CHIEF COMPLAINT: left hip fracture

PRESENT ILLNESS: 86yoF with DM, HTN, CAD, s/p fall out of bed on [**2105-6-22**]. Patient
was found to have L intertrochanteric fracture and was to under
ORIF on [**6-26**]. However on [**6-23**], pt developed NSTEMI and had a cath
on [**6-24**]. Cath demonstrated severe three vessel disease with
totally occluded RCA and LAD -- all vessels fed by the LCX. Pt
had POBA of the left circumflex. Had Left DHS surgery on [**6-26**]. In
the postop period, she developed AFib which spontaneously
converting to SR. She was hemodynamically stable during this
episode for AFib.

MEDICAL HISTORY: DM
Dementia
HTN
CAD s/p MI [**2095**]
endometrial Ca s/p XRT -> strictures -> ileostomy
spinal stenosis, L4-L5
hearing loss
Cataracts

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T 100.0 BP 104/28 HR 83 RR 20 100% on RA
Gen: NAD, resting comfortably in bed.
HEENT: OD with erythematous conjuctiva and crusting, PERRL and
EOM intact.
Neck: no LAD, no JVD, no masses.
Lungs: CTA b/l, no crackles or wheezes.
Heart: RRR, nl s1s2, iii/vi sem at LUSB, i/vi sem at apex.
Abd: ilial conduit for urine RLQ, abd soft, nt/nd, +bs, no
organomegaly.
Extr: wwp, 2+ distal pulses, no cyanosis, no edema; moving all 4
extremities, L leg externally rotated in bed.
Neuro: demented, awake, a&ox0, cn grossly intact.

FAMILY HISTORY: not contibutory

SOCIAL HISTORY: Lives with grandaughter. No ETOH/Tobacco abuse
Closed fracture of intertrochanteric section of neck of femur,Subendocardial infarction, initial episode of care,Atrial fibrillation,Urinary tract infection, site not specified,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Accidental fall from bed,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Long-term (current) use of insulin,Acute conjunctivitis, unspecified,Personal history of malignant neoplasm of cervix uteri,Unspecified hearing loss,Profound impairment, both eyes, impairment level not further specified,Attention to other artificial opening of urinary tract
Intertrochanteric fx-cl,Subendo infarct, initial,Atrial fibrillation,Urin tract infection NOS,Chronic kidney dis NOS,CHF NOS,Fall from bed,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Long-term use of insulin,Acute conjunctivitis NOS,Hx-cervical malignancy,Hearing loss NOS,Both eyes blind-who def,Atten to urinostomy NEC
Admission Date:  [**2105-6-22**]              Discharge Date:   [**2105-7-1**]


Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1377**]
Chief Complaint:
left hip fracture

Major Surgical or Invasive Procedure:
Left DHS (hip surgery)
Intubation for surgery


History of Present Illness:
86yoF with DM, HTN, CAD, s/p fall out of bed on [**2105-6-22**]. Patient
was found to have L intertrochanteric fracture and was to under
ORIF on [**6-26**]. However on [**6-23**], pt developed NSTEMI and had a cath
on [**6-24**]. Cath demonstrated severe three vessel disease with
totally occluded RCA and LAD -- all vessels fed by the LCX. Pt
had POBA of the left circumflex. Had Left DHS surgery on [**6-26**]. In
the postop period, she developed AFib which spontaneously
converting to SR. She was hemodynamically stable during this
episode for AFib.

Past Medical History:
DM
Dementia
HTN
CAD s/p MI [**2095**]
endometrial Ca s/p XRT -> strictures -> ileostomy
spinal stenosis, L4-L5
hearing loss
Cataracts


Social History:
Lives with grandaughter. No ETOH/Tobacco abuse

Family History:
not contibutory

Physical Exam:
VS: T 100.0 BP 104/28 HR 83 RR 20 100% on RA
Gen: NAD, resting comfortably in bed.
HEENT: OD with erythematous conjuctiva and crusting, PERRL and
EOM intact.
Neck: no LAD, no JVD, no masses.
Lungs: CTA b/l, no crackles or wheezes.
Heart: RRR, nl s1s2, iii/vi sem at LUSB, i/vi sem at apex.
Abd: ilial conduit for urine RLQ, abd soft, nt/nd, +bs, no
organomegaly.
Extr: wwp, 2+ distal pulses, no cyanosis, no edema; moving all 4
extremities, L leg externally rotated in bed.
Neuro: demented, awake, a&ox0, cn grossly intact.


Pertinent Results:
[**2105-7-1**] 05:50AM BLOOD WBC-7.4 RBC-3.43* Hgb-9.8* Hct-29.3*
MCV-86 MCH-28.5 MCHC-33.3 RDW-15.4 Plt Ct-261
[**2105-6-22**] 04:35PM BLOOD Neuts-84.7* Bands-0 Lymphs-8.6* Monos-4.7
Eos-1.1 Baso-0.8
[**2105-7-1**] 05:50AM BLOOD Plt Ct-261
[**2105-7-1**] 05:50AM BLOOD Glucose-195* UreaN-33* Creat-0.9 Na-137
K-4.5 Cl-102 HCO3-24 AnGap-16
[**2105-6-29**] 06:00AM BLOOD CK-MB-3 cTropnT-0.57*
[**2105-7-1**] 05:50AM BLOOD Calcium-8.0* Phos-2.6* Mg-1.8
[**2105-6-30**] 05:55AM BLOOD Triglyc-140 HDL-27 CHOL/HD-3.3 LDLcalc-33
[**2105-6-29**] 06:00AM BLOOD TSH-1.4
[**2105-6-29**] 06:00AM BLOOD Free T4-1.4
***
HIP UNILAT MIN 2 VIEWS LEFT  [**2105-6-22**]
Fracture lines through the left intertrochanteric area, with
bone fragment and displacement of the distal fracture fragment
laterally.
***
BILAT LOWER EXT VEINS  [**2105-6-22**]
No evidence of left or right lower extremity deep vein
thrombosis
***
ECHO Study Date of [**2105-6-23**]
The left atrium is normal in size. There is moderate symmetric
left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall left ventricular systolic function is
moderately-to-severely depressed (ejection fraction 30 percent)
secondary to severe hypokinesis of all walls except the
posterior wall, with apical akinesis. Tissue velocity imaging
E/e' is elevated (>15) suggesting increased left ventricular
filling pressure (PCWP>18mmHg). Tissue velocity imaging
demonstrates an e' of <0.08m/s c/w an elevated left ventricular
filling pressure (>12mmHg). No masses or thrombi are seen in the
left ventricle. There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. There
are three aortic valve leaflets. The aortic valve leaflets are
moderately thickened.
There is mild aortic valve stenosis. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are moderately
thickened. There is no mitral valve prolapse. There is moderate
thickening of the mitral valve chordae. The study is inadequate
to exclude significant mitral valve stenosis. Moderate (2+)
mitral regurgitation is seen. The left ventricular inflow
pattern suggests impaired relaxation. There is no pericardial
effusion.
***
C.CATH Study Date of [**2105-6-24**]
1. Selective coronary angiography showed a right dominant system
with
severe three vessel disease. The LMCA was angiographically
without
disease. The LAD was proximaly occluded and filled in the mid
section
via left-to-left collaterals. The LCX was heravily calcified in
the
proximal segment and filled a small OM1 with and ostial 95%
stenosis
(2.0 mm vessel). There was a very large OM2 with a hazy 80%
stenosis.
The OM2 gave collaterals to the LAD as well as to the RCA. The
RCA was
the dominant vessel which was occluded proximally. The rPDA and
the PL
filled via left-to-right collaterals from the OM2.
2. Successful POBA of the OM2 with a 2.5mm balloon with great
results
(see PTCA comments).
***
HIP UNILAT MIN 2 VIEWS LEFT  [**2105-6-26**] 2:16 PM
FINDINGS: Two intraoperative images from the operating room
demonstrates interval placement of a lateral plate and dynamic
hip screw fixating an intertrochanteric fracture of the left
proximal femur. A small displaced lesser trochanter fragment is
noted. Please refer to surgical report for further details

Brief Hospital Course:
A/P: 86yoF with L hip fracture and NSTEMI.
.
# CAD: She developed chest pain with CE leak few days prior to
her hip surgery. CEs positive, consistent with NSTEMI. Cath
([**6-24**]): Selective coronary angiography showed a right dominant
system with severe 3VD. The LMCA was angiographically without
disease. The LAD was proximally occluded and filled in the mid
section via left-to-left collaterals. The LCx was heavily
calcified in the proximal segment and filled a small OM1 with
and ostial 95% stenosis (2.0 mm vessel). There was a very large
OM2 with a hazy 80% stenosis. The OM2 gave collaterals to the
LAD as well as to the RCA. The RCA was the dominant vessel which
was occluded proximally. The rPDA and the PL filled via
left-to-right collaterals from the OM2.  s/p POBA to LCx.
Cardiology was following her and was started on ASA, plavix,
statin, BB, ACEI. They recommended outpt follow up for further
discussion about ICD placement. She has an appointment in [**Month (only) 205**]
for this.
.
# Atrial Fibrillation: had one episode in postop period after
which she spontaneously reverted back. After she was transferred
to the floor, she went back into Afib. She was tachy in the 130s
with pressure in 90's. She got 5mg IV lopressor after which her
rate came down to the 80's with pressure in 110's. Her BB was
increased and then she reverted back to sinus rhytm. She
remained in sinus rhythm. She was started on Amiodarone with a
loading dose and also started on Digoxin. Her BB was titrated.
It was decided not to anticoagulate her with coumadin as she is
very high risk for falls. This was done in discussion with the
patient, her family and PCP.
.
# Hip fracture: She had a DHS procedure for her left hip
fracture. She was placed on lovenox for DVT prophylaxis which
was to be continued for total of 14 days after surgery. She was
seen by physical therapy and there was no restriction on her
activity.
.
# UTI: u/a consistent with UTI, cx shows coag + SA, but could be
skin flora contaminant.  repeat urine cx NGTD. She completed 5
days of Ciprofloxacin and 3 days of Levofloxacin.
.
# HTN: Her BP remained stable.
.
# CRI: Cr elevated to 1.4 from baseline 0.8-0.9 on admission,
then resolved, likely dehydrated.
.
# DM2: continue fixed humalog and ISS as needed with QID f/s.
Humalog was titrated during this hospital admission.
.
# conjunctivitis: continued to treat with erythromycin drops.
erythema and discharge improved.

Discharge Medications:
1. Erythromycin 5 mg/g Ointment Sig: One (1)  Ophthalmic  QID (4
times a day).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4-6H (every 4 to 6 hours) as needed.
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed.
7. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 5 days.
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
Please start this after completion of 400 mg [**Hospital1 **] of Amiodarone.

10. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Insulin Regimen
Please see the attached sheet (Fixed dose and sliding scale) for
insulin regimen
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
14. Toprol XL 200 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
15. Lasix 20 mg Tablet Sig: One (1) Tablet PO QAM.
16. Lovenox 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
twice a day for 10 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Hip Fracture
MI
Atrial fibrillation


Discharge Condition:
Stable


Discharge Instructions:
Please take all your medication and follow up with all your
appointments. Please report to the ED or to your physician if
you have worsening chest pain, nausea/vomiting, shortness of
breath, sever pain in hip or any other concerns.


Followup Instructions:
Appointments:

1. Dr.[**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 679**]: on [**7-15**] at 11AM
.
2. Cardiology: Arrythmia service for evaluation of ICD
placement. Provider: [**Last Name (NamePattern4) **]. [**First Name11 (Name Pattern1) 275**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Phone:[**Telephone/Fax (1) 2934**]
Date/Time:[**2105-7-31**] 10:00


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 1379**]

Completed by:[**2105-7-1**]
{'Closed fracture of intertrochanteric section of neck of femur,Subendocardial infarction, initial episode of care,Atrial fibrillation,Urinary tract infection, site not specified,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Accidental fall from bed,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Long-term (current) use of insulin,Acute conjunctivitis, unspecified,Personal history of malignant neoplasm of cervix uteri,Unspecified hearing loss,Profound impairment, both eyes, impairment level not further specified,Attention to other artificial opening of urinary tract'}


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: left hip fracture

PRESENT ILLNESS: 86yoF with DM, HTN, CAD, s/p fall out of bed on [**2105-6-22**]. Patient
was found to have L intertrochanteric fracture and was to under
ORIF on [**6-26**]. However on [**6-23**], pt developed NSTEMI and had a cath
on [**6-24**]. Cath demonstrated severe three vessel disease with
totally occluded RCA and LAD -- all vessels fed by the LCX. Pt
had POBA of the left circumflex. Had Left DHS surgery on [**6-26**]. In
the postop period, she developed AFib which spontaneously
converting to SR. She was hemodynamically stable during this
episode for AFib.

MEDICAL HISTORY: DM
Dementia
HTN
CAD s/p MI [**2095**]
endometrial Ca s/p XRT -> strictures -> ileostomy
spinal stenosis, L4-L5
hearing loss
Cataracts

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T 100.0 BP 104/28 HR 83 RR 20 100% on RA
Gen: NAD, resting comfortably in bed.
HEENT: OD with erythematous conjuctiva and crusting, PERRL and
EOM intact.
Neck: no LAD, no JVD, no masses.
Lungs: CTA b/l, no crackles or wheezes.
Heart: RRR, nl s1s2, iii/vi sem at LUSB, i/vi sem at apex.
Abd: ilial conduit for urine RLQ, abd soft, nt/nd, +bs, no
organomegaly.
Extr: wwp, 2+ distal pulses, no cyanosis, no edema; moving all 4
extremities, L leg externally rotated in bed.
Neuro: demented, awake, a&ox0, cn grossly intact.

FAMILY HISTORY: not contibutory

SOCIAL HISTORY: Lives with grandaughter. No ETOH/Tobacco abuse 

### Response:
{'Closed fracture of intertrochanteric section of neck of femur,Subendocardial infarction, initial episode of care,Atrial fibrillation,Urinary tract infection, site not specified,Chronic kidney disease, unspecified,Congestive heart failure, unspecified,Accidental fall from bed,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Long-term (current) use of insulin,Acute conjunctivitis, unspecified,Personal history of malignant neoplasm of cervix uteri,Unspecified hearing loss,Profound impairment, both eyes, impairment level not further specified,Attention to other artificial opening of urinary tract'}
