CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 52M h/o dilated CM (EF 30-35% on [**2195-12-10**]), crack cocaine abuse
c/b crack pneumonitis, MRSA PNA, COPD, and Type I DM p/w
acute-onset SOB. He was in his USOH until the morning of
admission, when he developed SOB and nonradiating substernal
"chest tightness" x1h after ambulating to the couch, prompting
him to call EMS. He notes that the current episode is similar to
past episodes of DOE and chest tightness in the setting of crack
cocaine use; he last used cocaine and cigarettes on the evening
of [**2196-2-27**]. He endorses minimal wheeze on the evening PTA,
bilateral LE edema minimally increased from baseline, and stable
2-pillow orthopnea. He denies f/c/s, cough/URI symptoms,
pleuritic chest pain, PND, medication noncompliance, or recent
dietary indiscretion. He has no home O2 requirement.

MEDICAL HISTORY: - Type II Diabetes
- Hyperlipidemia
- HTN
- Nonischemic dilated cardiomyopathy ([**10/2195**]-LVEF 30-35%, mild
RV dilation, borderline function, 1+ MR)
- Hepatitis C antibody positive
- MRSA pneumonia (requiring tracheostomy)
- COPD
- Substance abuse (cocaine)
- Tobacco abuse
- Schizophrenia

MEDICATION ON ADMISSION: Ipratropium bromide 0.02% soln q6h prn wheeze
Albuterol 0.083% soln q6h
Fluticasone-salmeterol 250-50 mcg/dose inh [**Hospital1 **]
Furosemide 40 mg PO qd
Carvedilol 6.25 mg PO bid-->plan to decrease to 3.125mg [**Hospital1 **] per
PCP
[**Name Initial (PRE) **] 5 mg PO qd-->plan to decrease to 2.5mg per PCP
Insulin [**Name9 (PRE) **] 50u SQ qhs
Novolog SS
Atorvastatin 20 mg PO qd
ASA 81 mg PO qd
Sertraline 25 mg PO qd
Ferrous sulfate 300 mg PO qd
Omeprazole 20 mg PO qd
Quetiapine 100 mg PO qhs
?Tramadol 50mg [**Hospital1 **] for severe pain only

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
Vitals: 97.6  107  98/60  93% on nonrebreather at 100% FiO2
General: Alert, oriented in no acute distress.
HEENT: Sclera anicteric, EOMI, PERRL.
Neck: JVP to the clavicle, no change with hepatojugular
maneuver.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops.
Lungs: Tachypneic with mildly increased WOB, bilateral anterior
and L basilar crackles, scattered faint wheeze.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no organomegaly.
GU: No foley.
Ext: Warm, well perfused, 2+ brachial/DP pulses, trace LE edema
R>L minimally increased from baseline per patient.
Neuro: CNII-XII grossly intact, grossly normal sensation,
bilateral UE resting tremor without intention tremor or
asterixis.
.
Discharge Exam:
Patient was able to ambulate and maintain oxygen > 90%

FAMILY HISTORY: - Father: pacemaker, deceased
- mother: died of breast cancer

SOCIAL HISTORY: - history of multiple incarcerations (>6 months in [**2193**])
- lives with sister
- walks w/ cane due to right sided foot drop
- Tobacco history: current smoker, 1 cig per day
- ETOH: denies
- Illicit drugs: crack cocaine on day of admission, recurrent
crack relapses
Poisoning by cocaine,Acute respiratory failure,Acute on chronic systolic heart failure,Other primary cardiomyopathies,Alkalosis,Bronchitis and pneumonitis due to fumes and vapors,Cocaine dependence, continuous,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Hemoptysis, unspecified,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of insulin,Unspecified schizophrenia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted,Other, mixed, or unspecified drug abuse, unspecified,Other acquired deformities of ankle and foot,Personal history of noncompliance with medical treatment, presenting hazards to health
Poisoning by cocaine,Acute respiratry failure,Ac on chr syst hrt fail,Prim cardiomyopathy NEC,Alkalosis,Fum/vapor bronc/pneumon,Cocaine depend-contin,DMII wo cmp uncntrld,Hemoptysis NOS,Chr airway obstruct NEC,Long-term use of insulin,Schizophrenia NOS-unspec,Hyperlipidemia NEC/NOS,Hypertension NOS,Undet pois-med agnt NEC,Drug abuse NEC-unspec,Acq ankle-foot def NEC,Hx of past noncompliance
Admission Date:  [**2196-2-29**]              Discharge Date:   [**2196-3-5**]

Date of Birth:  [**2143-6-4**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
None

History of Present Illness:
52M h/o dilated CM (EF 30-35% on [**2195-12-10**]), crack cocaine abuse
c/b crack pneumonitis, MRSA PNA, COPD, and Type I DM p/w
acute-onset SOB. He was in his USOH until the morning of
admission, when he developed SOB and nonradiating substernal
"chest tightness" x1h after ambulating to the couch, prompting
him to call EMS. He notes that the current episode is similar to
past episodes of DOE and chest tightness in the setting of crack
cocaine use; he last used cocaine and cigarettes on the evening
of [**2196-2-27**]. He endorses minimal wheeze on the evening PTA,
bilateral LE edema minimally increased from baseline, and stable
2-pillow orthopnea. He denies f/c/s, cough/URI symptoms,
pleuritic chest pain, PND, medication noncompliance, or recent
dietary indiscretion. He has no home O2 requirement.

Of note, he has had multiple admissions for SOB and chest
tightness in the setting of crack cocaine use and attributed to
crack pneumonitis, most recently [**Date range (1) 35039**]/12, during which time
he underwent aggressive diuresis for likely concomittant CHF
exacerbation and received empiric levofloxacin x7d and IV
solumedrol followed by a prednisone taper. He has required ICU
admission and BiPAP during previous admissions for crack
pneumonitis, including a stay concluding [**2196-2-3**].

In the ED, initial VS were as follows: 123, 136/82, 33, 100% on
BiPAP initiated by EMS. CXR demonstrated bilateral patchy
opacities with diffuse reactive inflammatory process. Following
discontinuation of BiPAP, he developed RR to 50s, prompting
resumption of BiPAP. He received 40 mg IV Lasix, with 400 cc UOP
in ED, and 325 mg ASA, and nitroglycerin gtt was initiated. When
he developed SBP to 80s, nitroglycerin gtt was discontinued.

On arrival to the MICU, he was weaned successfully to
nonrebreather at 100% FiO2, with ABG: 7.47/40/82. An additional
225 cc UOP was noted.

In the MICU, the patient was put on BIPAP and an ABG was
obtained which showed a respiratory alkalosis with a large A-a
gradient. He was given 1. steroids, 2. vanc,cefepime,azithro, 3.
and IV lasix for chest xray concerning for pulmonary edema.
After stabilization in the MICU, his supplemental oxygen was
weaned to where he was saturating 97% on 3L NC with no signs of
excess work of breathing. He was transferred from the MICU
denying chest pain and he was sitting in bed comfortably
watching TV while receiving his IV antibiotics.

Past Medical History:
- Type II Diabetes
- Hyperlipidemia
- HTN
- Nonischemic dilated cardiomyopathy ([**10/2195**]-LVEF 30-35%, mild
RV dilation, borderline function, 1+ MR)
- Hepatitis C antibody positive
- MRSA pneumonia (requiring tracheostomy)
- COPD
- Substance abuse (cocaine)
- Tobacco abuse
- Schizophrenia

Social History:
- history of multiple incarcerations (>6 months in [**2193**])
- lives with sister
- walks w/ cane due to right sided foot drop
- Tobacco history: current smoker, 1 cig per day
- ETOH: denies
- Illicit drugs: crack cocaine on day of admission, recurrent
crack relapses


Family History:
- Father: pacemaker, deceased
- mother: died of breast cancer

Physical Exam:
Admission Exam:
Vitals: 97.6  107  98/60  93% on nonrebreather at 100% FiO2
General: Alert, oriented in no acute distress.
HEENT: Sclera anicteric, EOMI, PERRL.
Neck: JVP to the clavicle, no change with hepatojugular
maneuver.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops.
Lungs: Tachypneic with mildly increased WOB, bilateral anterior
and L basilar crackles, scattered faint wheeze.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no organomegaly.
GU: No foley.
Ext: Warm, well perfused, 2+ brachial/DP pulses, trace LE edema
R>L minimally increased from baseline per patient.
Neuro: CNII-XII grossly intact, grossly normal sensation,
bilateral UE resting tremor without intention tremor or
asterixis.
.
Discharge Exam:
Patient was able to ambulate and maintain oxygen > 90%

Pertinent Results:
Admission Labs:

[**2196-2-29**] 10:15AM BLOOD WBC-12.1*# RBC-3.85* Hgb-10.1* Hct-31.6*
MCV-82 MCH-26.3* MCHC-32.1 RDW-16.7* Plt Ct-326
[**2196-2-29**] 10:15AM BLOOD PT-10.4 PTT-33.1 INR(PT)-1.0
[**2196-2-29**] 10:15AM BLOOD WBC-12.1*# RBC-3.85* Hgb-10.1* Hct-31.6*
MCV-82 MCH-26.3* MCHC-32.1 RDW-16.7* Plt Ct-326
[**2196-2-29**] 10:15AM BLOOD Glucose-188* UreaN-17 Creat-1.1 Na-143
K-5.0 Cl-107 HCO3-25 AnGap-16
[**2196-2-29**] 10:15AM BLOOD CK(CPK)-211
[**2196-2-29**] 10:15AM BLOOD CK-MB-6 proBNP-3125*
[**2196-2-29**] 10:15AM BLOOD cTropnT-0.03*
[**2196-2-29**] 05:11PM BLOOD CK-MB-7 cTropnT-0.04*
[**2196-3-1**] 03:23AM BLOOD CK-MB-6 cTropnT-0.02*
[**2196-2-29**] 05:11PM BLOOD Mg-1.4*
[**2196-3-1**] 03:23AM BLOOD Calcium-8.8 Phos-2.2*# Mg-2.1
[**2196-2-29**] 01:53PM BLOOD Type-ART pO2-82* pCO2-40 pH-7.47*
calTCO2-30 Base XS-4
[**2196-2-29**] 10:21AM BLOOD Glucose-184* Na-144 K-4.2 Cl-105
calHCO3-27
[**2196-2-29**] 10:21AM BLOOD Hgb-10.7* calcHCT-32

Discharge Labs:

.
CXR ([**2196-2-29**]):
Bilateral opacities occupying nearly the totality of the lungs
consistent with acute pulmonary edema. Diffuse reactive
inflammatory process such as pneumonitis or infection cannot be
excluded.

[**2196-3-5**] 07:50AM BLOOD WBC-11.1* RBC-3.62* Hgb-9.4* Hct-31.1*
MCV-86 MCH-26.0* MCHC-30.3* RDW-17.1* Plt Ct-282
[**2196-3-4**] 07:56AM BLOOD WBC-10.9 RBC-3.94* Hgb-10.3* Hct-32.3*
MCV-82 MCH-26.1* MCHC-31.8 RDW-16.7* Plt Ct-289
[**2196-3-3**] 07:50AM BLOOD WBC-8.7# RBC-3.51* Hgb-9.0* Hct-29.1*
MCV-83 MCH-25.6* MCHC-30.8* RDW-16.6* Plt Ct-322
[**2196-3-2**] 08:20AM BLOOD WBC-19.1* RBC-3.67* Hgb-9.5* Hct-29.9*
MCV-82 MCH-26.0* MCHC-31.8 RDW-17.0* Plt Ct-341
[**2196-3-1**] 03:23AM BLOOD WBC-14.6* RBC-3.67* Hgb-9.5* Hct-29.2*
MCV-80* MCH-25.8* MCHC-32.4 RDW-16.4* Plt Ct-333
[**2196-2-29**] 10:15AM BLOOD WBC-12.1*# RBC-3.85* Hgb-10.1* Hct-31.6*
MCV-82 MCH-26.3* MCHC-32.1 RDW-16.7* Plt Ct-326
[**2196-3-1**] 03:23AM BLOOD PT-12.0 PTT-35.7 INR(PT)-1.1
[**2196-3-1**] 03:23AM BLOOD Plt Ct-333
[**2196-2-29**] 10:15AM BLOOD Glucose-188* UreaN-17 Creat-1.1 Na-143
K-5.0 Cl-107 HCO3-25 AnGap-16
[**2196-3-1**] 03:23AM BLOOD Glucose-236* UreaN-22* Creat-1.1 Na-140
K-4.1 Cl-104 HCO3-28 AnGap-12
[**2196-3-2**] 08:20AM BLOOD Glucose-183* UreaN-31* Creat-1.1 Na-141
K-4.4 Cl-104 HCO3-27 AnGap-14
[**2196-3-3**] 07:50AM BLOOD Glucose-292* UreaN-29* Creat-1.0 Na-141
K-4.1 Cl-105 HCO3-27 AnGap-13
[**2196-3-1**] 03:23AM BLOOD CK-MB-6 cTropnT-0.02*
[**2196-2-29**] 05:11PM BLOOD CK-MB-7 cTropnT-0.04*
[**2196-2-29**] 10:15AM BLOOD cTropnT-0.03*
[**2196-2-29**] 05:11PM BLOOD CK(CPK)-226
[**2196-2-29**] 10:15AM BLOOD CK(CPK)-211
[**2196-3-3**] 07:50AM BLOOD Calcium-8.6 Phos-3.3 Mg-2.0
[**2196-2-29**] 07:05PM BLOOD HIV Ab-NEGATIVE

Blood and urine culture: Negative.

Brief Hospital Course:
In the MICU, patient was treated with solumedrol, oxygen, and
lasix for presumed pneumonitis and CHF exacerbation.  He
improved and was transferred to the floor.

Upon transfer to the floor, the patient required supplemental
oxygen to maintain oxygen saturation greater than 92%. He was
hemodynamically stable with a sinus tachycardia in the high
90s-100s. The patient??????s antibiotics were discontinued as there
was no evidence that he had a bacterial pneumonia: no white
blood cell count, no fever, rapid improvement in symptoms with
steroids. Upon discontinuation of his antibiotics, he remained
afebrile. He was treated with supportive therapy for
crack-cocaine pneumonititis with nebulizers and a 4 day course
of oral prednisone. His hospitalization on the floor was
uneventful. He spent most of the day watching TV and talking on
the telephone. Each day his oxygenation improved until the day
of discharge where he was able to ambulate with a oxygen
saturation above 90%.

At that point, he was discharged with an appointment at the
[**Hospital1 **] Dual Diagnosis Partial Day Program on [**3-7**]. Psychiatry
recommended stopping his Zoloft because they felt that he was
not clinically depressed and Zoloft was not indicated. The
patient was continued on his home medications (lasix 40mg was
restarted) and given a prescription to attend [**Hospital 63676**]
rehabilitation.
Transitional issues:
1.	Cessation of smoking (crack and tobacco)
2.	Outpatient Dual Diagnosis therapy
3.	Outpatient [**Hospital 63676**] rehabilitation
4.	Monitoring of blood sugar and titrating insulin regimen
5.	Follow up with EP for evaluation for placement for an AICD
for prevention of sudden cardiac death.


Medications on Admission:
Ipratropium bromide 0.02% soln q6h prn wheeze
Albuterol 0.083% soln q6h
Fluticasone-salmeterol 250-50 mcg/dose inh [**Hospital1 **]
Furosemide 40 mg PO qd
Carvedilol 6.25 mg PO bid-->plan to decrease to 3.125mg [**Hospital1 **] per
PCP
[**Name Initial (PRE) **] 5 mg PO qd-->plan to decrease to 2.5mg per PCP
Insulin [**Name9 (PRE) **] 50u SQ qhs
Novolog SS
Atorvastatin 20 mg PO qd
ASA 81 mg PO qd
Sertraline 25 mg PO qd
Ferrous sulfate 300 mg PO qd
Omeprazole 20 mg PO qd
Quetiapine 100 mg PO qhs
?Tramadol 50mg [**Hospital1 **] for severe pain only


Discharge Medications:
1. ipratropium bromide 0.02 % Solution Sig: One (1) unit
Inhalation Q6H (every 6 hours) as needed for shortness of breath
or wheezing.
2. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation every 4-6 hours as needed for shortness of
breath or wheezing.
3. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
4. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
5. carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
6. Outpatient Physical Therapy
Outpatient [**Hospital **] rehab.
7. lisinopril 5 mg Tablet Sig: [**12-21**] Tablet PO DAILY (Daily).
8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
9. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
10. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. quetiapine 25 mg Tablet Sig: Four (4) Tablet PO HS (at
bedtime).
12. tramadol 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for pain.
13. ferrous sulfate 300  mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
14. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
15. insulin glargine 100 unit/mL Solution Sig: Fifty (50) units
Subcutaneous at bedtime.
16. Novolog 100 unit/mL Solution Sig: As directed by sliding
scale ml Subcutaneous with meals: Please take as directed per
home sliding scale.
17. tramadol 50 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain: do not drink alcohol. do not drive while
taking. .
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Respiratory failure
2. Crack cocaine pneumonitis
3. acute on chronic systolic heart failure

Secondary diagnoses:
DMII uncontrolled
schizophrenia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname 10794**],

You were admitted for respiratory failure. Smoking crack caused
your respiratory failure. Smoking crack is incredibly dangerous
and can be deadly. Crack-cocaine is very damaging to your lungs
and to your heart. Also, please stop smoking cigarettes as
cigarettes are very damaging to your lungs and heart also.

Going forward it is critical that you take your medications as
stated by your doctors and to not do drugs. Our social workers
have arranged for you to go the dual diagnosis partial hospital
program at [**Hospital 1680**] Hospital in [**Location (un) 538**] starting on Monday
[**2196-3-7**]. At this program, they will help you with your addiction
to crack cocaine. Also we have given you a perscription for
outpatient [**Hospital 63676**] rehab. Please attend this program as
it will improve your perform your daily activities without
becoming short of breath. Since you are going to this day
program, your home VNA will not be able to visit you while you
are at the program. Please discuss resuming home VNA with your
PCP after you complete the program.

You also should follow up with Cardiology for evaluation for
placement of a defibrillator.

We have made the following changes to your medications:

1. Stop Zoloft (sertraline 25mg) once a day

Please resume your home medications. You should weigh yourself
every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs.If you
experience any of the danger signs listed below please call your
PCP or go to the nearest emergency department.

Followup Instructions:
Intake appointment at [**Hospital 1680**] Hospital - [**Location (un) 9096**] in the partial hospitalization program for Monday, [**3-7**],
at 9:00am
([**Telephone/Fax (1) 63677**]

Department: [**Hospital 7975**] [**Hospital **] HEALTH CENTER
When: TUESDAY [**2196-3-8**] at 1 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 22387**], MD [**Telephone/Fax (1) 7976**]
Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

Department: [**Hospital 7975**] [**Hospital **] HEALTH CENTER
When: TUESDAY [**2196-3-22**] at 3:30 PM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 12898**], DPM [**Telephone/Fax (1) 7976**]
Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

Department: PULMONARY FUNCTION LAB
When: MONDAY [**2196-4-25**] at 4:10 PM
With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: [**Hospital1 7975**] INTERNAL MEDICINE
When: MONDAY [**2196-3-14**] at 10:30 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 63642**], MD [**Telephone/Fax (1) 7976**]
Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

Department: CARDIAC SERVICES
When: FRIDAY [**2196-4-1**] at 12:00 PM
With: [**Name6 (MD) **] [**Name8 (MD) 163**], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Poisoning by cocaine,Acute respiratory failure,Acute on chronic systolic heart failure,Other primary cardiomyopathies,Alkalosis,Bronchitis and pneumonitis due to fumes and vapors,Cocaine dependence, continuous,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Hemoptysis, unspecified,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of insulin,Unspecified schizophrenia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted,Other, mixed, or unspecified drug abuse, unspecified,Other acquired deformities of ankle and foot,Personal history of noncompliance with medical treatment, presenting hazards to health'}


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: 52M h/o dilated CM (EF 30-35% on [**2195-12-10**]), crack cocaine abuse
c/b crack pneumonitis, MRSA PNA, COPD, and Type I DM p/w
acute-onset SOB. He was in his USOH until the morning of
admission, when he developed SOB and nonradiating substernal
"chest tightness" x1h after ambulating to the couch, prompting
him to call EMS. He notes that the current episode is similar to
past episodes of DOE and chest tightness in the setting of crack
cocaine use; he last used cocaine and cigarettes on the evening
of [**2196-2-27**]. He endorses minimal wheeze on the evening PTA,
bilateral LE edema minimally increased from baseline, and stable
2-pillow orthopnea. He denies f/c/s, cough/URI symptoms,
pleuritic chest pain, PND, medication noncompliance, or recent
dietary indiscretion. He has no home O2 requirement.

MEDICAL HISTORY: - Type II Diabetes
- Hyperlipidemia
- HTN
- Nonischemic dilated cardiomyopathy ([**10/2195**]-LVEF 30-35%, mild
RV dilation, borderline function, 1+ MR)
- Hepatitis C antibody positive
- MRSA pneumonia (requiring tracheostomy)
- COPD
- Substance abuse (cocaine)
- Tobacco abuse
- Schizophrenia

MEDICATION ON ADMISSION: Ipratropium bromide 0.02% soln q6h prn wheeze
Albuterol 0.083% soln q6h
Fluticasone-salmeterol 250-50 mcg/dose inh [**Hospital1 **]
Furosemide 40 mg PO qd
Carvedilol 6.25 mg PO bid-->plan to decrease to 3.125mg [**Hospital1 **] per
PCP
[**Name Initial (PRE) **] 5 mg PO qd-->plan to decrease to 2.5mg per PCP
Insulin [**Name9 (PRE) **] 50u SQ qhs
Novolog SS
Atorvastatin 20 mg PO qd
ASA 81 mg PO qd
Sertraline 25 mg PO qd
Ferrous sulfate 300 mg PO qd
Omeprazole 20 mg PO qd
Quetiapine 100 mg PO qhs
?Tramadol 50mg [**Hospital1 **] for severe pain only

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
Vitals: 97.6  107  98/60  93% on nonrebreather at 100% FiO2
General: Alert, oriented in no acute distress.
HEENT: Sclera anicteric, EOMI, PERRL.
Neck: JVP to the clavicle, no change with hepatojugular
maneuver.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops.
Lungs: Tachypneic with mildly increased WOB, bilateral anterior
and L basilar crackles, scattered faint wheeze.
Abdomen: Soft, non-tender, non-distended, bowel sounds present,
no organomegaly.
GU: No foley.
Ext: Warm, well perfused, 2+ brachial/DP pulses, trace LE edema
R>L minimally increased from baseline per patient.
Neuro: CNII-XII grossly intact, grossly normal sensation,
bilateral UE resting tremor without intention tremor or
asterixis.
.
Discharge Exam:
Patient was able to ambulate and maintain oxygen > 90%

FAMILY HISTORY: - Father: pacemaker, deceased
- mother: died of breast cancer

SOCIAL HISTORY: - history of multiple incarcerations (>6 months in [**2193**])
- lives with sister
- walks w/ cane due to right sided foot drop
- Tobacco history: current smoker, 1 cig per day
- ETOH: denies
- Illicit drugs: crack cocaine on day of admission, recurrent
crack relapses 

### Response:
{'Poisoning by cocaine,Acute respiratory failure,Acute on chronic systolic heart failure,Other primary cardiomyopathies,Alkalosis,Bronchitis and pneumonitis due to fumes and vapors,Cocaine dependence, continuous,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Hemoptysis, unspecified,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of insulin,Unspecified schizophrenia, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted,Other, mixed, or unspecified drug abuse, unspecified,Other acquired deformities of ankle and foot,Personal history of noncompliance with medical treatment, presenting hazards to health'}
