CHIEF COMPLAINT: Respiratory distress, hypotension.

PRESENT ILLNESS: 81 yo man with a h/o COPD who presented to [**Hospital 1474**] hospital
today with cough for the past few days and fevers to 102. He was
noted to have SBP 90's, tachypnea, sat 89% on RA. He was given
500cc NS and was intbuated. He was given ceftriaxone and
azithromycin. He was started on peripheral levophed. He was
transferred to [**Hospital1 18**]. Per his family he has had 6-7 episodes of
PNA in the past 3 years. He was discharged from [**Hospital 28159**]
Hospital 3 weeks ago from the most recent episode. He has never
been intubated with PNA previously. He has not had a speech and
swallow eval per family. There also was concern for urinary
tract infections in the past.
.
On arrival VS: BP 101/52, HR 82, RR 18, sat 98%, Temp 99.2
rectal. He had a RIJ sepsis catheter placed. He was given 1 gm
vancomycin, and 6mg versed iv. He was continued on levophed,
though this was decreased prior to transfer (BP in ED
110-120's). He was given 3.2L NS and had 600cc UOP. Blood
cultures were drawn and sent.
.
ROS: Nods no to chest pain, abdominal pain, HA; nods yes to
needing inhaler.

MEDICAL HISTORY: Nods yes to: COPD, ? GERD or esophageal c/o, leg pain/OA, h/o
CVA; nods no to CAD, atrial fibrilation, CHF.
Per family: hyperlipidemia, COPD with recurrent PNA, s/p brain
surgery to excise non-malignant tumor encasing brain stem in
[**2177**] at [**Hospital1 2025**], CVA [**2161**] with no residual deficits, s/p hip
replacement [**2179**], elevated PSA.

MEDICATION ON ADMISSION: per family has difficulty swallowing pills (must crush them,
always has)
zocor 40mg daily
aspirin 81mg daily
protonix 40mg daily
sertraline 50mg daily
trospium chloride 20mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afebrile, on room air, normotensive, in no respiratory
distress
Gen: Elderly, NAD
HEENT -- dentures, right IJ TLC removed with dressing intact
Heart -- regular
Lungs -- left base with crackles, right mid lung with decreased
sounds and soft rales
Abd -- obese, benign
Ext -- no edema, lesion or rash

FAMILY HISTORY: Lives alone with very close friend and multiple family memebers
near by. Rare etoh (last thought to be 18 years ago per family)
but does make wine. Ex-smoker, quit [**2161**].

SOCIAL HISTORY: Lives alone with very close friend and multiple family memebers
near by. Rare etoh (last thought to be 18 years ago per family)
but does make wine. Ex-smoker, quit [**2161**].
Acute respiratory failure,Pneumonia, organism unspecified,Unspecified septicemia,Sepsis,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Esophageal reflux,Other functional disorder of bladder
Acute respiratry failure,Pneumonia, organism NOS,Septicemia NOS,Sepsis,Chr airway obstruct NEC,Hyperlipidemia NEC/NOS,Depressive disorder NEC,Esophageal reflux,Oth func dsdr bladder
Admission Date:  [**2183-10-9**]              Discharge Date:   [**2183-10-12**]

Date of Birth:  [**2101-10-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 358**]
Chief Complaint:
Respiratory distress, hypotension.

Major Surgical or Invasive Procedure:
none


History of Present Illness:
81 yo man with a h/o COPD who presented to [**Hospital 1474**] hospital
today with cough for the past few days and fevers to 102. He was
noted to have SBP 90's, tachypnea, sat 89% on RA. He was given
500cc NS and was intbuated. He was given ceftriaxone and
azithromycin. He was started on peripheral levophed. He was
transferred to [**Hospital1 18**]. Per his family he has had 6-7 episodes of
PNA in the past 3 years. He was discharged from [**Hospital 28159**]
Hospital 3 weeks ago from the most recent episode. He has never
been intubated with PNA previously. He has not had a speech and
swallow eval per family. There also was concern for urinary
tract infections in the past.
.
On arrival VS: BP 101/52, HR 82, RR 18, sat 98%, Temp 99.2
rectal. He had a RIJ sepsis catheter placed. He was given 1 gm
vancomycin, and 6mg versed iv. He was continued on levophed,
though this was decreased prior to transfer (BP in ED
110-120's). He was given 3.2L NS and had 600cc UOP. Blood
cultures were drawn and sent.
.
ROS: Nods no to chest pain, abdominal pain, HA; nods yes to
needing inhaler.

Past Medical History:
Nods yes to: COPD, ? GERD or esophageal c/o, leg pain/OA, h/o
CVA; nods no to CAD, atrial fibrilation, CHF.
Per family: hyperlipidemia, COPD with recurrent PNA, s/p brain
surgery to excise non-malignant tumor encasing brain stem in
[**2177**] at [**Hospital1 2025**], CVA [**2161**] with no residual deficits, s/p hip
replacement [**2179**], elevated PSA.


Social History:
Lives alone with very close friend and multiple family memebers
near by. Rare etoh (last thought to be 18 years ago per family)
but does make wine. Ex-smoker, quit [**2161**].

Family History:
Lives alone with very close friend and multiple family memebers
near by. Rare etoh (last thought to be 18 years ago per family)
but does make wine. Ex-smoker, quit [**2161**].

Physical Exam:
VS: afebrile, on room air, normotensive, in no respiratory
distress
Gen: Elderly, NAD
HEENT -- dentures, right IJ TLC removed with dressing intact
Heart -- regular
Lungs -- left base with crackles, right mid lung with decreased
sounds and soft rales
Abd -- obese, benign
Ext -- no edema, lesion or rash

Pertinent Results:
[**2183-10-9**] 12:00PM   PT-14.2* PTT-28.3 INR(PT)-1.2*
[**2183-10-9**] 12:00PM   PLT SMR-NORMAL PLT COUNT-315
[**2183-10-9**] 12:00PM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2183-10-9**] 12:00PM   NEUTS-88* BANDS-8* LYMPHS-1* MONOS-2 EOS-0
BASOS-0 ATYPS-0 METAS-1* MYELOS-0
[**2183-10-9**] 12:00PM   WBC-20.1* RBC-4.67 HGB-14.2 HCT-41.0 MCV-88
MCH-30.3 MCHC-34.5 RDW-14.8
[**2183-10-9**] 12:00PM   CALCIUM-8.2* PHOSPHATE-2.1* MAGNESIUM-2.2
[**2183-10-9**] 12:00PM   CK-MB-NotDone proBNP-554
[**2183-10-9**] 12:00PM   cTropnT-0.05*
[**2183-10-9**] 12:00PM   CK(CPK)-90
[**2183-10-9**] 12:00PM   estGFR-Using this
[**2183-10-9**] 12:00PM   GLUCOSE-132* UREA N-19 CREAT-1.0 SODIUM-142
POTASSIUM-3.8 CHLORIDE-107 TOTAL CO2-23 ANION GAP-16
[**2183-10-9**] 12:16PM   LACTATE-1.6
[**2183-10-9**] 04:17PM   HGB-14.3 calcHCT-43 O2 SAT-91
[**2183-10-9**] 04:25PM   TYPE-ART PO2-166* PCO2-35 PH-7.35 TOTAL
CO2-20* BASE XS--5 INTUBATED-INTUBATED
[**2183-10-9**] 06:47PM   PLT COUNT-297
[**2183-10-9**] 06:47PM   WBC-22.9* RBC-4.53* HGB-13.4* HCT-41.1 MCV-91
MCH-29.7 MCHC-32.7 RDW-14.0
[**2183-10-9**] 06:47PM   CORTISOL-60.2*
[**2183-10-9**] 06:47PM   ALBUMIN-3.4 CALCIUM-7.5* PHOSPHATE-2.7
MAGNESIUM-2.2
[**2183-10-9**] 06:47PM   ALT(SGPT)-14 AST(SGOT)-14 LD(LDH)-152 ALK
PHOS-56 TOT BILI-0.4
[**2183-10-9**] 06:47PM   GLUCOSE-158* UREA N-13 CREAT-0.7 SODIUM-140
POTASSIUM-3.8 CHLORIDE-110* TOTAL CO2-21* ANION GAP-13
[**2183-10-9**] 08:05PM   O2 SAT-98
[**2183-10-9**] 08:05PM   TYPE-ART PO2-113* PCO2-30* PH-7.43 TOTAL
CO2-21 BASE XS--2
.
Studies:
CXR [**2183-10-9**]: S/p RIJ placement, ETT 4 cm above carina, no
pneumothorax, RLL consolidation, low-lung volumes, ? also LLL
infiltrate.
.
ECG [**2183-10-9**]: Ectopic atrial bradycardia (does not appear
sinus), left axis (-7), NL intervals, no ischemic changes (no
olds for comparison).
[**2183-10-12**] 06:36AM BLOOD WBC-10.0 RBC-4.79 Hgb-14.9# Hct-43.1
MCV-90 MCH-31.0 MCHC-34.5 RDW-14.3 Plt Ct-278
[**2183-10-12**] 06:36AM BLOOD Glucose-93 UreaN-18 Creat-0.9 Na-139
K-4.1 Cl-104 HCO3-25 AnGap-14

Brief Hospital Course:
# Community Acquired Pneumonia/Sepsis/Respiratory failure:
Initially admitted to the ICU, as was transferred intubated.
Treated with IV vancomycin, ceftriaxone and azithromycin.
Improved rapidly and extubated, transferred to the floor on the
hospital medicine team.  He was transitioned to oral
antibiotics, weaned off oxygen and continued to do well.  He
showed no overt evidence of aspiration, but did not undergo a
formal swallow evaluation because of the holiday weekend and his
eagerness for discharge.  He was advised to discuss a barium
swallow with his primary physician and schedule an evaluation at
his/her discretion.  His recurrent pneumonia may be related to
his underlying lung disease rather than aspiration.  He will
finish a total of 14 days of antibiotics, discharged on
cefpodoxime and azithromycin.  His sputum culture, urinary
legionella antigen and blood cultures were negative for a
source.
.
# COPD:
- scheduled albuterol and ipratropium nebs.
.
# Hyperlipidemia: simvastatin.
.
# Bladder muscle dysfunction: Substituted sanctura with ditropan
in house since we don't carry sanctura.
.
# Depression: continued sertraline.
.
# GERD: Continued pantoprazole.
.


Medications on Admission:
per family has difficulty swallowing pills (must crush them,
always has)
zocor 40mg daily
aspirin 81mg daily
protonix 40mg daily
sertraline 50mg daily
trospium chloride 20mg daily

Discharge Medications:
1. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Oxybutynin Chloride 5 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
6. Cefpodoxime 200 mg Tablet Sig: One (1) Tablet PO twice a day
for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
7. Azithromycin 250 mg Tablet Sig: One (1) Tablet PO once a day
for 3 days.
Disp:*3 Tablet(s)* Refills:*0*
8. Albuterol 90 mcg/Actuation Aerosol Sig: [**11-19**]  Inhalation every
four (4) hours as needed for shortness of breath or wheezing.
Disp:*1 inhaler* Refills:*0*
9. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: One (1)
Inhalation twice a day.
Disp:*1 inhaler* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
community acquired pneumonia


Discharge Condition:
stable, on room air


Discharge Instructions:
You were hospitalized with a pneumonia.  Please finish all the
antibiotics prescribed.  If you have fever, shortness of breath,
increasing cough or other difficulties, please contact your
primary physician or return to the emergency department.

Followup Instructions:
Call Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 75671**] to make an appointment
in the next 1-2 weeks.

You may benefit from a barium swallow evaluation to make sure
you are not aspirating food.
{'Acute respiratory failure,Pneumonia, organism unspecified,Unspecified septicemia,Sepsis,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Esophageal reflux,Other functional disorder of bladder'}


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: Respiratory distress, hypotension.

PRESENT ILLNESS: 81 yo man with a h/o COPD who presented to [**Hospital 1474**] hospital
today with cough for the past few days and fevers to 102. He was
noted to have SBP 90's, tachypnea, sat 89% on RA. He was given
500cc NS and was intbuated. He was given ceftriaxone and
azithromycin. He was started on peripheral levophed. He was
transferred to [**Hospital1 18**]. Per his family he has had 6-7 episodes of
PNA in the past 3 years. He was discharged from [**Hospital 28159**]
Hospital 3 weeks ago from the most recent episode. He has never
been intubated with PNA previously. He has not had a speech and
swallow eval per family. There also was concern for urinary
tract infections in the past.
.
On arrival VS: BP 101/52, HR 82, RR 18, sat 98%, Temp 99.2
rectal. He had a RIJ sepsis catheter placed. He was given 1 gm
vancomycin, and 6mg versed iv. He was continued on levophed,
though this was decreased prior to transfer (BP in ED
110-120's). He was given 3.2L NS and had 600cc UOP. Blood
cultures were drawn and sent.
.
ROS: Nods no to chest pain, abdominal pain, HA; nods yes to
needing inhaler.

MEDICAL HISTORY: Nods yes to: COPD, ? GERD or esophageal c/o, leg pain/OA, h/o
CVA; nods no to CAD, atrial fibrilation, CHF.
Per family: hyperlipidemia, COPD with recurrent PNA, s/p brain
surgery to excise non-malignant tumor encasing brain stem in
[**2177**] at [**Hospital1 2025**], CVA [**2161**] with no residual deficits, s/p hip
replacement [**2179**], elevated PSA.

MEDICATION ON ADMISSION: per family has difficulty swallowing pills (must crush them,
always has)
zocor 40mg daily
aspirin 81mg daily
protonix 40mg daily
sertraline 50mg daily
trospium chloride 20mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afebrile, on room air, normotensive, in no respiratory
distress
Gen: Elderly, NAD
HEENT -- dentures, right IJ TLC removed with dressing intact
Heart -- regular
Lungs -- left base with crackles, right mid lung with decreased
sounds and soft rales
Abd -- obese, benign
Ext -- no edema, lesion or rash

FAMILY HISTORY: Lives alone with very close friend and multiple family memebers
near by. Rare etoh (last thought to be 18 years ago per family)
but does make wine. Ex-smoker, quit [**2161**].

SOCIAL HISTORY: Lives alone with very close friend and multiple family memebers
near by. Rare etoh (last thought to be 18 years ago per family)
but does make wine. Ex-smoker, quit [**2161**]. 

### Response:
{'Acute respiratory failure,Pneumonia, organism unspecified,Unspecified septicemia,Sepsis,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Esophageal reflux,Other functional disorder of bladder'}
