CHIEF COMPLAINT: hypotension and hypoxia

PRESENT ILLNESS: 52yo man with history of Rheumatoid arthritis on gold
injections, hepatitis C, and pulmonary fibrosis was trasferred
from [**Hospital6 204**] for worsening dyspnea/hypoxemia and
for potential lung biopsy. He was admitted there on [**2157-11-7**]
where he presented after one to two weeks of chills and low
grade fevers with progressive shortness of breath. This is in
the setting of previously asymptomatic chest CT findings dating
back to [**8-28**] with nodules, scarring, and chest/abdominal
lymphadenopathy. His initial ABG was 7.49/34/65/94% on 4L nc.
His CT chest demonstrated multiple abnormal findings with
evidence of bullous disease, honeycombing in the bases and a
mosaic pattern of interstitial infiltrates. He reportedly was
presented options of going for lung biopsy or having an empiric
course of corticosteroids at that time. He opted for empiric
steroid treatment.
.
His hospital course was notable for worsening dyspnea to the
point of not being able to speak in sentences and progressive
hypoxemia. He was admitted on room air, and steadily progressed
to 40% mask -> 100% NRB with oxygen saturation of 95%; ABG
demonstrated 7.53/27/65. Throughout his hospital course, he
remained afebrile. He was initially treated with ceftriaxone and
azithromycin. This was later tapered down to only azithromycin.
Chest films did not show any evidence of focal consolidation.
Rather, they demonstrated bilateral ground glass opacities.
.
In [**Hospital Unit Name 153**] respiratory status was monitored and intubated yesterday
for progressive hypoxia and in anticipation of VATS for lung
biopsy and bronch today. While in OR today developed increasing
hypoxia and difficulty oxygenating, Swan was attempted
unsuccessfully and Right IJ cordis was placed. Eventually thick
secretions were noted in ETT which was pulled and a LMA was
placed for airway support. He was then transferred to ICU for
further management. Here is ventilated on AC 600/30/10/100%FiO2.
Preliminary pathology on biopsy results is consistent with dense
fibrosis. He is currently on Propofol gtt and appears
comfortable.
.

MEDICAL HISTORY: 1. Rheumatoid arthritis - on gold treatments; last was few weeks
ago
2. Hepatitis C
3. Pulmonary fibrosis
4. Epilepsy - first diagnosed as a child; ? trauma
5. h/o Lyme disease
6. h/o anal fissure repair
7. distant etoh abuse
8. right knee surgery
9. By report, normal pulmonary function tests and TTE in [**7-30**].

MEDICATION ON ADMISSION: Medications on transfer:
Humibid DM 1 po BID
Tolmetin 600mg po BID
Lovenox 40mg daily
protonix 40mg daily
Zithromax 250mg qD
Prednisone 60mg daily
Regular insulin sliding scale
.
Medications from [**Hospital Unit Name 153**]:
Methylprednisolone Na Succ 50 mg IV BID
Midazolam HCl 0.5-2 mg/hr IV DRIP TITRATE TO sedation
Acetaminophen 325-650 mg PO Q4-6H:PRN
Morphine Sulfate 0.5-2 mg IV Q3-4H:PRN
Fentanyl Citrate 25-100 mcg/hr IV DRIP INFUSION
Pantoprazole 40 mg IV Q24H
Heparin 5000 UNIT SC TID
Ibuprofen 400 mg PO Q8H:PRN
Sodium Chloride Nasal [**11-28**] SPRY NU QID:PRN
Insulin SC Sliding Scale
Sulfameth/Trimethoprim 370 mg IV Q8H

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: gen: sedated, nad
heent: perrl, MMM, LMA in place
neck: right IJ cordis in place
cv: RRR, tachy, no murmurs
resp: CTAB with diffuse bilateral crackles
abd: soft, NT/ND, +BS
extr: no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Notable for smoking history and occupational exposure to
concrete (works in swimming pool business). About 50pack year
smoking history.
.
Postinflammatory pulmonary fibrosis,Acute respiratory failure,Hypoxemia,Other emphysema,Pneumonia, organism unspecified,Iatrogenic pneumothorax,Chronic hepatitis C without mention of hepatic coma,Rheumatoid arthritis,Other chronic pulmonary heart diseases,Anemia, unspecified,Other abnormal blood chemistry,Encounter for palliative care,Personal history of contact with and (suspected) exposure to asbestos
Postinflam pulm fibrosis,Acute respiratry failure,Hypoxemia,Emphysema NEC,Pneumonia, organism NOS,Iatrogenic pneumothorax,Chrnc hpt C wo hpat coma,Rheumatoid arthritis,Chr pulmon heart dis NEC,Anemia NOS,Abn blood chemistry NEC,Encountr palliative care,Hx-contct/expos asbestos
Admission Date:  [**2157-11-13**]              Discharge Date:   [**2157-11-25**]

Date of Birth:  [**2105-6-23**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
hypotension and hypoxia

Major Surgical or Invasive Procedure:
VATS

History of Present Illness:
52yo man with history of Rheumatoid arthritis on gold
injections, hepatitis C, and pulmonary fibrosis was trasferred
from [**Hospital6 204**] for worsening dyspnea/hypoxemia and
for potential lung biopsy. He was admitted there on [**2157-11-7**]
where he presented after one to two weeks of chills and low
grade fevers with progressive shortness of breath. This is in
the setting of previously asymptomatic chest CT findings dating
back to [**8-28**] with nodules, scarring, and chest/abdominal
lymphadenopathy. His initial ABG was 7.49/34/65/94% on 4L nc.
His CT chest demonstrated multiple abnormal findings with
evidence of bullous disease, honeycombing in the bases and a
mosaic pattern of interstitial infiltrates. He reportedly was
presented options of going for lung biopsy or having an empiric
course of corticosteroids at that time. He opted for empiric
steroid treatment.
.
His hospital course was notable for worsening dyspnea to the
point of not being able to speak in sentences and progressive
hypoxemia. He was admitted on room air, and steadily progressed
to 40% mask -> 100% NRB with oxygen saturation of 95%; ABG
demonstrated 7.53/27/65. Throughout his hospital course, he
remained afebrile. He was initially treated with ceftriaxone and
azithromycin. This was later tapered down to only azithromycin.
Chest films did not show any evidence of focal consolidation.
Rather, they demonstrated bilateral ground glass opacities.
.
In [**Hospital Unit Name 153**] respiratory status was monitored and intubated yesterday
for progressive hypoxia and in anticipation of VATS for lung
biopsy and bronch today. While in OR today developed increasing
hypoxia and difficulty oxygenating, Swan was attempted
unsuccessfully and Right IJ cordis was placed. Eventually thick
secretions were noted in ETT which was pulled and a LMA was
placed for airway support. He was then transferred to ICU for
further management. Here is ventilated on AC 600/30/10/100%FiO2.
Preliminary pathology on biopsy results is consistent with dense
fibrosis. He is currently on Propofol gtt and appears
comfortable.
.


Past Medical History:
1. Rheumatoid arthritis - on gold treatments; last was few weeks
ago
2. Hepatitis C
3. Pulmonary fibrosis
4. Epilepsy - first diagnosed as a child; ? trauma
5. h/o Lyme disease
6. h/o anal fissure repair
7. distant etoh abuse
8. right knee surgery
9. By report, normal pulmonary function tests and TTE in [**7-30**].


Social History:
Notable for smoking history and occupational exposure to
concrete (works in swimming pool business). About 50pack year
smoking history.
.


Family History:
NC

Physical Exam:
gen: sedated, nad
heent: perrl, MMM, LMA in place
neck: right IJ cordis in place
cv: RRR, tachy, no murmurs
resp: CTAB with diffuse bilateral crackles
abd: soft, NT/ND, +BS
extr: no edema


Pertinent Results:
[**2157-11-14**] 01:54AM BLOOD WBC-10.1 RBC-3.69* Hgb-10.8* Hct-32.3*
MCV-88 MCH-29.3 MCHC-33.4 RDW-12.7 Plt Ct-439
[**2157-11-14**] 01:54AM BLOOD Neuts-83.7* Lymphs-12.5* Monos-2.6
Eos-1.2 Baso-0.1
[**2157-11-14**] 01:54AM BLOOD PT-12.9 PTT-24.4 INR(PT)-1.1
[**2157-11-14**] 01:54AM BLOOD Glucose-107* UreaN-17 Creat-0.8 Na-140
K-4.4 Cl-103 HCO3-28 AnGap-13
[**2157-11-17**] 05:15PM BLOOD ALT-93* AST-40 LD(LDH)-385* AlkPhos-109
TotBili-0.2
[**2157-11-14**] 01:54AM BLOOD Calcium-8.6 Phos-4.2 Mg-2.4
[**2157-11-15**] 04:45AM BLOOD calTIBC-165* Ferritn-277 TRF-127*
[**2157-11-17**] 05:15PM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE
HBcAb-NEGATIVE
[**2157-11-17**] 05:15PM BLOOD ANCA-NEGATIVE B
[**2157-11-17**] 05:15PM BLOOD C3-171 C4-39
[**2157-11-17**] 05:15PM BLOOD RheuFac-101*
[**2157-11-19**] 04:26AM BLOOD HIV Ab-NEGATIVE
[**2157-11-18**] 06:36PM BLOOD Glucose-172* Lactate-1.6 Na-133* K-4.8
Cl-95*

Brief Hospital Course:
52yo man with history of RA, hepatitis C, and pulmonary fibrosis
of uncertain etiology admitted to MICU with progressive hypoxia
after VATS.  Progressive hypoxia secondary to pulmonary fibrosis
and worsening hypoxia despite maximum oxigenation.  Pt was
continued on supportive O2 ventilation with paralysis.
Complicating matters. patient with growing pneumothorax after
VATS requiring re-initiation of chest tube  to suction.  Biopsy
pathology demonstrated change consistent with organizing stage
of diffuse alveolar damage, possibly complicating a
bacterial/viral infection, over a background of chronic
interstitial lung disease.  In workup echo remarkable for right
to left interatrial shunt; which under consultation from
cardiology felt to be of little clinical significance as well as
Pt not being a candidate for closure.  Given patient's disease
process, only potential "cure" would be heart lung transplant
but patient a poor candidate, contributing to very poor
prognosis.  Family meeting held where goals of care were
discussed.  Pt made CMO and transplant service consulted for
possible candidancy.  Pt was taken off ventilatory support and
died shortly thereafter.  Patient subsequently taken to the OR
for organ harvest.


Medications on Admission:
Medications on transfer:
Humibid DM 1 po BID
Tolmetin 600mg po BID
Lovenox 40mg daily
protonix 40mg daily
Zithromax 250mg qD
Prednisone 60mg daily
Regular insulin sliding scale
.
Medications from [**Hospital Unit Name 153**]:
Methylprednisolone Na Succ 50 mg IV BID
Midazolam HCl 0.5-2 mg/hr IV DRIP TITRATE TO sedation
Acetaminophen 325-650 mg PO Q4-6H:PRN
Morphine Sulfate 0.5-2 mg IV Q3-4H:PRN
Fentanyl Citrate 25-100 mcg/hr IV DRIP INFUSION
Pantoprazole 40 mg IV Q24H
Heparin 5000 UNIT SC TID
Ibuprofen 400 mg PO Q8H:PRN
Sodium Chloride Nasal [**11-28**] SPRY NU QID:PRN
Insulin SC Sliding Scale
Sulfameth/Trimethoprim 370 mg IV Q8H


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
Pulmonary fibrosis
Hepatitis C
Rheumatoid arthritis

Discharge Condition:
deceased

Discharge Instructions:
N.A.

Followup Instructions:
N.A.
{'Postinflammatory pulmonary fibrosis,Acute respiratory failure,Hypoxemia,Other emphysema,Pneumonia, organism unspecified,Iatrogenic pneumothorax,Chronic hepatitis C without mention of hepatic coma,Rheumatoid arthritis,Other chronic pulmonary heart diseases,Anemia, unspecified,Other abnormal blood chemistry,Encounter for palliative care,Personal history of contact with and (suspected) exposure to asbestos'}


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: hypotension and hypoxia

PRESENT ILLNESS: 52yo man with history of Rheumatoid arthritis on gold
injections, hepatitis C, and pulmonary fibrosis was trasferred
from [**Hospital6 204**] for worsening dyspnea/hypoxemia and
for potential lung biopsy. He was admitted there on [**2157-11-7**]
where he presented after one to two weeks of chills and low
grade fevers with progressive shortness of breath. This is in
the setting of previously asymptomatic chest CT findings dating
back to [**8-28**] with nodules, scarring, and chest/abdominal
lymphadenopathy. His initial ABG was 7.49/34/65/94% on 4L nc.
His CT chest demonstrated multiple abnormal findings with
evidence of bullous disease, honeycombing in the bases and a
mosaic pattern of interstitial infiltrates. He reportedly was
presented options of going for lung biopsy or having an empiric
course of corticosteroids at that time. He opted for empiric
steroid treatment.
.
His hospital course was notable for worsening dyspnea to the
point of not being able to speak in sentences and progressive
hypoxemia. He was admitted on room air, and steadily progressed
to 40% mask -> 100% NRB with oxygen saturation of 95%; ABG
demonstrated 7.53/27/65. Throughout his hospital course, he
remained afebrile. He was initially treated with ceftriaxone and
azithromycin. This was later tapered down to only azithromycin.
Chest films did not show any evidence of focal consolidation.
Rather, they demonstrated bilateral ground glass opacities.
.
In [**Hospital Unit Name 153**] respiratory status was monitored and intubated yesterday
for progressive hypoxia and in anticipation of VATS for lung
biopsy and bronch today. While in OR today developed increasing
hypoxia and difficulty oxygenating, Swan was attempted
unsuccessfully and Right IJ cordis was placed. Eventually thick
secretions were noted in ETT which was pulled and a LMA was
placed for airway support. He was then transferred to ICU for
further management. Here is ventilated on AC 600/30/10/100%FiO2.
Preliminary pathology on biopsy results is consistent with dense
fibrosis. He is currently on Propofol gtt and appears
comfortable.
.

MEDICAL HISTORY: 1. Rheumatoid arthritis - on gold treatments; last was few weeks
ago
2. Hepatitis C
3. Pulmonary fibrosis
4. Epilepsy - first diagnosed as a child; ? trauma
5. h/o Lyme disease
6. h/o anal fissure repair
7. distant etoh abuse
8. right knee surgery
9. By report, normal pulmonary function tests and TTE in [**7-30**].

MEDICATION ON ADMISSION: Medications on transfer:
Humibid DM 1 po BID
Tolmetin 600mg po BID
Lovenox 40mg daily
protonix 40mg daily
Zithromax 250mg qD
Prednisone 60mg daily
Regular insulin sliding scale
.
Medications from [**Hospital Unit Name 153**]:
Methylprednisolone Na Succ 50 mg IV BID
Midazolam HCl 0.5-2 mg/hr IV DRIP TITRATE TO sedation
Acetaminophen 325-650 mg PO Q4-6H:PRN
Morphine Sulfate 0.5-2 mg IV Q3-4H:PRN
Fentanyl Citrate 25-100 mcg/hr IV DRIP INFUSION
Pantoprazole 40 mg IV Q24H
Heparin 5000 UNIT SC TID
Ibuprofen 400 mg PO Q8H:PRN
Sodium Chloride Nasal [**11-28**] SPRY NU QID:PRN
Insulin SC Sliding Scale
Sulfameth/Trimethoprim 370 mg IV Q8H

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: gen: sedated, nad
heent: perrl, MMM, LMA in place
neck: right IJ cordis in place
cv: RRR, tachy, no murmurs
resp: CTAB with diffuse bilateral crackles
abd: soft, NT/ND, +BS
extr: no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Notable for smoking history and occupational exposure to
concrete (works in swimming pool business). About 50pack year
smoking history.
. 

### Response:
{'Postinflammatory pulmonary fibrosis,Acute respiratory failure,Hypoxemia,Other emphysema,Pneumonia, organism unspecified,Iatrogenic pneumothorax,Chronic hepatitis C without mention of hepatic coma,Rheumatoid arthritis,Other chronic pulmonary heart diseases,Anemia, unspecified,Other abnormal blood chemistry,Encounter for palliative care,Personal history of contact with and (suspected) exposure to asbestos'}
