CHIEF COMPLAINT: Asthma attack

PRESENT ILLNESS: This 79 female with h.o asthma who presents acute dyspnea
xseveral weeks. Pt reports acute worsening of dyspnea after
aspirin ingestion at home for a headache around 1am. Pt denies
f/c/URI/change in cough, has chronic cough productive of yellow
sputum, hemoptysis, CP, palpitations, orthopnea/PND. She reports
she had never been hospitalized for asthma in the past.
Currently, pt reports breathing much improved.
She also denies headache/LH/dizziness/blurred vision, abd
pain/n/v/d/c/melena/brbpr/dysuria/hematuria/joint
pain/paresthesias/weakness.
.
In the ED, EKG unrevealing, thought to be tight, sating well on
NRB. Given nebs, solumedrol, zofran. Per ED no indication for
ABG, speaking in full sentences. Pt would "like to go vote
tomorrow".

MEDICAL HISTORY: 1.  Appendectomy with intestinal obstruction, age 4.
2.  Cholecystectomy in her 20's.
3.  Rhinoplasty in her 20's.
4.  Concussion after skiing in her 20's, no sequelae.
5.  Asthma
6.  Osteoporosis

MEDICATION ON ADMISSION: albuterol 2 puffs QID prn
diazepam 2mg 1 daily prn
fluticasone 50mcg 2 sprasy each nostril daily
triamcinolone acetonide 100mcg 2 puffs [**Hospital1 **]
calcium +D

ALLERGIES: Aspirin

PHYSICAL EXAM: gen-well appearing but anxious, NAD, able to speak in full
sentences, but noticeable prolonged expiratory phase,
intermittent wheezing during conversation.
vitals-T. 97.1, BP 118/62, HR 103, RR 22 sat 94%2L
HEENT-nc/at, PERRLA, EOMI, anicteric, MMM, no oropharyngeal
lesions/exudates
neck-no JVD, no LAD, supple
chest-b/l ae +scant expiratory wheezing, no c/r, good
airmovement except in bases.
heart-s1s2 rrr no m/r/g
abd-+bs, soft, NT,ND
ext-no C/C/E 2+pulses
neuro-aaox2, CN2-12 intact, non-focal

FAMILY HISTORY: father-HD/MI
brother-asthma, [**Name2 (NI) 499**] cancer

SOCIAL HISTORY: Lives alone. Former smoker, quit 20 yrs ago. Occasional ETOH/few
drinks per week, denies drug use.
Asthma, unspecified type, with (acute) exacerbation,Anxiety state, unspecified
Asthma NOS w (ac) exac,Anxiety state NOS
Admission Date:  [**2105-11-17**]              Discharge Date:   [**2105-11-17**]

Date of Birth:  [**2026-6-20**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin

Attending:[**First Name3 (LF) 8487**]
Chief Complaint:
Asthma attack

Major Surgical or Invasive Procedure:
None


History of Present Illness:
This 79 female with h.o asthma who presents acute dyspnea
xseveral weeks. Pt reports acute worsening of dyspnea after
aspirin ingestion at home for a headache around 1am. Pt denies
f/c/URI/change in cough, has chronic cough productive of yellow
sputum, hemoptysis, CP, palpitations, orthopnea/PND. She reports
she had never been hospitalized for asthma in the past.
Currently, pt reports breathing much improved.
She also denies headache/LH/dizziness/blurred vision, abd
pain/n/v/d/c/melena/brbpr/dysuria/hematuria/joint
pain/paresthesias/weakness.
.
In the ED, EKG unrevealing, thought to be tight, sating well on
NRB. Given nebs, solumedrol, zofran. Per ED no indication for
ABG, speaking in full sentences. Pt would "like to go vote
tomorrow".

Past Medical History:
1.  Appendectomy with intestinal obstruction, age 4.
2.  Cholecystectomy in her 20's.
3.  Rhinoplasty in her 20's.
4.  Concussion after skiing in her 20's, no sequelae.
5.  Asthma
6.  Osteoporosis

Social History:
Lives alone. Former smoker, quit 20 yrs ago. Occasional ETOH/few
drinks per week, denies drug use.


Family History:
father-HD/MI
brother-asthma, [**Name2 (NI) 499**] cancer


Physical Exam:
gen-well appearing but anxious, NAD, able to speak in full
sentences, but noticeable prolonged expiratory phase,
intermittent wheezing during conversation.
vitals-T. 97.1, BP 118/62, HR 103, RR 22 sat 94%2L
HEENT-nc/at, PERRLA, EOMI, anicteric, MMM, no oropharyngeal
lesions/exudates
neck-no JVD, no LAD, supple
chest-b/l ae +scant expiratory wheezing, no c/r, good
airmovement except in bases.
heart-s1s2 rrr no m/r/g
abd-+bs, soft, NT,ND
ext-no C/C/E 2+pulses
neuro-aaox2, CN2-12 intact, non-focal


Pertinent Results:
[**2105-11-17**] 06:15AM BLOOD WBC-13.5*# RBC-4.53 Hgb-13.7 Hct-39.7
MCV-88 MCH-30.1 MCHC-34.4 RDW-12.2 Plt Ct-251
[**2105-11-17**] 02:33AM BLOOD Neuts-48.5* Lymphs-40.2 Monos-3.8
Eos-7.1* Baso-0.5
[**2105-11-17**] 02:33AM BLOOD PT-12.2 PTT-22.6 INR(PT)-1.0
[**2105-11-17**] 06:15AM BLOOD Glucose-163* UreaN-20 Creat-1.1 Na-136
K-3.5 Cl-100 HCO3-25 AnGap-15
[**2105-11-17**] 06:15AM BLOOD AlkPhos-64
[**2105-11-17**] 02:33AM BLOOD CK(CPK)-136
[**2105-11-17**] 02:33AM BLOOD cTropnT-<0.01
[**2105-11-17**] 06:15AM BLOOD Calcium-9.0 Phos-2.4* Mg-2.3

[**2105-11-17**] CXR PA portable- 1. Subtle increased linear opacity in
the medial aspect of the right lower lobe on this AP radiograph.
Recommend formal PA and Lateral radiographs to evaluate for
developing pneumonia as discussed with Dr. [**First Name8 (NamePattern2) 1169**] [**Last Name (NamePattern1) **] the
day of examination at 8:07 AM.
2. Increased lung volumes suggesting obstructive lung disease.


Brief Hospital Course:
This is a 79 y.o female with a h/o asthma who presents with
dyspnea/hypoxia.
.
1. [**Name (NI) 19299**] Pt with dyspnea, decreased response to albuterol and
worsening SOB in the setting of recently ingesting an aspirin
and having exposure to construction work around her home. Thus,
he symptoms wer thought likely due to an asthma flare. Other
possibilities include infection, but clear chest x-ray/no white
count/no fever, PE however, wheezing on exam and seems to be c/w
asthma flare, unlikely to be MI given no CP/diaphoresis/or EKG
changes. S/P solumedrol, nebs in the ED. She was monitored
overnight in the ICU where she had stable vitals and O2 sat. She
was started on azithromycin and prednisone taper. Her inhaled
steroids were also switched from triamcinolone to fluticasone
[**Hospital1 **]. She will follow up both with pulmonology and her PCP. [**Name10 (NameIs) **]
was vaccinated for influenza and pneumonia.
.
2. Anxiety-Continued prn ativan.

Medications on Admission:
albuterol 2 puffs QID prn
diazepam 2mg 1 daily prn
fluticasone 50mcg 2 sprasy each nostril daily
triamcinolone acetonide 100mcg 2 puffs [**Hospital1 **]
calcium +D


Discharge Medications:
1. Azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 4 doses.
Disp:*4 Tablet(s)* Refills:*0*
2. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily)
for 11 days: Please take 2 pills daily for 3 days (starting on
Wednesday), 1 pill daily for 4 days then half a pill daily for 4
days.
Disp:*12 Tablet(s)* Refills:*0*
3. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation every four (4) hours as needed for shortness of
breath or wheezing.
4. Diazepam 2 mg Tablet Sig: One (1) Tablet PO once a day as
needed.
5. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
sprays in each nostril Nasal once a day.
6. CALCIUM 500+D 500 (1,250)-200 mg-unit Tablet Sig: One (1)
Tablet PO twice a day.
7. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation twice a day.
Disp:*1 inhaler* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
Asthma exacerbation


Discharge Condition:
Good. Ambulating without desaturation.


Discharge Instructions:
You were admitted with an asthma exacerbation. This could have
been caused by exposure to fumes from construction near your
home or from your use of aspirin. We are sending you home on
antibiotics to start on Wednesday to take for 4 days and
steroids which you will taper as prescribed over the next 11
days. We also switched your triamcinolone inhaler to a
fluticasone inhaler which we think will be a better steroid
inhaler for you. Please continue your fluticasone nasal spray
and your albuterol as needed.
.
We added prednisone and azithromycin to your medications.
We changed your inhaled triamcinolone to fluticasone.
.
Please keep your follow up appointments as below.
.
Please call your doctor or return to the ED if you have
increasing shortness of breath, headache, fever, chills, cough,
nausea, vomitting or any other concerning symptoms.

Followup Instructions:
Please follow up with your primary doctor Dr. [**Last Name (STitle) 26894**] at 10:30 am
on Wednesday [**2105-10-18**].
.
Someone from the pulmonology clinic will contact you within 2
days with a follow up appointment.



Completed by:[**2105-11-17**]
{'Asthma, unspecified type, with (acute) exacerbation,Anxiety state, unspecified'}


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: Asthma attack

PRESENT ILLNESS: This 79 female with h.o asthma who presents acute dyspnea
xseveral weeks. Pt reports acute worsening of dyspnea after
aspirin ingestion at home for a headache around 1am. Pt denies
f/c/URI/change in cough, has chronic cough productive of yellow
sputum, hemoptysis, CP, palpitations, orthopnea/PND. She reports
she had never been hospitalized for asthma in the past.
Currently, pt reports breathing much improved.
She also denies headache/LH/dizziness/blurred vision, abd
pain/n/v/d/c/melena/brbpr/dysuria/hematuria/joint
pain/paresthesias/weakness.
.
In the ED, EKG unrevealing, thought to be tight, sating well on
NRB. Given nebs, solumedrol, zofran. Per ED no indication for
ABG, speaking in full sentences. Pt would "like to go vote
tomorrow".

MEDICAL HISTORY: 1.  Appendectomy with intestinal obstruction, age 4.
2.  Cholecystectomy in her 20's.
3.  Rhinoplasty in her 20's.
4.  Concussion after skiing in her 20's, no sequelae.
5.  Asthma
6.  Osteoporosis

MEDICATION ON ADMISSION: albuterol 2 puffs QID prn
diazepam 2mg 1 daily prn
fluticasone 50mcg 2 sprasy each nostril daily
triamcinolone acetonide 100mcg 2 puffs [**Hospital1 **]
calcium +D

ALLERGIES: Aspirin

PHYSICAL EXAM: gen-well appearing but anxious, NAD, able to speak in full
sentences, but noticeable prolonged expiratory phase,
intermittent wheezing during conversation.
vitals-T. 97.1, BP 118/62, HR 103, RR 22 sat 94%2L
HEENT-nc/at, PERRLA, EOMI, anicteric, MMM, no oropharyngeal
lesions/exudates
neck-no JVD, no LAD, supple
chest-b/l ae +scant expiratory wheezing, no c/r, good
airmovement except in bases.
heart-s1s2 rrr no m/r/g
abd-+bs, soft, NT,ND
ext-no C/C/E 2+pulses
neuro-aaox2, CN2-12 intact, non-focal

FAMILY HISTORY: father-HD/MI
brother-asthma, [**Name2 (NI) 499**] cancer

SOCIAL HISTORY: Lives alone. Former smoker, quit 20 yrs ago. Occasional ETOH/few
drinks per week, denies drug use. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Anxiety state, unspecified'}
