CHIEF COMPLAINT: dyspnea and tachycardia x 48h

PRESENT ILLNESS: 39 y.o. F w/h/o etoh and crack cocaine abuse as well as h/o
psychosis w/h/o of multiple hospitalizations for her psychiatric
issues who p/w SOB which began during her most recent inpatient
stay for detoxification at [**Hospital **] Hospital([**Date range (1) 54167**]). She had
been transferred there from [**Hospital 1474**] Hospital where she spent 24
h, [**Date range (1) 54168**]. Per her brother, she has been in and out of
hospitals for the past 4-5 years for psychiatric and substance
abuse issues. He notes that she "smokes more than anyone he
knows" and notes that he thinks that her friend has been
bringing her crack cocaine with greater frequency lately. Per
brother, she had been admitted to [**Name (NI) 1474**] Hospital because her
[**Name (NI) 269**] was concerned about her because her heart rate was high, her
temp at home was "99". She was at [**Hospital1 1474**] for 24 h but was
transferred to [**Hospital **] Hospital for her substance abuse issues.
There, she was noted to have SOB and wheezing and began to be
treated for COPD/asthma flare. CXR there was unremarkable. She
was transferred to [**Hospital1 18**] for further management of her medical
problems.
.
In the ED, she was hypertensive to 160s tachycardic to the 120s
afebrile and sating 100%RA; she had diffuse wheezes on exam. Her
CXR was unrevealing and CT chest was negative for PE. She
received 1.5 LNS and 20mg valium as well as combivent nebs,
Azithromycin, and steroids for COPD flare.
.
Currently, unable to relate hx, denies current SOB, denies pain;
would like to go home. Does endorse having had cough, SOB
before. Denies recent drug use but notes that she did have a
drink prior to admission to the hospital- likely [**Hospital1 1474**].
Unable to relay how much.

MEDICAL HISTORY: 1. Basal ganglia/frontal cortical axis dysfunction
complicated by Parkinson-like symptoms with baseline tremor
and slurred speech as well as acute psychosis
2. History of sexual abuse by her brother.
3. History of alcohol abuse.
4. History of crack cocaine abuse.
5. h/o anticholinergic tox syndrome

MEDICATION ON ADMISSION: Home Medications: Risperdal, o/w unknown  (per brother)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: MICU ADMISSION PHYSICAL EXAM:
==============================
VS: T 100.4 HR 124 BP 111/49 RR 36 sat 99 on 6LNC
GEN: weepy, difficult to understand, but speaking in full
sentences
HEENT: AT, NC, Pupils small but reactive BL, EOMI, no
conjuctival injection, anicteric, OP clear, MMM
Neck: flat JVP, supple, no LAD, no carotid bruits
CV: RRR, nl s1, s2, +systolic murmur, no rubs, gallops
PULM: diffuse wheezes BL, no rhonchi, rales
ABD: soft, NT, ND, + BS, no HSM noted
EXT: warm, dry, +2 distal pulses BL
NEURO: "[**Month (only) **]" for date, unable to describe reason for being
here, unable to understand her statment for place, CN II-XII
grossly intact, 5/5 strength throughout. No sensory deficits to
light touch appreciated. No asterixis.
PSYCH: weepy, responds but unintelligibly, often inappropriately

FAMILY HISTORY: mother w/emphysema, father w/cerebral aneurysm, both parents
w/h/o HTN

SOCIAL HISTORY: Smokes 2ppd, unable to relay how much she drinks, denies other
drug use. Lives at home w/[**Last Name (LF) 269**], [**First Name3 (LF) **] brother has a friend who
brings her crack cocaine.
Abnormal innervation syndrome of eyelid,Chronic obstructive asthma with (acute) exacerbation,Personal history of alcoholism,Cocaine abuse, unspecified,Diverticulum of esophagus, acquired,Stridor,Other specified cardiac dysrhythmias
Abnorm innervation synd,Ch obst asth w (ac) exac,Hx of alcoholism,Cocaine abuse-unspec,Acq esophag diverticulum,Stridor,Cardiac dysrhythmias NEC
Admission Date:  [**2194-6-18**]              Discharge Date:   [**2194-6-23**]

Date of Birth:  [**2154-6-29**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2186**]
Chief Complaint:
dyspnea and tachycardia x 48h

Major Surgical or Invasive Procedure:
Bronchoscopy


History of Present Illness:
39 y.o. F w/h/o etoh and crack cocaine abuse as well as h/o
psychosis w/h/o of multiple hospitalizations for her psychiatric
issues who p/w SOB which began during her most recent inpatient
stay for detoxification at [**Hospital **] Hospital([**Date range (1) 54167**]). She had
been transferred there from [**Hospital 1474**] Hospital where she spent 24
h, [**Date range (1) 54168**]. Per her brother, she has been in and out of
hospitals for the past 4-5 years for psychiatric and substance
abuse issues. He notes that she "smokes more than anyone he
knows" and notes that he thinks that her friend has been
bringing her crack cocaine with greater frequency lately. Per
brother, she had been admitted to [**Name (NI) 1474**] Hospital because her
[**Name (NI) 269**] was concerned about her because her heart rate was high, her
temp at home was "99". She was at [**Hospital1 1474**] for 24 h but was
transferred to [**Hospital **] Hospital for her substance abuse issues.
There, she was noted to have SOB and wheezing and began to be
treated for COPD/asthma flare. CXR there was unremarkable. She
was transferred to [**Hospital1 18**] for further management of her medical
problems.
.
In the ED, she was hypertensive to 160s tachycardic to the 120s
afebrile and sating 100%RA; she had diffuse wheezes on exam. Her
CXR was unrevealing and CT chest was negative for PE. She
received 1.5 LNS and 20mg valium as well as combivent nebs,
Azithromycin, and steroids for COPD flare.
.
Currently, unable to relate hx, denies current SOB, denies pain;
would like to go home. Does endorse having had cough, SOB
before. Denies recent drug use but notes that she did have a
drink prior to admission to the hospital- likely [**Hospital1 1474**].
Unable to relay how much.


Past Medical History:
1. Basal ganglia/frontal cortical axis dysfunction
complicated by Parkinson-like symptoms with baseline tremor
and slurred speech as well as acute psychosis
2. History of sexual abuse by her brother.
3. History of alcohol abuse.
4. History of crack cocaine abuse.
5. h/o anticholinergic tox syndrome


Social History:
Smokes 2ppd, unable to relay how much she drinks, denies other
drug use. Lives at home w/[**Last Name (LF) 269**], [**First Name3 (LF) **] brother has a friend who
brings her crack cocaine.

Family History:
mother w/emphysema, father w/cerebral aneurysm, both parents
w/h/o HTN

Physical Exam:
MICU ADMISSION PHYSICAL EXAM:
==============================
VS: T 100.4 HR 124 BP 111/49 RR 36 sat 99 on 6LNC
GEN: weepy, difficult to understand, but speaking in full
sentences
HEENT: AT, NC, Pupils small but reactive BL, EOMI, no
conjuctival injection, anicteric, OP clear, MMM
Neck: flat JVP, supple, no LAD, no carotid bruits
CV: RRR, nl s1, s2, +systolic murmur, no rubs, gallops
PULM: diffuse wheezes BL, no rhonchi, rales
ABD: soft, NT, ND, + BS, no HSM noted
EXT: warm, dry, +2 distal pulses BL
NEURO: "[**Month (only) **]" for date, unable to describe reason for being
here, unable to understand her statment for place, CN II-XII
grossly intact, 5/5 strength throughout. No sensory deficits to
light touch appreciated. No asterixis.
PSYCH: weepy, responds but unintelligibly, often inappropriately

Skin: no rashes

PHYSICAL EXAM ON TRANSFER TO MEDICINE FLOOR:
============================================
Vitals - T: 96.3 BP: 99/64 (from 130/70) HR: 86 RR: 28 02 sat:
94% RA
GENERAL: NAD, speaking in full sentences, rocking back and forth

HEENT: EOMI, PERRL, anicteric, OP - no exudate, no erythema, no
LAD
CARDIAC: RRR, nl S1, S2, no m/r/g
LUNG: prolonged expiratory phase with expiratory wheezes
throughout, no rales/rhonchi
ABDOMEN: NDNT, soft, NABS
EXT: no c/c/e
NEURO: cooperative, denies AH and VH, although states that "God
is talking to her."

Pertinent Results:
ADMISSION LABS:
===============
        13.3
 8.8 >-------< 296
        40.4

MCV 92  Neuts 80.1  Bands 0  Lymphs 16.9  Monos 2.2  Eos 0.5
Basos 0.3

 140   103    12
-----|-----|-----< 152
 3.0   24     0.8

ALT 18  AST 21  LDH 216  Alk Phos 33  Bili 0.2  Alb 4.5
Ca 8.6  Phos 2.9  Mg 1.8

CK 137  MB 5  Trop <0.01

TSH 3.5
Serum Tox Screen: negative
Urine Tox Screen: negative
Lactate 2.8
UA negative

PERTINENT LABS DURING HOSPITALIZATION:
=======================================
WBC trend: 8.8 - 6.2 - 11.1
BNP 191

Labs at discharge:
creatinine 0.6
bicarbonate 20
WBC 10.9, Hct 38.7, Plt 386

MICROBIOLOGY:
=============
[**6-18**] BCx x 2:  NGTD
[**6-18**] UCx: negative

STUDIES:
========
[**6-18**] EKG:
Sinus tachycardia. Left atrial enlargement. Compared to the
previous tracing of [**2189-11-10**] there are non-specific
inferolateral ST segment changes and an increase in rate.
Otherwise, no diagnostic interim change.

[**6-18**] PCXR:
IMPRESSION: No cardiopulmonary process.

[**6-18**] CTA CHEST W&W/O C&RECONS, NON-CORONARY
IMPRESSION:
1. No evidence of pulmonary embolus or acute thoracic aortic
dissection.
2. Findings suggestive of esophageal diverticulum without any
the secondary signs to suggest a fistula. Consider further
evaluation with esophagram if warranted clinically.

[**6-19**] CHEST (PORTABLE AP)
IMPRESSION: No acute intrathoracic pathology including no
pneumonia or heart failure.

6/19 ESOPHAGUS
IMPRESSION: Unremarkable barium esophagram, without evidence of
a
tracheoesophageal fistula.

TTE (Complete) Done [**2194-6-20**]
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%) Tissue Doppler imaging
suggests a normal left ventricular filling pressure
(PCWP<12mmHg). Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is no mitral
valve prolapse. The pulmonary artery systolic pressure could not
be determined. There is no pericardial effusion. IMPRESSION:
Normal study. Normal biventricular cavity sizes with preserved
global and regional biventricular systolic function. No valvular
pathology or pathologic flow identified.

[**6-20**] CXR (PA & LATERAL)
FINDINGS: In comparison with the study of [**6-19**], there is no
interval change.  The cardiac silhouette remains within normal
limits with no evidence of vascular congestion, pleural
effusion, or acute pneumonia. Of incidental note is contrast
material, possibly from a recent CT, in the
left upper quadrant of the abdomen.

Brief Hospital Course:
MICU COURSE SUMMARY:
=====================
Ms. [**Known lastname 5108**] is a 39 y.o. with alcohol and crack cocaine abuse
history, h/o psychosis and multiple hospitalizations for psych
issues, and no known pulmonary disorder, transferred from OSH
for dyspnea and tachycardia during her most recent inpatient
stay for detox at [**Hospital **] Hospital ([**Date range (1) 54167**]). She then was
transferred to [**Hospital 1474**] Hospital because her [**Hospital 269**] noticed that
she was tachycardic, her temperature was "99". She was there for
24 hours, then transferred to [**Hospital **] Hospital for substance abuse
issues. She was noted to have increased SOB and wheezing and
treated for COPD/asthma flare. Prior to this, she reports having
a cough for about 2 weeks. She was transferred to [**Hospital1 18**] for
further management of her medical problems.

In the ED, she was hypertensive to 160s tachycardic to the 120s
afebrile and sating 100%RA. She had diffuse wheezes on exam. Her
CXR was unrevealing and CT chest was negative for PE. She
received 1.5 L NS and 20mg Valium as well as Combivent nebs,
Azithromycin, and steroids for COPD flare.

In the MICU, pt had insp/exp stridor. CTA initially showed ?
esoph diverticulum vs tracheoesophageal fistula (final read did
not show TEF). She underwent bronch and barium study, which were
both neg for fistula. ENT was consulted, and it was thought she
had paradoxical vocal cord motion causing insp stridor. Exp
wheezing was thought from a possible COPD flare (but no prior hx
of COPD). She was treated with levofloxacin and IV steroids, and
her stridor improved. She was persistently tachy up to 120's,
with some improvement to 110's after IVF. Tachycardia was
thought to be sinus tach [**2-1**] COPD flare and EtOH/cocaine
withdrawal. She was also agitated on admission to the MICU and
was hearing voices, got haldol, and was seen by psych who rec'd
continuing outpt regimen plus haldol prn.

MEDICINE FLOOR SUMMARY:
=======================
# Wheeze: Unclear etiology, but now improved. Patient without
known asthma or COPD, but has a significant smoking history. No
PE on CTA.  She was continued on po steroids that will be
tapered over 3 weeks.  She was also treated with levofloxacin to
complete a 7 day course.  She was placed on standing and prn
albuterol and atrovent.  CXR did not show any cardiopulmonary
process.  Pulmonary consult saw the patient and recommended long
3 week steroid taper as well as outpatient follow up in
[**Hospital1 1474**]. She should have PFTs in the future.

# Stridor: Patient initially had stridor heard bilaterally on
exam, but now only expiratory wheezing heard. No signs of
tracheoesophageal fistula by bronch or barium study. Stridor
likely due to paradoxical vocal cord motion per ENT. If pt
continues to have episodes of stridor, she may follow up with
[**Hospital **] Clinic as outpatient.

# Tachycardia: On admission, the patient was tachycardic. Her
sinus tachycardia somewhat improved with IVF and valium. Likely
multifactorial in setting of ? COPD exacerbation, EtOH/cocaine
withdrawal.  Tachycardia began to resolve. She was monitored on
telemetry.

# Etoh abuse: Multiple hospitalizations for detoxification;
unclear when her last drink was, or how much she drinks at
baseline.  CIWA scale initiated with po Diazepam but
discontinued on her 2nd day on the medical floor.  Aspiration
precautions maintained.  Social work/addiction consulted.

# Psych: Psychiatry followed patient while in the
hospitalization. Risperdal and trileptal continued.  1:1 sitter
maintained. She is being discharged to [**Hospital 1680**] Hospital for
further inpatient psychiatric treatment.

# ? Sz d/o: Was on trileptal at [**Hospital **] Hospital and continued in
[**Hospital1 18**].

# CODE: FULL

# CONTACT: [**Name (NI) 892**] ([**Telephone/Fax (1) 54169**]

Medications on Admission:
Home Medications: Risperdal, o/w unknown  (per brother)

Transfer Medications from OSH: colace, risperdal, trileptal,
flovent, albuterol, MOM, [**Name (NI) 54170**], MOM, Mylanta, [**Name (NI) 54171**]
gum

Transfer Medications from MICU to Medcine Floor:
Transfer meds:
Albuterol 0.083% Neb Soln 1 NEB IH Q4H
MethylPREDNISolone Sodium Succ 50 mg IV Q8H
Diazepam 5 mg PO Q4H PRN CIWA > 10
Nicotine Patch 14 mg TD DAILY
Oxcarbazepine 300 mg PO BID
Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
Heparin 5000 UNIT SC TID
Ipratropium Bromide Neb 1 NEB IH Q4H
Levofloxacin 500 mg PO Q24H
Risperidone 3 mg PO HS
Senna 1 TAB PO BID:PRN


Discharge Medications:
1. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) nebulizers Inhalation Q4H (every 4
hours).
Disp:*qs nebulizers* Refills:*2*
2. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
Disp:*30 Patch 24 hr(s)* Refills:*2*
3. Risperidone 1 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
Disp:*90 Tablet(s)* Refills:*2*
4. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
Disp:*qs units* Refills:*2*
5. Oxcarbazepine 300 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Ipratropium Bromide 0.02 % Solution Sig: One (1) nebulizer
Inhalation Q6H (every 6 hours).
Disp:*120 nebulizer* Refills:*2*
7. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 1 days.
Disp:*1 Tablet(s)* Refills:*0*
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
9. Prednisone 10 mg Tablet Sig: as directed Tablet PO once a
day: please take 6 tablets x 6 days ([**6-24**] - [**6-26**]), then take 4
tablets x 5 days ([**6-27**] - [**7-1**]), then 2 tablets x 4 days ([**7-2**] -
[**7-5**]), then 1 tablet x 3 days ([**7-6**] - [**7-8**]), and then [**1-1**] tablet x
3 days ([**7-9**] - [**7-11**]).
Disp:*51 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital 1680**] Hospital - [**Location (un) 538**]

Discharge Diagnosis:
Primary Diagnosis:
1. Paradoxical Vocal Cord Motion
2. Presumed COPD Exacerbation/Asthma

Secondary Diagnosis:
1. Alcohol abuse
2. Psychiatric disorder


Discharge Condition:
Stable. Ambulating. Oxygenating well.


Discharge Instructions:
You were admitted with shortness of breath, wheezing, and
stridor.  You were admitted to the ICU for respiratory distress.
 ENT evaluted you and believe that you have paradoxical vocal
cord motion.  You also were treated for a COPD flare and treated
with inhalers, steroids, and antibiotics.  Once you were
stabilized, you were transferred from the MICU to the medicine
floor.  You got better with medical management.

You should continue to take all your medications as prescribed.
You will go home on a 3 week steroid (prednisone) taper.

Please make all your medical appointments.

If you have any of the following symptoms, please call your
doctor or go to the nearest ER: fever>101, chest pain, shortness
of breath, abdominal pain, or any other concerning symptoms.

Followup Instructions:
Please call Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 35266**], your primary care physician, [**Name10 (NameIs) **]
schedule an appointment in [**1-1**] weeks.  Phone: [**Telephone/Fax (1) 35269**].

Please follow up with [**Hospital **] Clinic if you continue to have
stridor.  Call ([**Telephone/Fax (1) 6213**].

Please ask your doctor to give you a referral to a pulmonologist
in [**Hospital1 1474**].  You will need follow up for possible COPD/asthma.



Completed by:[**2194-6-23**]
{'Abnormal innervation syndrome of eyelid,Chronic obstructive asthma with (acute) exacerbation,Personal history of alcoholism,Cocaine abuse, unspecified,Diverticulum of esophagus, acquired,Stridor,Other specified cardiac dysrhythmias'}


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 and tachycardia x 48h

PRESENT ILLNESS: 39 y.o. F w/h/o etoh and crack cocaine abuse as well as h/o
psychosis w/h/o of multiple hospitalizations for her psychiatric
issues who p/w SOB which began during her most recent inpatient
stay for detoxification at [**Hospital **] Hospital([**Date range (1) 54167**]). She had
been transferred there from [**Hospital 1474**] Hospital where she spent 24
h, [**Date range (1) 54168**]. Per her brother, she has been in and out of
hospitals for the past 4-5 years for psychiatric and substance
abuse issues. He notes that she "smokes more than anyone he
knows" and notes that he thinks that her friend has been
bringing her crack cocaine with greater frequency lately. Per
brother, she had been admitted to [**Name (NI) 1474**] Hospital because her
[**Name (NI) 269**] was concerned about her because her heart rate was high, her
temp at home was "99". She was at [**Hospital1 1474**] for 24 h but was
transferred to [**Hospital **] Hospital for her substance abuse issues.
There, she was noted to have SOB and wheezing and began to be
treated for COPD/asthma flare. CXR there was unremarkable. She
was transferred to [**Hospital1 18**] for further management of her medical
problems.
.
In the ED, she was hypertensive to 160s tachycardic to the 120s
afebrile and sating 100%RA; she had diffuse wheezes on exam. Her
CXR was unrevealing and CT chest was negative for PE. She
received 1.5 LNS and 20mg valium as well as combivent nebs,
Azithromycin, and steroids for COPD flare.
.
Currently, unable to relate hx, denies current SOB, denies pain;
would like to go home. Does endorse having had cough, SOB
before. Denies recent drug use but notes that she did have a
drink prior to admission to the hospital- likely [**Hospital1 1474**].
Unable to relay how much.

MEDICAL HISTORY: 1. Basal ganglia/frontal cortical axis dysfunction
complicated by Parkinson-like symptoms with baseline tremor
and slurred speech as well as acute psychosis
2. History of sexual abuse by her brother.
3. History of alcohol abuse.
4. History of crack cocaine abuse.
5. h/o anticholinergic tox syndrome

MEDICATION ON ADMISSION: Home Medications: Risperdal, o/w unknown  (per brother)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: MICU ADMISSION PHYSICAL EXAM:
==============================
VS: T 100.4 HR 124 BP 111/49 RR 36 sat 99 on 6LNC
GEN: weepy, difficult to understand, but speaking in full
sentences
HEENT: AT, NC, Pupils small but reactive BL, EOMI, no
conjuctival injection, anicteric, OP clear, MMM
Neck: flat JVP, supple, no LAD, no carotid bruits
CV: RRR, nl s1, s2, +systolic murmur, no rubs, gallops
PULM: diffuse wheezes BL, no rhonchi, rales
ABD: soft, NT, ND, + BS, no HSM noted
EXT: warm, dry, +2 distal pulses BL
NEURO: "[**Month (only) **]" for date, unable to describe reason for being
here, unable to understand her statment for place, CN II-XII
grossly intact, 5/5 strength throughout. No sensory deficits to
light touch appreciated. No asterixis.
PSYCH: weepy, responds but unintelligibly, often inappropriately

FAMILY HISTORY: mother w/emphysema, father w/cerebral aneurysm, both parents
w/h/o HTN

SOCIAL HISTORY: Smokes 2ppd, unable to relay how much she drinks, denies other
drug use. Lives at home w/[**Last Name (LF) 269**], [**First Name3 (LF) **] brother has a friend who
brings her crack cocaine. 

### Response:
{'Abnormal innervation syndrome of eyelid,Chronic obstructive asthma with (acute) exacerbation,Personal history of alcoholism,Cocaine abuse, unspecified,Diverticulum of esophagus, acquired,Stridor,Other specified cardiac dysrhythmias'}
