CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: 51 y/o M w/IPF on home O2 who presented to the ED last night
with worsening dyspnea. This has been slowly worsening for the
past few weeks, but over 2 days severely worsened to the point
where he was short of breath at rest.  He also has had a cough
productive of yellow blood-tinged sputum for 2 days (normally
has a non-productive cough at baseline).  According to his
pulmonary rehab notes, he has been increasingly unable to
exercise due to hypoxemia with exertion despite supplemental O2.
 He has also had anterior chest pain which he associates with
coughing.  The chest pain is not exertional.  He denies
orthopnea and LE edema.  He has had chills over the past couple
of days, but no fevers.

MEDICAL HISTORY: 1. IPF: Diagnosed on VATS [**2116**], treated with gamma-interferon
for one year around that time.  Has also been on
N-acetylcysteine but stopped last year.  Not a candidate for
BUILD3 due to FVC <50%.  Has never been treated with steroids.
Undergoing transplant w/u at [**Hospital1 112**] (per pt, currently contingent
on weight loss but remainder of w/u done).  In pulmonary rehab
here, and at home is on 2L O2 continuous with 4L O2 for
exertion.  Most recent PFTs [**2-17**]: FEV1 1.58 (51%), FVC 1.84
(44%), FEV1/FVC 86%, TLC 2.61 (43% in [**12-17**]), DLCO 8.6 (32% in
[**12-17**]).

MEDICATION ON ADMISSION: patient expired

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Overweight / Obese, tachypneic, in mild
respiratory distress
Head, Ears, Nose, Throat: Normocephalic
Lymphatic: No(t) Cervical WNL, No(t) Supraclavicular WNL
Cardiovascular: (S1: Normal), (S2: Normal), (Murmur: No(t)
Systolic), Unable to appreciate loud P2
Peripheral Vascular: (Right radial pulse: Not assessed), (Left
radial pulse: Not assessed), (Right DP pulse: Present), (Left DP
pulse: Not assessed)
Respiratory / Chest: (Expansion: Symmetric), (Percussion:
Dullness : bilateral bases), (Breath Sounds: Crackles : [**1-11**] way
on R, [**1-12**] way on L, No(t) Wheezes : ), egophony at bilateral
bases
Abdominal: Soft, Non-tender, Bowel sounds present
Extremities: Right: Absent, Left: Absent, No(t) Cyanosis, No(t)
Clubbing
Skin:  Warm, No(t) Rash:
Neurologic: Attentive, Responds to: Verbal stimuli, Movement:
Not assessed, Tone: Not assessed

FAMILY HISTORY: non-contributory.

SOCIAL HISTORY: Occupation: Currently unable to work but formerly worked for
Merchant Marine
Drugs: No
Tobacco: Never
Alcohol: No
Other: No animals at home. No sick contacts.
Acute respiratory failure,Pneumonia, organism unspecified,Obstructive sleep apnea (adult)(pediatric),Other dependence on machines, supplemental oxygen,Encounter for palliative care,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Acute respiratry failure,Pneumonia, organism NOS,Obstructive sleep apnea,Depend-supplement oxygen,Encountr palliative care,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2119-6-24**]              Discharge Date:   [**2119-6-28**]

Date of Birth:  [**2067-8-15**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 495**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
none

History of Present Illness:
51 y/o M w/IPF on home O2 who presented to the ED last night
with worsening dyspnea. This has been slowly worsening for the
past few weeks, but over 2 days severely worsened to the point
where he was short of breath at rest.  He also has had a cough
productive of yellow blood-tinged sputum for 2 days (normally
has a non-productive cough at baseline).  According to his
pulmonary rehab notes, he has been increasingly unable to
exercise due to hypoxemia with exertion despite supplemental O2.
 He has also had anterior chest pain which he associates with
coughing.  The chest pain is not exertional.  He denies
orthopnea and LE edema.  He has had chills over the past couple
of days, but no fevers.

In the ED, he was intermittently hypoxic to the 70s and 80s on
4L so was switched to a NRB.  He was also tachycardic in the
110s.  He was given levofloxacin for pna.  Because of the
tachycardia and hypoxia, he underwent a CTA which was negative
for PE but showed multifocal airspace disease.  He was admitted
to the [**Hospital Unit Name 153**].


Past Medical History:
1. IPF: Diagnosed on VATS [**2116**], treated with gamma-interferon
for one year around that time.  Has also been on
N-acetylcysteine but stopped last year.  Not a candidate for
BUILD3 due to FVC <50%.  Has never been treated with steroids.
Undergoing transplant w/u at [**Hospital1 112**] (per pt, currently contingent
on weight loss but remainder of w/u done).  In pulmonary rehab
here, and at home is on 2L O2 continuous with 4L O2 for
exertion.  Most recent PFTs [**2-17**]: FEV1 1.58 (51%), FVC 1.84
(44%), FEV1/FVC 86%, TLC 2.61 (43% in [**12-17**]), DLCO 8.6 (32% in
[**12-17**]).

2. OSA, on CPAP

3. GERD

4. HTN

5. DM

6. Depression



[**Last Name (un) 1724**]: albuterol MDI prn, atenolol 50 mg daily, bupropion SR 200
mg qAM, celexa 40 mg daily, hctz 25 mg daily, lantus 14 U qhs,
metformin 1000 mg [**Hospital1 **], trazodone 50 mg qhs:prn, aspirin 325 mg
daily, amino acids, omeprazole 20 mg daily, flovent 220 mcg 2
puffs qAM (recently restarted at pulmonary rehab)


Social History:
Occupation: Currently unable to work but formerly worked for
Merchant Marine
Drugs: No
Tobacco: Never
Alcohol: No
Other: No animals at home. No sick contacts.


Family History:
non-contributory.

Physical Exam:
General Appearance: Overweight / Obese, tachypneic, in mild
respiratory distress
Head, Ears, Nose, Throat: Normocephalic
Lymphatic: No(t) Cervical WNL, No(t) Supraclavicular WNL
Cardiovascular: (S1: Normal), (S2: Normal), (Murmur: No(t)
Systolic), Unable to appreciate loud P2
Peripheral Vascular: (Right radial pulse: Not assessed), (Left
radial pulse: Not assessed), (Right DP pulse: Present), (Left DP
pulse: Not assessed)
Respiratory / Chest: (Expansion: Symmetric), (Percussion:
Dullness : bilateral bases), (Breath Sounds: Crackles : [**1-11**] way
on R, [**1-12**] way on L, No(t) Wheezes : ), egophony at bilateral
bases
Abdominal: Soft, Non-tender, Bowel sounds present
Extremities: Right: Absent, Left: Absent, No(t) Cyanosis, No(t)
Clubbing
Skin:  Warm, No(t) Rash:
Neurologic: Attentive, Responds to: Verbal stimuli, Movement:
Not assessed, Tone: Not assessed


Pertinent Results:
patient expired

Brief Hospital Course:
51 yoM w/ a h/o of IPF presented with a significant worsening of
his IPF.  Moving in bed would cause his O2 sat to drop to 60%
while on FiO2 100%.  Patient was DNR / DNI.  Not on the
transplant list due to BMI > 30 and evaluated at the [**Hospital1 112**].
[**Hospital6 **] was contact[**Name (NI) **] who confirmed the fact that
the patient was not on the list and there was no way to place
him on a list for an urgent lung transplant.  Discussion with
the family led to the decision to make the patient comfort
measures only.  Patient Died on [**2119-6-28**].


Medications on Admission:
patient expired

Discharge Medications:
patient expired

Discharge Disposition:
Expired

Discharge Diagnosis:
patient expired

Discharge Condition:
patient expired

Discharge Instructions:
patient expired

Followup Instructions:
patient expired
{'Acute respiratory failure,Pneumonia, organism unspecified,Obstructive sleep apnea (adult)(pediatric),Other dependence on machines, supplemental oxygen,Encounter for palliative care,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: dyspnea

PRESENT ILLNESS: 51 y/o M w/IPF on home O2 who presented to the ED last night
with worsening dyspnea. This has been slowly worsening for the
past few weeks, but over 2 days severely worsened to the point
where he was short of breath at rest.  He also has had a cough
productive of yellow blood-tinged sputum for 2 days (normally
has a non-productive cough at baseline).  According to his
pulmonary rehab notes, he has been increasingly unable to
exercise due to hypoxemia with exertion despite supplemental O2.
 He has also had anterior chest pain which he associates with
coughing.  The chest pain is not exertional.  He denies
orthopnea and LE edema.  He has had chills over the past couple
of days, but no fevers.

MEDICAL HISTORY: 1. IPF: Diagnosed on VATS [**2116**], treated with gamma-interferon
for one year around that time.  Has also been on
N-acetylcysteine but stopped last year.  Not a candidate for
BUILD3 due to FVC <50%.  Has never been treated with steroids.
Undergoing transplant w/u at [**Hospital1 112**] (per pt, currently contingent
on weight loss but remainder of w/u done).  In pulmonary rehab
here, and at home is on 2L O2 continuous with 4L O2 for
exertion.  Most recent PFTs [**2-17**]: FEV1 1.58 (51%), FVC 1.84
(44%), FEV1/FVC 86%, TLC 2.61 (43% in [**12-17**]), DLCO 8.6 (32% in
[**12-17**]).

MEDICATION ON ADMISSION: patient expired

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Overweight / Obese, tachypneic, in mild
respiratory distress
Head, Ears, Nose, Throat: Normocephalic
Lymphatic: No(t) Cervical WNL, No(t) Supraclavicular WNL
Cardiovascular: (S1: Normal), (S2: Normal), (Murmur: No(t)
Systolic), Unable to appreciate loud P2
Peripheral Vascular: (Right radial pulse: Not assessed), (Left
radial pulse: Not assessed), (Right DP pulse: Present), (Left DP
pulse: Not assessed)
Respiratory / Chest: (Expansion: Symmetric), (Percussion:
Dullness : bilateral bases), (Breath Sounds: Crackles : [**1-11**] way
on R, [**1-12**] way on L, No(t) Wheezes : ), egophony at bilateral
bases
Abdominal: Soft, Non-tender, Bowel sounds present
Extremities: Right: Absent, Left: Absent, No(t) Cyanosis, No(t)
Clubbing
Skin:  Warm, No(t) Rash:
Neurologic: Attentive, Responds to: Verbal stimuli, Movement:
Not assessed, Tone: Not assessed

FAMILY HISTORY: non-contributory.

SOCIAL HISTORY: Occupation: Currently unable to work but formerly worked for
Merchant Marine
Drugs: No
Tobacco: Never
Alcohol: No
Other: No animals at home. No sick contacts. 

### Response:
{'Acute respiratory failure,Pneumonia, organism unspecified,Obstructive sleep apnea (adult)(pediatric),Other dependence on machines, supplemental oxygen,Encounter for palliative care,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
