CHIEF COMPLAINT: worsening cough, sob x1 day

PRESENT ILLNESS: This is a 84 year-old female with a PMHx history of moderate
COPD, CAD, cardiomyopathy, atrial fibrillation, who presents
with worsening cough and shortness of breath x1 day. Patient
denies subjective fevers at home. Denies any chest pain, denies
pleuritic chest pain. Denies abdominal pain. Denies any dysuria.
Of note, patient recently released from [**Hospital 100**] Rehab. Prior to
[**Hospital 100**] rehab patient was previously at [**Hospital3 **] treated with
RLL pneumonia with vancomycin and levoquin in the setting of
MRSA in the sputum.
.
In the ED, with concern for pneumonia patient given ceftriaxone
1 gram IV, Vanco 1 g IV q12, azithromycin 500 mg PO IV, 10 mg
decadron IV x1. Patient was noted to be febrile to 102,
tachycardic to 122 with BP of 92/54 O2 sats 87% on 2L.
.
ROS: The patient denies any fevers, chills, weight change,
nausea, vomiting, abdominal pain, diarrhea, constipation,
melena, hematochezia, chest pain, shortness of breath,
orthopnea, PND, lower extremity oedema, cough, urinary
frequency, urgency, dysuria, lightheadedness, gait unsteadiness,
focal weakness, vision changes, headache, rash or skin changes.

MEDICAL HISTORY: 1. Emphysema previously followed by Dr. [**First Name (STitle) 9464**] at [**Hospital1 3372**], now seen by Dr. [**Last Name (STitle) 575**]
2. Coronary artery disease status post MI [**22**] years ago. EF
30-35%
3. History of polio.
4. History of falls.
5. Hyperlipidemia.
6. Osteoporosis.
7. Ischemic cardiomyopathy (EF 40% in [**3-10**])

MEDICATION ON ADMISSION: Flovent 220 mcg 2 puffs [**Hospital1 **]
Acapella device
mucormyst q 6 hrs INH
coumadin 10 mg PO daily
albuterol nebs q 6
digoxin 125 mcg daily
citalopram 20 mg po daily
lisinopril 10 mg daily
omeprazole 40 mg po bid
simvastatin 20 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97.9 BP: 100/56 HR: 94 RR: 24 O2Sat: 97% on 2L
GEN: elderly female, tachypeic, mild and appropriate distress,
coughing louding
HEENT: EOMI, sclera anicteric, no epistaxis or rhinorrhea, MMM,
OP Clear
NECK: no cervical lymphadenopathy appreciated
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2, cardiac exam
limited secondary to loud lung sounds
PULM: diffusely rhonchi bilaterally, anterior auscultation only,
greater on left on the right
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities.
SKIN: No jaundice, cyanosis, or gross dermatitis. scatterred
ecchymoses.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: The patient does not smoke now, but smoked significantly quit 20
years ago.  Today she said she smoked 3 pks/day for 20+ years.
Denies etoh or illicits. Lives in [**Location **], originally from
South [**Country 480**].
Unspecified septicemia,Pneumonia, organism unspecified,Pulmonary collapse,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Other specified forms of chronic ischemic heart disease,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Mitral valve disorders,Other chronic pulmonary heart diseases,Old myocardial infarction,Carrier or suspected carrier of other specified bacterial diseases
Septicemia NOS,Pneumonia, organism NOS,Pulmonary collapse,Severe sepsis,Chr airway obstruct NEC,Atrial fibrillation,Chr ischemic hrt dis NEC,Long-term use anticoagul,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Mitral valve disorder,Chr pulmon heart dis NEC,Old myocardial infarct,Bacteria dis carrier NEC
Admission Date:  [**2111-8-4**]              Discharge Date:   [**2111-8-5**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
worsening cough, sob x1 day

Major Surgical or Invasive Procedure:
none

History of Present Illness:
This is a 84 year-old female with a PMHx history of moderate
COPD, CAD, cardiomyopathy, atrial fibrillation, who presents
with worsening cough and shortness of breath x1 day. Patient
denies subjective fevers at home. Denies any chest pain, denies
pleuritic chest pain. Denies abdominal pain. Denies any dysuria.
Of note, patient recently released from [**Hospital 100**] Rehab. Prior to
[**Hospital 100**] rehab patient was previously at [**Hospital3 **] treated with
RLL pneumonia with vancomycin and levoquin in the setting of
MRSA in the sputum.
.
In the ED, with concern for pneumonia patient given ceftriaxone
1 gram IV, Vanco 1 g IV q12, azithromycin 500 mg PO IV, 10 mg
decadron IV x1. Patient was noted to be febrile to 102,
tachycardic to 122 with BP of 92/54 O2 sats 87% on 2L.
.
ROS: The patient denies any fevers, chills, weight change,
nausea, vomiting, abdominal pain, diarrhea, constipation,
melena, hematochezia, chest pain, shortness of breath,
orthopnea, PND, lower extremity oedema, cough, urinary
frequency, urgency, dysuria, lightheadedness, gait unsteadiness,
focal weakness, vision changes, headache, rash or skin changes.



Past Medical History:
1. Emphysema previously followed by Dr. [**First Name (STitle) 9464**] at [**Hospital1 3372**], now seen by Dr. [**Last Name (STitle) 575**]
2. Coronary artery disease status post MI [**22**] years ago. EF
30-35%
3. History of polio.
4. History of falls.
5. Hyperlipidemia.
6. Osteoporosis.
7. Ischemic cardiomyopathy (EF 40% in [**3-10**])

Social History:
The patient does not smoke now, but smoked significantly quit 20
years ago.  Today she said she smoked 3 pks/day for 20+ years.
Denies etoh or illicits. Lives in [**Location **], originally from
South [**Country 480**].


Family History:
Noncontributory

Physical Exam:
Vitals: T: 97.9 BP: 100/56 HR: 94 RR: 24 O2Sat: 97% on 2L
GEN: elderly female, tachypeic, mild and appropriate distress,
coughing louding
HEENT: EOMI, sclera anicteric, no epistaxis or rhinorrhea, MMM,
OP Clear
NECK: no cervical lymphadenopathy appreciated
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2, cardiac exam
limited secondary to loud lung sounds
PULM: diffusely rhonchi bilaterally, anterior auscultation only,
greater on left on the right
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities.
SKIN: No jaundice, cyanosis, or gross dermatitis. scatterred
ecchymoses.


Pertinent Results:
[**2111-8-4**] 03:10PM BLOOD WBC-33.4*# RBC-3.82* Hgb-11.5* Hct-34.3*
MCV-90 MCH-30.1 MCHC-33.4 RDW-14.2 Plt Ct-415#
[**2111-8-4**] 03:10PM BLOOD Neuts-95.4* Bands-0 Lymphs-1.9* Monos-2.6
Eos-0.1 Baso-0.1
[**2111-8-4**] 03:10PM BLOOD Plt Smr-VERY LOW Plt Ct-415#
[**2111-8-4**] 03:10PM BLOOD Glucose-151* UreaN-20 Creat-0.6 Na-133
K-5.4* Cl-97 HCO3-27 AnGap-14
[**2111-8-4**] 03:10PM BLOOD CK(CPK)-72
[**2111-8-4**] 03:45PM BLOOD Type-ART pO2-59* pCO2-35 pH-7.51*
calTCO2-29 Base XS-4 Comment-O2 DELIVER
[**2111-8-4**] 03:59PM BLOOD Lactate-2.0
[**2111-8-4**] 10:08PM BLOOD Lactate-1.0
[**2111-8-4**] 10:08PM BLOOD freeCa-1.12

chest x-ray - Left lower lobe collapse with small left shift of
the mediastinum. Increased opacity at left upper lung likely
reflects consolidation due to infectious etiology. There may
also be a left pleural effusion. A left-sided [**Location (un) 21851**]
resulting in collapse and post-obstructive consolidation cannot
be ruled out. Right lung well aerated.


Brief Hospital Course:
84 year-old female with a history of moderate COPD, atrial
fibrillation, CAD who presents with fever, leukocytosis, and
chest x-ray consistent with new LUL consolidation consistent
with healthcare associated pneumonia.
.
# Pneumonia Patient presented with fever, worsening cough,
hypotension, decreasing oxygen saturating likely with SIRS
symptoms with evidence of new infiltrate on chest x-ray
concerning for healthcare associated pneumonia with a previous
history of MRSA in the sputum.  Confirmed code status with
patient on admission to be DNR/DNI. Patient was very clear on
her goals of care. Patient had previously seen Dr. [**First Name4 (NamePattern1) 8513**] [**Last Name (NamePattern1) **] in
pulmonary clinic and code status was confirmed at that time as
well. Patient did not want central lines placed or any invasive
procedures done. Placed patient on nasal cannula with escalating
O2 doses, and then eventually CPAP and started broad spectrum
antibiotics with Levoquin 750 mg PO q 24, Vancomycin 1 g q 12
hrs, Ceftriaxone 1 g q24 hours to cover for possible MRSA
previously seen in sputum, also for strep pneumo and good gram
negative coverage. Urine legionella was sent and was pending at
the time.  Patient had a small troponin of 0.23 with flat CKs
and CK-MBs with some New T wave inversion in the lateral leads
likely secondary to demand ischemia in the setting of
significant ischemic cardiomyopathy and in the setting of
respiratory compromise.  Patient was chest pain free. Patient
became apneic and desaturated first to the 80s, and then became
bradycardic very quickly - likely thought to be due to acute
mucus plugging. Patient did not respond to CPAP and expired very
quickly. The family was called immediately on patient's initial
decompensation, however patient expired quickly afterwards, so
family was not at the bedside.




Medications on Admission:
Flovent 220 mcg 2 puffs [**Hospital1 **]
Acapella device
mucormyst q 6 hrs INH
coumadin 10 mg PO daily
albuterol nebs q 6
digoxin 125 mcg daily
citalopram 20 mg po daily
lisinopril 10 mg daily
omeprazole 40 mg po bid
simvastatin 20 mg daily


Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
pneumonia, lung collapse

Discharge Condition:
death

Discharge Instructions:
NA

Followup Instructions:
NA


Completed by:[**2111-8-13**]
{'Unspecified septicemia,Pneumonia, organism unspecified,Pulmonary collapse,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Other specified forms of chronic ischemic heart disease,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Mitral valve disorders,Other chronic pulmonary heart diseases,Old myocardial infarction,Carrier or suspected carrier of other specified bacterial diseases'}


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: worsening cough, sob x1 day

PRESENT ILLNESS: This is a 84 year-old female with a PMHx history of moderate
COPD, CAD, cardiomyopathy, atrial fibrillation, who presents
with worsening cough and shortness of breath x1 day. Patient
denies subjective fevers at home. Denies any chest pain, denies
pleuritic chest pain. Denies abdominal pain. Denies any dysuria.
Of note, patient recently released from [**Hospital 100**] Rehab. Prior to
[**Hospital 100**] rehab patient was previously at [**Hospital3 **] treated with
RLL pneumonia with vancomycin and levoquin in the setting of
MRSA in the sputum.
.
In the ED, with concern for pneumonia patient given ceftriaxone
1 gram IV, Vanco 1 g IV q12, azithromycin 500 mg PO IV, 10 mg
decadron IV x1. Patient was noted to be febrile to 102,
tachycardic to 122 with BP of 92/54 O2 sats 87% on 2L.
.
ROS: The patient denies any fevers, chills, weight change,
nausea, vomiting, abdominal pain, diarrhea, constipation,
melena, hematochezia, chest pain, shortness of breath,
orthopnea, PND, lower extremity oedema, cough, urinary
frequency, urgency, dysuria, lightheadedness, gait unsteadiness,
focal weakness, vision changes, headache, rash or skin changes.

MEDICAL HISTORY: 1. Emphysema previously followed by Dr. [**First Name (STitle) 9464**] at [**Hospital1 3372**], now seen by Dr. [**Last Name (STitle) 575**]
2. Coronary artery disease status post MI [**22**] years ago. EF
30-35%
3. History of polio.
4. History of falls.
5. Hyperlipidemia.
6. Osteoporosis.
7. Ischemic cardiomyopathy (EF 40% in [**3-10**])

MEDICATION ON ADMISSION: Flovent 220 mcg 2 puffs [**Hospital1 **]
Acapella device
mucormyst q 6 hrs INH
coumadin 10 mg PO daily
albuterol nebs q 6
digoxin 125 mcg daily
citalopram 20 mg po daily
lisinopril 10 mg daily
omeprazole 40 mg po bid
simvastatin 20 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97.9 BP: 100/56 HR: 94 RR: 24 O2Sat: 97% on 2L
GEN: elderly female, tachypeic, mild and appropriate distress,
coughing louding
HEENT: EOMI, sclera anicteric, no epistaxis or rhinorrhea, MMM,
OP Clear
NECK: no cervical lymphadenopathy appreciated
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2, cardiac exam
limited secondary to loud lung sounds
PULM: diffusely rhonchi bilaterally, anterior auscultation only,
greater on left on the right
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities.
SKIN: No jaundice, cyanosis, or gross dermatitis. scatterred
ecchymoses.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: The patient does not smoke now, but smoked significantly quit 20
years ago.  Today she said she smoked 3 pks/day for 20+ years.
Denies etoh or illicits. Lives in [**Location **], originally from
South [**Country 480**]. 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Pulmonary collapse,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Other specified forms of chronic ischemic heart disease,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Mitral valve disorders,Other chronic pulmonary heart diseases,Old myocardial infarction,Carrier or suspected carrier of other specified bacterial diseases'}
