CHIEF COMPLAINT: The patient came in with hematemesis,
melanotic stools.

PRESENT ILLNESS: This is an 83 year old female
with past medical history of cerebrovascular accident,
congestive heart failure, hypertension, prior seizure
disorder treated one month ago for congestive heart failure
flare, diagnosed at [**Hospital6 256**] in
the Emergency Department by chest x-ray.  The patient had two
episodes of hematemesis and multiple episodes of melena.  The
patient was admitted to the Emergency Department from the
nursing home PD.  No 1:2 contact and could not communicate
well with anyone at the nursing home.  In the Emergency Room
the patient had one episode of hypotension.  A right internal
jugular central line was placed.  The patient had nasogastric
lavage which was grossly bloody with no clots.  The patient
received 1.9 liters of fluid and was hemodynamically stable.
The patient also received 5 mg Vitamin K subcutaneously.  The
patient received 1 unit of fresh frozen plasma in the
Emergency Department and 1 unit of fresh frozen plasma on the
way to the unit.  The patient was Do-Not-Resuscitate,
Do-Not-Intubate and the patient had no shortness of breath or
chest pain.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Congestive heart failure, unspecified,Other convulsions,Hyperosmolality and/or hypernatremia,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Coronary atherosclerosis of native coronary artery,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Obesity, unspecified
Chr duoden ulcer w hem,CHF NOS,Convulsions NEC,Hyperosmolality,Gstr/ddnts NOS w/o hmrhg,Crnry athrscl natve vssl,Depressive disorder NEC,Hypertension NOS,Obesity NOS
Admission Date:  [**2130-7-3**]       Discharge Date:  [**2130-7-6**]


Service:  Medicine Intensive Care Unit - Green

CHIEF COMPLAINT:  The patient came in with hematemesis,
melanotic stools.

HISTORY OF PRESENT ILLNESS:  This is an 83 year old female
with past medical history of cerebrovascular accident,
congestive heart failure, hypertension, prior seizure
disorder treated one month ago for congestive heart failure
flare, diagnosed at [**Hospital6 256**] in
the Emergency Department by chest x-ray.  The patient had two
episodes of hematemesis and multiple episodes of melena.  The
patient was admitted to the Emergency Department from the
nursing home PD.  No 1:2 contact and could not communicate
well with anyone at the nursing home.  In the Emergency Room
the patient had one episode of hypotension.  A right internal
jugular central line was placed.  The patient had nasogastric
lavage which was grossly bloody with no clots.  The patient
received 1.9 liters of fluid and was hemodynamically stable.
The patient also received 5 mg Vitamin K subcutaneously.  The
patient received 1 unit of fresh frozen plasma in the
Emergency Department and 1 unit of fresh frozen plasma on the
way to the unit.  The patient was Do-Not-Resuscitate,
Do-Not-Intubate and the patient had no shortness of breath or
chest pain.

PHYSICAL EXAMINATION:  On physical examination the patient
had a temperature of 97.  The patient had a blood pressure of
116/63, pulse of 80, respiratory rate of 21 and was sating
96% on room air.  Pertinent physical findings revealed the
patient's chest was clear to auscultation bilaterally.
Heart, regular rate and rhythm, no murmurs, rubs or gallops.
Abdomen was soft and obese and she had some right upper
quadrant tenderness.  Extremities were 1+ edema bilateral
lower.  Neurologically she had some right facial weakness,
otherwise cranial nerves were grossly intact.

LABORATORY DATA:  She came in with a hematocrit of 31.6 and
an INR of 4.2.  The patient had a chest x-ray which showed a
right venous catheter and bilateral mid to lower lung sound
atelectasis.  The patient had electrocardiogram, sinus at 96
with normal axis, normal intervals, no ST-T wave changes
except for flip Ts in 1 and AVL which were consistent with
previous electrocardiogram.

HOSPITAL COURSE:  The patient was admitted to the Medicine
Intensive Care Unit and diagnosed with gastrointestinal
bleed.  The patient received 2 units of blood and a total of
4 units of fresh frozen plasma over the course of the stay
for the gastrointestinal bleed.  On [**7-6**], the patient
underwent an upper esophagogastroduodenoscopy that showed
gastritis and two ulcers in the duodenal bulb which were not
given any treatment.  There was no blood and they stabilized
on their own.  The patient also received Protonix 40 mg
intravenously b.i.d.

Cardiac - The patient has a history of congestive heart
failure, coronary artery disease, kept hematocrit greater
than 30 with 2 units of packed red blood cells and gave only
careful hydration, one bolus of 250 cc.  The patient also had
Zestril changes to Captopril in case of bleed.  That should
be decided by outpatient doctor, what to do with cardiac
medications.

Chest - We monitored the patient for congestive heart
failure.  The patient was fine.

Heme - The patient received fresh frozen plasma and packed
red blood cells as previously stated.  The patient also
received Vitamin K as previously stated.  INR was reduced to
1.3.  The patient is to have Pneuma boots in [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **]
rather than Coumadin because of bleed risk.  Outpatient
doctor [**First Name (Titles) **] [**Last Name (Titles) 11197**] in future for Coumadin.

Neurological - The patient had previous cerebrovascular
accident and we continued on Phenobarbital and Prozac with
seizure history.

Infectious disease - No issues.

Genitourinary - The patient had Foley catheter placed to
monitor intake and output.  Electrolytes were monitored over
the course of the stay.  The patient had a brief episode of
hypernatremia treated with free water.  The patient prepared
for discharge with discontinuation of right internal jugular
line, central line, right nasal cannula, Foley catheter and
Telemetry.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Back to [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **], already talked to
the nurse on the floor.

DISCHARGE DIAGNOSIS:
1.  Upper gastrointestinal bleed due to duodenal bulb ulcers

DISCHARGE MEDICATIONS:
1.  Pantoprazole 40 mg p.o. q. 12 hours
2.  Phenobarbital 90 mg p.o. q. AM
3.  Fluoxetine 20 mg p.o. q.d.
4.  Colace 100 mg p.o. b.i.d. prn

The patient did not receive ACE inhibitors in-house on [**7-6**] due to low blood pressure.  Outpatient doctor to decide,
though the patient's pressure remains low.



                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 968**]

Dictated By:[**Name8 (MD) 23023**]
MEDQUIST36

D:  [**2130-7-6**]  11:53
T:  [**2130-7-6**]  14:23
JOB#:  [**Job Number 31671**]
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Congestive heart failure, unspecified,Other convulsions,Hyperosmolality and/or hypernatremia,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Coronary atherosclerosis of native coronary artery,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Obesity, unspecified'}


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: The patient came in with hematemesis,
melanotic stools.

PRESENT ILLNESS: This is an 83 year old female
with past medical history of cerebrovascular accident,
congestive heart failure, hypertension, prior seizure
disorder treated one month ago for congestive heart failure
flare, diagnosed at [**Hospital6 256**] in
the Emergency Department by chest x-ray.  The patient had two
episodes of hematemesis and multiple episodes of melena.  The
patient was admitted to the Emergency Department from the
nursing home PD.  No 1:2 contact and could not communicate
well with anyone at the nursing home.  In the Emergency Room
the patient had one episode of hypotension.  A right internal
jugular central line was placed.  The patient had nasogastric
lavage which was grossly bloody with no clots.  The patient
received 1.9 liters of fluid and was hemodynamically stable.
The patient also received 5 mg Vitamin K subcutaneously.  The
patient received 1 unit of fresh frozen plasma in the
Emergency Department and 1 unit of fresh frozen plasma on the
way to the unit.  The patient was Do-Not-Resuscitate,
Do-Not-Intubate and the patient had no shortness of breath or
chest pain.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Congestive heart failure, unspecified,Other convulsions,Hyperosmolality and/or hypernatremia,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Coronary atherosclerosis of native coronary artery,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Obesity, unspecified'}
