CHIEF COMPLAINT: Chest pain and shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 2026**] is a 33 year old male who was transferred to [**Hospital1 18**]-ED
on [**3-29**] after developing chest pain and shortness of breath, a
code blue was called while on [**Hospital Ward Name **] for out-patient CT
scan. He is well known to the surgical service, he has a past
medical history significant for sigmoid diverticulitis s/p
laparoscopic sigmoid colectomy. CT scan of chest demonstrated
bilateral pulmonary emboli, he was oxygenating well on nasal
cannula, an intravenous Heparin drip was started and he was
transferred to the ICU for close monitoring.

MEDICAL HISTORY: Past Surgical History:

MEDICATION ON ADMISSION: Colace
Percocet

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:

FAMILY HISTORY: HTN and DM

SOCIAL HISTORY: Smokes half a pack a day of tobacco. Alcohol rarely. No IV drug
use
Other pulmonary embolism and infarction,Tobacco use disorder,Colostomy status,Intestinal bypass or anastomosis status
Pulm embol/infarct NEC,Tobacco use disorder,Colostomy status,Intestinal bypass status
Admission Date:  [**2103-3-29**]              Discharge Date:   [**2103-4-10**]

Date of Birth:  [**2069-12-2**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3376**]
Chief Complaint:
Chest pain and shortness of breath

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mr. [**Known lastname 2026**] is a 33 year old male who was transferred to [**Hospital1 18**]-ED
on [**3-29**] after developing chest pain and shortness of breath, a
code blue was called while on [**Hospital Ward Name **] for out-patient CT
scan. He is well known to the surgical service, he has a past
medical history significant for sigmoid diverticulitis s/p
laparoscopic sigmoid colectomy. CT scan of chest demonstrated
bilateral pulmonary emboli, he was oxygenating well on nasal
cannula, an intravenous Heparin drip was started and he was
transferred to the ICU for close monitoring.

Past Medical History:
Past Surgical History:

Diverticulitis
Post-operative abdominal collection

Past Surgical History:

[**2-28**] Laparoscopic sigmoid colectomy, c/b anastomotic leak, s/p
[**Doctor Last Name 3379**] procedure
Umbilical hernia repair

Social History:
Smokes half a pack a day of tobacco. Alcohol rarely. No IV drug
use


Family History:
HTN and DM

Physical Exam:
Upon admission:

98.2  102  137/89  19  98% room air

Gen: No active distress
Head/Eyes: Pupils equal and reactive to light, extraocular
movements intact
ENT: Oropharynx clear, no jugular venous distention
Chest: Clear to auscultation bilaterally
CV: Regular rate, tachycardic
Abd: Soft, non-distended, +colostomy with yellow/green output,
no cellulitis, drain at right lower quadrant
MSK: Full range of motion 5/5 strength upper and lower
extremities, deep tendon reflexes 2+ bilateral, senstations
intact
Neuro: CN's III-XII intact
Psych: Alert and oriented to time, place, and person

Pertinent Results:
Abdominal and Pelvic CT scan [**3-29**]:
IMPRESSION:
1. Patent IVC without filling defects.
2. Previously seen fluid collections in the abdomen have
resolved.

Bilateral lower extremity ultrasound [**3-29**]:
IMPRESSION:
1. No evidence of thrombosis in the deep veins of either lower
extremity.
2. Relatively low-amplitude waveforms with reportedly "sluggish
flow" in all lower extremity veins; however, the overall
appearance is unchanged since the [**2103-3-14**] examination. Central
(eg. IVC) non-occlusive thrombus cannot be completely excluded
by this examination.

CT chest [**3-29**]:
IMPRESSION:
1. Bilateral large lobar pulmonary emboli.
2. Bilateral basal wedge-shaped parenchymal opacities, left
greater than right, worrisome for pulmonary infarctions.

Chest X-ray [**3-29**]:
IMPRESSION: New focal airspace process at the left lung base,
associated with low lung volumes and prominence of the central
pulmonary arteries, which may reflect pulmonary hypertension.
This likely at least in part, corresponds to the organized
pulmonary infarct in the left lower lobe, in the setting of
massive acute pulmonary embolism

Echo [**3-29**]:
Conclusions:
The left atrium is normal in size. Left ventricular wall
thicknesses are
normal. The left ventricular cavity size is normal. Left
ventricular systolic
function is hyperdynamic (EF 70-80%). There is no ventricular
septal defect.
Right ventricular chamber size and free wall motion are normal.
The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and
no aortic regurgitation. The mitral valve appears structurally
normal with
trivial mitral regurgitation. There is no pericardial effusion.


CT abscessogram [**3-31**]:
FINDINGS: The contrast appears to have filled some of the small
bowel indicating communication of the pigtail with the small
bowel.
IMPRESSION:
1. Injection of contrast into pigtail reveals opacification of
some small bowel. This tube may be left in situ for a total of
three weeks after which a tract may be formed and the tube can
then be removed similar to a jejunostomy.
2. Left iliac fossa stoma.
3. Bilateral atelectasis, left more than right.

Admission labs:
[**2103-3-29**] 07:30AM BLOOD WBC-11.9* RBC-3.96* Hgb-11.7* Hct-34.4*
MCV-87 MCH-29.6 MCHC-34.1 RDW-14.8 Plt Ct-337
[**2103-3-29**] 07:30AM BLOOD Neuts-78.3* Lymphs-13.7* Monos-5.4
Eos-2.3 Baso-0.2
[**2103-3-29**] 07:30AM BLOOD PT-13.2* PTT-25.1 INR(PT)-1.2*
[**2103-3-29**] 07:30AM BLOOD Glucose-105 UreaN-7 Creat-0.9 Na-140
K-4.2 Cl-103 HCO3-26 AnGap-15
[**2103-3-29**] 07:30AM BLOOD CK(CPK)-63
[**2103-3-29**] 07:30AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2103-3-29**] 07:30AM BLOOD Calcium-9.5 Phos-4.5 Mg-1.9

Discharge labs:
[**2103-4-5**] 06:40AM BLOOD WBC-7.7 RBC-3.75* Hgb-10.8* Hct-32.3*
MCV-86 MCH-28.7 MCHC-33.4 RDW-14.8 Plt Ct-453*#
[**2103-4-10**] 06:45AM BLOOD PT-21.5* PTT-107.9* INR(PT)-2.1*
[**2103-4-9**] 01:11PM BLOOD Type-ART pO2-88 pCO2-38 pH-7.46*
calTCO2-28 Base XS-2

Brief Hospital Course:
Mr. [**Known lastname 2026**] was admitted to the ICU, he was NPO with intravenous
hydration, Dilaudid PCA, Heparin drip; he was oxygenating well
on supplemental oxygen, his ostomy was functioning well and his
abscess drain was intact with bilious drainage. An echo
demonstrated his EF > 75% with hyperdynamic left ventricular
function and normal right ventricular size and motion, bilateral
lower extremity ultrasound was negative for a thrombus. HD 3,
his chest pain and shortness of breath had improved, he was
transferred to an in-patient nursing unit, his diet was
advanced, he had good pain control with oral Dilaudid, the
Heparin drip was adjusted with serial PTT's goal between 60 and
80; an abscessogram demonstrated the catheter to be in
communication with the small bowel with resolution of fluid
collections. HD 5, he was made NPO for 48 hrs, Octreotide was
started, and the drain was removed. HD 7, his diet was advanced
which he tolerated well, Octreotide was stopped; Coumadin
therapy was initiated with dosage adjustments made on Heparin
drip. HD 13, his INR was therapeutic at 2.1, the Heparin drip
was discontinued, he was tolerating a regular diet, remained
afebrile, ambulating independently, and oxygenating well on room
air. He was discharged home in good condition on [**4-10**], with
instructions to have his PT and INR checked twice a week
starting [**4-11**], and close follow-up with a PCP [**Name Initial (PRE) 3380**] [**4-12**]. He
was provided prescriptions for Coumadin, Percocet, PT/INR draws,
and Ambien. He was to follow-up with Dr. [**Last Name (STitle) 1120**] in [**12-26**] weeks.

Medications on Admission:
Colace
Percocet

Discharge Medications:
1. Blood draws  Sig: PT, INR  Process STAT   Twice a week: Start
[**4-11**], fax results to Dr.[**Last Name (STitle) 3381**] [**Hospital1 18**]
[**Telephone/Fax (1) 3382**]
phone#[**Telephone/Fax (1) 250**].
[**Telephone/Fax (1) **]:*14 * Refills:*2*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
[**Telephone/Fax (1) **]:*20 Tablet(s)* Refills:*0*
3. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
[**Telephone/Fax (1) **]:*10 Tablet(s)* Refills:*0*
4. Coumadin 5 mg Tablet Sig: 1.5 Tablets PO at bedtime: Unless
dose changed by PCP.
[**Name Initial (NameIs) **]:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Pulmonary embolus


Discharge Condition:
Good


Discharge Instructions:
Notify MD or return to the emergency department if you
experience:

*Increased or persistent pain
*Fever > 101.5
*Bleeding or bruising from any part of the body
*Shortness of breath or chest pain
*Nausea, vomiting, abdominal distention, increased or decreased
ostomy outputs, change in color or appearance of stoma
*Any other concerns

No driving or alcohol use while taking pain medication

You may shower and wash incision with soap and water, pat dry
Allow white paper strips to peel away on their own
No swimming or tub baths
You should slowly start to resume your daily activities

Please take the Coumadin as directed in the evening, do not skip
any doses, your PCP will adjust the dose depending on your blood
levels
Please be sure to have your blood drawn twice a week, starting
Wed. [**4-11**]
You can go to the lab at [**Hospital3 3383**] Hospital
[**Location (un) 3384**]
[**Location (un) 686**], [**Numeric Identifier 3385**]
[**Telephone/Fax (1) 3386**]

Please keep all scheduled appointments

Followup Instructions:
BuildingProvider: Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD
Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2103-4-12**] 9:30, [**Location (un) 3387**], [**Location (un) **] [**Hospital Ward Name 23**] Building

Provider: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2103-4-16**] 2:00, [**Location (un) 830**], [**Location (un) **] [**Hospital Ward Name 23**]




Completed by:[**2103-4-10**]
{'Other pulmonary embolism and infarction,Tobacco use disorder,Colostomy status,Intestinal bypass or anastomosis status'}


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: Chest pain and shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 2026**] is a 33 year old male who was transferred to [**Hospital1 18**]-ED
on [**3-29**] after developing chest pain and shortness of breath, a
code blue was called while on [**Hospital Ward Name **] for out-patient CT
scan. He is well known to the surgical service, he has a past
medical history significant for sigmoid diverticulitis s/p
laparoscopic sigmoid colectomy. CT scan of chest demonstrated
bilateral pulmonary emboli, he was oxygenating well on nasal
cannula, an intravenous Heparin drip was started and he was
transferred to the ICU for close monitoring.

MEDICAL HISTORY: Past Surgical History:

MEDICATION ON ADMISSION: Colace
Percocet

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:

FAMILY HISTORY: HTN and DM

SOCIAL HISTORY: Smokes half a pack a day of tobacco. Alcohol rarely. No IV drug
use 

### Response:
{'Other pulmonary embolism and infarction,Tobacco use disorder,Colostomy status,Intestinal bypass or anastomosis status'}
