CHIEF COMPLAINT: Hematoma s/p procedure

PRESENT ILLNESS: 80M with h/o HTN, HL, CAD, DM, presented for elective PTA and
stenting of right femoral/SFA, complicated by large hematoma
requiring ICU monitoring.
.
Pt with lower extremity pain with rest and activity and open
ulcers bilaterally since [**Month (only) **]/[**Month (only) 1096**]. Also reported swelling,
rednes and scaliness.  Pt referred for angiography after ABI on
left was 1.66, left CFA and SFA were biphasic on doppler, left
popliteal , DP and PT were monophasic.
.
Procedure was successful to RSFA (ballooned and stented) but
complicated by tear of branch of common femoral mid procedure
causing large hematoma. An angioseal was placed, protamine
given, pressure held on large hematoma. No aneurysm suspected.
.
ROS: Dizzy at baseline, denies SOB, CP, palpitation,
lightheadedness. Back pain at center, behind umbilicus.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:  CAD s/p LAD stenting in [**2163**]. Most recent
ETT [**11-25**]: no ischemia. LVEF 63%.
3. OTHER PAST MEDICAL HISTORY:
-- Possible AAA. [**2175-4-10**] u/s:  difficult study, no aneurysm
seen.
-- atrial fibrillation on Coumadin
-- PVD
   - [**2176-2-19**] noninvasive study: RLE: moderate to severe
atherosclerotic disease. Evidence of severe RSFA stenosis and/or
occlusion. Right ABI 0.31. LLE: Evidence for left SFA stenosis
and/or occlusion. ABI 1.66.
    -[**2176-2-20**] CT of pelvis and LE: right SFA mid vessel occlusion.
Left popliteal artery focal 70% calcific stenosis at the level
of
the patella.
-- Gout
-- Insomnia
-- Vitamin B12 deficiency
-- COPD
-- Tremor, unsteady gait s/p fall [**9-25**] with fractured right ribs
(has refused to see neurologist)
-- [**2166**], [**12-26**]: cellulitis
-- lumbar spondylosis
--  chronic back pain with possible compression fractures s/p
fall
-- full thickness right rotator cuff tear
-- Cataracts s/p surgery

MEDICATION ON ADMISSION: ALLOPURINOL 300 mg by mouth once a day
ATORVASTATIN 40 mg by mouth every evening
FLUTICASONE-SALMETEROL 250 mcg-50 mcg 1 puff twice a day
FUROSEMIDE 20 mg on M/W/F, 2 tablets all other days
GABAPENTIN 300 mg by mouth daily
L-METHYLFOLATE-VIT B12-VIT B6 2 mg-2.8 mg-25 mg by mouth daily
METFORMIN 500 mg by mouth twice a day
METOPROLOL TARTRATE 25 mg by mouth twice a day
OMEPRAZOLE 20 mg by mouth every morning
WARFARIN 6 mg by mouth every evening, last dose [**2176-2-23**] pre
angiogram
ASPIRIN 325 mg by mouth daily
CYANOCOBALAMIN 1,000 mcg by mouth daily
VIT C-VIT E-COPPER-ZNOX-LUTEIN [PRESERVISION] 226 mg-200 unit-[**Unit Number **]
mg-0.8 mg-34.8 mg by mouth twice a day
VITAMIN A-VITAMIN C-VIT E-MIN [OCUVITE] by mouth twice a day

ALLERGIES: Keflex

PHYSICAL EXAM: GENERAL: WDWN male in NAD. Oriented x3.  Frustrated

FAMILY HISTORY: Mother died of CHF at age 66

SOCIAL HISTORY: Patient is widowed and lives alone. He has five
children.  He has a history of multiple falls. He does not use a
cane or a walker.
Tobacco: Patient smoked for approximately 45 years. Quit
approximately 15 years ago.
ETOH: None
Hematoma complicating a procedure,Atherosclerosis of native arteries of the extremities with intermittent claudication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Long-term (current) use of anticoagulants,Gout, unspecified,Chronic airway obstruction, not elsewhere classified,Other B-complex deficiencies
Hematoma complic proc,Ath ext ntv at w claudct,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Atrial fibrillation,Long-term use anticoagul,Gout NOS,Chr airway obstruct NEC,B-complex defic NEC
Admission Date:  [**2176-2-29**]              Discharge Date:   [**2176-3-1**]

Date of Birth:  [**2095-3-29**]             Sex:   M

Service: MEDICINE

Allergies:
Keflex

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Hematoma s/p procedure

Major Surgical or Invasive Procedure:
Stenting of the Right Superficial Femoral Artery


History of Present Illness:
80M with h/o HTN, HL, CAD, DM, presented for elective PTA and
stenting of right femoral/SFA, complicated by large hematoma
requiring ICU monitoring.
.
Pt with lower extremity pain with rest and activity and open
ulcers bilaterally since [**Month (only) **]/[**Month (only) 1096**]. Also reported swelling,
rednes and scaliness.  Pt referred for angiography after ABI on
left was 1.66, left CFA and SFA were biphasic on doppler, left
popliteal , DP and PT were monophasic.
.
Procedure was successful to RSFA (ballooned and stented) but
complicated by tear of branch of common femoral mid procedure
causing large hematoma. An angioseal was placed, protamine
given, pressure held on large hematoma. No aneurysm suspected.
.
ROS: Dizzy at baseline, denies SOB, CP, palpitation,
lightheadedness. Back pain at center, behind umbilicus.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:  CAD s/p LAD stenting in [**2163**]. Most recent
ETT [**11-25**]: no ischemia. LVEF 63%.
3. OTHER PAST MEDICAL HISTORY:
-- Possible AAA. [**2175-4-10**] u/s:  difficult study, no aneurysm
seen.
-- atrial fibrillation on Coumadin
-- PVD
   - [**2176-2-19**] noninvasive study: RLE: moderate to severe
atherosclerotic disease. Evidence of severe RSFA stenosis and/or
occlusion. Right ABI 0.31. LLE: Evidence for left SFA stenosis
and/or occlusion. ABI 1.66.
    -[**2176-2-20**] CT of pelvis and LE: right SFA mid vessel occlusion.
Left popliteal artery focal 70% calcific stenosis at the level
of
the patella.
-- Gout
-- Insomnia
-- Vitamin B12 deficiency
-- COPD
-- Tremor, unsteady gait s/p fall [**9-25**] with fractured right ribs
(has refused to see neurologist)
-- [**2166**], [**12-26**]: cellulitis
-- lumbar spondylosis
--  chronic back pain with possible compression fractures s/p
fall
-- full thickness right rotator cuff tear
-- Cataracts s/p surgery


Social History:
Patient is widowed and lives alone. He has five
children.  He has a history of multiple falls. He does not use a
cane or a walker.
Tobacco: Patient smoked for approximately 45 years. Quit
approximately 15 years ago.
ETOH: None

Family History:
Mother died of CHF at age 66


Physical Exam:
GENERAL: WDWN male in NAD. Oriented x3.  Frustrated

HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, dry mucus membranes

NECK: JVP not elevated

CARDIAC:  irregular rhythm, rate 50s

LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB

ABDOMEN: Soft, NTND. No HSM or tenderness.

EXTREMITIES: No c/c/e. Left large groin hematoma with dark
ecchymosis, no tenderness

SKIN:  Back with no bruising or signs of retroperitoneal
bleeding


Pertinent Results:
[**2176-2-29**] 09:42PM BLOOD WBC-9.5 RBC-3.91* Hgb-11.7* Hct-35.0*
MCV-90 MCH-29.8 MCHC-33.3 RDW-16.7* Plt Ct-143*
[**2176-3-1**] 06:11AM BLOOD WBC-10.7 RBC-3.85* Hgb-12.0* Hct-34.9*
MCV-91 MCH-31.1 MCHC-34.3 RDW-17.1* Plt Ct-158
[**2176-2-29**] 08:15AM BLOOD PT-14.4* INR(PT)-1.2*
[**2176-2-29**] 09:42PM BLOOD Glucose-109* UreaN-28* Creat-1.4* Na-139
K-4.1 Cl-99 HCO3-31 AnGap-13
[**2176-3-1**] 06:11AM BLOOD Glucose-100 UreaN-25* Creat-1.3* Na-142
K-4.0 Cl-101 HCO3-31 AnGap-14
[**2176-2-29**] 09:42PM BLOOD CK(CPK)-65

Cardiology Report	Cardiac Cath	Study Date of [**2176-2-29**]
FINAL DIAGNOSIS:
1. Peripheral artery disease.
2. Successful PTA and stenting of the RSFA with a 8.0x60mm
Zilver stent
that was postdilated with a 6.0x20mm Viatrac balloon. Final
angiography
revealed no residual stenosis, no angiographically apparent
dissection
and good distal flow (see PTA comments).
3. Successful deployment of angioseal closure device.

Radiology Report	CT ABDOMEN W/O CONTRAST	Study Date of [**2176-2-29**]
3:40 PM
PRELIMINARY REPORT
Large subcutaneous hematoma extending from the left groin access
site
inferiorly to the superior medial thigh, and superiorly to the
left iliac
crest. No retroperitoneal blood

Radiology Report	FEMORAL VASCULAR US LEFT	Study Date of [**2176-3-1**]
9:06 AM
No pseudoaneurysm identified in the left groin. A limited
examination was performed due to the large infiltrative hematoma
in the left
groin. No discrete collection identified.

Brief Hospital Course:
Mr. [**Known lastname 13469**] is an 80 year old male with history of hypertension,
hyperlipidemia, CAD, diabetes, who presented for elective
percutaneous transluminal angioplasty and stenting of right
superficial femoral artery, complicated by large hematoma
requiring ICU monitoring.

# Left Groin Hematoma:
Patient was transfused two units of pRBCs, after which his
hematocrit remained stable.  His coumadin was held in the
setting of bleed, but his aspirin and plavix were continued in
the setting of recent stenting. Left groin ultrasound ruled out
aneurysm and AV fistula, and noncontrast CT scan ruled out
retroperitoneal bleed. CT scan showed extent of large hematoma
in subcutaneous tissue.

# Peripheral Vascular Disease:
Right Superficial Femoral Artery was successfully stented by
Interventional Cardiology. The patient was noted to have
complication of large left hematoma at the site of entry for the
procedure.  After the procedure, the patient's right foot was
noted to have strong dorsalis pedis pulse and was warm, well
perfused, while the left foot felt colder in comparison with
dopplerable pulses.
.
# Hypertension:
Home dose of metoprolol was held overnight in order to monitor
hemodynamic status more effectively and in setting of
bradycardia with ventricular rates in 50s; metoprolol was
restarted prior to discharge.  Patient may benefit from an ACE
inhibitor for renal and cardiac protection in the setting of
diabetes and heart disease if there are no contraindications to
its use in him.
.
# Hyperlipidemia:
Lipid panel was last checked in the [**Hospital1 18**] system in [**2163**], and
lipids appear to have been well controlled at that time.
Patient was continued on home dose atorvastatin during this
hospitalization.
.
# Coronary Artery Disease:
Patient was continued on aspiring, plavix, statin.  His
metoprolol was held overnight to monitor his hemodynamic status
and was restarted prior to discharge.
.

# Chronic renal insufficiency:
Patient presumed to have chronic renal insufficiency because
creatinine in [**2163**] in [**Hospital1 18**] system was 1.2, though patient may
have had acute issue at that time elevating creatinine; current
baseline renal function unclear. Creatinine 1.4 prior to
angiography, stable at 1.3 prior to discharge.  Creatinine
should be closely monitored after contrast load for procedure in
the setting of renal insufficiency.
.
# Diabetes Mellitus:
Patient's metformin was held during hospitalization and is to be
restarted the day after discharge.  His blood sugars were
monitored, and he was placed on an insulin sliding scale during
this hospitalization.
.
# Atrail Fibrillation:
Patient is on coumadin at home, which was held overnight in the
setting of bleed and restarted the next day when hematoma was
found to be stable.  Patient remained in slow atrial
fibrillation, rates in 50s during this hospitalization, likely
with some vagal response from groin hematoma.  Metoprolol was
held in the setting of already slow rate.

.
# COPD:
Home Advair was continued.
.
# Gout:
Patient was continued on home dose allopurinol.


Medications on Admission:
ALLOPURINOL 300 mg by mouth once a day
ATORVASTATIN 40 mg by mouth every evening
FLUTICASONE-SALMETEROL 250 mcg-50 mcg 1 puff twice a day
FUROSEMIDE 20 mg on M/W/F, 2 tablets all other days
GABAPENTIN 300 mg by mouth daily
L-METHYLFOLATE-VIT B12-VIT B6 2 mg-2.8 mg-25 mg by mouth daily
METFORMIN 500 mg by mouth twice a day
METOPROLOL TARTRATE 25 mg by mouth twice a day
OMEPRAZOLE 20 mg by mouth every morning
WARFARIN 6 mg by mouth every evening, last dose [**2176-2-23**] pre
angiogram
ASPIRIN 325 mg by mouth daily
CYANOCOBALAMIN 1,000 mcg by mouth daily
VIT C-VIT E-COPPER-ZNOX-LUTEIN [PRESERVISION] 226 mg-200 unit-[**Unit Number **]
mg-0.8 mg-34.8 mg by mouth twice a day
VITAMIN A-VITAMIN C-VIT E-MIN [OCUVITE] by mouth twice a day

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) puff Inhalation [**Hospital1 **] (2 times a day).
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
6. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO once a day.

7. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) puff Inhalation once a day.
8. Furosemide 20 mg Tablet Sig: as directed Tablet PO once a
day: please take 20mg (1 tab) on Mon, Wed, Fri, please take 40mg
(2 tabs) on Tue, [**Last Name (un) **], Sat, Sun.
9. L-Methylfolate-Vit B12-Vit B6 2.8-2-25 mg Tablet Sig: One (1)
Tablet PO once a day.
10. Metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day.

11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO
twice a day.
12. Famotidine 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
13. Vit C-Vit E-Copper-ZnOx-Lutein 226-200-5 mg-unit-mg Capsule
Sig: One (1) Capsule PO twice a day.
14. Vitamin A-Vitamin C-Vit E-Min     Tablet Sig: One (1) Tablet
PO twice a day.
15. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every six (6) hours as needed for pain for 15 doses.
Disp:*15 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
1. hematoma
2. PVD

Secondary Diagnoses:
1. Atrial fibrillation
2. COPD
3. Lumbar spondylosis


Discharge Condition:
Mental Status:Clear and coherent
Level of Consciousness:Alert and interactive
Activity Status:Ambulatory - Independent


Discharge Instructions:
Dear Mr. [**Known lastname 13469**],
You were admitted to the hospital after a procedure to stent an
artery in your right leg because you had a lot of bleeding into
your left groin that we wanted to monitor.  We transfused you
with two units of blood and monitored you overnight to make sure
your blood counts were stable and you did not continue to bleed.
Your blood counts were stable and you were discharged home. You
should not take your coumadin for the next three days. You will
be contact[**Name (NI) **] by Dr. [**Last Name (STitle) **] on Monday. If you do not hear from
 him by noon on Monday please call him at [**Telephone/Fax (1) 8725**]. Please
discuss restarting your coumadin at this appointment. Also,
please discuss whether an ACE inhibitor would be beneficial.

The following changes have been made to your medications:
- Stop coumadin until your appointment with Dr. [**Last Name (STitle) **] on
Monday**
- START plavix 75mg by mouth daily - please do not stop taking
this for any reason. Only your cardiologist should stop this
medication.
- Stop Omeprazole - as this medication interacts with plavix
- START famotidine 20mg by mouth daily

Please be sure to keep all of your followup appointments.

Please seek medical attention if you experience any symptoms
concerning to you.

Followup Instructions:
Please be sure to keep all of your followup appointments.

You will be contact[**Name (NI) **] by Dr.[**Name (NI) 8716**] office on Monday
[**2176-3-4**]. If you do not hear from his office by noon please call
them at [**Telephone/Fax (1) 8725**] and schedule an appointment immediately.
{'Hematoma complicating a procedure,Atherosclerosis of native arteries of the extremities with intermittent claudication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Long-term (current) use of anticoagulants,Gout, unspecified,Chronic airway obstruction, not elsewhere classified,Other B-complex deficiencies'}


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: Hematoma s/p procedure

PRESENT ILLNESS: 80M with h/o HTN, HL, CAD, DM, presented for elective PTA and
stenting of right femoral/SFA, complicated by large hematoma
requiring ICU monitoring.
.
Pt with lower extremity pain with rest and activity and open
ulcers bilaterally since [**Month (only) **]/[**Month (only) 1096**]. Also reported swelling,
rednes and scaliness.  Pt referred for angiography after ABI on
left was 1.66, left CFA and SFA were biphasic on doppler, left
popliteal , DP and PT were monophasic.
.
Procedure was successful to RSFA (ballooned and stented) but
complicated by tear of branch of common femoral mid procedure
causing large hematoma. An angioseal was placed, protamine
given, pressure held on large hematoma. No aneurysm suspected.
.
ROS: Dizzy at baseline, denies SOB, CP, palpitation,
lightheadedness. Back pain at center, behind umbilicus.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:  CAD s/p LAD stenting in [**2163**]. Most recent
ETT [**11-25**]: no ischemia. LVEF 63%.
3. OTHER PAST MEDICAL HISTORY:
-- Possible AAA. [**2175-4-10**] u/s:  difficult study, no aneurysm
seen.
-- atrial fibrillation on Coumadin
-- PVD
   - [**2176-2-19**] noninvasive study: RLE: moderate to severe
atherosclerotic disease. Evidence of severe RSFA stenosis and/or
occlusion. Right ABI 0.31. LLE: Evidence for left SFA stenosis
and/or occlusion. ABI 1.66.
    -[**2176-2-20**] CT of pelvis and LE: right SFA mid vessel occlusion.
Left popliteal artery focal 70% calcific stenosis at the level
of
the patella.
-- Gout
-- Insomnia
-- Vitamin B12 deficiency
-- COPD
-- Tremor, unsteady gait s/p fall [**9-25**] with fractured right ribs
(has refused to see neurologist)
-- [**2166**], [**12-26**]: cellulitis
-- lumbar spondylosis
--  chronic back pain with possible compression fractures s/p
fall
-- full thickness right rotator cuff tear
-- Cataracts s/p surgery

MEDICATION ON ADMISSION: ALLOPURINOL 300 mg by mouth once a day
ATORVASTATIN 40 mg by mouth every evening
FLUTICASONE-SALMETEROL 250 mcg-50 mcg 1 puff twice a day
FUROSEMIDE 20 mg on M/W/F, 2 tablets all other days
GABAPENTIN 300 mg by mouth daily
L-METHYLFOLATE-VIT B12-VIT B6 2 mg-2.8 mg-25 mg by mouth daily
METFORMIN 500 mg by mouth twice a day
METOPROLOL TARTRATE 25 mg by mouth twice a day
OMEPRAZOLE 20 mg by mouth every morning
WARFARIN 6 mg by mouth every evening, last dose [**2176-2-23**] pre
angiogram
ASPIRIN 325 mg by mouth daily
CYANOCOBALAMIN 1,000 mcg by mouth daily
VIT C-VIT E-COPPER-ZNOX-LUTEIN [PRESERVISION] 226 mg-200 unit-[**Unit Number **]
mg-0.8 mg-34.8 mg by mouth twice a day
VITAMIN A-VITAMIN C-VIT E-MIN [OCUVITE] by mouth twice a day

ALLERGIES: Keflex

PHYSICAL EXAM: GENERAL: WDWN male in NAD. Oriented x3.  Frustrated

FAMILY HISTORY: Mother died of CHF at age 66

SOCIAL HISTORY: Patient is widowed and lives alone. He has five
children.  He has a history of multiple falls. He does not use a
cane or a walker.
Tobacco: Patient smoked for approximately 45 years. Quit
approximately 15 years ago.
ETOH: None 

### Response:
{'Hematoma complicating a procedure,Atherosclerosis of native arteries of the extremities with intermittent claudication,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Long-term (current) use of anticoagulants,Gout, unspecified,Chronic airway obstruction, not elsewhere classified,Other B-complex deficiencies'}
