CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: 61 y/o gentleman with a past medical history of spontaneous
pneumothorax [**2155**] and bullous emphysema presenting with
complaints of dyspnea x several weeks. The patient reports his
shortness of breath has worsened slowly over time but his
dyspnea has progressed more rapidly over the past 1 week. He
denies cough or wheezing. Denies fever/chills. He reports weight
loss and a poor appetite. He states he is not short of breath at
rest or with laying flat but becomes dyspneic with walking. He
also reports using a space heater at work, which sits next to
his legs. He developed burns over both his LE with blistering
that he was unaware of until the blisters popped and he felt the
fluid on his legs. He continues to smoke 1 pack/day.
.
In the ED, initial vitals: T 97.4 HR 106 BP 106/70. RR 21, O2
93-100% on 3L NC. There was great difficulty trying to get a
good O2 sat [**Location (un) 1131**]. CXR demonstrated shows large blebs but no
PNA. He was given albuterol neb x2, atrovent neb, ceftriaxone
1gm IV, azithromycin 500mg IV and solu-medrol 125mg IV. He was
given 2L NS. CE sent. ECG demonstrated TWI II, III, AVF with no
prior for comparison.
.
On arrival to the medical floor, the patient denies current
dyspnea with rest, speaks in short sentences.

MEDICAL HISTORY: Spontaneous Left Pneumothorax [**2155**]
Bullous Emphysema
? Alpha-1 antitrypsin deficiency

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 96.1, HR 102, BP 132/72, RR 14, O2 98% 2L.
GEN: cachectic appearing male, using accessory muscles with
respiration but able to speak in short sentences with relative
comfort
[**Name (NI) 4459**]: dry MM, no scleral icterus
CV: RRR, distant heart tones, no MRG appreciated
RESP: markedly decreased breath sounds throughout all lung
fields
Abd: soft, NT/ND, NABS
Ext: + clubbing, cool LE with decreased PT/DP pulses
Skin: bilateral LE burns with blistering - R LE 9.5 X 7cm, L 6 X
5.5

FAMILY HISTORY: Mother: died age 82 unknown
Father: died in 90's unknown
Siblings: 1 brother & sister alive and well

SOCIAL HISTORY: The patient lives alone. He has 3 children. He works as a
security guard. He has a 60-100 pack year smoking history. He
used to smoke up to 3 PPD but more recently has been smoke 1
PPD. He drinks white wine 1 time per week to "get drunk." He may
have been exposed to asbestos and [**Doctor Last Name 360**] [**Location (un) 2452**] in the past. He
denies any IVDU or illict drug use.
Emphysematous bleb,Acute respiratory failure,Acute cor pulmonale,Cachexia,Acidosis,Obstructive chronic bronchitis with (acute) exacerbation,Diastolic heart failure, unspecified,Polycythemia vera,Loss of weight,Burn of unspecified degree of lower leg,Tobacco use disorder,Accident caused by other hot substance or object
Emphysematous bleb,Acute respiratry failure,Acute cor pulmonale,Cachexia,Acidosis,Obs chr bronc w(ac) exac,Diastolc hrt failure NOS,Polycythemia vera,Abnormal loss of weight,Burn NOS lower leg,Tobacco use disorder,Hot substance accid NEC
Admission Date:  [**2159-2-25**]              Discharge Date:   [**2159-3-6**]

Date of Birth:  [**2097-6-20**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
None

History of Present Illness:
61 y/o gentleman with a past medical history of spontaneous
pneumothorax [**2155**] and bullous emphysema presenting with
complaints of dyspnea x several weeks. The patient reports his
shortness of breath has worsened slowly over time but his
dyspnea has progressed more rapidly over the past 1 week. He
denies cough or wheezing. Denies fever/chills. He reports weight
loss and a poor appetite. He states he is not short of breath at
rest or with laying flat but becomes dyspneic with walking. He
also reports using a space heater at work, which sits next to
his legs. He developed burns over both his LE with blistering
that he was unaware of until the blisters popped and he felt the
fluid on his legs. He continues to smoke 1 pack/day.
.
In the ED, initial vitals: T 97.4 HR 106 BP 106/70. RR 21, O2
93-100% on 3L NC. There was great difficulty trying to get a
good O2 sat [**Location (un) 1131**]. CXR demonstrated shows large blebs but no
PNA. He was given albuterol neb x2, atrovent neb, ceftriaxone
1gm IV, azithromycin 500mg IV and solu-medrol 125mg IV. He was
given 2L NS. CE sent. ECG demonstrated TWI II, III, AVF with no
prior for comparison.
.
On arrival to the medical floor, the patient denies current
dyspnea with rest, speaks in short sentences.

Past Medical History:
Spontaneous Left Pneumothorax [**2155**]
Bullous Emphysema
? Alpha-1 antitrypsin deficiency

Social History:
The patient lives alone. He has 3 children. He works as a
security guard. He has a 60-100 pack year smoking history. He
used to smoke up to 3 PPD but more recently has been smoke 1
PPD. He drinks white wine 1 time per week to "get drunk." He may
have been exposed to asbestos and [**Doctor Last Name 360**] [**Location (un) 2452**] in the past. He
denies any IVDU or illict drug use.

Family History:
Mother: died age 82 unknown
Father: died in 90's unknown
Siblings: 1 brother & sister alive and well


Physical Exam:
Vitals: T 96.1, HR 102, BP 132/72, RR 14, O2 98% 2L.
GEN: cachectic appearing male, using accessory muscles with
respiration but able to speak in short sentences with relative
comfort
[**Name (NI) 4459**]: dry MM, no scleral icterus
CV: RRR, distant heart tones, no MRG appreciated
RESP: markedly decreased breath sounds throughout all lung
fields
Abd: soft, NT/ND, NABS
Ext: + clubbing, cool LE with decreased PT/DP pulses
Skin: bilateral LE burns with blistering - R LE 9.5 X 7cm, L 6 X
5.5

Pertinent Results:
CXR [**2159-2-25**] - prelim - my read - hyperinflated lung fields with
diffuse emphysematous changes, no clear infiltrate
.
ECG - [**2159-2-25**] - NSR 100bpm, RAD, nl int, RAA, RVH, TWI II, III,
AVF, no prior for comparison

Brief Hospital Course:
61 year old man with a past medical history of spontaneous
pneumothorax [**2155**] and bullous emphysema presenting with
complaints of dyspnea for several weeks consistent with COPD
exacerbation. He was treated with bronchodilators, steroids, and
azithromycin. CTA chest showed no evidence of pulmonary
embolism.  On the floor, he developed hypercarbic respiratory
failure. He was placed on BiPAP and transferred to the MICU.
There, he was rapidly weaned off BiPAP. He was treated with a 14
day prednisone taper along with a 7 day course of azithromycin.
Patient was counseled regarding the importance of smoking
cessation and a nicotine patch daily. He will need close
pulmonary followup and home oxygenation. The patient had clear
evidence of cor pulmonale in setting of long-standing severe
COPD. His severely overloaded RV compromised LV filling, and
therefore likely contributing to poor exercise tolerance and
pulmonary edema. He was diuresed with lasix and started on
digoxin with good effect. He was discharged on PO lasix and will
require regular volume status monitoring following discharge.
He was also started on a low dose ace-inhibitor, digoxin, and
asa. In regards to his lower extremity wounds, sustained at home
from a space heater, they did not appear infected. These were
managed with topical treatments recommended by the wound care
nurse.

Medications on Admission:
None.

Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
2. Silver Sulfadiazine 1 % Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
3. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
4. Prednisone 10 mg Tablet Sig: see below Tablet PO see below:
Prednisone 30mg Tues/Wed ([**Date range (1) 30677**]), 20mg Thurs/Fri
([**Date range (1) 30678**]), 10mg Sat/Sun ([**Date range (1) 30679**]).
5. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q4H (every 4 hours) as needed for
wheezing/sob.
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
10. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
11. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
12. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Enalapril Maleate 5 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
14. Aspirin 81 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable
PO DAILY (Daily).
15. oxygen
Please provide oxygen take to keep O2 sats between 87-90%.
16. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2857**] - [**Location (un) 1121**] - [**Location (un) 4310**]

Discharge Diagnosis:
Primary:
Severe Emphesema
Cor pulmonale/RHF


Discharge Condition:
Alert and oriented x3, self-ambulatory


Discharge Instructions:
We had the pleasure of taking care of you while you were at
[**Hospital1 18**].  You were admitted because of shortness of breath.  We
did imaging study that shows you have very severe lung disease
that is called emphysema. This is due to your longstanding
smoking history.  Because of your lung disease, you have
developed right sided heart failure.  It is VERY IMPORTANT that
you STOP SMOKING.  Smoking will worsen the course of disease.

We have started the following medications:
1. Digoxin - started for your heart failure
2. Enalapril - started for your heart failure
3. Lasix - started for your heart failure and swelling in your
legs
4. Advair, Spiriva, and Albuterol - started for your emphysema
and shortness of breath
5. Prednisone Taper - take 30mg Tues/Wed ([**Date range (1) 30677**]), 20mg
Thurs/Fri ([**Date range (1) 30678**]), 10mg Sat/Sun ([**Date range (1) 30679**]).  This is
for your emphysema
6. Protonix - take while you are taking prednisone
7. Aspirin
8. Senna, Colace, Bisacodyl - started for consipation


Followup Instructions:
Department: [**Hospital3 249**]
When: THURSDAY [**2159-3-8**] at 2:10 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
PLEASE CALL YOUR INS. CO TO UPDATE YOUR PCP.  [**Name10 (NameIs) **] THEM YOU ARE
NOW SEEING YOUR PCP AT [**Hospital3 249**] AT [**Hospital3 **].
THIS IS VERY IMPORTANT TO DO BEFORE YOUR APPT.

Department: PULMONARY FUNCTION LAB
When: THURSDAY [**2159-4-5**] at 2:30 PM
With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: MEDICAL SPECIALTIES
When: THURSDAY [**2159-4-5**] at 3:00 PM
With: DR. [**First Name (STitle) 1112**]/DR. [**Last Name (STitle) **] [**Telephone/Fax (1) 612**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: TUESDAY [**2159-3-20**] at 3:20 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4511**], MD [**Telephone/Fax (1) 62**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2159-3-7**]
{'Emphysematous bleb,Acute respiratory failure,Acute cor pulmonale,Cachexia,Acidosis,Obstructive chronic bronchitis with (acute) exacerbation,Diastolic heart failure, unspecified,Polycythemia vera,Loss of weight,Burn of unspecified degree of lower leg,Tobacco use disorder,Accident caused by other hot substance or object'}


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: Dyspnea

PRESENT ILLNESS: 61 y/o gentleman with a past medical history of spontaneous
pneumothorax [**2155**] and bullous emphysema presenting with
complaints of dyspnea x several weeks. The patient reports his
shortness of breath has worsened slowly over time but his
dyspnea has progressed more rapidly over the past 1 week. He
denies cough or wheezing. Denies fever/chills. He reports weight
loss and a poor appetite. He states he is not short of breath at
rest or with laying flat but becomes dyspneic with walking. He
also reports using a space heater at work, which sits next to
his legs. He developed burns over both his LE with blistering
that he was unaware of until the blisters popped and he felt the
fluid on his legs. He continues to smoke 1 pack/day.
.
In the ED, initial vitals: T 97.4 HR 106 BP 106/70. RR 21, O2
93-100% on 3L NC. There was great difficulty trying to get a
good O2 sat [**Location (un) 1131**]. CXR demonstrated shows large blebs but no
PNA. He was given albuterol neb x2, atrovent neb, ceftriaxone
1gm IV, azithromycin 500mg IV and solu-medrol 125mg IV. He was
given 2L NS. CE sent. ECG demonstrated TWI II, III, AVF with no
prior for comparison.
.
On arrival to the medical floor, the patient denies current
dyspnea with rest, speaks in short sentences.

MEDICAL HISTORY: Spontaneous Left Pneumothorax [**2155**]
Bullous Emphysema
? Alpha-1 antitrypsin deficiency

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 96.1, HR 102, BP 132/72, RR 14, O2 98% 2L.
GEN: cachectic appearing male, using accessory muscles with
respiration but able to speak in short sentences with relative
comfort
[**Name (NI) 4459**]: dry MM, no scleral icterus
CV: RRR, distant heart tones, no MRG appreciated
RESP: markedly decreased breath sounds throughout all lung
fields
Abd: soft, NT/ND, NABS
Ext: + clubbing, cool LE with decreased PT/DP pulses
Skin: bilateral LE burns with blistering - R LE 9.5 X 7cm, L 6 X
5.5

FAMILY HISTORY: Mother: died age 82 unknown
Father: died in 90's unknown
Siblings: 1 brother & sister alive and well

SOCIAL HISTORY: The patient lives alone. He has 3 children. He works as a
security guard. He has a 60-100 pack year smoking history. He
used to smoke up to 3 PPD but more recently has been smoke 1
PPD. He drinks white wine 1 time per week to "get drunk." He may
have been exposed to asbestos and [**Doctor Last Name 360**] [**Location (un) 2452**] in the past. He
denies any IVDU or illict drug use. 

### Response:
{'Emphysematous bleb,Acute respiratory failure,Acute cor pulmonale,Cachexia,Acidosis,Obstructive chronic bronchitis with (acute) exacerbation,Diastolic heart failure, unspecified,Polycythemia vera,Loss of weight,Burn of unspecified degree of lower leg,Tobacco use disorder,Accident caused by other hot substance or object'}
