CHIEF COMPLAINT: HYPOXIA

PRESENT ILLNESS: 82 yo Vietnamese, but Cantonese speaking man with a history of
COPD and Pulm HTN on Home O2 (2L) who was referred to Dr. [**Last Name (STitle) **]
in [**11/2188**] for 4 years of progressively worsening dyspnea.
Since that visit the patient's dyspnea has progressed and now he
has dyspnea at rest and exertion and was placed on home 02.  CT
scan revealed calcified granulomas and concern for possible
smoldering infection such as Tb or [**Doctor First Name **] vs. sarcoid, chronic
hypersensitivity pneumonitis, Fibrosing NSIP.  The patient was
referred to the [**Hospital **] clinic for evaluation of bronchoscopy, BAL
and biopsy.

MEDICAL HISTORY: COPD / Bronchiectasis
HTN
Hyperlipidemia
s/p cataracts bilaterally
Moderate aortic regurgitation (TTE [**4-/2188**] at [**Hospital1 3278**])
Moderate mitral regurgitation (TTE [**4-/2188**] at [**Hospital1 3278**])
Moderate Pulmonary Hypertension (TTE [**4-/2188**] at [**Hospital1 3278**])
Elevated PSA - negative prostate biopsy x2
No history of malignancy, connective tissue disease or pulmonary
disease.

MEDICATION ON ADMISSION: Combivent MDI prn
Advair 100/50 Inh [**Hospital1 **]
ASA 81mg daily
Lisinopril 40mg daily
Simvastatin 20mg qhs
Omeprazole ER 40mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
Vitals: T: 97.7, BP: 151/71, HR: 95 RR: 30, 99%4L (95% RA)
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, EOMI, PERRL
Neck: supple, no LAD
CV: tachycardic, regular rhythm, normal S1 + S2, [**2-9**]+ Diastolic
murmur
Lungs: poor inspiratory breath with equal inspiratory and
expiratory phases, crackles throughout with some velcro sounds
in the anterior left lung fields.
Abdomen: soft, non-distended, bowel sounds present,no tenderness
to palpation, no rebound or guarding
Ext: Warm, well pErfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred.
.
DISCHARGE EXAM
Tmax: 36.8 ??????C (98.2 ??????F)
Tcurrent: 36.4 ??????C (97.5 ??????F)
HR: 69 (68 - 102) bpm
BP: 100/47(59) {99/43(56) - 131/59(74)} mmHg
RR: 27 (17 - 30) insp/min
SpO2: 100%/2L
General: Alert, oriented, no acute distress. Speaks mandarin.
HEENT: Sclera anicteric, MMM, EOMI,
Neck: supple, no LAD
CV: regular rate, regular rhythm, normal S1 + S2, [**2-9**]+ Diastolic
murmur heard best at the LUSB  with no radiation
Lungs: poor inspiratory breath with equal inspiratory and
expiratory phases, wheeze at left base.
Abdomen: soft, non-distended, bowel sounds present,no tenderness
to palpation, no rebound or guarding
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred.

FAMILY HISTORY: 

SOCIAL HISTORY: Lives by himself, three sons in the USA
Denies tobacco, alcohol and drug use.
In [**Country 3992**] he was a textile worker and worked in that capacity
for years.
Acute edema of lung, unspecified,Acute kidney failure, unspecified,Aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Chronic airway obstruction, not elsewhere classified,Other chronic pulmonary heart diseases,Other dependence on machines, supplemental oxygen,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Mitral valve insufficiency and aortic valve insufficiency,Tachycardia, unspecified,Esophageal reflux,Solitary pulmonary nodule,Anemia, unspecified,Hypoxemia
Acute lung edema NOS,Acute kidney failure NOS,Abn react-fluid aspirat,Chr airway obstruct NEC,Chr pulmon heart dis NEC,Depend-supplement oxygen,Hypertension NOS,Hyperlipidemia NEC/NOS,Mitral/aortic val insuff,Tachycardia NOS,Esophageal reflux,Solitary pulmonry nodule,Anemia NOS,Hypoxemia
Admission Date:  [**2189-6-5**]              Discharge Date:   [**2189-6-6**]

Date of Birth:  [**2107-2-8**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
HYPOXIA

Major Surgical or Invasive Procedure:
Bronchoscopy with biopsies


History of Present Illness:
82 yo Vietnamese, but Cantonese speaking man with a history of
COPD and Pulm HTN on Home O2 (2L) who was referred to Dr. [**Last Name (STitle) **]
in [**11/2188**] for 4 years of progressively worsening dyspnea.
Since that visit the patient's dyspnea has progressed and now he
has dyspnea at rest and exertion and was placed on home 02.  CT
scan revealed calcified granulomas and concern for possible
smoldering infection such as Tb or [**Doctor First Name **] vs. sarcoid, chronic
hypersensitivity pneumonitis, Fibrosing NSIP.  The patient was
referred to the [**Hospital **] clinic for evaluation of bronchoscopy, BAL
and biopsy.

Patient presented for elective bronchoscopy on [**2189-6-5**] and
procedure went well.  During recovery, he was noted to be
hypoxic to 83% on room air and tachycardic to the 120's.  CXR
LLL pulmonary edema, and given lasix 20mg IV, also given
solumedrol and nebulizers.  He improved to 88% on room air and
will be admitted to the ICU for overnight monitoring.

Past Medical History:
COPD / Bronchiectasis
HTN
Hyperlipidemia
s/p cataracts bilaterally
Moderate aortic regurgitation (TTE [**4-/2188**] at [**Hospital1 3278**])
Moderate mitral regurgitation (TTE [**4-/2188**] at [**Hospital1 3278**])
Moderate Pulmonary Hypertension (TTE [**4-/2188**] at [**Hospital1 3278**])
Elevated PSA - negative prostate biopsy x2
No history of malignancy, connective tissue disease or pulmonary
disease.


Social History:
Lives by himself, three sons in the USA
Denies tobacco, alcohol and drug use.
In [**Country 3992**] he was a textile worker and worked in that capacity
for years.


Physical Exam:
ADMISSION EXAM
Vitals: T: 97.7, BP: 151/71, HR: 95 RR: 30, 99%4L (95% RA)
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, EOMI, PERRL
Neck: supple, no LAD
CV: tachycardic, regular rhythm, normal S1 + S2, [**2-9**]+ Diastolic
murmur
Lungs: poor inspiratory breath with equal inspiratory and
expiratory phases, crackles throughout with some velcro sounds
in the anterior left lung fields.
Abdomen: soft, non-distended, bowel sounds present,no tenderness
to palpation, no rebound or guarding
Ext: Warm, well pErfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred.
.
DISCHARGE EXAM
Tmax: 36.8 ??????C (98.2 ??????F)
Tcurrent: 36.4 ??????C (97.5 ??????F)
HR: 69 (68 - 102) bpm
BP: 100/47(59) {99/43(56) - 131/59(74)} mmHg
RR: 27 (17 - 30) insp/min
SpO2: 100%/2L
General: Alert, oriented, no acute distress. Speaks mandarin.
HEENT: Sclera anicteric, MMM, EOMI,
Neck: supple, no LAD
CV: regular rate, regular rhythm, normal S1 + S2, [**2-9**]+ Diastolic
murmur heard best at the LUSB  with no radiation
Lungs: poor inspiratory breath with equal inspiratory and
expiratory phases, wheeze at left base.
Abdomen: soft, non-distended, bowel sounds present,no tenderness
to palpation, no rebound or guarding
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred.



Pertinent Results:
ADMISSION LABS
[**2189-6-5**] 04:48PM BLOOD WBC-13.8*# RBC-3.66* Hgb-9.9* Hct-32.2*
MCV-88 MCH-27.1 MCHC-30.8* RDW-14.6 Plt Ct-324
[**2189-6-5**] 04:48PM BLOOD Glucose-114* UreaN-24* Creat-1.3* Na-139
K-3.7 Cl-102 HCO3-27 AnGap-14
[**2189-6-5**] 04:48PM BLOOD CK-MB-3 cTropnT-<0.01
.
DISCHARGE LABS
[**2189-6-6**] 04:20AM BLOOD WBC-17.6* RBC-3.35* Hgb-9.1* Hct-29.3*
MCV-87 MCH-27.2 MCHC-31.1 RDW-14.7 Plt Ct-317
[**2189-6-6**] 04:20AM BLOOD PT-11.5 PTT-31.4 INR(PT)-1.1
[**2189-6-6**] 04:20AM BLOOD Glucose-166* UreaN-31* Creat-1.5* Na-137
K-3.7 Cl-100 HCO3-28 AnGap-13
[**2189-6-6**] 04:20AM BLOOD CK(CPK)-259 CK-MB-2
[**2189-6-6**] 04:20AM BLOOD [**2189-6-6**] 04:20AM BLOOD Calcium-7.9*
Phos-3.5 Mg-2.1
.
PLEURAL FLUID ANALYSIS
[**2189-6-5**] 10:00AM OTHER BODY FLUID Polys-94* Lymphs-1* Monos-0
Eos-2* Macro-3*
[**2189-6-5**] 03:21PM OTHER BODY FLUID CD4/CD8-1.5
.
MICRO
[**2189-6-6**] MRSA SCREEN-PENDING
[**2189-6-5**] BIOPSY GRAM STAIN-FINAL; TISSUE-PRELIMINARY {GRAM
POSITIVE BACTERIA}; ANAEROBIC CULTURE-PRELIMINARY; ACID FAST
SMEAR-FINAL; ACID FAST CULTURE-PRELIMINARY; FUNGAL
CULTURE-PRELIMINARY; POTASSIUM HYDROXIDE PREPARATION-FINAL
[**Last Name (LF) **],[**First Name3 (LF) **] E.
[**2189-6-5**] BRONCHOALVEOLAR LAVAGE GRAM STAIN-FINAL; RESPIRATORY
CULTURE-PRELIMINARY {GRAM NEGATIVE ROD(S)}; ACID FAST
SMEAR-FINAL; ACID FAST CULTURE-PRELIMINARY; FUNGAL
CULTURE-PRELIMINARY; POTASSIUM HYDROXIDE PREPARATION-FINAL;
MODIFIED ACID-FAST STAIN FOR NOCARDIA-PRELIMINARY; NOCARDIA
CULTURE-PRELIMINARY
.
STUDIES
[**2189-6-5**]   Pathology Tissue: left lower lobe
.
[**2189-6-5**] POST-PROCEDURE CXR
Left lung has a decreased volume with large areas of
consolidations in the
left lower lobe and mediastinal shift to the left side. Multiple
other tiny opacities in the right lung and mild bronchiectasis
in the right middle lobe and right lower lung are present. No
pneumothorax or pleural effusion on the right side. All these
findings are better evaluated on a chest CT dated [**2189-1-8**]
which suggest multifocal consolidation and bronchiolitis and
bronchiectasis likely from infection. No pneumothorax.
.
[**2189-6-5**] INTERVAL CXR
TECHNIQUE: Single upright portable chest view was read in
comparison with the prior radiograph done on the same day five
hours apart.
There is no evidence of pneumothorax. Other findings including
left lower
lung consolidation, left lung volume loss, and multiple tiny
opacities in the right lung are all unchanged.
IMPRESSION: No evidence of pneumothorax.
.
[**2189-6-6**] INTERVAL CXR
IMPRESSION:
1. The left lung remains diminished in overall volume with air
bronchograms and patchy opacity predominantly in the left mid
and lower lung. There are bullous changes at the left apex which
are stable. No pneumothorax is seen. The right lung demonstrates
some prominent interstitial markings suggestive of
bronchiectasis but the appearance does not appear to be
significantly changed since [**2189-6-5**]. No evidence of pulmonary
edema. Probable left pleural effusion versus chronic pleural
thickening. No pneumothorax.


Brief Hospital Course:
82M w/hx of obstructive and restrictive lung disease, admitted
after he developed hypoxia and tachycardia in the PACU after
outpatient scheduled bronchoscopy, found to have LLL congestion.
After overnight monitoring in the MICU, he was called out to the
floor.
.
HYPOXIA
Pt underwent scheduled outpatient bronchoscopy and LLL lung
biopsy for known pulmonary disease of unknown etiology
documented on recent CT chest. Has been using oxygen more over
the past few months - during exertion and when sleeping but not
at rest. His procedure was uncomplicated, but soon thereafter in
the PACU he was noted to be hypoxia, w/supplemental NC oxygen
requirement. There was concern for PTX, vascular congestion
and/or post-bronchoscopy inflammation. CXR showed LLL congestion
(no pre-procedure CXR for comparison). He was given lasix with
some improvement. Also received combivent nebs in the PACU and
overnight in the MICU. By the morning, he was breathing
comfortably w/O2 sat >95% on minimal supplemental O2 similar to
recent home O2 requirement. Multiple pending studies from the
bronchoscopy (micro, path) to be followed-up by outpatient
pulmonologist.

TACHYCARDIA
Pt tachycardic in the PACU coincident w/onset of hypoxia. Sinus
rhythm on telemetry. Thought to be [**3-12**] respiratory distress plus
significant albuterol received. EKG not suggestive of acute
cardiac issues.

COPD/BRONCHIECTASIS
Continued home meds: combivent and advair. No wheeze on exam.

HTN
Normotensive. Continued Lisinopril 40mg daily.

Hyperlipidemia
Continued home Simvastatin 20mg qHS.

GERD
Continued home Omeprazole ER 40mg daily.
.
TRANSITIONAL ISSUES
*PULMONARY FOLLOW-UP TBD




Medications on Admission:
Combivent MDI prn
Advair 100/50 Inh [**Hospital1 **]
ASA 81mg daily
Lisinopril 40mg daily
Simvastatin 20mg qhs
Omeprazole ER 40mg daily


Discharge Medications:
1. Combivent 18-103 mcg/actuation Aerosol Sig: One (1)
Inhalation once a day as needed for cough.
2. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. fluticasone-salmeterol 100-50 mcg/dose Disk with Device Sig:
[**2-9**] Disk with Devices Inhalation [**Hospital1 **] (2 times a day).


Discharge Disposition:
Home

Discharge Diagnosis:
Monitoring after procedure


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


Discharge Instructions:
Dear Mr [**Known lastname 32289**],

It was a pleasure to care for you at [**Doctor First Name **]-[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].

You were admitted to the ICU overnight because of low oxygen
after your bronchoscopy yesterday. Your breathing was back to
normal by the following morning.

We did not make any changes to your medications.

Followup Instructions:
You should follow-up with your pulmonologist [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **],MD
([**Telephone/Fax (1) 513**]. Please call his office for an appointment.

We also recommend you call your PCP for an appointment before
next Friday.


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Acute edema of lung, unspecified,Acute kidney failure, unspecified,Aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Chronic airway obstruction, not elsewhere classified,Other chronic pulmonary heart diseases,Other dependence on machines, supplemental oxygen,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Mitral valve insufficiency and aortic valve insufficiency,Tachycardia, unspecified,Esophageal reflux,Solitary pulmonary nodule,Anemia, unspecified,Hypoxemia'}


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: HYPOXIA

PRESENT ILLNESS: 82 yo Vietnamese, but Cantonese speaking man with a history of
COPD and Pulm HTN on Home O2 (2L) who was referred to Dr. [**Last Name (STitle) **]
in [**11/2188**] for 4 years of progressively worsening dyspnea.
Since that visit the patient's dyspnea has progressed and now he
has dyspnea at rest and exertion and was placed on home 02.  CT
scan revealed calcified granulomas and concern for possible
smoldering infection such as Tb or [**Doctor First Name **] vs. sarcoid, chronic
hypersensitivity pneumonitis, Fibrosing NSIP.  The patient was
referred to the [**Hospital **] clinic for evaluation of bronchoscopy, BAL
and biopsy.

MEDICAL HISTORY: COPD / Bronchiectasis
HTN
Hyperlipidemia
s/p cataracts bilaterally
Moderate aortic regurgitation (TTE [**4-/2188**] at [**Hospital1 3278**])
Moderate mitral regurgitation (TTE [**4-/2188**] at [**Hospital1 3278**])
Moderate Pulmonary Hypertension (TTE [**4-/2188**] at [**Hospital1 3278**])
Elevated PSA - negative prostate biopsy x2
No history of malignancy, connective tissue disease or pulmonary
disease.

MEDICATION ON ADMISSION: Combivent MDI prn
Advair 100/50 Inh [**Hospital1 **]
ASA 81mg daily
Lisinopril 40mg daily
Simvastatin 20mg qhs
Omeprazole ER 40mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
Vitals: T: 97.7, BP: 151/71, HR: 95 RR: 30, 99%4L (95% RA)
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, EOMI, PERRL
Neck: supple, no LAD
CV: tachycardic, regular rhythm, normal S1 + S2, [**2-9**]+ Diastolic
murmur
Lungs: poor inspiratory breath with equal inspiratory and
expiratory phases, crackles throughout with some velcro sounds
in the anterior left lung fields.
Abdomen: soft, non-distended, bowel sounds present,no tenderness
to palpation, no rebound or guarding
Ext: Warm, well pErfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred.
.
DISCHARGE EXAM
Tmax: 36.8 ??????C (98.2 ??????F)
Tcurrent: 36.4 ??????C (97.5 ??????F)
HR: 69 (68 - 102) bpm
BP: 100/47(59) {99/43(56) - 131/59(74)} mmHg
RR: 27 (17 - 30) insp/min
SpO2: 100%/2L
General: Alert, oriented, no acute distress. Speaks mandarin.
HEENT: Sclera anicteric, MMM, EOMI,
Neck: supple, no LAD
CV: regular rate, regular rhythm, normal S1 + S2, [**2-9**]+ Diastolic
murmur heard best at the LUSB  with no radiation
Lungs: poor inspiratory breath with equal inspiratory and
expiratory phases, wheeze at left base.
Abdomen: soft, non-distended, bowel sounds present,no tenderness
to palpation, no rebound or guarding
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred.

FAMILY HISTORY: 

SOCIAL HISTORY: Lives by himself, three sons in the USA
Denies tobacco, alcohol and drug use.
In [**Country 3992**] he was a textile worker and worked in that capacity
for years. 

### Response:
{'Acute edema of lung, unspecified,Acute kidney failure, unspecified,Aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Chronic airway obstruction, not elsewhere classified,Other chronic pulmonary heart diseases,Other dependence on machines, supplemental oxygen,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Mitral valve insufficiency and aortic valve insufficiency,Tachycardia, unspecified,Esophageal reflux,Solitary pulmonary nodule,Anemia, unspecified,Hypoxemia'}
