CHIEF COMPLAINT: SOB, here for pleuroscopy

PRESENT ILLNESS: 81 yo man with h/o A fib (on coumadin), HTN, DM,
hyperthyroidism, and recurrent pleural effusion x 6 weeks who is
being admitted for pleuroscopy tomorrow.  Patient had effusion
drained at [**Hospital 46**] Hosp 6 weeks ago.  Over the past 6 weeks, the
fluid has reaccumulated and the patient's pulmonologist referred
the patient to [**Hospital1 18**] intervential pulmonology for pleuroscopy.
Patient was to have procedure done today, but had high coags.
Patient admitted today to receive FFP in preparation of
pleuroscopy tomorrow.

MEDICAL HISTORY: HTN
A fib
Hyperthyroidism
DM
recurrent pleural effusion (drained 6 weeks ago at [**Hospital 46**] Hosp)

MEDICATION ON ADMISSION: Methimazole 10 mg PO BID
lisinopril/HCTZ 20/12.5mg po QD
Atenolol 50 qam, 25 qpm
Glyburide 1.25 mg po BID
Coumadin 2 mg po qhs
Tylenol 2 tabs [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T=100.6 BP=134/74 HR=139 RR=18 O2=96%
GEN: elderly man, lying in bed, not speaking in full sentences,
SOB
HEENT: PERRL OU, EOMI bilaterally, OP clear, MMM
CV: No elevated JVD, Non-displaced PMI, tachy at about 150,
Normal S1S2, No M/R/G
RESP: + accessory muscle use, dullness to percussion on left
side, decreased BS on left, no w/r/r
ABD: Normo active BS, obese, non-tender, no rebound,
non-distended, no masses, no organomegaly appreciated; appy scar
RLQ
EXT: no cyanosis, edema, or clubbing
PULSES: 1+ dp/pt pulses bilaterally
NEURO: A&Ox3; CN II-XII intact bilat; sensation and motor exams
intact bilaterally

FAMILY HISTORY: unknown

SOCIAL HISTORY: unknown
Pleurisy without mention of effusion or current tuberculosis,Atrial fibrillation,Empyema without mention of fistula,Congestive heart failure, unspecified,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Tachypnea,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Pleurisy w/o effus or TB,Atrial fibrillation,Empyema w/o fistula,CHF NOS,Thyrotox NOS no crisis,Tachypnea,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2158-6-22**]              Discharge Date:   [**2158-7-5**]


Service: TSURG

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
SOB, here for pleuroscopy

Major Surgical or Invasive Procedure:
[**2158-6-24**]: Pleuroscopy


History of Present Illness:
81 yo man with h/o A fib (on coumadin), HTN, DM,
hyperthyroidism, and recurrent pleural effusion x 6 weeks who is
being admitted for pleuroscopy tomorrow.  Patient had effusion
drained at [**Hospital 46**] Hosp 6 weeks ago.  Over the past 6 weeks, the
fluid has reaccumulated and the patient's pulmonologist referred
the patient to [**Hospital1 18**] intervential pulmonology for pleuroscopy.
Patient was to have procedure done today, but had high coags.
Patient admitted today to receive FFP in preparation of
pleuroscopy tomorrow.


Past Medical History:
HTN
A fib
Hyperthyroidism
DM
recurrent pleural effusion (drained 6 weeks ago at [**Hospital 46**] Hosp)

s/p appy at age 8


Social History:
unknown

Family History:
unknown

Physical Exam:
VS: T=100.6 BP=134/74 HR=139 RR=18 O2=96%
GEN: elderly man, lying in bed, not speaking in full sentences,
SOB
HEENT: PERRL OU, EOMI bilaterally, OP clear, MMM
CV: No elevated JVD, Non-displaced PMI, tachy at about 150,
Normal S1S2, No M/R/G
RESP: + accessory muscle use, dullness to percussion on left
side, decreased BS on left, no w/r/r
ABD: Normo active BS, obese, non-tender, no rebound,
non-distended, no masses, no organomegaly appreciated; appy scar
RLQ
EXT: no cyanosis, edema, or clubbing
PULSES: 1+ dp/pt pulses bilaterally
NEURO: A&Ox3; CN II-XII intact bilat; sensation and motor exams
intact bilaterally


Pertinent Results:
[**2158-6-23**] 06:30AM BLOOD WBC-12.4* RBC-4.54* Hgb-11.8* Hct-37.7*
MCV-83 MCH-26.0* MCHC-31.3 RDW-12.4 Plt Ct-441*
[**2158-6-24**] 04:30AM BLOOD WBC-11.8* RBC-3.80* Hgb-10.3* Hct-31.5*
MCV-83 MCH-27.2 MCHC-32.7 RDW-12.4 Plt Ct-320
[**2158-6-22**] 12:30PM BLOOD PT-18.5* INR(PT)-2.3
[**2158-6-24**] 08:23AM BLOOD PT-16.5* PTT-38.6* INR(PT)-1.8
[**2158-6-23**] 06:30AM BLOOD Glucose-114* UreaN-22* Creat-0.7 Na-137
K-4.1 Cl-98 HCO3-27 AnGap-16
[**2158-6-24**] 04:30AM BLOOD Glucose-186* UreaN-23* Creat-0.7 Na-140
K-3.7 Cl-100 HCO3-27 AnGap-17
[**2158-6-24**] 11:10AM BLOOD Calcium-9.0 Phos-4.6* Mg-1.9
[**2158-6-24**] 11:53AM BLOOD Type-ART Temp-37.7 PEEP-5 O2-50 pO2-134*
pCO2-56* pH-7.33* calHCO3-31* Base XS-2 Intubat-INTUBATED
Vent-SPONTANEOU
[**2158-6-25**] 12:12AM BLOOD pO2-76* pCO2-39 pH-7.39 calHCO3-24 Base
XS-0
[**2158-7-3**] 04:59AM BLOOD WBC-7.8 RBC-3.62* Hgb-9.5* Hct-29.9*
MCV-83 MCH-26.3* MCHC-31.7 RDW-14.0 Plt Ct-405

[**2158-6-28**] 09:50PM URINE Hours-RANDOM Creat-154 Na-LESS THAN  K-42

Brief Hospital Course:
Mr. [**Known lastname 10680**] was admitted to the floor to receive FFP in order to
bring his INR below 1.5 so that he could have pleuroscopy the
following day.  During the first night of his admission, he was
in a fib on telemetry and his heart rate was initially in the
150's.  He had not taken his evening dose of atenolol yet.  He
was given that dose, as well as a dose of IV lopressor.  His
heart rate then came down to the 110's.  Later that evening, he
required another dose of IV lopressor as well as PO metoprolol.

*
Mr. [**Known lastname 58571**] INR was originally 2.3.  He was initially given 2
units of FFP which brought his INR down to 1.9.  An additional 2
units were given; however, his INR was still too high at 1.8.
The procedure was postponed until the following day so that the
patient could receive more FFP in an attempt to lower his INR <
1.5.  He was given an additional 2 units of FFP overnight, and a
recheck of his INR was 1.8.  He was given 2 more units of FFP,
but his INR remained at 1.8.  He was brought to the operating
room to have a VATS by thoracic surgery despite having an
INR=1.8.  He required the OR because it was a weekend day, and
there were no [**Name8 (MD) 58572**] RN's to do the procedure in the
pulmonary procedure suite.  After the procedure, the patient had
a prolonged stay in the PACU because he was in rapid a fib and
had new onset mild CHF (likely rate related).  He was diuresed
and rate controlled (with diltiazem drip and PO metoprolol).  He
was maintained on dilt drip and metoprolol on transfer to the
floor.  Thoracic surgery recommended that they perform a
decortication later in the week to free the patient's trapped
lung.
*
For the following week, the patient was continued on rate
control with diltiazem drip and metoprolol.  His metoprolol was
slowly titrated up while trying to keep SBP>90.  He was bolused
gently on [**1-3**] occasions for low BP (with 250 cc NS).  Overall,
the patient did well in the pre-op period; however, his rate was
difficult to control while maintaining adequate BP.  His rate
remained in the range of 90-110 (occasionally up to 120), with
BP in range of 90-110/50-80.  His INR continued to rise despite
receiving FFP and holding coumadin.  After reaching 3.2, vitamin
K 5mg po was given x 1 dose to reverse pt so he would be able to
go for decortication.  After vitamin K, the patient's INR fell
to 1.9.*
Cardiology was consulted the day prior to surgery for
recommendations of better rate control.  They recommended
digoxin 0.125 mg PO qd and lisinopril 75mg PO TID for rate
control. The patient was rate controlled prior to left
thorocatomy and decortication on [**6-28**]. Post-operatively the
patient did well and was transferred to the ICU intubated. The
patient's TSH was evaluated and deemed to be low POD #1 with
this may have been adding to difficult with rate control of his
afib. His anti- hyperthroid med methimazole 10 mg PO BOD was
restarted POD 5.The patient was diuresed with lasix while in the
unit and responded well and his creatinine remained stable. He
was treated with aggressive pulmonary toilet and his chest tubes
remained to suction. POD 3 the patient had a PA and Lateral CxR
to evaluate the left lung and the fluid in the intrapleural
space. The patient's CXR appeared stable and much improved to
previous films that had showed a large pleural effusion on the
left side.The patient's pain was managed with PO morphine PRN
and toradol 15mg PO PRN. The was put on aspiration precaustions
and his INR was stable at 2.5. The patient began to work with PT
on POD 3 in order to improve his mobility. The patient had a
weak cough and difficulty moving around in bed.The patient
remained stable in the unit POD [**3-6**]. He was transfered to the
floor on POD 6 where he was restarted on all his home meds.
Particularly he was switched from lopressor to atenolol and
restarted on his glyburide 1.5 mg PO BID and coumadin 2 mg PO
qd. The patient continued to work with PT and made improvement
in his strength and previously limited mobility. The patient
will follow up with Dr. [**Last Name (STitle) **] in addtion to a prior schedule
pulmonology appointment. THe patient is going to rehab on all
his prior meds and on the same doses of those medications. He is
doing well and will require once a day dressing changes along
with physical therapy in order to increase his strength and
mobility. The patient will also require aggressive pulmonary
toilet and encourage for taking food.


Medications on Admission:
Methimazole 10 mg PO BID
lisinopril/HCTZ 20/12.5mg po QD
Atenolol 50 qam, 25 qpm
Glyburide 1.25 mg po BID
Coumadin 2 mg po qhs
Tylenol 2 tabs [**Hospital1 **]


Discharge Medications:
1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
2. Methimazole 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
3. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO QD (once
a day).
4. Atenolol 50 mg Tablet Sig: One (1) Tablet PO QAM (once a day
(in the morning)).
5. Atenolol 25 mg Tablet Sig: One (1) Tablet PO QPM (once a day
(in the evening)).
6. Methimazole 10 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
7. Warfarin Sodium 2 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
8. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1) Tablet
PO Q6H (every 6 hours) as needed.
9. Glyburide Micronized 3 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day) as needed for type II DM.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 30191**] - [**Location (un) 22287**]

Discharge Diagnosis:
Recurrent pleural effusion
PMH: Diabetes mellitus type II, hypertension, repeated history
of pleural effusions, atrial fibrillation, hyperthroidism


Discharge Condition:
Stable


Discharge Instructions:
Please come to the emergency room if you have worsening
shortness of breath, chest pain, severe cough, or fever.  Take
all medications as prescribed.

Followup Instructions:
Please follow up with pulmonology as scheduled. Please follow
with Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] as scheduled. If appointment not already
schedule or change in patient's condition occurs, patient should
call Dr.[**Doctor Last Name 4738**] office inorder to schedule appointment.
{'Pleurisy without mention of effusion or current tuberculosis,Atrial fibrillation,Empyema without mention of fistula,Congestive heart failure, unspecified,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Tachypnea,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: SOB, here for pleuroscopy

PRESENT ILLNESS: 81 yo man with h/o A fib (on coumadin), HTN, DM,
hyperthyroidism, and recurrent pleural effusion x 6 weeks who is
being admitted for pleuroscopy tomorrow.  Patient had effusion
drained at [**Hospital 46**] Hosp 6 weeks ago.  Over the past 6 weeks, the
fluid has reaccumulated and the patient's pulmonologist referred
the patient to [**Hospital1 18**] intervential pulmonology for pleuroscopy.
Patient was to have procedure done today, but had high coags.
Patient admitted today to receive FFP in preparation of
pleuroscopy tomorrow.

MEDICAL HISTORY: HTN
A fib
Hyperthyroidism
DM
recurrent pleural effusion (drained 6 weeks ago at [**Hospital 46**] Hosp)

MEDICATION ON ADMISSION: Methimazole 10 mg PO BID
lisinopril/HCTZ 20/12.5mg po QD
Atenolol 50 qam, 25 qpm
Glyburide 1.25 mg po BID
Coumadin 2 mg po qhs
Tylenol 2 tabs [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T=100.6 BP=134/74 HR=139 RR=18 O2=96%
GEN: elderly man, lying in bed, not speaking in full sentences,
SOB
HEENT: PERRL OU, EOMI bilaterally, OP clear, MMM
CV: No elevated JVD, Non-displaced PMI, tachy at about 150,
Normal S1S2, No M/R/G
RESP: + accessory muscle use, dullness to percussion on left
side, decreased BS on left, no w/r/r
ABD: Normo active BS, obese, non-tender, no rebound,
non-distended, no masses, no organomegaly appreciated; appy scar
RLQ
EXT: no cyanosis, edema, or clubbing
PULSES: 1+ dp/pt pulses bilaterally
NEURO: A&Ox3; CN II-XII intact bilat; sensation and motor exams
intact bilaterally

FAMILY HISTORY: unknown

SOCIAL HISTORY: unknown 

### Response:
{'Pleurisy without mention of effusion or current tuberculosis,Atrial fibrillation,Empyema without mention of fistula,Congestive heart failure, unspecified,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Tachypnea,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
