CHIEF COMPLAINT: respiratory distress

PRESENT ILLNESS: 73 y/o M with multiple medical problems including CAD s/p CABG,
DM, ESRD on HD, CHF, AF c/b stroke on coumadin, CVA, and
paraplegia who presented to [**Hospital6 4620**] from
[**Hospital1 **] today after being found lethargic, and in respiratory
distress with an RR in the 30s. At the OSH he was found in
severe respiratory distress with "agonal breathing" [**Name8 (MD) **] MD
report. Apparently this was severe enough to warrant the
physician to recommend [**Name9 (PRE) 3225**] measures to the family. An ABG showed
a respiratory acidosis, and the patient was placed on a NRB. A
CXR showed a LLL PNA in the setting of transient hypotension
(SBP as low as 57) requiring levophed, and a new leukocytosis.
He was given 1 gram of vancomycin.

MEDICAL HISTORY: CAD s/p CABG '[**20**] - Coronary bypass graft x3, left internal
mammary artery to left anterior ascending artery, saphenous vein
graft to 2nd obtuse marginal branch, saphenous vein graft to
posterior descending coronary artery.
CHF EF 42% on PMIMI from [**10-6**]
DM II
Hyperlipidemia
HTN
CKD V due to diabetic nephropathy on HD since [**3-/2122**]
moderate pulm HTN
AF on coumadin, history of stroke (by report) with mild residual
R-sided weakness
PVD s/p L SFA to PT bypass for nonhealing ulcer
tachy-brady s/p PM '[**16**]
C4-C5 spinal cord injury after fall at home in [**10-6**]
s/p R BKA in [**11-5**] for right foot ulcer

MEDICATION ON ADMISSION: Flagyl 500 q12 until [**4-14**]
Cefepime 1g q24 until [**4-14**]
Lantus 16 units qPM
ISS
Lisinopril 5mg qday
Metoprolol tartrate 25mg [**Hospital1 **]
Simvastatin 40mg daily
ASA 81mg qday
Coumadin 6mg daily (last dose)
Citalopram 5mg daily
Carbamazepine 100mg chewable daily
Epoetin alfa [**Numeric Identifier 389**] units with HD
Docusate sodium 50mg/5mL 100mg daily
Senna syrup 5mL qday
Bisacodyl prn
Lactulose prn
Lansoprazole solutab 30mg daily
Heparin SC
Folic Acid 1mg daily
Pyridoxine 50mg daily
Cyanocobalmin 500mcg daily
Ascorbic acid 500mg daily
Accuzyme 30gm topical [**Hospital1 **]
Oxycodone IR 5mg daily
Acetaminophen 160mg/5mL q4H prn
Guaifenesin prn

ALLERGIES: Methyldopa / Shellfish

PHYSICAL EXAM: VS: T 96.9' BP 100/32; HR ; RR
GEN: Chronically ill-appearing gentleman wearing shovel mask,
responding to questions appropriately
HEENT:
LUNGS: Crackles at base bilaterally with decreased breath sounds
on R. Occ rhonchi
HEART:
ABD:
EXT:
NEU:

FAMILY HISTORY: Father with CAD, mother with HTN and DM

SOCIAL HISTORY: He currently lives at rehab facility.  He used to work as real
estate broker.
He smoked [**1-2**] ppd for 10 years, quit 30 yrs ago.  He denies
current ethanol use but history of heavy use, no history of
IVDA.
Unspecified septicemia,Septic shock,Acidosis,Pneumonitis due to inhalation of food or vomitus,Chronic systolic heart failure,Secondary hyperparathyroidism (of renal origin),Pressure ulcer, lower back,Paraplegia,End stage renal disease,Severe sepsis,Anemia in chronic kidney disease,Late effects of cerebrovascular disease, other paralytic syndrome, bilateral,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Aortocoronary bypass status
Septicemia NOS,Septic shock,Acidosis,Food/vomit pneumonitis,Chr systolic hrt failure,Sec hyperparathyrd-renal,Pressure ulcer, low back,Paraplegia NOS,End stage renal disease,Severe sepsis,Anemia in chr kidney dis,Lt ef oth parals-bilat,Atrial fibrillation,DMII wo cmp uncntrld,Aortocoronary bypass
Admission Date:  [**2124-4-9**]              Discharge Date:   [**2124-4-12**]

Date of Birth:  [**2050-8-26**]             Sex:   M

Service: MEDICINE

Allergies:
Methyldopa / Shellfish

Attending:[**First Name3 (LF) 1042**]
Chief Complaint:
respiratory distress

Major Surgical or Invasive Procedure:
None


History of Present Illness:
73 y/o M with multiple medical problems including CAD s/p CABG,
DM, ESRD on HD, CHF, AF c/b stroke on coumadin, CVA, and
paraplegia who presented to [**Hospital6 4620**] from
[**Hospital1 **] today after being found lethargic, and in respiratory
distress with an RR in the 30s. At the OSH he was found in
severe respiratory distress with "agonal breathing" [**Name8 (MD) **] MD
report. Apparently this was severe enough to warrant the
physician to recommend [**Name9 (PRE) 3225**] measures to the family. An ABG showed
a respiratory acidosis, and the patient was placed on a NRB. A
CXR showed a LLL PNA in the setting of transient hypotension
(SBP as low as 57) requiring levophed, and a new leukocytosis.
He was given 1 gram of vancomycin.

He was recently discharged from the [**Hospital1 18**] on [**2124-4-4**]. He was
admitted on [**3-2**] for an AV fistula repair complicated by LLL
collapse and effusion s/p bronchoscopy. He was also started on a
course for hospital acquired/aspiration PNA with cefepime anf
flagyl. He was found to have a stage IV sacral decubitus ulcer
which was treated with a wound-vac assisted closure with
enzymatic debridement in consultation with plastic surgery who
did not want to perform an OR debridement. XR did not show OM.
He had a speech and swallow eval which he failed and was started
on tube feeds. He was dx with depression/adj. disorder and start
on citalopram. He was discharged to [**Hospital **] rehab for completion
of IV abx.


Past Medical History:
CAD s/p CABG '[**20**] - Coronary bypass graft x3, left internal
mammary artery to left anterior ascending artery, saphenous vein
graft to 2nd obtuse marginal branch, saphenous vein graft to
posterior descending coronary artery.
CHF EF 42% on PMIMI from [**10-6**]
DM II
Hyperlipidemia
HTN
CKD V due to diabetic nephropathy on HD since [**3-/2122**]
moderate pulm HTN
AF on coumadin, history of stroke (by report) with mild residual
R-sided weakness
PVD s/p L SFA to PT bypass for nonhealing ulcer
tachy-brady s/p PM '[**16**]
C4-C5 spinal cord injury after fall at home in [**10-6**]
s/p R BKA in [**11-5**] for right foot ulcer

Social History:
He currently lives at rehab facility.  He used to work as real
estate broker.
He smoked [**1-2**] ppd for 10 years, quit 30 yrs ago.  He denies
current ethanol use but history of heavy use, no history of
IVDA.


Family History:
Father with CAD, mother with HTN and DM

Physical Exam:
VS: T 96.9' BP 100/32; HR ; RR
GEN: Chronically ill-appearing gentleman wearing shovel mask,
responding to questions appropriately
HEENT:
LUNGS: Crackles at base bilaterally with decreased breath sounds
on R. Occ rhonchi
HEART:
ABD:
EXT:
NEU:


Pertinent Results:
[**2124-4-9**] 06:58PM   WBC-16.5* RBC-2.40* HGB-7.0* HCT-23.6*
MCV-99* MCH-29.4 MCHC-29.8* RDW-21.9*
[**2124-4-9**] 06:58PM   PLT COUNT-360
[**2124-4-9**] 06:58PM   PLT COUNT-360
[**2124-4-9**] 06:58PM   PT-38.6* PTT-44.6* INR(PT)-4.2*
[**2124-4-9**] 06:58PM   GLUCOSE-51* UREA N-69* CREAT-2.8* SODIUM-137
POTASSIUM-4.2 CHLORIDE-102 TOTAL CO2-24 ANION GAP-15
===========
CHEST (PORTABLE AP)  [**2124-4-9**] 10:20 AM

CHEST (PORTABLE AP)

Reason: assess lung status

[**Hospital 93**] MEDICAL CONDITION:
73 year old man with respiratory failure and aspiration event
REASON FOR THIS EXAMINATION:
assess lung status
PORTABLE CHEST OF [**2124-4-9**]

COMPARISON: [**2124-4-3**].

INDICATION: Respiratory failure and aspiration event.

Left pleural effusion has decreased in size with residual
moderate effusion and adjacent atelectasis remaining. New patchy
and linear right infrahilar opacities have developed, and may be
due to clinically suspected acute aspiration. Cardiomediastinal
contours and indwelling devices appear unchanged.
==========
ECG (5/11/8)
Regular ventricular pacing with probable underlying atrial
fibrillation.
Compared to the previous tracing ventricular pacing is new.


Brief Hospital Course:
The patient was transferred from the outside hospital to the
MICU for further observation. His septic shock was treated with
aggressive normal saline IVF boluses, and broadening of his
antibiotic regimen to meropenem, metronidazole, and vancomycin.
He continued to receive his hemodialysis. His tube feeds were
resumed without incident. He received local, aggressive care of
his decubitus ulcers. He was transferred back to rehabilitation
to complete his antibiotic regimen for his aspiration pneumonia
and continue wound care and medical care.

Medications on Admission:
Flagyl 500 q12 until [**4-14**]
Cefepime 1g q24 until [**4-14**]
Lantus 16 units qPM
ISS
Lisinopril 5mg qday
Metoprolol tartrate 25mg [**Hospital1 **]
Simvastatin 40mg daily
ASA 81mg qday
Coumadin 6mg daily (last dose)
Citalopram 5mg daily
Carbamazepine 100mg chewable daily
Epoetin alfa [**Numeric Identifier 389**] units with HD
Docusate sodium 50mg/5mL 100mg daily
Senna syrup 5mL qday
Bisacodyl prn
Lactulose prn
Lansoprazole solutab 30mg daily
Heparin SC
Folic Acid 1mg daily
Pyridoxine 50mg daily
Cyanocobalmin 500mcg daily
Ascorbic acid 500mg daily
Accuzyme 30gm topical [**Hospital1 **]
Oxycodone IR 5mg daily
Acetaminophen 160mg/5mL q4H prn
Guaifenesin prn

Discharge Medications:
1. Albuterol Sulfate 2.5 mg/3 mL Solution for Nebulization [**Hospital1 **]:
[**12-1**] neb Inhalation Q6H (every 6 hours) as needed.
2. Papain-Urea 830,000-10 unit/g-% Ointment [**Month/Day (2) **]: One (1) Appl
Topical DAILY (Daily).
3. Guaifenesin 100 mg/5 mL Syrup [**Month/Day (2) **]: Fifteen (15) ML PO Q6H
(every 6 hours).
4. B Complex-Vitamin C-Folic Acid 1 mg Capsule [**Month/Day (2) **]: One (1) Cap
PO DAILY (Daily).
5. Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (2) **]: Five (5) mL PO BID (2
times a day).
6. Cyanocobalamin 100 mcg Tablet [**Month/Day (2) **]: 0.5 Tablet PO DAILY
(Daily).
7. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
8. Carbamazepine 100 mg Tablet, Chewable [**Last Name (STitle) **]: One (1) Tablet,
Chewable PO BID (2 times a day).
9. Pyridoxine 50 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily).

10. Aspirin 81 mg Tablet, Chewable [**Last Name (STitle) **]: One (1) Tablet, Chewable
PO DAILY (Daily).
11. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID
(2 times a day).
12. Ascorbic Acid 500 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
13. Simvastatin 10 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO DAILY
(Daily).
14. Metronidazole in NaCl (Iso-os) 500 mg/100 mL Piggyback [**Last Name (STitle) **]:
Five Hundred (500) mg Intravenous Q8H (every 8 hours) for 10
days.
15. Meropenem 500 mg Recon Soln [**Last Name (STitle) **]: Five Hundred (500) mg
Intravenous Q24H (every 24 hours) for 10 days: Give after
hemodialysis.
16. Vancomycin in Dextrose 1 gram/200 mL Piggyback [**Last Name (STitle) **]: 1000
(1000) mg Intravenous Q48H (every 48 hours) for 10 days: Give
during hemodialysis.
17. Heparin, Porcine (PF) 10 unit/mL Syringe [**Last Name (STitle) **]: Two (2) ML
Intravenous PRN (as needed) as needed for line flush.
18. Lantus 100 unit/mL Solution [**Last Name (STitle) **]: Sixteen (16) units
Subcutaneous once a day.
19. Insulin sliding scale
Check fingerstick glucose four times daily. Glucose < 70 mg/dL:
give juice and contact physician on call, 71-150: observe,
151-200: 1 unit lispro insulin SQ, 201-250: 3 units, 251-300: 5
units, 301-350: 7 units, 351-400: 9 units, >400: call physician
on call
20. Outpatient Lab Work
Please check CBC with differential, PT/INR, comprehensive
metabolic panel, phosphorus, magnesium, random vancomycin level,
and blood culture once a week.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] Northeast - [**Hospital1 **]

Discharge Diagnosis:
1. Aspiration pneumonia
2. Atrial fibrillation with history of stroke with residual
deficits
3. Coronary artery disease h/o CABG
4. Chronic systolic congestive heart failure
5. Type 2 diabetes mellitus uncontrolled with complications
6. ESRD with associated hyperparathyroidism and anemia
7. Stage 4 decubitus ulcers
8. Cervical vertebral fracture with quadriparesis
9. Hyperlipidemia
10. Tachy/brady syndrome
11. Moderate pulmonary hypertension, secondary
12. History of multiple aspiration events


Discharge Condition:
Guarded


Discharge Instructions:
Please contact the physician on call at your facility if you
develop fevers, sweats, chills, difficulty breathing, confusion,
or worsening skin ulcers.

Followup Instructions:
Provider: [**Name10 (NameIs) **] SURGERY CLINIC Phone:[**Telephone/Fax (1) 4652**]
Date/Time:[**2124-4-21**] 1:00
Provider: [**Name10 (NameIs) **] [**Apartment Address(1) 871**] ([**Doctor First Name **]) [**Doctor First Name **] LMOB (NHB)
Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2124-8-31**] 1:00
Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2124-8-31**] 1:45
{'Unspecified septicemia,Septic shock,Acidosis,Pneumonitis due to inhalation of food or vomitus,Chronic systolic heart failure,Secondary hyperparathyroidism (of renal origin),Pressure ulcer, lower back,Paraplegia,End stage renal disease,Severe sepsis,Anemia in chronic kidney disease,Late effects of cerebrovascular disease, other paralytic syndrome, bilateral,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Aortocoronary bypass status'}


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: respiratory distress

PRESENT ILLNESS: 73 y/o M with multiple medical problems including CAD s/p CABG,
DM, ESRD on HD, CHF, AF c/b stroke on coumadin, CVA, and
paraplegia who presented to [**Hospital6 4620**] from
[**Hospital1 **] today after being found lethargic, and in respiratory
distress with an RR in the 30s. At the OSH he was found in
severe respiratory distress with "agonal breathing" [**Name8 (MD) **] MD
report. Apparently this was severe enough to warrant the
physician to recommend [**Name9 (PRE) 3225**] measures to the family. An ABG showed
a respiratory acidosis, and the patient was placed on a NRB. A
CXR showed a LLL PNA in the setting of transient hypotension
(SBP as low as 57) requiring levophed, and a new leukocytosis.
He was given 1 gram of vancomycin.

MEDICAL HISTORY: CAD s/p CABG '[**20**] - Coronary bypass graft x3, left internal
mammary artery to left anterior ascending artery, saphenous vein
graft to 2nd obtuse marginal branch, saphenous vein graft to
posterior descending coronary artery.
CHF EF 42% on PMIMI from [**10-6**]
DM II
Hyperlipidemia
HTN
CKD V due to diabetic nephropathy on HD since [**3-/2122**]
moderate pulm HTN
AF on coumadin, history of stroke (by report) with mild residual
R-sided weakness
PVD s/p L SFA to PT bypass for nonhealing ulcer
tachy-brady s/p PM '[**16**]
C4-C5 spinal cord injury after fall at home in [**10-6**]
s/p R BKA in [**11-5**] for right foot ulcer

MEDICATION ON ADMISSION: Flagyl 500 q12 until [**4-14**]
Cefepime 1g q24 until [**4-14**]
Lantus 16 units qPM
ISS
Lisinopril 5mg qday
Metoprolol tartrate 25mg [**Hospital1 **]
Simvastatin 40mg daily
ASA 81mg qday
Coumadin 6mg daily (last dose)
Citalopram 5mg daily
Carbamazepine 100mg chewable daily
Epoetin alfa [**Numeric Identifier 389**] units with HD
Docusate sodium 50mg/5mL 100mg daily
Senna syrup 5mL qday
Bisacodyl prn
Lactulose prn
Lansoprazole solutab 30mg daily
Heparin SC
Folic Acid 1mg daily
Pyridoxine 50mg daily
Cyanocobalmin 500mcg daily
Ascorbic acid 500mg daily
Accuzyme 30gm topical [**Hospital1 **]
Oxycodone IR 5mg daily
Acetaminophen 160mg/5mL q4H prn
Guaifenesin prn

ALLERGIES: Methyldopa / Shellfish

PHYSICAL EXAM: VS: T 96.9' BP 100/32; HR ; RR
GEN: Chronically ill-appearing gentleman wearing shovel mask,
responding to questions appropriately
HEENT:
LUNGS: Crackles at base bilaterally with decreased breath sounds
on R. Occ rhonchi
HEART:
ABD:
EXT:
NEU:

FAMILY HISTORY: Father with CAD, mother with HTN and DM

SOCIAL HISTORY: He currently lives at rehab facility.  He used to work as real
estate broker.
He smoked [**1-2**] ppd for 10 years, quit 30 yrs ago.  He denies
current ethanol use but history of heavy use, no history of
IVDA. 

### Response:
{'Unspecified septicemia,Septic shock,Acidosis,Pneumonitis due to inhalation of food or vomitus,Chronic systolic heart failure,Secondary hyperparathyroidism (of renal origin),Pressure ulcer, lower back,Paraplegia,End stage renal disease,Severe sepsis,Anemia in chronic kidney disease,Late effects of cerebrovascular disease, other paralytic syndrome, bilateral,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Aortocoronary bypass status'}
