CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 43921**] is a
72 year old man who underwent coronary artery bypass grafting
times three as well as Maze procedure on [**2-12**], with an
unremarkable postoperative course.  He was discharged to
rehabilitation on [**2-18**] on Amiodarone and Coumadin for
his atrial fibrillation.  He presented to the Emergency Room
on [**2-21**], with bloody drainage from the lower aspect of
his sternal wound.  The drainage began suddenly on the day of
assessment following a coughing episode.  It was not
associated with any chest pain or increasing shortness of
breath.  The patient also denies fevers, chills and redness
about the wound.  He was transferred from the Emergency Room
at [**Hospital **] Hospital to Far 2 at [**Hospital6 2018**].  A chest x-ray showed misaligned sternal layers in
the inferior sternum with no infiltrates.

MEDICAL HISTORY: Significant for coronary artery
disease, status post coronary artery bypass grafting times
three with left internal mammary artery to the left anterior
descending coronary artery, saphenous vein graft to the
posterior descending coronary artery and saphenous vein graft
to the obtuse marginal, paroxysmal atrial
fibrillation/flutter, status post Maze procedure done during
coronary artery bypass grafting, hypercholesterolemia,
noninsulin dependent diabetes mellitus, history of urosepsis,
history of colon carcinoma, hypertension, degenerative joint
disease, abdominal aortic aneurysm, bilateral cataract
surgery, colon resection and bilateral total knee
replacement.

MEDICATION ON ADMISSION: Aspirin 81 once daily, Lasix 20
b.i.d., Colace 100 b.i.d., potassium chloride 20 b.i.d.,
Percocet prn, Glipizide 2.5 once daily, Amiodarone 400
b.i.d., Lipitor 40 once daily, Lopressor 50 b.i.d. and
Coumadin 7.5 once daily.

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died of prostate cancer, otherwise
insignificant.

SOCIAL HISTORY: The patient lives alone, remote tobacco
history, quit 18 years ago and alcohol use is limited to one
drink per day.
Disruption of internal operation (surgical) wound,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Pure hypercholesterolemia,Old myocardial infarction,Aortocoronary bypass status,Infection with microorganisms without mention of resistance to multiple drugs,Personal history of malignant neoplasm of large intestine,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Disrup internal op wound,Other staphylococcus,CHF NOS,Atrial fibrillation,Hypertension NOS,DMII wo cmp nt st uncntr,Osteoarthros NOS-l/leg,Pure hypercholesterolem,Old myocardial infarct,Aortocoronary bypass,Inf mcr rst ot drg nt ml,Hx of colonic malignancy,Abn react-anastom/graft
Admission Date: [**2116-2-21**]        Discharge Date: [**2116-2-28**]

Date of Birth:  [**2043-5-20**]        Sex:  M

Service:  CSU


CHIEF COMPLAINT/HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 43921**] is a
72 year old man who underwent coronary artery bypass grafting
times three as well as Maze procedure on [**2-12**], with an
unremarkable postoperative course.  He was discharged to
rehabilitation on [**2-18**] on Amiodarone and Coumadin for
his atrial fibrillation.  He presented to the Emergency Room
on [**2-21**], with bloody drainage from the lower aspect of
his sternal wound.  The drainage began suddenly on the day of
assessment following a coughing episode.  It was not
associated with any chest pain or increasing shortness of
breath.  The patient also denies fevers, chills and redness
about the wound.  He was transferred from the Emergency Room
at [**Hospital **] Hospital to Far 2 at [**Hospital6 2018**].  A chest x-ray showed misaligned sternal layers in
the inferior sternum with no infiltrates.

PAST MEDICAL HISTORY:  Significant for coronary artery
disease, status post coronary artery bypass grafting times
three with left internal mammary artery to the left anterior
descending coronary artery, saphenous vein graft to the
posterior descending coronary artery and saphenous vein graft
to the obtuse marginal, paroxysmal atrial
fibrillation/flutter, status post Maze procedure done during
coronary artery bypass grafting, hypercholesterolemia,
noninsulin dependent diabetes mellitus, history of urosepsis,
history of colon carcinoma, hypertension, degenerative joint
disease, abdominal aortic aneurysm, bilateral cataract
surgery, colon resection and bilateral total knee
replacement.

SOCIAL HISTORY:  The patient lives alone, remote tobacco
history, quit 18 years ago and alcohol use is limited to one
drink per day.

FAMILY HISTORY:  Father died of prostate cancer, otherwise
insignificant.

ALLERGIES:  The patient states no known drug allergies.

MEDICATIONS ON ADMISSION:  Aspirin 81 once daily, Lasix 20
b.i.d., Colace 100 b.i.d., potassium chloride 20 b.i.d.,
Percocet prn, Glipizide 2.5 once daily, Amiodarone 400
b.i.d., Lipitor 40 once daily, Lopressor 50 b.i.d. and
Coumadin 7.5 once daily.

PHYSICAL EXAMINATION:  Temperature 98.9, heart rate 67, blood
pressure 138/62, respiratory rate 24, oxygen saturation 94
percent on 3 liters.  Neurologically alert and oriented times
three on focal examination.  Cardiovascular, irregular rhythm
with no murmur, rubs or gallops and no jugular venous
distension.  Respiratory, coarse breath sounds, decreased at
the bases, sternal wound with serosanguinous drainage, no
surrounding erythema, fluctuance or tenderness.  Abdomen is
soft, nontender, nondistended with normoactive bowel sounds.

DICTATION ENDED



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2116-2-27**] 16:01:21
T:  [**2116-2-27**] 16:52:27
Job#:  [**Job Number 43924**]


Admission Date: [**2116-2-21**]        Discharge Date: [**2116-2-28**]

Date of Birth:  [**2043-5-20**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 43921**] is a 72 year old man
who underwent coronary artery bypass grafting times three as
well as a Maze procedure on the [**3-14**] with an
unremarkable postoperative course.  He was discharged to
rehabilitation on [**2-18**] and presented to the emergency
room at [**Hospital **] Hospital on [**2-21**] with
serosanguineous drainage from the lower aspect of his sternal
wound.  The drainage began suddenly following an episode of
coughing not associated with any chest pain, increasing
shortness of breath, fever, chills, redness or erythema of
the wound.  He was transferred to [**Hospital1 190**] from [**Hospital **] Hospital following initial
evaluation at the emergency room at [**Location (un) **].

PAST MEDICAL HISTORY:  Is significant for coronary artery
disease, status post coronary artery bypass grafting,
congestive heart failure, paroxysmal atrial
fibrillation/flutter, status post Maze procedure,
hypercholesterolemia, noninsulin dependent diabetes mellitus,
history of urosepsis, history of colon carcinoma, status post
colonic resection, hypertension, degenerative joint disease,
status post bilateral total knee replacement, abdominal
aortic aneurysm and bilateral cataract surgery.

SOCIAL HISTORY:  Patient lives alone.  He has a remote
tobacco history, quit over 18 years ago alcohol use limited
to one drink per day.

FAMILY HISTORY:  Father died of prostate carcinoma.

ALLERGIES:  Patient states no known drug allergies.

MEDICATIONS ON ADMISSION:  Include aspirin 81 mg daily, Lasix
20 mg B.I.D., Colace 100 mg B.I.D., potassium chloride 20 mEq
B.I.D., Percocet PRN, Glipizide 2.5 mg daily, amiodarone 400
mg B.I.D., Lipitor 40 mg daily, Lopressor 50 mg B.I.D.,
Coumadin 7.5 mg daily

PHYSICAL EXAMINATION:  Temperature 98.9, heart rate 67, blood
pressure 138/62, respiratory rate 24, O2 saturation 94
percent on 3 liters.  Neurologic:  Alert and oriented times
three, nonfocal examination.  Cardiovascular:  Regular rhythm
with no murmurs, rubs or gallops, no jugular venous
distension.  Respiratory:  Coarse breath sounds diminished at
the bases.  Sternal wound dehiscence with serosanguineous
drainage, no surrounding erythema, fluctuance or tenderness.
Abdomen is soft, nontender, nondistended with normal active
bowel sounds.  Extremities are warm and well perfused with
trace edema and no cyanosis.

HOSPITAL COURSE:  Patient was admitted to cardiothoracic
surgery.  Chest x-ray showed misaligned sternal wires.  His
Coumadin was discontinued and he was scheduled to go to the
operating room upon correction of his INR.  On the [**2-23**] the patient was brought to the operating room where
he underwent sternal debridement and reclosure.  The patient
tolerated the operation well and was transferred from the
operating room to the cardiothoracic Intensive Care Unit.  He
did well in the immediate postoperative area.  His anesthesia
was reversed and he weaned from the ventilator and
successfully extubated.  The following morning the patient
remained hemodynamically stable.  His chest tubes were
removed and he was transferred to 424 for continuous
postoperative management.  Over the next several days the
patient had an uneventful postoperative course.  His activity
level was increased with the assistance of the nursing staff
as well as the physical therapy staff on [**2-27**].  A PICC
line was placed for administration of long term antibiotics.
At that time the patient's culture data from the operating
room came back as rare coag negative staph as well as sparse
enterococcus from broth culture only resistant to Vancomycin,
sensitive to linezolid.  At that time it was decided that the
patient was stable and ready to be transferred to
rehabilitation for continuing postoperative care as well as
antibiotic administration.

The patient's physical examination at the time of discharge:
Temperature 99, heart rate 90, blood pressure 152/75,
respiratory rate 24, O2 saturation 95 percent on room air.
Weight 99.4 kilos.  Laboratory data:  PT/INR 13.4, INR 1.1.
Physical examination neurologic:  Alert and oriented times
three, moves all extremities, follows commands, nonfocal
examination.  Pulmonary:  Upper airway wheezes, otherwise
clear to auscultation.  Cardiac:  Irregular rate and rhythm.
Sternum is stable.  Incision with staples without erythema or
drainage.  Abdomen is soft, nontender, nondistended, normal
active bowel sounds.  Extremities are warm with no edema.
Bilateral leg incision open to air with no erythema.  PICC
line in the right antecubital space, a 4 French single lumen
catheter.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSES:
1. Coronary artery disease, status post coronary artery
   bypass grafting times three complicated by sternal
   drainage requiring sternal rewiring on [**2-23**].
2. Atrial fibrillation status post Maze.
3. Hypertension.
4. Hypercholesterolemia.
5. Noninsulin dependent diabetes mellitus.
6. Degenerative joint disease, status post bilateral total
   knee replacement.
7. Abdominal aortic aneurysm.
8. Colon carcinoma, status post colonic resection.
9. Status post bilateral cataract surgery.


FOLLOW UP:  The patient is have follow up in the wound clinic
one week following his discharge from [**Hospital1 190**], that would be on [**5-18**] with one of the mid
level practitioners, and follow up with Dr. [**Last Name (STitle) **] in three
to four weeks.

MEDICATIONS AT TIME OF DISCHARGE:  Include metoprolol 75 mg
B.I.D., atorvastatin 40 mg daily, Percocet 5/325 one to two
tablets q 4 to 6 hours PRN, amiodarone 200 mg B.I.D. times
seven days, then daily, lorazepam 0.5 mg to 1 mg q 6 hours
PRN, Combivent 2 puffs q 6 hours, Flovent 2 puffs B.I.D.,
Lasix 40 mg daily, warfarin as directed to maintain a goal
INR of 2 to 2.5.  The patient received 5 mg on [**2-26**] as well as
[**2-27**].  His warfarin dose prior to admission was 7.5 mg.
Colace 100 mg B.I.D. and linezolid 600 mg B.I.D. times four
weeks.

It should be noted that the patient will require CBC as well
as liver function tests q week while he is on linezolid.  His
staples can be removed on or about [**3-15**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2116-2-27**] 16:25:26
T:  [**2116-2-27**] 17:21:18
Job#:  [**Job Number 43923**]
{'Disruption of internal operation (surgical) wound,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Pure hypercholesterolemia,Old myocardial infarction,Aortocoronary bypass status,Infection with microorganisms without mention of resistance to multiple drugs,Personal history of malignant neoplasm of large intestine,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname 43921**] is a
72 year old man who underwent coronary artery bypass grafting
times three as well as Maze procedure on [**2-12**], with an
unremarkable postoperative course.  He was discharged to
rehabilitation on [**2-18**] on Amiodarone and Coumadin for
his atrial fibrillation.  He presented to the Emergency Room
on [**2-21**], with bloody drainage from the lower aspect of
his sternal wound.  The drainage began suddenly on the day of
assessment following a coughing episode.  It was not
associated with any chest pain or increasing shortness of
breath.  The patient also denies fevers, chills and redness
about the wound.  He was transferred from the Emergency Room
at [**Hospital **] Hospital to Far 2 at [**Hospital6 2018**].  A chest x-ray showed misaligned sternal layers in
the inferior sternum with no infiltrates.

MEDICAL HISTORY: Significant for coronary artery
disease, status post coronary artery bypass grafting times
three with left internal mammary artery to the left anterior
descending coronary artery, saphenous vein graft to the
posterior descending coronary artery and saphenous vein graft
to the obtuse marginal, paroxysmal atrial
fibrillation/flutter, status post Maze procedure done during
coronary artery bypass grafting, hypercholesterolemia,
noninsulin dependent diabetes mellitus, history of urosepsis,
history of colon carcinoma, hypertension, degenerative joint
disease, abdominal aortic aneurysm, bilateral cataract
surgery, colon resection and bilateral total knee
replacement.

MEDICATION ON ADMISSION: Aspirin 81 once daily, Lasix 20
b.i.d., Colace 100 b.i.d., potassium chloride 20 b.i.d.,
Percocet prn, Glipizide 2.5 once daily, Amiodarone 400
b.i.d., Lipitor 40 once daily, Lopressor 50 b.i.d. and
Coumadin 7.5 once daily.

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died of prostate cancer, otherwise
insignificant.

SOCIAL HISTORY: The patient lives alone, remote tobacco
history, quit 18 years ago and alcohol use is limited to one
drink per day. 

### Response:
{'Disruption of internal operation (surgical) wound,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Pure hypercholesterolemia,Old myocardial infarction,Aortocoronary bypass status,Infection with microorganisms without mention of resistance to multiple drugs,Personal history of malignant neoplasm of large intestine,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
