CHIEF COMPLAINT: SOB

PRESENT ILLNESS: Pt is a 85 y/o man w/ Parkinsons dz, COPD, and CHF who presented
to [**Hospital6 33**] from his nursing home w/ complaints of a
low grade temperature and SOB this AM.  He complained
additionally of a dry cough but denied leg pain/swelling/rash.
He has had no recent medication changes or diet changes.  At the
outside hospital, he was found to be tachycardic to 118,
hypertensive  to the 160s and hypoxic to the high 80s on a NRB.
He developed rapid atrial fibrillation requiring
cardioconversion and was noted to have precordial ST elevations
with CKs in the 500s.  His CMO code status was reversed so that
the son in [**Name (NI) 108**] could come up to see his father and he was
intubated for respiratory distress.  He was transferred to [**Hospital1 18**]
for further evaluation and possible cath.  Her in the CCU, his
ST elevations had resolved although he was still tachycardic in
a. fib and febrile.

MEDICAL HISTORY: 1. Parkinson's Disease
2. COPD
3. Recurrent aspiration
4. CHF

MEDICATION ON ADMISSION: protonix
metoprolol
albuterol
carbidopa
aricept

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: Intubated, sedated, diaphoretic
HEENT: Pupils slowly reactive, MMM
Neck: -LAD/JVD appreciated
CV: Irregular rhythm, S1/S2, -M/R/G ascultated
Lungs: coarse inspiratory breath sounds.
Abd: S/NT, no wincing to palpatation
Ext: + extremity edema b/l, extremities cold to palpation,
pulses dopplerable

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives in a chronic care facility
Acute respiratory failure,Unspecified septicemia,Severe sepsis,Pneumonitis due to inhalation of food or vomitus,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Pressure ulcer, buttock,Encounter for palliative care,Paralysis agitans,Dementia in conditions classified elsewhere without behavioral disturbance,Infection with microorganisms resistant to penicillins
Acute respiratry failure,Septicemia NOS,Severe sepsis,Food/vomit pneumonitis,Subendo infarct, initial,Atrial fibrillation,CHF NOS,Pressure ulcer, buttock,Encountr palliative care,Paralysis agitans,Dementia w/o behav dist,Inf mcrg rstn pncllins
Admission Date:  [**2143-9-16**]              Discharge Date:   [**2143-9-27**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 11495**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
Pt is a 85 y/o man w/ Parkinsons dz, COPD, and CHF who presented
to [**Hospital6 33**] from his nursing home w/ complaints of a
low grade temperature and SOB this AM.  He complained
additionally of a dry cough but denied leg pain/swelling/rash.
He has had no recent medication changes or diet changes.  At the
outside hospital, he was found to be tachycardic to 118,
hypertensive  to the 160s and hypoxic to the high 80s on a NRB.
He developed rapid atrial fibrillation requiring
cardioconversion and was noted to have precordial ST elevations
with CKs in the 500s.  His CMO code status was reversed so that
the son in [**Name (NI) 108**] could come up to see his father and he was
intubated for respiratory distress.  He was transferred to [**Hospital1 18**]
for further evaluation and possible cath.  Her in the CCU, his
ST elevations had resolved although he was still tachycardic in
a. fib and febrile.

Past Medical History:
1. Parkinson's Disease
2. COPD
3. Recurrent aspiration
4. CHF

Social History:
Lives in a chronic care facility

Family History:
NC

Physical Exam:
Gen: Intubated, sedated, diaphoretic
HEENT: Pupils slowly reactive, MMM
Neck: -LAD/JVD appreciated
CV: Irregular rhythm, S1/S2, -M/R/G ascultated
Lungs: coarse inspiratory breath sounds.
Abd: S/NT, no wincing to palpatation
Ext: + extremity edema b/l, extremities cold to palpation,
pulses dopplerable

Pertinent Results:
[**2143-9-16**] 12:07PM BLOOD WBC-11.1* RBC-3.89* Hgb-11.5* Hct-37.5*
MCV-96 MCH-29.6 MCHC-30.7* RDW-13.7 Plt Ct-299
[**2143-9-19**] 04:22AM BLOOD Neuts-93.1* Lymphs-4.8* Monos-2.1 Eos-0
Baso-0
[**2143-9-16**] 12:07PM BLOOD Plt Ct-299
[**2143-9-16**] 04:19PM BLOOD PT-14.6* PTT-49.1* INR(PT)-1.4
[**2143-9-16**] 12:07PM BLOOD Glucose-137* UreaN-31* Creat-1.3* Na-153*
K-3.9 Cl-111* HCO3-28 AnGap-18
[**2143-9-16**] 12:07PM BLOOD CK(CPK)-440*
[**2143-9-16**] 04:42PM BLOOD CK(CPK)-428*
[**2143-9-17**] 02:00AM BLOOD CK(CPK)-355*
[**2143-9-16**] 12:07PM BLOOD CK-MB-21* MB Indx-4.8 cTropnT-2.14*
[**2143-9-16**] 04:42PM BLOOD CK-MB-16* MB Indx-3.7 cTropnT-2.75*
[**2143-9-17**] 02:00AM BLOOD CK-MB-16* MB Indx-4.5 cTropnT-1.64*
[**2143-9-16**] 12:07PM BLOOD Calcium-8.6 Phos-4.3 Mg-2.1
[**2143-9-19**] 04:22AM BLOOD Vanco-53.2*
[**2143-9-20**] 04:29AM BLOOD Vanco-11.8*
[**2143-9-21**] 05:02AM BLOOD Vanco-17.5*
[**2143-9-16**] 12:07PM BLOOD Cortsol-25.0*
[**2143-9-16**] 07:45PM BLOOD Cortsol-31.2*
[**2143-9-17**] 02:00AM BLOOD Cortsol-23.7*
[**2143-9-16**] 02:11PM BLOOD Type-ART Temp-37.9 pO2-117* pCO2-41
pH-7.46* calHCO3-30 Base XS-4 Intubat-INTUBATED
[**2143-9-22**] 10:13AM BLOOD Type-ART Temp-36.1 FiO2-100 pO2-112*
pCO2-47* pH-7.36 calHCO3-28 Base XS-0 AADO2-573 REQ O2-92
Intubat-NOT INTUBA
.
ECHO [**8-30**]:
The left atrium is moderately dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. There is severe global left ventricular hypokinesis. No
masses or thrombi are seen in the left ventricle. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. There is an
anterior space which most likely represents a fat pad, though a
loculated anterior pericardial effusion cannot be excluded.


Brief Hospital Course:
A/P: Pt is an 85 y/o man w/ a PMH of parkinsons and COPD who
presented w/ SOB and ekg changes along with enzyme elevations.
.
1. Cardiac - patient had CE elevations w/out EKG changes when
transferred to [**Hospital1 18**].  His family deferred catheterization due
to his poor condition and previous DNR/DNI status.  He was
initially hypotensive necessitating pressors upon admission.  He
did not appear to be in CHF and responded well to fluid boluses.
 His pressors were weaned off and he remained pressor free for
the remainder of his stay.  His initially had afib when
evaluated at the outside hospital and was cardioconverted to
NSR.  He was monitored on tele throughout his admission.  He
occassionally reverted to afib during his admission and was rate
controlled with metoprolol for these tachyarrhythmias.
.
2. Respiratory distress - the patient has a hx of copd and chf.
He was transferred to us intubated although he had previously
been DNR/DNI.  He tolerated a wean of his ventillator and was
successfully extubated during his stay.  His family discussed
the options with the covering team and decided that he should be
DNI if he ever again decompenstated from a respiratory
standpoint.  He was maintained on stress dose steroids for 5d
and received nebs.  His sputum cx grew MRSA which was treated w/
vancomycin.  He was diuresed later on in his hospital course and
responded well to 40mg lasix IV.
.
3. CRI - the patient's creatinine on arrival was 1.3 but quickly
normalized
.
4. ID - the patient was never febrile during his admission and
mostly was hypothermic to the 95-96 range.  He had a
persistently elevated WBC count and a hemodynamic picture c/w
sepsis on admission.  He was treated w/ IVF and empirically
started on vancomycin, ceftazidime, and flagyl.  Blood and urine
cultures grew nothing but his sputum cx grew MRSA.  He was
underwent a 10d course of vancomycin.

The patient continued to have poor functional status and was
transfered from the CCU to step down floor for continued care.
Discussion were held with the patient's family and they decided
to have him made CMO, with antibiotics and morphine drip for
comfort care. The patient expired on [**2143-9-27**].

Medications on Admission:
protonix
metoprolol
albuterol
carbidopa
aricept

Discharge Medications:
None-Deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
NSTEMI

Discharge Condition:
Patient Expired

Discharge Instructions:
None

Followup Instructions:
None


Completed by:[**2143-11-22**]
{'Acute respiratory failure,Unspecified septicemia,Severe sepsis,Pneumonitis due to inhalation of food or vomitus,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Pressure ulcer, buttock,Encounter for palliative care,Paralysis agitans,Dementia in conditions classified elsewhere without behavioral disturbance,Infection with microorganisms resistant to penicillins'}


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

PRESENT ILLNESS: Pt is a 85 y/o man w/ Parkinsons dz, COPD, and CHF who presented
to [**Hospital6 33**] from his nursing home w/ complaints of a
low grade temperature and SOB this AM.  He complained
additionally of a dry cough but denied leg pain/swelling/rash.
He has had no recent medication changes or diet changes.  At the
outside hospital, he was found to be tachycardic to 118,
hypertensive  to the 160s and hypoxic to the high 80s on a NRB.
He developed rapid atrial fibrillation requiring
cardioconversion and was noted to have precordial ST elevations
with CKs in the 500s.  His CMO code status was reversed so that
the son in [**Name (NI) 108**] could come up to see his father and he was
intubated for respiratory distress.  He was transferred to [**Hospital1 18**]
for further evaluation and possible cath.  Her in the CCU, his
ST elevations had resolved although he was still tachycardic in
a. fib and febrile.

MEDICAL HISTORY: 1. Parkinson's Disease
2. COPD
3. Recurrent aspiration
4. CHF

MEDICATION ON ADMISSION: protonix
metoprolol
albuterol
carbidopa
aricept

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: Intubated, sedated, diaphoretic
HEENT: Pupils slowly reactive, MMM
Neck: -LAD/JVD appreciated
CV: Irregular rhythm, S1/S2, -M/R/G ascultated
Lungs: coarse inspiratory breath sounds.
Abd: S/NT, no wincing to palpatation
Ext: + extremity edema b/l, extremities cold to palpation,
pulses dopplerable

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives in a chronic care facility 

### Response:
{'Acute respiratory failure,Unspecified septicemia,Severe sepsis,Pneumonitis due to inhalation of food or vomitus,Subendocardial infarction, initial episode of care,Atrial fibrillation,Congestive heart failure, unspecified,Pressure ulcer, buttock,Encounter for palliative care,Paralysis agitans,Dementia in conditions classified elsewhere without behavioral disturbance,Infection with microorganisms resistant to penicillins'}
