CHIEF COMPLAINT: Bilateral knee pain / osteoarthritis

PRESENT ILLNESS: 70 year old woman with a history of hypertension,
osteoarthritis, herpes simplex encephalitis w/ secondary seizure
disorder and memory loss with a history of increasing bilateral
knee pain and difficulty with ambulation presents to [**Hospital1 18**] for
elective bilateral total knee replacement.

MEDICAL HISTORY: 1. Hypertension
2. Osteoarthritis
3. Seizures and memory loss due to encephalitis
4. HSV encephalitis [**2108**]

MEDICATION ON ADMISSION: 1. Aspirin 81 mg daily
2. Atenolol 100 mg daily
3. Hydrochlorothiazide 25 mg daily
4. Norvasc 5 mg daily
5. Phenytoin 100 mg tid
6. glucosamine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
VS: T 94.2 ax 95.7 po HR 75 BP 100/63 RR O2 sat 100%
Gen: Intubated and sedated.
HEENT: PERRLA EOMI MM pink and moist
CV: RRR no m/r/g
Lungs: CTA anterior exam
soft, NT, ND normoactive BS
Bilateral knee incisions clean, dry, and intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Mandarin speaking, lives with husband and has daughters who
assist with her care. No history of tobacco or alcohol.
Osteoarthrosis, unspecified whether generalized or localized, lower leg,Other convulsions,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Acidosis,Other and unspecified coagulation defects,Hematoma complicating a procedure,Late effects of viral encephalitis,Other iatrogenic hypotension,Unspecified essential hypertension,Hypocalcemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]
Osteoarthros NOS-l/leg,Convulsions NEC,Ac posthemorrhag anemia,Thrombocytopenia NOS,Acidosis,Coagulat defect NEC/NOS,Hematoma complic proc,Late eff viral encephal,Iatrogenc hypotnsion NEC,Hypertension NOS,Hypocalcemia,Elev transaminase/ldh
Admission Date:  [**2115-12-3**]              Discharge Date:   [**2116-1-1**]

Date of Birth:  [**2045-1-27**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 52022**]
Chief Complaint:
Bilateral knee pain / osteoarthritis

Major Surgical or Invasive Procedure:
Bilateral total knee arthroplasy
Placement of IVC filter


History of Present Illness:
70 year old woman with a history of hypertension,
osteoarthritis, herpes simplex encephalitis w/ secondary seizure
disorder and memory loss with a history of increasing bilateral
knee pain and difficulty with ambulation presents to [**Hospital1 18**] for
elective bilateral total knee replacement.

Past Medical History:
1. Hypertension
2. Osteoarthritis
3. Seizures and memory loss due to encephalitis
4. HSV encephalitis [**2108**]


Social History:
Mandarin speaking, lives with husband and has daughters who
assist with her care. No history of tobacco or alcohol.


Family History:
non-contributory

Physical Exam:
PE:
VS: T 94.2 ax 95.7 po HR 75 BP 100/63 RR O2 sat 100%
Gen: Intubated and sedated.
HEENT: PERRLA EOMI MM pink and moist
CV: RRR no m/r/g
Lungs: CTA anterior exam
soft, NT, ND normoactive BS
Bilateral knee incisions clean, dry, and intact.

Pertinent Results:
[**2115-12-16**] 06:05AM BLOOD WBC-9.9 RBC-3.88* Hgb-11.6* Hct-34.8*
MCV-90 MCH-29.8 MCHC-33.3 RDW-15.2 Plt Ct-559*
[**2115-12-15**] 06:00AM BLOOD WBC-9.9 RBC-3.80* Hgb-11.4* Hct-33.8*
MCV-89 MCH-30.0 MCHC-33.7 RDW-15.4 Plt Ct-499*
[**2115-12-14**] 06:10AM BLOOD WBC-11.3* RBC-3.68* Hgb-11.5* Hct-33.2*
MCV-90 MCH-31.3 MCHC-34.7 RDW-16.8* Plt Ct-408
[**2115-12-13**] 07:30PM BLOOD Hct-34*
[**2115-12-13**] 01:00PM BLOOD Hct-34.9*
[**2115-12-13**] 06:00AM BLOOD Hct-29.0*
[**2115-12-13**] 06:00AM BLOOD WBC-11.3* RBC-3.61* Hgb-11.3* Hct-32.2*
MCV-89 MCH-31.3 MCHC-35.1* RDW-17.1* Plt Ct-358
[**2115-12-12**] 11:50PM BLOOD Hct-32.6*
[**2115-12-12**] 04:42AM BLOOD WBC-10.0 RBC-3.72* Hgb-11.3* Hct-31.6*
MCV-85 MCH-30.3 MCHC-35.7* RDW-16.1* Plt Ct-280
[**2115-12-11**] 09:01PM BLOOD Hct-31.9* Plt Ct-263
[**2115-12-11**] 01:24PM BLOOD WBC-10.3 RBC-3.67* Hgb-11.5* Hct-32.1*
MCV-88 MCH-31.4 MCHC-35.9* RDW-17.0* Plt Ct-235
[**2115-12-11**] 05:45AM BLOOD WBC-10.3 RBC-3.67* Hgb-11.3*# Hct-31.8*
MCV-87 MCH-30.8 MCHC-35.5* RDW-17.0* Plt Ct-208
[**2115-12-11**] 12:18AM BLOOD Hct-30.6*
[**2115-12-10**] 05:14PM BLOOD Hct-31.3*#
[**2115-12-10**] 05:01AM BLOOD WBC-9.0 RBC-2.98* Hgb-8.8* Hct-24.9*
MCV-84 MCH-29.5 MCHC-35.3* RDW-16.3* Plt Ct-170
[**2115-12-10**] 02:09AM BLOOD Hct-25.4*
[**2115-12-9**] 06:22PM BLOOD Hct-27.0*
[**2115-12-9**] 05:45AM BLOOD WBC-9.7 RBC-2.94* Hgb-9.2* Hct-25.4*#
MCV-86 MCH-31.2 MCHC-36.1* RDW-16.0* Plt Ct-165
[**2115-12-8**] 11:43PM BLOOD Hct-18.7* Plt Ct-154
[**2115-12-8**] 04:47PM BLOOD Hct-21.2*
[**2115-12-8**] 10:55AM BLOOD WBC-8.0 RBC-3.26* Hgb-9.9* Hct-27.8*
MCV-84 MCH-30.3 MCHC-36.0* RDW-15.6* Plt Ct-105*
[**2115-12-8**] 12:26AM BLOOD Hct-22.4*
[**2115-12-7**] 07:35PM BLOOD WBC-8.0 RBC-2.88* Hgb-9.0* Hct-24.7*
MCV-86 MCH-31.3 MCHC-36.4* RDW-16.5* Plt Ct-107*
[**2115-12-7**] 01:39PM BLOOD Hct-26.9*
[**2115-12-7**] 05:35AM BLOOD WBC-9.0 RBC-3.10* Hgb-9.5* Hct-26.5*
MCV-86 MCH-30.6 MCHC-35.7* RDW-16.6* Plt Ct-106*
[**2115-12-6**] 12:11PM BLOOD Hct-30.7*
[**2115-12-6**] 05:20AM BLOOD Hct-29.3*
[**2115-12-6**] 03:00AM BLOOD WBC-10.5 RBC-3.46* Hgb-11.0* Hct-30.0*
MCV-87 MCH-31.7 MCHC-36.7* RDW-16.2* Plt Ct-96*
[**2115-12-5**] 07:55PM BLOOD Hct-30.9* Plt Ct-96*
[**2115-12-5**] 03:42PM BLOOD Hct-28.1*
[**2115-12-5**] 11:47AM BLOOD Hct-30.1*
[**2115-12-5**] 08:20AM BLOOD Hct-29.4*
[**2115-12-5**] 06:18AM BLOOD WBC-12.7* RBC-3.40*# Hgb-10.7*# Hct-29.3*
MCV-86 MCH-31.7 MCHC-36.7* RDW-16.0* Plt Ct-103*
[**2115-12-5**] 01:35AM BLOOD Hct-26.9*
[**2115-12-4**] 05:45PM BLOOD Hct-27.4*
[**2115-12-4**] 01:02PM BLOOD Hct-28.7*#
[**2115-12-4**] 05:48AM BLOOD WBC-11.6* RBC-2.56* Hgb-8.3* Hct-22.8*
MCV-89 MCH-32.2* MCHC-36.2* RDW-16.1* Plt Ct-202#
[**2115-12-4**] 12:21AM BLOOD WBC-14.5* RBC-3.28* Hgb-10.2* Hct-29.3*
MCV-89 MCH-31.2 MCHC-35.0 RDW-15.9* Plt Ct-92*
[**2115-12-3**] 03:51PM BLOOD WBC-13.7*# RBC-3.27* Hgb-10.5* Hct-29.9*
MCV-91 MCH-32.1* MCHC-35.1* RDW-15.3 Plt Ct-85*#
[**2115-12-16**] 06:05AM BLOOD Plt Ct-559*
[**2115-12-13**] 06:00AM BLOOD PT-12.5 PTT-23.4 INR(PT)-1.0
[**2115-12-12**] 04:42AM BLOOD Plt Ct-280
[**2115-12-12**] 04:42AM BLOOD PT-12.5 PTT-21.3* INR(PT)-1.0
[**2115-12-11**] 09:01PM BLOOD Plt Ct-263
[**2115-12-11**] 05:45AM BLOOD PT-12.7 PTT-22.2 INR(PT)-1.1
[**2115-12-11**] 12:30AM BLOOD PT-12.8 PTT-23.6 INR(PT)-1.1
[**2115-12-10**] 05:14PM BLOOD PT-13.4* PTT-26.2 INR(PT)-1.2
[**2115-12-10**] 05:01AM BLOOD PT-13.8* PTT-25.4 INR(PT)-1.3
[**2115-12-9**] 06:22PM BLOOD PT-15.1* PTT-43.4* INR(PT)-1.6
[**2115-12-9**] 05:45AM BLOOD PT-14.5* PTT-30.6 INR(PT)-1.4
[**2115-12-9**] 02:27AM BLOOD PT-14.6* PTT-36.4* INR(PT)-1.5
[**2115-12-8**] 10:55AM BLOOD PT-16.6* PTT-56.4* INR(PT)-1.9
[**2115-12-7**] 05:35AM BLOOD PT-14.5* PTT-39.7* INR(PT)-1.4
[**2115-12-6**] 03:00AM BLOOD PT-14.7* PTT-40.0* INR(PT)-1.5
[**2115-12-5**] 06:18AM BLOOD PT-15.6* PTT-33.2 INR(PT)-1.7
[**2115-12-4**] 05:48AM BLOOD PT-14.8* PTT-31.4 INR(PT)-1.5
[**2115-12-3**] 07:50PM BLOOD PT-13.9* PTT-27.6 INR(PT)-1.3
[**2115-12-3**] 03:51PM BLOOD Plt Smr-LOW Plt Ct-85*#
[**2115-12-3**] 03:51PM BLOOD PT-14.7* PTT-37.3* INR(PT)-1.5
[**2115-12-12**] 04:42AM BLOOD Fibrino-663*
[**2115-12-9**] 10:39AM BLOOD Fibrino-631*# D-Dimer-3171*
[**2115-12-7**] 05:35AM BLOOD Fibrino-785* D-Dimer-2280* Thrombn-70.1*
[**2115-12-6**] 03:00AM BLOOD Fibrino-691*#
[**2115-12-5**] 06:18AM BLOOD Fibrino-524*#
[**2115-12-4**] 05:48AM BLOOD Fibrino-292#
[**2115-12-3**] 07:50PM BLOOD Fibrino-97*
[**2115-12-13**] 06:00AM BLOOD Glucose-123* UreaN-19 Creat-0.6 Na-136
K-4.2 Cl-103 HCO3-24 AnGap-13
[**2115-12-11**] 05:45AM BLOOD Glucose-120* UreaN-20 Creat-0.6 Na-141
K-4.1 Cl-109* HCO3-24 AnGap-12
[**2115-12-10**] 05:01AM BLOOD Glucose-111* UreaN-17 Creat-0.6 Na-141
K-3.6 Cl-108 HCO3-26 AnGap-11
[**2115-12-8**] 04:27AM BLOOD Glucose-113* UreaN-11 Creat-0.6 Na-141
K-3.5 Cl-108 HCO3-25 AnGap-12
[**2115-12-6**] 03:00AM BLOOD Glucose-138* UreaN-9 Creat-0.6 Na-142
K-3.7 Cl-110* HCO3-24 AnGap-12
[**2115-12-4**] 05:45PM BLOOD Glucose-162* UreaN-18 Creat-0.9 Na-139
K-3.8 Cl-108 HCO3-21* AnGap-14
[**2115-12-3**] 03:51PM BLOOD Glucose-235* UreaN-17 Creat-0.8 Na-139
K-4.5 Cl-106 HCO3-19* AnGap-19
[**2115-12-15**] 06:00AM BLOOD ALT-82* AST-89* AlkPhos-166* TotBili-1.3
[**2115-12-13**] 06:00AM BLOOD ALT-49* AST-59* AlkPhos-145* TotBili-1.4
[**2115-12-12**] 04:42AM BLOOD LD(LDH)-437* TotBili-1.4
[**2115-12-11**] 05:45AM BLOOD TotBili-1.6* DirBili-0.7* IndBili-0.9
[**2115-12-11**] 12:18AM BLOOD ALT-50* AST-73* LD(LDH)-434* AlkPhos-135*
TotBili-1.7*
[**2115-12-9**] 06:22PM BLOOD ALT-57* AST-62* LD(LDH)-444* TotBili-2.2*
[**2115-12-8**] 11:43PM BLOOD CK-MB-2 cTropnT-<0.01
[**2115-12-8**] 04:47PM BLOOD CK-MB-2 cTropnT-<0.01
[**2115-12-5**] 10:16AM BLOOD Type-ART Temp-36.9 Rates-/16 Tidal V-400
PEEP-5 FiO2-40 pO2-114* pCO2-39 pH-7.42 calHCO3-26 Base XS-1
Intubat-INTUBATED
[**2115-12-4**] 06:00PM BLOOD Type-ART pO2-107* pCO2-35 pH-7.43
calHCO3-24 Base XS-0
[**2115-12-4**] 06:19AM BLOOD Type-ART Temp-37.6 pO2-139* pCO2-35
pH-7.37 calHCO3-21 Base XS--3
[**2115-12-3**] 07:54PM BLOOD Type-ART pO2-221* pCO2-33* pH-7.36
calHCO3-19* Base XS--5
[**2115-12-3**] 02:35PM BLOOD Type-ART FiO2-40 pO2-130* pCO2-46*
pH-7.29* calHCO3-23 Base XS--4 Intubat-INTUBATED Vent-CONTROLLED
[**2115-12-3**] 12:44PM BLOOD Type-ART FiO2-40 pO2-171* pCO2-36 pH-7.44
calHCO3-25 Base XS-1 Intubat-INTUBATED Vent-CONTROLLED
Comment-ETT
[**2115-12-3**] 11:36AM BLOOD Type-ART FiO2-40 pO2-182* pCO2-42 pH-7.39
calHCO3-26 Base XS-0 Intubat-INTUBATED Vent-CONTROLLED
Comment-ETT

Brief Hospital Course:
70 F s/p bilateral total knee arthoplasty (see operative report
for details) for osteoarthritis [**2115-12-3**]. Patient developed
postoperative hypotension and transfusion requirement
necessitating an ICU admission. Postop, patient was hypotensive
in PACU, required pressors and was transfered to ICU for close
monitoring.

Postoperative hematocrit was unresponsive to repeated
transfusions of PRBC.

Patient was taken to the interventional radiology suite on
[**2115-12-5**] for suspicion of arterial vs. venous bleed into the
surgical bed of the right knee. Arteriographic imaging of
popliteal and genicular circlution revealed "No active
extravasation, pseudoaneurysm or other evidence for arterial
bleeding was identified from the arteries around the knees on
either side." Per interventional radiology, the decision was
made to image the venous system around the knees by
ultrasonography given the edema in the patient's lower
extremities which would make cannulation for venography
difficult.
Ultrasonography on the same date showed " 1. Partially-occlusive
thrombus within the right common femoral and right popliteal
veins. 2. No deep venous thrombosis within the left upper
extremity. 3. No evidence of a hematoma within the right knee."
Patient was treated for DVT with therapeutic Lovenox (1mg/kg).

-IVC filter was inserted on [**2115-12-9**]

CT scan on [**12-9**] showed "within the musculature of both thighs,
particularly the quadriceps, evidence of bilateral hematoma,
with expansion of the musculature as well as high- and
low-attenuation collections. There are hematocrit levels within
both thighs. The hematoma on the left is greater than right, and
extends to
the height of the quadriceps musculature, and measures
approximately 4.5 x 7
cm."
Follow-up CTA on [**12-11**] showed "1. Bilateral hematomas around the
recent knee joint surgery, larger on the left side. These are
stable compared to recent CT. No evidence of pseudoaneurysm or
active extravasation of contrast on the CTA.
2. Right lower limb deep venous thrombosis extending to the
upper common
femoral vein level. The patient has had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 260**] filter
placed."
Patient's INR was reversed with fresh frozen plasma, Hct was
stable for 48 hours, and was cleared by the ICU team for
transfer to the floor.

Patient subsequently continued to improve and made progress with
physical therapy. She was treated with a heparin drip for DVT
and continued on coumadin. Her pain was adequately controlled,
she tolerated a Cardiac/Heart healthy /Pureed/Honey prethickened
liquids diet.
She was discharged to follow-up with Dr. [**Last Name (STitle) **] in the orthopaedic
surgery clinic.

*** This discharge summary (hospital stay [**2115-12-3**] - [**2116-1-1**])
was completed--from the inpatient chart-- by the house officer
who was off service after [**2115-12-13**]. For further details about
the hospital course after [**2115-12-13**] please contact [**Name (NI) 1022**]
[**Name (NI) **], the discharging PA***


Medications on Admission:
1. Aspirin 81 mg daily
2. Atenolol 100 mg daily
3. Hydrochlorothiazide 25 mg daily
4. Norvasc 5 mg daily
5. Phenytoin 100 mg tid
6. glucosamine


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed.
Disp:*60 Tablet(s)* Refills:*0*
3. Coumadin 2 mg Tablet Sig: One (1) Tablet PO at bedtime: Goal
INR 2.0-2.5 for Tx of DVT.
-Please check 2x weekly
-Please call result to [**Telephone/Fax (1) 9118**] Attn. [**Doctor Last Name **] Brown.
Disp:*30 Tablet(s)* Refills:*2*
4. Outpatient Lab Work
Please Check INR 2x weekly. Goal INR 2.0-2.5 for Tx of DVT.
Please call results to [**Telephone/Fax (1) 9118**].
Attn [**Doctor Last Name **] Brown.


Discharge Disposition:
Home

Discharge Diagnosis:
s/p bilateral total knee replacement
Bilateral OA of knees
DVT R popliteal vein
pharyngeal dysphagia


Discharge Condition:
stable

Discharge Instructions:
[**Name8 (MD) **] M.D. for increase in severity of symptoms, breakdown of
surgical wound, fever, pain, questions or other concerns.

Continue with weight bearing as tolerated bilateral lower
extremities. Continue to take Coumadin for treatment of DVT.
Keep brace on right leg at all times when ambulating. Please
call/return if any fevers, increased discharge from incision or
trouble breathing.  Continue with out-patient physical therapy.
Please have INR checked 2x weekly while taking Coumadin. Please
call results to [**Telephone/Fax (1) 9118**] attn. [**Doctor Last Name **] Brown. Goal INR 2.0-2.5

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in the Orthopaedic Surgery clinic in
[**11-8**] days, please call clinic to schedule @ [**Telephone/Fax (1) 1228**].

Provider: [**Name (NI) **] [**Name (NI) 6724**], PT Phone:[**Telephone/Fax (1) 2484**] Date/Time:[**2116-1-3**]
8:00
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 1228**]  Call to schedule
appointment
for 10-14 days after discharge



Completed by:[**2116-2-26**]
{'Osteoarthrosis, unspecified whether generalized or localized, lower leg,Other convulsions,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Acidosis,Other and unspecified coagulation defects,Hematoma complicating a procedure,Late effects of viral encephalitis,Other iatrogenic hypotension,Unspecified essential hypertension,Hypocalcemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}


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: Bilateral knee pain / osteoarthritis

PRESENT ILLNESS: 70 year old woman with a history of hypertension,
osteoarthritis, herpes simplex encephalitis w/ secondary seizure
disorder and memory loss with a history of increasing bilateral
knee pain and difficulty with ambulation presents to [**Hospital1 18**] for
elective bilateral total knee replacement.

MEDICAL HISTORY: 1. Hypertension
2. Osteoarthritis
3. Seizures and memory loss due to encephalitis
4. HSV encephalitis [**2108**]

MEDICATION ON ADMISSION: 1. Aspirin 81 mg daily
2. Atenolol 100 mg daily
3. Hydrochlorothiazide 25 mg daily
4. Norvasc 5 mg daily
5. Phenytoin 100 mg tid
6. glucosamine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
VS: T 94.2 ax 95.7 po HR 75 BP 100/63 RR O2 sat 100%
Gen: Intubated and sedated.
HEENT: PERRLA EOMI MM pink and moist
CV: RRR no m/r/g
Lungs: CTA anterior exam
soft, NT, ND normoactive BS
Bilateral knee incisions clean, dry, and intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Mandarin speaking, lives with husband and has daughters who
assist with her care. No history of tobacco or alcohol. 

### Response:
{'Osteoarthrosis, unspecified whether generalized or localized, lower leg,Other convulsions,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Acidosis,Other and unspecified coagulation defects,Hematoma complicating a procedure,Late effects of viral encephalitis,Other iatrogenic hypotension,Unspecified essential hypertension,Hypocalcemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}
