CHIEF COMPLAINT: HYPOXIA

PRESENT ILLNESS: [**Age over 90 **]F h/o HTN, PVD, spinal stenosis, who was transferred from
[**Hospital1 **] after presenting with calf pain and numbness x 1
day. Pt reports having left leg pain "off and on" for months.
Was diagnosed with bursitis and has been receiving steroid
injections. Yesterday pt reports pain was so severe that she
fell to the ground. EMS was called, and pt was taken to OSH
where O2sat was 82% on RA/100%on NRB. Pt denied SOB, cough, CP.
Also denied N/V/D/F/C/dysuria, or abdominal pain
W/U at OSH notable for EKG changes without ishemic changes, CXR
showing honeycombing insterstitial patterns. CTA was negative
for PE but showed patchy ground glass opacities, bibasilar
fibrosis, peripheral bullous disease and increased interstitial
markings.
Pt started on empiric CTX and zithro, given supp O2, and
transferred to the [**Hospital1 **] per pt's request.

MEDICAL HISTORY: HTN, PVD, Hypercholesterolemia, spinal stenosis, h/o pleural
empyema as child s/p surgery, bilateral cataracts, fibrocystic
breast disease; echo [**2114**]: EF 65% with mild pulmonary HTN

MEDICATION ON ADMISSION: On Transfer:
Ceftriaxone 1g QD
Azithromycin 250mg QD
Lisinopril 5mg QD
Atenolol 25mg QD
Heparin 5000 SC TID
ASA 325mg QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: At the time of death:
Pulseless, apneic
No response to sternal rub, corneal reflex, or nailbed pressure.
No heart sounds or lung sounds.

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives alone in [**Hospital3 **].  Quit tobacco 30 years ago,
40-50 pack year history prior.  EtOH: 2 glasses of wine a day.
Former real estate [**Doctor Last Name 360**].
Acute and chronic respiratory failure,Other emphysema,Congestive heart failure, unspecified,Pressure ulcer, lower back,Acute kidney failure, unspecified,Other specified disorders of pancreatic internal secretion,Long-term (current) use of insulin,Adrenal cortical steroids causing adverse effects in therapeutic use,Spinal stenosis, unspecified region,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Pure hypercholesterolemia
Acute & chronc resp fail,Emphysema NEC,CHF NOS,Pressure ulcer, low back,Acute kidney failure NOS,Pancreatic disorder NEC,Long-term use of insulin,Adv eff corticosteroids,Spinal stenosis NOS,Hypertension NOS,Periph vascular dis NOS,Pure hypercholesterolem
Admission Date:  [**2115-12-30**]              Discharge Date:   [**2116-1-10**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
HYPOXIA

Major Surgical or Invasive Procedure:
Endotracheal intubation and ventilation
Arterial Line


History of Present Illness:
[**Age over 90 **]F h/o HTN, PVD, spinal stenosis, who was transferred from
[**Hospital1 **] after presenting with calf pain and numbness x 1
day. Pt reports having left leg pain "off and on" for months.
Was diagnosed with bursitis and has been receiving steroid
injections. Yesterday pt reports pain was so severe that she
fell to the ground. EMS was called, and pt was taken to OSH
where O2sat was 82% on RA/100%on NRB. Pt denied SOB, cough, CP.
Also denied N/V/D/F/C/dysuria, or abdominal pain
W/U at OSH notable for EKG changes without ishemic changes, CXR
showing honeycombing insterstitial patterns. CTA was negative
for PE but showed patchy ground glass opacities, bibasilar
fibrosis, peripheral bullous disease and increased interstitial
markings.
Pt started on empiric CTX and zithro, given supp O2, and
transferred to the [**Hospital1 **] per pt's request.

Past Medical History:
HTN, PVD, Hypercholesterolemia, spinal stenosis, h/o pleural
empyema as child s/p surgery, bilateral cataracts, fibrocystic
breast disease; echo [**2114**]: EF 65% with mild pulmonary HTN


Social History:
Lives alone in [**Hospital3 **].  Quit tobacco 30 years ago,
40-50 pack year history prior.  EtOH: 2 glasses of wine a day.
Former real estate [**Doctor Last Name 360**].

Family History:
Non contributory

Physical Exam:
At the time of death:
Pulseless, apneic
No response to sternal rub, corneal reflex, or nailbed pressure.
No heart sounds or lung sounds.

Pertinent Results:
[**2115-12-30**] 10:52PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.037*
[**2115-12-30**] 10:52PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2115-12-30**] 10:20PM   GLUCOSE-127* UREA N-25* CREAT-0.9 SODIUM-137
POTASSIUM-4.1 CHLORIDE-100 TOTAL CO2-22 ANION GAP-19
[**2115-12-30**] 10:20PM   CK(CPK)-100
[**2115-12-30**] 10:20PM   CK-MB-5 cTropnT-<0.01
[**2115-12-30**] 10:20PM   CALCIUM-8.6 PHOSPHATE-3.9 MAGNESIUM-2.0
[**2115-12-30**] 10:20PM   WBC-12.5* RBC-4.05* HGB-13.5 HCT-38.0 MCV-94
MCH-33.3* MCHC-35.5* RDW-13.4
[**2115-12-30**] 10:20PM   PLT COUNT-284
[**2115-12-30**] 09:07PM   TYPE-ART PO2-60* PCO2-28* PH-7.48* TOTAL
CO2-21 BASE XS-0
[**2115-12-30**] 09:07PM   LACTATE-1.4
[**2115-12-30**] 09:07PM   freeCa-1.12

UNILAT LOWER EXT VEINS LEFT PORT  [**2115-12-31**] 9:17 AM
Left common femoral, superficial femoral, and popliteal veins
demonstrate normal compressibility, color flow, Doppler
waveforms, and response to augmentation. No intraluminal
thrombus is identified.

CHEST (PORTABLE AP)  [**2115-12-30**] 9:20 PM
A mild degree of bilateral pulmonary vascular congestion and
cardiomegaly.

ECHO Study Date of [**2116-1-2**]
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF 60-70%). No masses or thrombi  are seen in the left
ventricle. There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
ascending aorta is moderately dilated. There are three aortic
valve leaflets. The aortic valve leaflets are moderately
thickened. There is moderate aortic valve stenosis. Mild to
moderate ([**11-24**]+) aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. There is no mitral valve
prolapse. Mild to moderate ([**11-24**]+) mitral regurgitation is seen.
The tricuspid valve leaflets are mildly thickened. Moderate [2+]
tricuspid regurgitation is seen. There is no pericardial
effusion.

CT Chest - Findings consistent with possible nonspecific
interstitial pneumonitis.


Brief Hospital Course:
Upon admission to [**Hospital1 18**] MICU, patient was placed on NRB w/ nasal
cannula for additional oxygen delivery, and it was noted that
patient would desaturate with any attempt to remove mask.  CT
suggested a diffuse process w/ ground-glass opacities and
differential diagnoses included LIP,IPF/UIP,AIP/ARDS,BOOP,PAP.
Nonetheless, patient appeared subjectively without distress.
However, on subsequent days, despite empiric antibiotic
treatment and diuresis for presumptive pneumonia and pulmonary
edema, patient's hypoxia continued to progress and patient
ultimately became subjectively dyspneic.  In addition, patient
was also treated empirically for Pneumocystis carinii pneumonia
w/ high dose sulfamethoxazole/trimethoprim.  Echocardiogram
revealed no significant only 2+TR, normal LV function, and no
findings that would explain patient's persistent progressive
hypoxia.  Lower extremity doppler ultrasound revealed no
evidence of deep venous thromboses.

Hypoxia was considered to be less likely due to infectious
and/or cardiogenic causes and thought more to be secondary to a
primary pulmonary process.  Radiological consultants suggested
that CT findings were consistent with nonspecific interstitial
pneumonitis.  Therefore, in addition to empiric antibiotics,
patient was given high dose steroids in an attempt to reverse
any acute changes - as it was felt that patient's hypoxia was
most likely an acute exacerbation of chronic pulmonary process.
On hospital day six, given patient's continued progressive
symptomatic hypoxia (found confused whenever patient had
accidentally removed NRB mask), patient was electively intubated
by anesthesia.

At that point, open lung biopsy was considered to determine
cause of patient's pulmonary disease, however, in discussion
with family and thoracic surgery consultants, it was felt that
patient would not have been interested in such an invasive
procedure, and that yield in terms of diagnosis of a reversible
cause would be extremely low.

As patient continued to exhibit no improvedment over the next
five days, a decision was made by the patient's family and
healthcare proxy to withdraw care and extubate patient.  Patient
was given comfort measures only and expired at 2:30 PM [**2116-1-10**].

Medications on Admission:
On Transfer:
Ceftriaxone 1g QD
Azithromycin 250mg QD
Lisinopril 5mg QD
Atenolol 25mg QD
Heparin 5000 SC TID
ASA 325mg QD

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Nonspecific interstitial pneumonitis
Respiratory failure
Myocardial infarction (post-mortem diagnosis)


Discharge Condition:
Deceased

Discharge Instructions:
n/a

Followup Instructions:
n/a
{'Acute and chronic respiratory failure,Other emphysema,Congestive heart failure, unspecified,Pressure ulcer, lower back,Acute kidney failure, unspecified,Other specified disorders of pancreatic internal secretion,Long-term (current) use of insulin,Adrenal cortical steroids causing adverse effects in therapeutic use,Spinal stenosis, unspecified region,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Pure hypercholesterolemia'}


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: [**Age over 90 **]F h/o HTN, PVD, spinal stenosis, who was transferred from
[**Hospital1 **] after presenting with calf pain and numbness x 1
day. Pt reports having left leg pain "off and on" for months.
Was diagnosed with bursitis and has been receiving steroid
injections. Yesterday pt reports pain was so severe that she
fell to the ground. EMS was called, and pt was taken to OSH
where O2sat was 82% on RA/100%on NRB. Pt denied SOB, cough, CP.
Also denied N/V/D/F/C/dysuria, or abdominal pain
W/U at OSH notable for EKG changes without ishemic changes, CXR
showing honeycombing insterstitial patterns. CTA was negative
for PE but showed patchy ground glass opacities, bibasilar
fibrosis, peripheral bullous disease and increased interstitial
markings.
Pt started on empiric CTX and zithro, given supp O2, and
transferred to the [**Hospital1 **] per pt's request.

MEDICAL HISTORY: HTN, PVD, Hypercholesterolemia, spinal stenosis, h/o pleural
empyema as child s/p surgery, bilateral cataracts, fibrocystic
breast disease; echo [**2114**]: EF 65% with mild pulmonary HTN

MEDICATION ON ADMISSION: On Transfer:
Ceftriaxone 1g QD
Azithromycin 250mg QD
Lisinopril 5mg QD
Atenolol 25mg QD
Heparin 5000 SC TID
ASA 325mg QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: At the time of death:
Pulseless, apneic
No response to sternal rub, corneal reflex, or nailbed pressure.
No heart sounds or lung sounds.

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives alone in [**Hospital3 **].  Quit tobacco 30 years ago,
40-50 pack year history prior.  EtOH: 2 glasses of wine a day.
Former real estate [**Doctor Last Name 360**]. 

### Response:
{'Acute and chronic respiratory failure,Other emphysema,Congestive heart failure, unspecified,Pressure ulcer, lower back,Acute kidney failure, unspecified,Other specified disorders of pancreatic internal secretion,Long-term (current) use of insulin,Adrenal cortical steroids causing adverse effects in therapeutic use,Spinal stenosis, unspecified region,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Pure hypercholesterolemia'}
