CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: [**Age over 90 **]F with with CBD stone, s/p CCY in [**11-1**] who is transferred to
[**Hospital Unit Name 153**] after arriving to ERCP suite in respiratory distress. She
initially presented to [**Hospital1 **] with worsening epigastric pain,
N/V, diarrhea, WBC 18, normal LFTs, amylase, lipase. She had a
failed ERCP there and was transferred to [**Hospital1 18**] surgical service.
On arrival to [**Hospital1 18**] on [**2128-12-24**], she was in rapid a.fib,
hypotensive, and had ST depressions on EKG. She converted after
5 IV lopressor and the hypotension resolved.  Her LFTs have been
in normal range. The plan was for her to have ERCP today to
removed the retained stones. On arrival to ERCP her RR was high
and she was satting in the low 80's on 2L liters NC,
hypertensive to systolic in 200s. Her CXR from this morning
shows new pleural effusions. She was put on 100% NRB and, given
nebs, lopressor, esmolol amd IV lasix and was transferred to he
[**Hospital Unit Name 153**] for further management.

MEDICAL HISTORY: cholelithiasis, s/p lap CCY [**11-1**], ERCP in [**11-1**] s/p partial
sphincterotomy and stent placment, c/b resp distress and CHF,
repeat ERCP on [**2128-12-7**] at [**Hospital1 **] with CBD stent, ?stent placed
in pancreatic duct.
[**2128-12-7**] admitted to [**Hospital1 **] with VRE bacteremia, ERCP done, stent
changed. started on linezolid, levoflox, flagyl
?gallbladder adeno ca in situ
CAD
CHF
afib
COPD ( on prednisone 15 mg QD at home)
DM
HTN
osteoarthritis
osteopenia
c.diff colitis currently being treated
VRE and enterocacter cloacae bacteremia [**2128-12-7**] on linezolid
.
PSH:
lap CCY [**11-1**], scars from unknown previous surgeries (?appy,
?hysterectomy)
Right hip replacment

MEDICATION ON ADMISSION: Meds on Admission:
cozaar 75', protonix 40', digoxin 0.125', norvasc 5', linezolid,
levoflox, flagyl, combivent, albuterol, atrovent, prednisone
15', vicodin, colace, FeSO4, MVI, vit C .
.
Meds on Tx:
lopressor 7.5 mg IV Q4
Flagyl
Linezolid
Ampicillin/sulbactam

ALLERGIES: Morphine / Nitrate / Cardizem

PHYSICAL EXAM: T 95.3, BP 165/63. HR 94, RR 36, 83% on RA, 98% on shovel tent
after nebs
Genl: tachypneic
HEENT: JVP about 8CM, OP dry, EOMI
CV: RRR + systolic murmur
Lungs: very tight, diffusely wheezy, no rhonchi
AbD: soft, NT, ND, +BS
Ext: no edema, 2+ pedal pulses
Neuro: following commands, answering questins, oriented to self,
place

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: former tobacco, no ETOH
Calculus of bile duct without mention of cholecystitis, with obstruction,Obstructive chronic bronchitis with (acute) exacerbation,Atrial fibrillation,Congestive heart failure, unspecified,Cholangitis,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Infection with microorganisms without mention of resistance to multiple drugs,Other specified antibiotics causing adverse effects in therapeutic use
Choledochlith NOS w obst,Obs chr bronc w(ac) exac,Atrial fibrillation,CHF NOS,Cholangitis,Urin tract infection NOS,Int inf clstrdium dfcile,DMII wo cmp nt st uncntr,Hypertension NOS,Inf mcr rst ot drg nt ml,Adv eff antibiotics NEC
Admission Date:  [**2128-12-24**]              Discharge Date:   [**2128-12-29**]


Service: MEDICINE

Allergies:
Morphine / Nitrate / Cardizem

Attending:[**First Name3 (LF) 11040**]
Chief Complaint:
Dyspnea


Major Surgical or Invasive Procedure:
none


History of Present Illness:
[**Age over 90 **]F with with CBD stone, s/p CCY in [**11-1**] who is transferred to
[**Hospital Unit Name 153**] after arriving to ERCP suite in respiratory distress. She
initially presented to [**Hospital1 **] with worsening epigastric pain,
N/V, diarrhea, WBC 18, normal LFTs, amylase, lipase. She had a
failed ERCP there and was transferred to [**Hospital1 18**] surgical service.
On arrival to [**Hospital1 18**] on [**2128-12-24**], she was in rapid a.fib,
hypotensive, and had ST depressions on EKG. She converted after
5 IV lopressor and the hypotension resolved.  Her LFTs have been
in normal range. The plan was for her to have ERCP today to
removed the retained stones. On arrival to ERCP her RR was high
and she was satting in the low 80's on 2L liters NC,
hypertensive to systolic in 200s. Her CXR from this morning
shows new pleural effusions. She was put on 100% NRB and, given
nebs, lopressor, esmolol amd IV lasix and was transferred to he
[**Hospital Unit Name 153**] for further management.




Past Medical History:
cholelithiasis, s/p lap CCY [**11-1**], ERCP in [**11-1**] s/p partial
sphincterotomy and stent placment, c/b resp distress and CHF,
repeat ERCP on [**2128-12-7**] at [**Hospital1 **] with CBD stent, ?stent placed
in pancreatic duct.
[**2128-12-7**] admitted to [**Hospital1 **] with VRE bacteremia, ERCP done, stent
changed. started on linezolid, levoflox, flagyl
?gallbladder adeno ca in situ
CAD
CHF
afib
COPD ( on prednisone 15 mg QD at home)
DM
HTN
osteoarthritis
osteopenia
c.diff colitis currently being treated
VRE and enterocacter cloacae bacteremia [**2128-12-7**] on linezolid
.
PSH:
lap CCY [**11-1**], scars from unknown previous surgeries (?appy,
?hysterectomy)
Right hip replacment

Social History:
former tobacco, no ETOH


Family History:
noncontributory

Physical Exam:
T 95.3, BP 165/63. HR 94, RR 36, 83% on RA, 98% on shovel tent
after nebs
Genl: tachypneic
HEENT: JVP about 8CM, OP dry, EOMI
CV: RRR + systolic murmur
Lungs: very tight, diffusely wheezy, no rhonchi
AbD: soft, NT, ND, +BS
Ext: no edema, 2+ pedal pulses
Neuro: following commands, answering questins, oriented to self,
place


Pertinent Results:
[**2128-12-29**] 04:44AM BLOOD WBC-5.3# RBC-2.94* Hgb-9.3* Hct-27.4*
MCV-93 MCH-31.5 MCHC-33.9 RDW-15.1 Plt Ct-79*
[**2128-12-24**] 11:25PM BLOOD WBC-14.6* RBC-3.63* Hgb-11.6* Hct-35.0*
MCV-96 MCH-31.8 MCHC-33.1 RDW-15.0 Plt Ct-126*
[**2128-12-28**] 02:06PM BLOOD Neuts-95.6* Lymphs-1.7* Monos-2.7 Eos-0.1
Baso-0
[**2128-12-29**] 04:44AM BLOOD Plt Ct-79*
[**2128-12-24**] 11:25PM BLOOD Plt Ct-126*
[**2128-12-24**] 11:25PM BLOOD PT-11.6 PTT-22.3 INR(PT)-1.0
[**2128-12-29**] 04:44AM BLOOD Glucose-120* UreaN-15 Creat-0.7 Na-142
K-3.9 Cl-106 HCO3-28 AnGap-12
[**2128-12-29**] 04:44AM BLOOD ALT-11 AST-18 AlkPhos-77 Amylase-40
TotBili-0.4
[**2128-12-29**] 04:44AM BLOOD Lipase-17
[**2128-12-28**] 05:53AM BLOOD CK-MB-NotDone cTropnT-0.12*
[**2128-12-29**] 04:44AM BLOOD Calcium-8.1* Phos-3.1 Mg-1.9
[**2128-12-28**] 05:53AM BLOOD Digoxin-0.7*
.
.
Imaging:
Markedly dilated common bile duct containing stones and sludge.
A biliary stent is positioned in the distal extrahepatic CBD
beyond the dilation.  Mild pancreatic and intrahepatic ductal
dilatation is also identified.
.
CT abd [**2128-12-24**] at [**Hospital1 **]
Catheter in small bowel likely the CBD stent. ductal dilation
within CBD.Diverticua, pericardial thikening,
.


Brief Hospital Course:
[**Age over 90 **] yo female with retained common bile duct stone, transferred
to [**Hospital1 18**] for ERPC after several failed attempts as OSH, who
became acutely SOB and wheezy en route to ERCP. She likely
develped a COPD flare and improved marginally with nebs and
solumedrol. Discussions with patient and her daughter confirmed
her DNR/DNI status and they decided ultimately to move to
hospice care. She did not have any symptoms of cholangitis but
was continued on unasyn while in house for prophylaxis, related
to her retained biliary stones. She completed a course of
linezolid for a VRE UTI. She also was diagnosed with c diff at
the outside hospital and was maintined on flagyl while in house.
She was not having any further diarrhea. We opted to discontinue
all antibiotics at discharge as she is now comfort measures
only. This is in line with goals of care per the patient and her
daughter. If she can take the prednisone it may help her
respiratory status/COPD flare.



Medications on Admission:
Meds on Admission:
cozaar 75', protonix 40', digoxin 0.125', norvasc 5', linezolid,
levoflox, flagyl, combivent, albuterol, atrovent, prednisone
15', vicodin, colace, FeSO4, MVI, vit C .
.
Meds on Tx:
lopressor 7.5 mg IV Q4
Flagyl
Linezolid
Ampicillin/sulbactam


Discharge Medications:
1. Hospice Consult
Please have hospice evaluate patient upon arrival
2. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
3. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q2H (every 2 hours) as needed.
4. Scopolamine Base 1.5 mg Patch 72HR Sig: One (1)  Transdermal
every seventy-two (72) hours as needed for secretions.
5. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
6. Oxycodone oral solution (20mg/ml) take 5-20 mg Q4 hours PO to
maintain ocmfort
7. Ativan oral solution (2 mg /ml) 0.5 mg- 2 mg Q6 PO hours to
maintain comfort


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **]healthcare center

Discharge Diagnosis:
Common bile duct stone
COPD flare
Atrial fibrillation


Discharge Condition:
Stable on 50% oxygen


Discharge Instructions:
Going back to nursing home, will be set up with hospice there.
We have provided rx for oral oxycodone solution and atival oral
solution

Followup Instructions:
Follow up with hospice care
{'Calculus of bile duct without mention of cholecystitis, with obstruction,Obstructive chronic bronchitis with (acute) exacerbation,Atrial fibrillation,Congestive heart failure, unspecified,Cholangitis,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Infection with microorganisms without mention of resistance to multiple drugs,Other specified antibiotics causing adverse effects in therapeutic use'}


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: Dyspnea

PRESENT ILLNESS: [**Age over 90 **]F with with CBD stone, s/p CCY in [**11-1**] who is transferred to
[**Hospital Unit Name 153**] after arriving to ERCP suite in respiratory distress. She
initially presented to [**Hospital1 **] with worsening epigastric pain,
N/V, diarrhea, WBC 18, normal LFTs, amylase, lipase. She had a
failed ERCP there and was transferred to [**Hospital1 18**] surgical service.
On arrival to [**Hospital1 18**] on [**2128-12-24**], she was in rapid a.fib,
hypotensive, and had ST depressions on EKG. She converted after
5 IV lopressor and the hypotension resolved.  Her LFTs have been
in normal range. The plan was for her to have ERCP today to
removed the retained stones. On arrival to ERCP her RR was high
and she was satting in the low 80's on 2L liters NC,
hypertensive to systolic in 200s. Her CXR from this morning
shows new pleural effusions. She was put on 100% NRB and, given
nebs, lopressor, esmolol amd IV lasix and was transferred to he
[**Hospital Unit Name 153**] for further management.

MEDICAL HISTORY: cholelithiasis, s/p lap CCY [**11-1**], ERCP in [**11-1**] s/p partial
sphincterotomy and stent placment, c/b resp distress and CHF,
repeat ERCP on [**2128-12-7**] at [**Hospital1 **] with CBD stent, ?stent placed
in pancreatic duct.
[**2128-12-7**] admitted to [**Hospital1 **] with VRE bacteremia, ERCP done, stent
changed. started on linezolid, levoflox, flagyl
?gallbladder adeno ca in situ
CAD
CHF
afib
COPD ( on prednisone 15 mg QD at home)
DM
HTN
osteoarthritis
osteopenia
c.diff colitis currently being treated
VRE and enterocacter cloacae bacteremia [**2128-12-7**] on linezolid
.
PSH:
lap CCY [**11-1**], scars from unknown previous surgeries (?appy,
?hysterectomy)
Right hip replacment

MEDICATION ON ADMISSION: Meds on Admission:
cozaar 75', protonix 40', digoxin 0.125', norvasc 5', linezolid,
levoflox, flagyl, combivent, albuterol, atrovent, prednisone
15', vicodin, colace, FeSO4, MVI, vit C .
.
Meds on Tx:
lopressor 7.5 mg IV Q4
Flagyl
Linezolid
Ampicillin/sulbactam

ALLERGIES: Morphine / Nitrate / Cardizem

PHYSICAL EXAM: T 95.3, BP 165/63. HR 94, RR 36, 83% on RA, 98% on shovel tent
after nebs
Genl: tachypneic
HEENT: JVP about 8CM, OP dry, EOMI
CV: RRR + systolic murmur
Lungs: very tight, diffusely wheezy, no rhonchi
AbD: soft, NT, ND, +BS
Ext: no edema, 2+ pedal pulses
Neuro: following commands, answering questins, oriented to self,
place

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: former tobacco, no ETOH 

### Response:
{'Calculus of bile duct without mention of cholecystitis, with obstruction,Obstructive chronic bronchitis with (acute) exacerbation,Atrial fibrillation,Congestive heart failure, unspecified,Cholangitis,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Infection with microorganisms without mention of resistance to multiple drugs,Other specified antibiotics causing adverse effects in therapeutic use'}
