of ventral hernia with
mesh and liver biopsy.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.6, 79, 123/65, 24, 98% 5L
General: Initially receiving ketamine drip and dilaudid IV for
pain management post op
Card: Nl S1S2, RRR
Lungs: Few crackles bilater bases
Abd: Soft, mild distention, initial dressing left on for 5 days
to protect initial incision. POst op the incision has remained
intact, without erythema or drainage. 1 JP drain with
serosanguinous fluid
Extr: No edema, venodynes in place

FAMILY HISTORY: Mother, 85: No known illness
Father, dead 76: Liver cancer
Twin brother, dead 18: Murdered
Brother, 35: No known illness
Brother, 46: No known illness

SOCIAL HISTORY: Currently smoking [**1-7**] ppd, denies etoh, ivdu.  History of IVDA
and ETOH abuse. He has abstained from both since transplant.
Other postoperative infection,Acute kidney failure, unspecified,Cellulitis and abscess of trunk,Unspecified diseases due to mycobacteria,Liver replaced by transplant,Other ascites,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Esophageal reflux,Unspecified viral hepatitis C without hepatic coma,Tobacco use disorder,Constipation, unspecified
Other postop infection,Acute kidney failure NOS,Cellulitis of trunk,Mycobacterial dis NOS,Liver transplant status,Ascites NEC,Peritoneal adhesions,Incisional hernia,DMII wo cmp nt st uncntr,Chr airway obstruct NEC,Esophageal reflux,Hpt C w/o hepat coma NOS,Tobacco use disorder,Constipation NOS
Admission Date:  [**2141-5-24**]              Discharge Date:   [**2141-6-4**]

Date of Birth:  [**2080-10-2**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
Wound infection

Major Surgical or Invasive Procedure:
[**2141-5-24**]:
- Extensive debridement of complicated wound, including
    multiple abscesses.
- Component separation of the anterior abdominal wall with
    fascial dissection and reconstruction.
- Repair of large incisional hernia with mesh.
- Lysis of adhesions
[**2141-5-29**] PICC line placement


History of Present Illness:
60 y/o male status post liver transplant.  Subsequent to his
liver transplant, he developed a mycobacterial infection of the
skin.  Despite aggressive
attempts at antibiotics and local debridement, he was not able
to clear his mycobacterial infection.  After consultation with
multiple providers including hernia experts and infectious
disease, it was elected to take him back to
the operating room to completely clean out his anterior
abdominal wound, place a mesh, and close the wound.


Past Medical History:
PAST MEDICAL HISTORY:
- metabolic bone disease
- hepatitis C cirrhosis s/p OLT [**2-14**] c/b poor wound healing, as
below.
- interstitial lung disease - dx 2y ago, no pulmonary follow-up,
does not use home inhalers presently.
- GERD
- chronic pain - abdominal and B LE (neuropathy)
- chronic BLE edema
- psoriasis
- DM2 - dx over past year, on insulin.
- h/o B LE burns [**2-7**] trauma in fire.
.
- denies CVA, CAD, HTN, CKD, PE/DVT, malignancy.
.
PAST SURGICAL/PROCEDURAL HISTORY
[**2138**] RFA of liver lesion
[**2132**] lung biopsy
[**2131**] Extensive burns&#[**Numeric Identifier 25684**];skin graft surgeries
[**2140-2-28**] liver transplant with repair of chronic diaphragmatic
hernia.
[**2140-3-1**] Exploratory laparotomy, repair of ventral hernia with
mesh and liver biopsy.

Social History:
Currently smoking [**1-7**] ppd, denies etoh, ivdu.  History of IVDA
and ETOH abuse. He has abstained from both since transplant.


Family History:
Mother, 85: No known illness
Father, dead 76: Liver cancer
Twin brother, dead 18: Murdered
Brother, 35: No known illness
Brother, 46: No known illness


Physical Exam:
VS: 98.6, 79, 123/65, 24, 98% 5L
General: Initially receiving ketamine drip and dilaudid IV for
pain management post op
Card: Nl S1S2, RRR
Lungs: Few crackles bilater bases
Abd: Soft, mild distention, initial dressing left on for 5 days
to protect initial incision. POst op the incision has remained
intact, without erythema or drainage. 1 JP drain with
serosanguinous fluid
Extr: No edema, venodynes in place

Pertinent Results:
On Admission: [**2141-5-25**]
WBC-23.0*# RBC-3.47* Hgb-10.9* Hct-33.2* MCV-96 MCH-31.4
MCHC-32.8 RDW-15.4 Plt Ct-127*#
PT-15.3* PTT-33.0 INR(PT)-1.3*
Glucose-197* UreaN-24* Creat-1.0 Na-135 K-5.5* Cl-106 HCO3-24
AnGap-11
ALT-71* AST-78* AlkPhos-127 TotBili-1.7*
Albumin-2.8* Calcium-7.6* Phos-2.7 Mg-1.8
At Discharge: [**2141-6-2**]
WBC-7.1 RBC-2.96* Hgb-9.2* Hct-28.6* MCV-97 MCH-30.9 MCHC-32.0
RDW-16.5* Plt Ct-123*
Glucose-146* UreaN-52* Creat-1.4* Na-130* K-5.9* Cl-101 HCO3-24
AnGap-11
ALT-50* AST-71* AlkPhos-293* TotBili-1.6*
Calcium-7.8* Phos-4.5 Mg-1.5*
tacroFK-5.8

Brief Hospital Course:
60 y/o male with complicated post liver transplant surgery
course. Since last year  his course has been complicated by
recurrent hernias requiring debridements and
infection with Mycobacterium abscesses. (MYCOBACTERIUM
ABSCESSUS/MASSILIENSE/BOLLETII GROUP)
He was taken to the OR with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**] for
Extensive debridement of complicated wound, including multiple
abscesses, Component separation of the anterior abdominal wall
with fascial dissection and reconstruction, Repair of large
incisional hernia with mesh, Lysis of adhesions times 1 hour and
Repair of wound more than 30 cm. This was an ext4ensive surgery,
which the patient tolerated well.
Due to past hsitory of narcotic tolerance, the patient was
initially managed on a ketamine drip in addition to dilaudid and
his baseline methadone. Over the course of the hospitalization
the regimen now includes Home Oxycontin and methadone,
breakthrough oxycodone and IV Morphine for breakthrough also.
The initial dressing was taken down at 5 days per Dr [**Last Name (STitle) 15283**]
instructions, and the incision has remianed intact, with no
erythema or drainage noted. The small wound from the previous
attempt at debridement has been intact as well.
Per ID recommendations, who were following prior to this
surgery, initial antibiotics were amikacin, tigecycline and
vancomycin. After further consideration, the Vanco was stopped
and azithromycin was added. ID continued to follow during this
admission, and when the creatinine was noted to be increasing,
the amikacin was stopped and Linezolid was added.
The patient received 4 days of lasix in an attempt to diurese.
He remains about 5 Liters above his admission weight, no further
lasix has been attempted, creatinine has leveled at 1.4
(baseline around 1)
On POD 8 he had a large amount of ascitic appearing fluid drain


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection TID (3 times a day).
2. Nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
3. Methadone 10 mg Tablet Sig: Eleven (11) Tablet PO DAILY
(Daily): Home dose.
4. Insulin Regular Human 100 unit/mL Solution Sig: per sliding
scale  Injection ASDIR (AS DIRECTED).
5. Sulfamethoxazole-Trimethoprim 400-80 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours).
7. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation Q6H (every 6 hours).
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
Once daily PRN constipation as needed for distention.
10. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
11. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
12. Tacrolimus 1 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
13. Oxycodone 40 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours): This is
patients home dose.
14. Tigecycline 50 mg Recon Soln Sig: Fifty (50) mg Intravenous
Q12H (every 12 hours).
15. Azithromycin 500 mg Recon Soln Sig: Five Hundred (500) mg
Intravenous Q24H (every 24 hours).
16. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: Two (2) ML
Intravenous PRN (as needed) as needed for line flush.
17. Sodium Chloride 0.9 % 0.9 % Parenteral Solution Sig: Ten
(10) ML Intravenous PRN (as needed) as needed for line flush.
18. Morphine Sulfate 1-4 mg IV Q4H:PRN breakthrough pain
19. Linezolid 600 mg/300 mL Parenteral Solution Sig: Six Hundred
(600) mg Intravenous Q12H (every 12 hours).
20. Tacrolimus 0.5 mg Capsule Sig: Three (3) Capsule PO Q12H
(every 12 hours): needs tacrolimus levels q wk.
Disp:*180 Capsule(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital - [**Hospital1 8**]

Discharge Diagnosis:
Complex abdominal wound with multiple abscesses, necrotizing
infection, and large hernia
Narcotic tolerance
Liver transplant [**2-/2140**]


Discharge Condition:
Stable/Fair
A+Ox3
Poor ambulatory state, needs extensive rehabilitation


Discharge Instructions:
please call the transplant clinic at [**Telephone/Fax (1) 673**] for fever,
chills, nausea, vomiting, increased abdominal pain, increased
drainage from the JP bulb or area around the JP drain insertion.
There is a pouch covering the JP drain insertion site due to
some leaking.
Drain and record JP drain output twice daily and more often as
needed. Please call the transplant clinic if the drainage
increases rgeatly, develops a foul odor or becomes bloody in
appearance.
No heavy lifting
Continue labwork q Monday/Thursday with results faxed to
transplant clinic. CBC, Chem 10, AST, ALT, Alk Phos, T bili,
Trough Prograf
Continue antibiotics via PICC line
Wear abdominal binder at all times

Followup Instructions:
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2141-6-8**] 10:40
[**Name6 (MD) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2141-6-12**] 8:00
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2141-6-15**] 8:00





Name:  [**Known lastname 10436**],[**Known firstname **]                     Unit No:   [**Numeric Identifier 10437**]

Admission Date:  [**2141-5-24**]              Discharge Date:   [**2141-6-4**]

Date of Birth:  [**2080-10-2**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2648**]
Addendum:
In the previously completed discharge summary, the patient was
coded as having impaired renal function when in fact he was in
acute renal failure

Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital - [**Hospital1 15**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2649**] MD [**MD Number(2) 2650**]

Completed by:[**2141-7-3**]
{'Other postoperative infection,Acute kidney failure, unspecified,Cellulitis and abscess of trunk,Unspecified diseases due to mycobacteria,Liver replaced by transplant,Other ascites,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Esophageal reflux,Unspecified viral hepatitis C without hepatic coma,Tobacco use disorder,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: Wound infection

PRESENT ILLNESS: 60 y/o male status post liver transplant.  Subsequent to his
liver transplant, he developed a mycobacterial infection of the
skin.  Despite aggressive
attempts at antibiotics and local debridement, he was not able
to clear his mycobacterial infection.  After consultation with
multiple providers including hernia experts and infectious
disease, it was elected to take him back to
the operating room to completely clean out his anterior
abdominal wound, place a mesh, and close the wound.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
- metabolic bone disease
- hepatitis C cirrhosis s/p OLT [**2-14**] c/b poor wound healing, as
below.
- interstitial lung disease - dx 2y ago, no pulmonary follow-up,
does not use home inhalers presently.
- GERD
- chronic pain - abdominal and B LE (neuropathy)
- chronic BLE edema
- psoriasis
- DM2 - dx over past year, on insulin.
- h/o B LE burns [**2-7**] trauma in fire.
.
- denies CVA, CAD, HTN, CKD, PE/DVT, malignancy.
.
PAST SURGICAL/PROCEDURAL HISTORY
[**2138**] RFA of liver lesion
[**2132**] lung biopsy
[**2131**] Extensive burns&#[**Numeric Identifier 25684**];skin graft surgeries
[**2140-2-28**] liver transplant with repair of chronic diaphragmatic
hernia.
[**2140-3-1**] Exploratory laparotomy, repair of ventral hernia with
mesh and liver biopsy.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.6, 79, 123/65, 24, 98% 5L
General: Initially receiving ketamine drip and dilaudid IV for
pain management post op
Card: Nl S1S2, RRR
Lungs: Few crackles bilater bases
Abd: Soft, mild distention, initial dressing left on for 5 days
to protect initial incision. POst op the incision has remained
intact, without erythema or drainage. 1 JP drain with
serosanguinous fluid
Extr: No edema, venodynes in place

FAMILY HISTORY: Mother, 85: No known illness
Father, dead 76: Liver cancer
Twin brother, dead 18: Murdered
Brother, 35: No known illness
Brother, 46: No known illness

SOCIAL HISTORY: Currently smoking [**1-7**] ppd, denies etoh, ivdu.  History of IVDA
and ETOH abuse. He has abstained from both since transplant. 

### Response:
{'Other postoperative infection,Acute kidney failure, unspecified,Cellulitis and abscess of trunk,Unspecified diseases due to mycobacteria,Liver replaced by transplant,Other ascites,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Esophageal reflux,Unspecified viral hepatitis C without hepatic coma,Tobacco use disorder,Constipation, unspecified'}
