CHIEF COMPLAINT: Left flank pain

PRESENT ILLNESS: 53M morbidly obese male s/p fall on Monday [**7-9**] presents for
evaluation of increasing left hip and flank pain.  As per
patient
he feel after his right knee gave out while going to the
bathroom.  He did not hit his head or neck, but sustained the
impact to his left flank and hip.  He denies LOC, remembers all
events and states that he has no pain anywhere else in his body
except his left side.  HE has had repeated falls in the past due
to weakness/ giving out of right knee that is chronically
affected by lymphedema.
In Ed patient was initially normotensive but then BP dropped to
mid 80s without tachycardia.  A left IJ was placed.  He was
receiving his first liter of fluid at the time of this
evaluation.

MEDICAL HISTORY: PMH
1. Hypertension
2. Obesity
3. Depression
4. MVA - remote, with fracture right upper extremity, s/p ORIF
5. Cellulitis
6. Chronic right lower extremity cellulitis and lymphedema
Atrial fibrillation, on Coumadin

MEDICATION ON ADMISSION: Calcium Citrate + 315 mg-200u 2 Tabs ", Vitamin B-12 1,000 mcg
Tab,Cholecalciferol (Vitamin D3) 1,000 unit, triamcinolone
acetonide 0.1 % Topical", Lasix 20 mg Tab, lisinopril 20 mg,
Omeprazole 20 mg, tramadol 50 mg, Docusate Sodium 100 mg",
trazodone 50 mg Tab, ferrous sulfate 325 mg", warfarin 5 mg
(need to verify dose, Gabapentin 800 mg Tab"', MVI, metoprolol
succinate ER 200 mg,Miralax 17 gram'

ALLERGIES: Adhesive Tape / Ibuprofen

PHYSICAL EXAM: Temp 97   HR 73   BP 114/64   RR 18   O2 sat 100% RA
GEN: Morbidly obese male in NAD.
Neuro: CNII-IV intact.  GCS 15
HEENT: Atraumatic/ NC, pupils 3>2 bilaterally, EOMI.  C spine
nontender and atraumatic.
CVS: RRR but decreased limited evaluation because of body
habitus
Stable sternum, no pain along ribs.
PUlM: CTAB but decreased [**1-25**] body habitus
Abdomen obese, midline incision mildly tender without evidence
of
hernia ( unable to stand so examined in supine position only).
Left inferior abdomen and flank with ecchymosis and tenderness
throughout, no skin breakdown. Pelvis stable.
GU: Externally WNL.
Ext: WWP with significant lymphedema  of the right leg, no
lymphedema of the left leg.  No evidence of trauma to
extremities.

FAMILY HISTORY: Lung CA in mother and father, both were smokers, and both died
of this, his mother at age 39.  His sister has ovarian ca. His
father also had gout.

SOCIAL HISTORY: Non-smoker. Denies EtOH or drug use. Patient is on disability.
Lives by himself in an apartment in [**Location (un) 86**].
Contusion of abdominal wall,Acute posthemorrhagic anemia,Body Mass Index 45.0-49.9, adult,Contusion of hip,Fall from other slipping, tripping, or stumbling,Home accidents,Morbid obesity,Unspecified essential hypertension,Atrial fibrillation,Long-term (current) use of anticoagulants,Bariatric surgery status,Abnormal coagulation profile,Other chronic pain,Hypotension, unspecified,Other lymphedema,Difficulty in walking
Contusion abdominal wall,Ac posthemorrhag anemia,BMI 45.0-49.9, adult,Contusion of hip,Fall from slipping NEC,Accident in home,Morbid obesity,Hypertension NOS,Atrial fibrillation,Long-term use anticoagul,Bariatric surgery status,Abnrml coagultion prfile,Chronic pain NEC,Hypotension NOS,Other lymphedema,Difficulty in walking
Admission Date:  [**2164-7-11**]              Discharge Date:   [**2164-7-17**]

Date of Birth:  [**2110-10-11**]             Sex:   M

Service: SURGERY

Allergies:
Adhesive Tape / Ibuprofen

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
Left flank pain

Major Surgical or Invasive Procedure:
none

History of Present Illness:
53M morbidly obese male s/p fall on Monday [**7-9**] presents for
evaluation of increasing left hip and flank pain.  As per
patient
he feel after his right knee gave out while going to the
bathroom.  He did not hit his head or neck, but sustained the
impact to his left flank and hip.  He denies LOC, remembers all
events and states that he has no pain anywhere else in his body
except his left side.  HE has had repeated falls in the past due
to weakness/ giving out of right knee that is chronically
affected by lymphedema.
In Ed patient was initially normotensive but then BP dropped to
mid 80s without tachycardia.  A left IJ was placed.  He was
receiving his first liter of fluid at the time of this
evaluation.


Past Medical History:
PMH
1. Hypertension
2. Obesity
3. Depression
4. MVA - remote, with fracture right upper extremity, s/p ORIF
5. Cellulitis
6. Chronic right lower extremity cellulitis and lymphedema
Atrial fibrillation, on Coumadin

PSH
1. Gastric Bypass surgery in [**2152**] [**Doctor First Name 30929**] followed by Dr. [**Last Name (STitle) **]
currently.
2. Right elbow surgery


Social History:
Non-smoker. Denies EtOH or drug use. Patient is on disability.
Lives by himself in an apartment in [**Location (un) 86**].


Family History:
Lung CA in mother and father, both were smokers, and both died
of this, his mother at age 39.  His sister has ovarian ca. His
father also had gout.

Physical Exam:
Temp 97   HR 73   BP 114/64   RR 18   O2 sat 100% RA
GEN: Morbidly obese male in NAD.
Neuro: CNII-IV intact.  GCS 15
HEENT: Atraumatic/ NC, pupils 3>2 bilaterally, EOMI.  C spine
nontender and atraumatic.
CVS: RRR but decreased limited evaluation because of body
habitus
Stable sternum, no pain along ribs.
PUlM: CTAB but decreased [**1-25**] body habitus
Abdomen obese, midline incision mildly tender without evidence
of
hernia ( unable to stand so examined in supine position only).
Left inferior abdomen and flank with ecchymosis and tenderness
throughout, no skin breakdown. Pelvis stable.
GU: Externally WNL.
Ext: WWP with significant lymphedema  of the right leg, no
lymphedema of the left leg.  No evidence of trauma to
extremities.


Pertinent Results:
[**2164-7-11**] 11:50AM   WBC-7.8 RBC-2.79*# HGB-7.9*# HCT-23.9*#
MCV-86 MCH-28.3 MCHC-33.1 RDW-17.8*
[**2164-7-11**] 11:50AM   NEUTS-69.4 BANDS-0 LYMPHS-20.2 MONOS-6.4
EOS-3.4 BASOS-0.5
[**2164-7-11**] 11:50AM   PLT SMR-UNABLE TO  PLT COUNT-UNABLE TO
[**2164-7-11**] 11:50AM   PT-37.8* PTT-35.2* INR(PT)-3.8*
[**2164-7-11**] 11:50AM   GLUCOSE-72 UREA N-20 CREAT-1.0 SODIUM-137
POTASSIUM-3.4 CHLORIDE-110* TOTAL CO2-20* ANION GAP-10

[**2164-7-11**] CT Abd/pelvis :
1. 37-cm obliquely oriented fluid collection in the left lateral
body wall, likely a hematoma.
2. No thigh hematoma.
3. No acute intra-abdominal process.
4. Seroma along anterior abdominal wall adjacent to mesh,
slightly decreased in size from [**2161**] CT.


Brief Hospital Course:
The patient was admitted to the ICU on [**2164-7-11**] from the ED.
Initially in the emergency room the patient was normotensive,
however he quickly dropped his pressures to SBP 80s without
tachycardia. A LIJ was placed and patient was given 10 units
VitK, 2u FFP, 2u pRBC. The patient received 4 additional units
of blood in the ICU, and his HCT improved to 32.1. The patient's
INR improved to 1.4 from 3.8 on admission. CT scan on [**7-11**]
showed a 37cm hematoma in the left lateral body wall. On [**7-12**],
the patient was hemodynamically stable. He was off pressors, and
did not require further transfusions. He was transferred to the
floor in stable condition.

Following transfer to the Trauma floor he had problems with pain
control and mobility.  He has a history of leg pains and prior
to admission was on Gabapentin with some effect.  Currently he
is taking a combination of Tizanidine, Tylenol, Morphine IR and
Ultram and generally is getting more pain control daily.  He
worked with the Physical  Therapy service to help him mobilize
and a short term rehab was recommended prior to his return home.

His hematocrit has been stable for > 72 hours and remains in the
32-35 range.  He was 23 on admission and stabilized after
transfusions.  He also has remained off Coumadin.  He had some
brief rapid atrial fibrillation 4 days ago which resolved after
resuming his beta blocker. He has had long standing hypertension
treated with Lisinopril 20 daily and Toprol 200 daily.  Due to
his hypotension on admission his medication was held.  Now that
he is euvolemic his blood pressure is 126/85 and his heart rate
is 77 which reflects Lopressor 25 mg [**Hospital1 **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP is
aware that we are keeping him off of Coumadin and he will be re
evaluated at his appointment with Dr. [**Last Name (STitle) 30375**] in early [**Month (only) 216**].

He had some complaints of left calf pain on [**2164-7-16**] and had
venous studies which were negative for DVT.. He remains on DVT
prophylaxis with Heparin 5000 units SC TID. Currently he is
tolerating a regular diet in modest amounts and is able to stay
well hydrated.  He was discharged on [**2164-7-17**] to rehab and will
follow up in the [**Hospital 2536**] Clinic in [**1-26**] weeks.

Medications on Admission:
Calcium Citrate + 315 mg-200u 2 Tabs ", Vitamin B-12 1,000 mcg
Tab,Cholecalciferol (Vitamin D3) 1,000 unit, triamcinolone
acetonide 0.1 % Topical", Lasix 20 mg Tab, lisinopril 20 mg,
Omeprazole 20 mg, tramadol 50 mg, Docusate Sodium 100 mg",
trazodone 50 mg Tab, ferrous sulfate 325 mg", warfarin 5 mg
(need to verify dose, Gabapentin 800 mg Tab"', MVI, metoprolol
succinate ER 200 mg,Miralax 17 gram'

Discharge Medications:
1. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
2. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
3. tramadol 50 mg Tablet Sig: One (1) Tablet PO QID (4 times a
day).
4. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day): Hold for SBP < 100, HR < 60.
5. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours).
6. tizanidine 2 mg Tablet Sig: Three (3) Tablet PO TID (3 times
a day).
7. morphine 15 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
8. gabapentin 300 mg Capsule Sig: Two (2) Capsule PO Q8H (every
8 hours).
9. Calcium Citrate + D 315-200 mg-unit Tablet Sig: Two (2)
Tablet PO twice a day.
10. Vitamin B-12 1,000 mcg Tablet Sig: One (1) Tablet PO once a
day.
11. Vitamin D-3 1,000 unit Tablet, Chewable Sig: One (1) Tablet,
Chewable PO once a day.
12. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
13. multivitamin     Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
S/P Fall
1. Hematoma left flank and hip
2. Acute blood loss anemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
* You were admitted to the hospital after falling with a large
hematoma on your left flank and hip area.  Your INR was elevated
and was reversed with blood products.  Your bleeding stopped and
your blood count has been stable. You have had problems with
pain control and mobility.
* You did not sustain any broken bones but sometimes the
generalized pain from falling can be debilitating.  For that
reason we are sendiong you to a rehab to try to gradually
increase your mobility so that you may return home.
* Due to your frequent episodes of falling at home we are
keeping you off Coumadin for now.  You will be able to discuss
this more when you see Dr. [**Last Name (STitle) 30375**] or [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].

Followup Instructions:
Call the Acute Care Clinic at [**Telephone/Fax (1) 600**] for a follow up
appointment in [**1-26**] weeks.

Provider: [**First Name8 (NamePattern2) 488**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2164-7-27**] 1:45

Provider: [**First Name4 (NamePattern1) 6100**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2164-8-1**] 1:00

Provider: [**First Name11 (Name Pattern1) 354**] [**Last Name (NamePattern4) 3013**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2164-11-14**] 8:30


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2164-7-17**]
{'Contusion of abdominal wall,Acute posthemorrhagic anemia,Body Mass Index 45.0-49.9, adult,Contusion of hip,Fall from other slipping, tripping, or stumbling,Home accidents,Morbid obesity,Unspecified essential hypertension,Atrial fibrillation,Long-term (current) use of anticoagulants,Bariatric surgery status,Abnormal coagulation profile,Other chronic pain,Hypotension, unspecified,Other lymphedema,Difficulty in walking'}


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 flank pain

PRESENT ILLNESS: 53M morbidly obese male s/p fall on Monday [**7-9**] presents for
evaluation of increasing left hip and flank pain.  As per
patient
he feel after his right knee gave out while going to the
bathroom.  He did not hit his head or neck, but sustained the
impact to his left flank and hip.  He denies LOC, remembers all
events and states that he has no pain anywhere else in his body
except his left side.  HE has had repeated falls in the past due
to weakness/ giving out of right knee that is chronically
affected by lymphedema.
In Ed patient was initially normotensive but then BP dropped to
mid 80s without tachycardia.  A left IJ was placed.  He was
receiving his first liter of fluid at the time of this
evaluation.

MEDICAL HISTORY: PMH
1. Hypertension
2. Obesity
3. Depression
4. MVA - remote, with fracture right upper extremity, s/p ORIF
5. Cellulitis
6. Chronic right lower extremity cellulitis and lymphedema
Atrial fibrillation, on Coumadin

MEDICATION ON ADMISSION: Calcium Citrate + 315 mg-200u 2 Tabs ", Vitamin B-12 1,000 mcg
Tab,Cholecalciferol (Vitamin D3) 1,000 unit, triamcinolone
acetonide 0.1 % Topical", Lasix 20 mg Tab, lisinopril 20 mg,
Omeprazole 20 mg, tramadol 50 mg, Docusate Sodium 100 mg",
trazodone 50 mg Tab, ferrous sulfate 325 mg", warfarin 5 mg
(need to verify dose, Gabapentin 800 mg Tab"', MVI, metoprolol
succinate ER 200 mg,Miralax 17 gram'

ALLERGIES: Adhesive Tape / Ibuprofen

PHYSICAL EXAM: Temp 97   HR 73   BP 114/64   RR 18   O2 sat 100% RA
GEN: Morbidly obese male in NAD.
Neuro: CNII-IV intact.  GCS 15
HEENT: Atraumatic/ NC, pupils 3>2 bilaterally, EOMI.  C spine
nontender and atraumatic.
CVS: RRR but decreased limited evaluation because of body
habitus
Stable sternum, no pain along ribs.
PUlM: CTAB but decreased [**1-25**] body habitus
Abdomen obese, midline incision mildly tender without evidence
of
hernia ( unable to stand so examined in supine position only).
Left inferior abdomen and flank with ecchymosis and tenderness
throughout, no skin breakdown. Pelvis stable.
GU: Externally WNL.
Ext: WWP with significant lymphedema  of the right leg, no
lymphedema of the left leg.  No evidence of trauma to
extremities.

FAMILY HISTORY: Lung CA in mother and father, both were smokers, and both died
of this, his mother at age 39.  His sister has ovarian ca. His
father also had gout.

SOCIAL HISTORY: Non-smoker. Denies EtOH or drug use. Patient is on disability.
Lives by himself in an apartment in [**Location (un) 86**]. 

### Response:
{'Contusion of abdominal wall,Acute posthemorrhagic anemia,Body Mass Index 45.0-49.9, adult,Contusion of hip,Fall from other slipping, tripping, or stumbling,Home accidents,Morbid obesity,Unspecified essential hypertension,Atrial fibrillation,Long-term (current) use of anticoagulants,Bariatric surgery status,Abnormal coagulation profile,Other chronic pain,Hypotension, unspecified,Other lymphedema,Difficulty in walking'}
