CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 25816**] is an 84 year old patient of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 25817**] who
presented to the ED today after 2 episodes vomiting and
diarrhea. Per his son, he lives independently and was doing well
until he woke up this morning with nausea, a single episode of
vomiting, a loose nonbloody stool, chills, and general malaise.
He called his son who brought him to the [**Name (NI) **].
.
In the waiting room, he had an episode of possible syncope. He
felt SOB and looked ill, and his family noticed that he seemed
confused. He was taken to the core area where he was found to
have 80% on RA. EKG showed no ischemic changes. CXR was
unremarkable. Labs notable for lactic acidosis with lactate 8.
CT torso was done to rule out PE. This showed diffuse ground
glass opacities in the lungs and AAA. Vascular Surgery service
saw him.
.
In the ED waiting room, patient had a brief episode of near
syncope during which he was feeling SOB and confused and "looked
bad." He was tachycardic and tachypneic. O2 Sat was 80% on RA
with venous pH 7.1, prompting intubation. Serial EKGs were
without ischemic changes. He was noted to be acidotic with
lactate 8. CT torso was done to rule out PE. No PE was
demonstrated, but there were diffuse ground glass opacities
concerning for multifocal pneumonia. He was given vancomycin,
zosyn, levofloxacin. CT also showed 3.8 cm infrarenal AAA.
Vascular Surgery service saw him in the ED. He was intubated and
admitted to the MICU for further managemenet.

MEDICAL HISTORY: GERD
Hyperlipidemia
Vertigo
BPH

MEDICATION ON ADMISSION: Aspirin 81 mg daily
lipitor 20 mg daily
omeprazole 20 mg daily
Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission exam:
VS: T 100.0, HR 88, BP 130/70RR 32, O2 100% on PSV with 100%
FiO2, [**6-20**]
Gen: intubated, sedated, doesn't open eyes to voice or follow
commands
HEENT: NCAT. Sclera anicteric. EOMI. OP clear, no exudates or
ulceration.
Neck: JVP flat, RIJ in place
CV: RRR, normal S1, S2. No m/r/g.
Chest: diffuse crackles.
Abd: Soft, NTND. No HSM or tenderness.
Ext: no edema
Skin: No stasis dermatitis, ulcers, scars.
Neuro: PERRL, does not follow commands

FAMILY HISTORY: The patient has a mother who had HTN and father who had a
stroke.

SOCIAL HISTORY: Lives with wife. [**Name (NI) **] is her primary care taker  as she has
suffered a recent stroke. Remote smoking history (30 pkyr).
Occasional alcohol use. No history of illicit drug use.
Unspecified septicemia,Acute respiratory failure,Methicillin resistant pneumonia due to Staphylococcus aureus,Septic shock,Peripheral vascular complications, not elsewhere classified,Acute venous embolism and thrombosis of superficial veins of upper extremity,Mixed acid-base balance disorder,Severe sepsis,Abdominal aneurysm without mention of rupture,Esophageal reflux,Pure hypercholesterolemia,Dizziness and giddiness,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anemia, unspecified,Muscle weakness (generalized),Other constipation,Personal history of tobacco use,Personal history of Methicillin resistant Staphylococcus aureus
Septicemia NOS,Acute respiratry failure,Meth res pneu d/t Staph,Septic shock,Surg comp-peri vasc syst,Ac embl suprfcl up ext,Mixed acid-base bal dis,Severe sepsis,Abdom aortic aneurysm,Esophageal reflux,Pure hypercholesterolem,Dizziness and giddiness,BPH w/o urinary obs/LUTS,Anemia NOS,Muscle weakness-general,Constipation NEC,History of tobacco use,Hx Methicln resist Staph
Admission Date:  [**2153-4-13**]              Discharge Date:   [**2153-4-27**]

Date of Birth:  [**2068-9-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Doctor Last Name 10493**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
Mr. [**Known lastname 25816**] is an 84 year old patient of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 25817**] who
presented to the ED today after 2 episodes vomiting and
diarrhea. Per his son, he lives independently and was doing well
until he woke up this morning with nausea, a single episode of
vomiting, a loose nonbloody stool, chills, and general malaise.
He called his son who brought him to the [**Name (NI) **].
.
In the waiting room, he had an episode of possible syncope. He
felt SOB and looked ill, and his family noticed that he seemed
confused. He was taken to the core area where he was found to
have 80% on RA. EKG showed no ischemic changes. CXR was
unremarkable. Labs notable for lactic acidosis with lactate 8.
CT torso was done to rule out PE. This showed diffuse ground
glass opacities in the lungs and AAA. Vascular Surgery service
saw him.
.
In the ED waiting room, patient had a brief episode of near
syncope during which he was feeling SOB and confused and "looked
bad." He was tachycardic and tachypneic. O2 Sat was 80% on RA
with venous pH 7.1, prompting intubation. Serial EKGs were
without ischemic changes. He was noted to be acidotic with
lactate 8. CT torso was done to rule out PE. No PE was
demonstrated, but there were diffuse ground glass opacities
concerning for multifocal pneumonia. He was given vancomycin,
zosyn, levofloxacin. CT also showed 3.8 cm infrarenal AAA.
Vascular Surgery service saw him in the ED. He was intubated and
admitted to the MICU for further managemenet.


Past Medical History:
GERD
Hyperlipidemia
Vertigo
BPH


Social History:
Lives with wife. [**Name (NI) **] is her primary care taker  as she has
suffered a recent stroke. Remote smoking history (30 pkyr).
Occasional alcohol use. No history of illicit drug use.


Family History:
The patient has a mother who had HTN and father who had a
stroke.

Physical Exam:
Admission exam:
VS: T 100.0, HR 88, BP 130/70RR 32, O2 100% on PSV with 100%
FiO2, [**6-20**]
Gen: intubated, sedated, doesn't open eyes to voice or follow
commands
HEENT: NCAT. Sclera anicteric. EOMI. OP clear, no exudates or
ulceration.
Neck: JVP flat, RIJ in place
CV: RRR, normal S1, S2. No m/r/g.
Chest: diffuse crackles.
Abd: Soft, NTND. No HSM or tenderness.
Ext: no edema
Skin: No stasis dermatitis, ulcers, scars.
Neuro: PERRL, does not follow commands


Pertinent Results:
Admission labs:

[**2153-4-13**] 01:30PM   WBC-3.7* RBC-4.82 HGB-14.4 HCT-45.2 MCV-94
MCH-29.9 MCHC-31.9 RDW-13.0
[**2153-4-13**] 01:30PM   NEUTS-47* BANDS-17* LYMPHS-26 MONOS-4 EOS-0
BASOS-0 ATYPS-1* METAS-3* MYELOS-2*
[**2153-4-13**] 01:30PM   GLUCOSE-229* UREA N-26* CREAT-1.2 SODIUM-138
POTASSIUM-4.6 CHLORIDE-100 TOTAL CO2-21* ANION GAP-22*
[**2153-4-13**] 01:30PM   CALCIUM-9.3 PHOSPHATE-4.6*# MAGNESIUM-2.0

Brief Hospital Course:
An 84 year-old man presents with likely sepsis secondary to
pneumonia.
.
# Respiratory failure: patient was intubated in ED for hypoxemic
respiratory failure, likely secondary to pneumonia. Due to
initial aggressive fluid resuscitation, patient had to be
diuresed over several days before extubation. During the course
of intubation, patient intermittently hyperventilated regardless
of ventilator settings and failed repeated SBTs. Benzodiazepenes
and opiates briefly brought down respiratory rate. At one point,
family considered making patient CMO and terminal extubation.
However, patient was gradually more alert and once asked
declined terminal extubation and agreed that if extubation was
unsuccessful, re-intubation would be okay. Patient was
successfully extubated on [**2153-4-24**] and called out to the medicine
floor.  Patient remained comfortable on 4L with improved breath
sounds.
.
# MRSA pneumonia: Patient presented with bandemia and
leukopenia, fevers, and CT with multilobar infiltrates
diagnostic of severe pneumonia. Vancomycin, zosyn, and
levofloxacin were started. He initially required levophed to
maintain MAP >65.  Sputum cultures grew MRSA.  Antibiotics were
narrowed to vancomycin.  Levophed was weaned, and BP remained
normal to hypertensive.  However, a few days into his MICU
course, he was again febrile and clinically tenuous, so
antibiotic regimen was broadened back to include cefepime and
ciprofloxacin in addition to the IV vancomycin. He finished his
course of antibiotics on [**2153-4-24**] and he has been stable on 4L of
O2 with gradually improving breath sounds.
.
# RUE edema/weakness - upper extremity ultrasound showed an age
indeterminate midcephalic vein clot with signs of distal flow.
Vascular surgery was consulted, recommended no anticoagulation.
Warm packs, elevation, and NSAIDS were used.  Head CT was
performed with no signs of intracranial process to explain
weakness.  Patient will require physical rehabilitation of right
arm.
.
# Hct drop: Hct fell from 35 on admission to 27, likely
secondary to fluids, and was subsequently stable.
.
# Hyperlipidemia:  Atorvastatin was continued.
.
# AAA: 3 cm, newly discovered.  Patient was seen by vascular in
ED who recommended repeat US in 6 months
.
CODE STATUS: Full code

Medications on Admission:
Aspirin 81 mg daily
lipitor 20 mg daily
omeprazole 20 mg daily
Multivitamin


Discharge Medications:
1. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
2. Docusate Sodium 100 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO twice
a day.
3. Senna 8.6 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
4. Quetiapine 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3 times a
day).
5. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Last Name (STitle) **]: One (1) nebulizer Inhalation Q6H (every 6
hours) as needed for SOB, wheezing.
6. Ipratropium Bromide 0.02 % Solution [**Last Name (STitle) **]: One (1) nebulizer
Inhalation Q6H (every 6 hours) as needed for SOB, wheezing.
7. Heparin (Porcine) 5,000 unit/mL Solution [**Last Name (STitle) **]: 5000 (5000)
units Injection TID (3 times a day).
8. Atorvastatin 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
9. Aspirin 81 mg Tablet, Delayed Release (E.C.) [**Last Name (STitle) **]: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
10. Multivitamin     Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
11. Acetaminophen 325 mg Tablet [**Last Name (STitle) **]: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever, pain.
12. Ibuprofen 400 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.


Discharge Disposition:
Extended Care

Facility:
Newbridge on the [**Doctor Last Name **]

Discharge Diagnosis:
Primary Diagnosis:
MRSA pneumonia
Secondary Diagnosis:
GERD
Hyperlipidemia
Vertigo
BPH


Discharge Condition:
Mental Status: Confused - sometimes
Level of Consciousness: Alert and interactive
Activity Status: Out of Bed with assistance to chair or
wheelchair


Discharge Instructions:
You were admitted to [**Hospital1 69**] for
respiratory distress.  You were found to have a MRSA pneumonia,
and you needed to be admitted to the ICU and required intubation
to help with your breathing.  You received a course of
antibiotics to help clear your infection.  You are being
transferred to a rehabilitation facility to help you improve
your breathing functions.

Your medications have changed.  Please take only the medications
as listed below:
Aspirin 81 mg daily
Albuterol nebulizer every 6 hours as needed for shortness of
breath or wheezing
Atorvastatin 20 mg daily
Docusate sodium 100 mg twice a day
Heparin 5000 units injected under the skin three times a day
Ipratropium nebulizer every 6 hours as needed for shortness of
breath and wheezing
Lansoprazole 30 mg daily
Multivitamin 1 tablet daily
Ibuprofen 400 mg every 8 hours as needed for pain
Tylenol 325-650 mg every 6 hours as needed for pain, fever
Quetiapine 25 mg three times a day

If you experience chest pain, worsening shortness of breath, or
any other worrisome symptoms please return to the emergency room

Followup Instructions:
Please follow up with your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1007**]
([**Telephone/Fax (1) 10492**]), after discharge from the pulmonary
rehabilitation facility


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**] MD, [**MD Number(3) 10495**]
{'Unspecified septicemia,Acute respiratory failure,Methicillin resistant pneumonia due to Staphylococcus aureus,Septic shock,Peripheral vascular complications, not elsewhere classified,Acute venous embolism and thrombosis of superficial veins of upper extremity,Mixed acid-base balance disorder,Severe sepsis,Abdominal aneurysm without mention of rupture,Esophageal reflux,Pure hypercholesterolemia,Dizziness and giddiness,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anemia, unspecified,Muscle weakness (generalized),Other constipation,Personal history of tobacco use,Personal history of Methicillin resistant Staphylococcus aureus'}


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: shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 25816**] is an 84 year old patient of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 25817**] who
presented to the ED today after 2 episodes vomiting and
diarrhea. Per his son, he lives independently and was doing well
until he woke up this morning with nausea, a single episode of
vomiting, a loose nonbloody stool, chills, and general malaise.
He called his son who brought him to the [**Name (NI) **].
.
In the waiting room, he had an episode of possible syncope. He
felt SOB and looked ill, and his family noticed that he seemed
confused. He was taken to the core area where he was found to
have 80% on RA. EKG showed no ischemic changes. CXR was
unremarkable. Labs notable for lactic acidosis with lactate 8.
CT torso was done to rule out PE. This showed diffuse ground
glass opacities in the lungs and AAA. Vascular Surgery service
saw him.
.
In the ED waiting room, patient had a brief episode of near
syncope during which he was feeling SOB and confused and "looked
bad." He was tachycardic and tachypneic. O2 Sat was 80% on RA
with venous pH 7.1, prompting intubation. Serial EKGs were
without ischemic changes. He was noted to be acidotic with
lactate 8. CT torso was done to rule out PE. No PE was
demonstrated, but there were diffuse ground glass opacities
concerning for multifocal pneumonia. He was given vancomycin,
zosyn, levofloxacin. CT also showed 3.8 cm infrarenal AAA.
Vascular Surgery service saw him in the ED. He was intubated and
admitted to the MICU for further managemenet.

MEDICAL HISTORY: GERD
Hyperlipidemia
Vertigo
BPH

MEDICATION ON ADMISSION: Aspirin 81 mg daily
lipitor 20 mg daily
omeprazole 20 mg daily
Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission exam:
VS: T 100.0, HR 88, BP 130/70RR 32, O2 100% on PSV with 100%
FiO2, [**6-20**]
Gen: intubated, sedated, doesn't open eyes to voice or follow
commands
HEENT: NCAT. Sclera anicteric. EOMI. OP clear, no exudates or
ulceration.
Neck: JVP flat, RIJ in place
CV: RRR, normal S1, S2. No m/r/g.
Chest: diffuse crackles.
Abd: Soft, NTND. No HSM or tenderness.
Ext: no edema
Skin: No stasis dermatitis, ulcers, scars.
Neuro: PERRL, does not follow commands

FAMILY HISTORY: The patient has a mother who had HTN and father who had a
stroke.

SOCIAL HISTORY: Lives with wife. [**Name (NI) **] is her primary care taker  as she has
suffered a recent stroke. Remote smoking history (30 pkyr).
Occasional alcohol use. No history of illicit drug use. 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Methicillin resistant pneumonia due to Staphylococcus aureus,Septic shock,Peripheral vascular complications, not elsewhere classified,Acute venous embolism and thrombosis of superficial veins of upper extremity,Mixed acid-base balance disorder,Severe sepsis,Abdominal aneurysm without mention of rupture,Esophageal reflux,Pure hypercholesterolemia,Dizziness and giddiness,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anemia, unspecified,Muscle weakness (generalized),Other constipation,Personal history of tobacco use,Personal history of Methicillin resistant Staphylococcus aureus'}
