CHIEF COMPLAINT: Hypoxia

PRESENT ILLNESS: 72 yo M w/ hx COPD on home O2, CAD, dementia was noted to have
increasing dyspnea at NSH w/ hypoxia to 84% on 2L NC improved on
NRB w/ CXR read as b/l infiltrates. Pt was transferred to [**Hospital 4068**]
Hospital. Pt received levo/flagyl/vanco, KCl and IV NS and was
transferred to [**Hospital1 18**] for further evaluation and treatment.  Pt
has a PEG and is allowed to have nectar liquid shake under
supervision w/ family or staff. He has been NPO for the past few
days, however unclear whether pt's family has been feeding him
as well.
Pt reports increasing SOB over a week, no cough or fevers, no
dysuria. He also reports diarrhea x 1 week, now improving. He
reports no PO intake in the last week. He reports his breathing
was difficult, but slightly easier now compared w/ earlier.

MEDICAL HISTORY: ? [**Hospital1 **]
emphysema on home O2
HTN
CAD
Dementia
UTI
depression
PEG
h/o aspiration PNAs
[**Hospital1 **] negative on [**2122-4-23**]
Started on flagyl [**5-5**] emperically for C diff

MEDICATION ON ADMISSION: tube feeds Jevity 1.2 cal 75cc/hr 6a-8p
home O2 2L NC
flagyl 500mg po qid started for [**Hospital1 **] d1 = [**2122-5-5**]
metoprolol 12.5mg po q24h
artificial tears
prevacid 30mg po q24h
flovent 110mcg 2 puffs q24h
reglan 10mg po tid
duoneb q6h
dulcolax PR prn
MOM prn
fleets enema prn
H2O flush 120cc qid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
Tm 102.1 Tc 101.8 HR 101 100/65 27 (27-34) 100% 10L NRB
Gen: thin, cauc M sitting up on stretcher using accessory
muscles of respirations w/ end exp abdominal push;
HEENT: PERRL, arcus senilis, PERRL, poor dentition, OP clear, MM
dry
Heart: RRR, S1, S2, no m/r/g, distant HS
Lungs: mild exp wheezing, no rales or crackles, distant BS
Abd: PEG in place, S/NT/ND/no masses
Ext: no edema, thin
R chest several well healed scars, healed trach scar;

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives in Nursing home, spanish speaking w/some english. Family
involved.
Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Pneumonia due to Pseudomonas,Acute kidney failure, unspecified,Acidosis,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Intussusception,Other gastrostomy complications,Congestive heart failure, unspecified,Unspecified essential hypertension,Anemia of other chronic disease,Other specified disorders of pancreatic internal secretion,Aneurysm of iliac artery,Adrenal cortical steroids causing adverse effects in therapeutic use
Acute respiratry failure,Food/vomit pneumonitis,Pseudomonal pneumonia,Acute kidney failure NOS,Acidosis,Int inf clstrdium dfcile,Urin tract infection NOS,Obs chr bronc w(ac) exac,Intussusception,Gastrostomy comp NEC,CHF NOS,Hypertension NOS,Anemia-other chronic dis,Pancreatic disorder NEC,Iliac artery aneurysm,Adv eff corticosteroids
Admission Date:  [**2122-5-6**]              Discharge Date:   [**2122-5-19**]

Date of Birth:  [**2049-10-4**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
Hypoxia

Major Surgical or Invasive Procedure:
Intubation
Arterial line

History of Present Illness:
72 yo M w/ hx COPD on home O2, CAD, dementia was noted to have
increasing dyspnea at NSH w/ hypoxia to 84% on 2L NC improved on
NRB w/ CXR read as b/l infiltrates. Pt was transferred to [**Hospital 4068**]
Hospital. Pt received levo/flagyl/vanco, KCl and IV NS and was
transferred to [**Hospital1 18**] for further evaluation and treatment.  Pt
has a PEG and is allowed to have nectar liquid shake under
supervision w/ family or staff. He has been NPO for the past few
days, however unclear whether pt's family has been feeding him
as well.
Pt reports increasing SOB over a week, no cough or fevers, no
dysuria. He also reports diarrhea x 1 week, now improving. He
reports no PO intake in the last week. He reports his breathing
was difficult, but slightly easier now compared w/ earlier.

Patient was admitted to the MICU, intubated for hypoxic
respiratory failure, found to have pneumonia (asp?), COPD flare,
anemia, renal insufficiency. Was extubated easily and on
transfer to the medical floor was breathing well on 3L NC.


Past Medical History:
? [**Hospital1 **]
emphysema on home O2
HTN
CAD
Dementia
UTI
depression
PEG
h/o aspiration PNAs
[**Hospital1 **] negative on [**2122-4-23**]
Started on flagyl [**5-5**] emperically for C diff


Social History:
Lives in Nursing home, spanish speaking w/some english. Family
involved.

Family History:
Non contributory

Physical Exam:
On admission:
Tm 102.1 Tc 101.8 HR 101 100/65 27 (27-34) 100% 10L NRB
Gen: thin, cauc M sitting up on stretcher using accessory
muscles of respirations w/ end exp abdominal push;
HEENT: PERRL, arcus senilis, PERRL, poor dentition, OP clear, MM
dry
Heart: RRR, S1, S2, no m/r/g, distant HS
Lungs: mild exp wheezing, no rales or crackles, distant BS
Abd: PEG in place, S/NT/ND/no masses
Ext: no edema, thin
R chest several well healed scars, healed trach scar;

Pertinent Results:
Micro:
[**2122-5-14**] STOOL INPATIENT C diff negative
[**2122-5-12**] STOOL INPATIENT C diff negative
[**2122-5-10**] STOOL INPATIENT C diff negative
[**2122-5-6**] SPUTUM Source: Expectorated.

                            **FINAL REPORT [**2122-5-15**]**

   GRAM STAIN (Final [**2122-5-6**]):
      >25 PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE ROD(S).
      4+   (>10 per 1000X FIELD):   GRAM NEGATIVE ROD(S).
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI IN
PAIRS, CHAINS,
      AND CLUSTERS.
      1+    (<1 per 1000X FIELD):   GRAM NEGATIVE DIPLOCOCCI.

   RESPIRATORY CULTURE (Final [**2122-5-8**]):
      MODERATE GROWTH OROPHARYNGEAL FLORA.
      PSEUDOMONAS AERUGINOSA.    MODERATE GROWTH.
      GRAM NEGATIVE ROD #2.    RARE GROWTH.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             PSEUDOMONAS AERUGINOSA
                             |
CEFEPIME--------------     4 S
CEFTAZIDIME-----------     8 S
CIPROFLOXACIN---------   =>4 R
GENTAMICIN------------   <=1 S
IMIPENEM--------------     2 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN----------     8 S
PIPERACILLIN/TAZO-----     8 S
TOBRAMYCIN------------   <=1 S

   LEGIONELLA CULTURE (Final [**2122-5-15**]):    NO LEGIONELLA
ISOLATED.

[**2122-5-6**] URINE EMERGENCY [**Hospital1 **] contaminated
[**2122-5-6**] BLOOD CULTURE EMERGENCY [**Hospital1 **] no growth

Reports:
[**2122-5-16**] Cardiology ECG
Sinus rhythm; Low limb leads voltage; Modest nonspecific low
amplitude lateral T waves; Since previous tracing of [**2122-5-7**],
probably no significant change

[**2122-5-15**] Radiology CT ABDOMEN/PELVIS
1) No intussusception. The Foley catheter now terminates in the
body of the stomach.
2) Large right common iliac artery aneurysm.
3) Diverticulosis without evidence of diverticulitis.
4) Large cystic spaces at the right lung bases.
5) Atelectasis or consolidation at the left lung base.

[**2122-5-14**] Radiology CT ABDOMEN/PELVIS
1) Likely transient intussusception of proximal jejunum caused
by an inflated Foley balloon used as a gastrostomy tube which
has migrated distally. These findings were immediately conveyed
to Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 1968**].
2) Large 6 cm right common iliac artery aneurysm. 3cm supra- and
infrarenal abdominal aortic aneurysms.
3) Diverticulosis without diverticulitis.
4) Two tiny low attenuation lesions at the head of the pancreas
as above. These most likely represent benign cysts. However,
IPMT cannot be excluded. Follow-up CT or MRI in 1 year is
recommended to ensure stability.

[**2122-5-13**] Radiology PORTABLE ABDOMEN
2 mm calcific density in the right mid abdomen, which may
represent a kidney stone.

[**2122-5-12**] Radiology CHEST (PORTABLE AP)
1. Worsening interstitial pattern in the mid and lower lung
zones, which may represent pulmonary edema in this patient with
history of volume overload clinically.
2. Persistent left retrocardiac process, which may relate to
either atelectasis or pneumonia. Infection is within the
differential diagnosis.
3. Severe upper lobe predominant emphysema.

[**2122-5-11**] Radiology CT CHEST W/O CONTRAST
1) Persistent left lower lobe process, which may reflect
combination of infectious consolidation and atelectasis. There
is slight interval improvement along the periphery, allowing for
differences in technique.
2) Diffuse emphysematous changes.
3) Nonspecific 4 mm right lower lobe noncalcified nodule. In the
absence of prior studies, follow up CT scan is recommended in
one year to ensure stability.
4) Focal aneurysmal dilation of the descending aorta measuring
3.5 cm in diameter.

[**2122-5-7**] Cardiology ECG [**2122-5-8**]
Sinus rhythm. Borderline low voltages of QRS and T waves. These
findings are non-specific but clinical correlation is suggested.
Since the previous tracing of [**2122-5-7**] sinus tachycardia and
atrial ectopy are absent and ST-T wave abnormalities have
decreased.

[**2122-5-7**] Radiology CHEST (PORTABLE AP)
Pulmonary edema/CHF with probable superimposed consolidation of
the left lower lobe.

[**2122-5-7**] Radiology PORTABLE ABDOMEN
1) Moderate gastric distention, without evidence of bowel
obstruction or significant bowel ileus.
2) Left lung base atelectasis/consolidation.

[**2122-5-6**] Cardiology ECG
Sinus tachycardia; Supraventricular extrasystoles; Short PR
interval;
Poor R wave progression - probable normal variant; Nonspecific
ST-T wave changes

[**2122-5-6**] Radiology CHEST (PORTABLE AP)
1) Probable left lower lobe pneumonia. A PA and lateral view
will be helpful for further assessment once the patient's
condition permits.
2) Bleb at the right medial lung.

CT OF THE CHEST WITHOUT INTRAVENOUS CONTRAST: Assessment of the
lungs demonstrates diffuse severe emphysematous changes with
both paraseptal and centrilobular distribution. Marked bullous
changes are also demonstrated at the apices. Consistent with the
prior chest x-rays, there is a consolidation in the medial
aspect of the left lower lobe with air bronchograms as well as
volume loss. Allowing for differences in technique, there is
suggestion of gradual improvement along the peripheral aspect of
this consolidation. There is a small left-sided pleural effusion
and trace right- sided effusion. An endotracheal tube is noted
in satisfactory position. A small calcified right upper lobe
granuloma is noted. A 4 mm noncalcified nodule is also noted in
the right lower lobe abutting the pleura on series 2, image 22.

There are no pathologically enlarged areas of adenopathy. A
calcified right paratracheal and right hilar lymph node are
noted, also consistent with prior granulomatous infection. Note
is made of coronary artery calcifications. The visualized great
vessels are remarkable for a focal aneurysmal dilatation of the
descending aorta at the level of the diaphragm measuring 3.5 cm
in its greatest dimension. The visualized portions of the upper
abdomen are remarkable for a G-tube. The osseous structures
demonstrate no suspicious lytic or sclerotic lesions.

IMPRESSION:

1) Persistent left lower lobe process, which may reflect
combination of infectious consolidation and atelectasis. There
is slight interval improvement along the periphery, allowing for
differences in technique.

2) Diffuse emphysematous changes.

3) Nonspecific 4 mm right lower lobe noncalcified nodule. In the
absence of prior studies, follow up CT scan is recommended in
one year to ensure stability.

4) Focal aneurysmal dilation of the descending aorta measuring
3.5 cm in diameter.

[**2122-5-14**]  CT abd/pelv:
IMPRESSION:
1) Likely transient intussusception of distal duodenum and
proximal jejunum caused by an inflated Foley balloon which has
migrated distally. These findings were immediately conveyed to
Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 1968**].
2) Large 6 cm right common iliac artery aneurysm. 3cm supra- and
infrarenal abdominal aortic aneurysms.
3) Diverticulosis without diverticulitis.
4) Two tiny low attenuation lesions at the head of the pancreas
as above. These most likely represent benign cysts. However,
IPMT cannot be excluded. Follow-up CT or MRI in 1 year is
recommended to ensure stability.

[**2122-5-15**]  CT abd/pelv:
IMPRESSION:
1) No intussusception. The Foley catheter now terminates in the
body of the stomach.
2) Large right common iliac artery aneurysm.
3) Diverticulosis without evidence of diverticulitis.
4) Large cystic spaces at the right lung bases.
5) Atelectasis or consolidation at the left lung base.

Labs:
[**2122-5-6**] 12:30AM BLOOD WBC-13.6* RBC-3.68* Hgb-10.1* Hct-32.5*
MCV-88 MCH-27.4 MCHC-31.0 RDW-15.7* Plt Ct-250
[**2122-5-18**] 06:50AM BLOOD WBC-13.9* RBC-4.24* Hgb-11.9* Hct-36.2*
MCV-86 MCH-28.2 MCHC-32.9 RDW-16.2* Plt Ct-279
[**2122-5-6**] 12:30AM BLOOD Neuts-82.3* Bands-0 Lymphs-12.4*
Monos-5.0 Eos-0.2 Baso-0.1
[**2122-5-14**] 04:55AM BLOOD PT-13.8* PTT-48.4* INR(PT)-1.2
[**2122-5-6**] 04:17AM BLOOD Ret Aut-1.3
[**2122-5-6**] 12:30AM BLOOD Glucose-171* UreaN-49* Creat-2.1* Na-156*
K-3.1* Cl-120* HCO3-21* AnGap-18
[**2122-5-18**] 06:50AM BLOOD Glucose-171* UreaN-33* Creat-1.2 Na-140
K-4.8 Cl-101 HCO3-33* AnGap-11
[**2122-5-6**] 12:30AM BLOOD ALT-19 AST-21 CK(CPK)-32* AlkPhos-70
TotBili-0.2
[**2122-5-7**] 09:44PM BLOOD LD(LDH)-171 TotBili-0.1
[**2122-5-6**] 12:30AM BLOOD Lipase-12
[**2122-5-18**] 06:50AM BLOOD Calcium-9.5 Phos-2.8 Mg-2.1
[**2122-5-7**] 09:44PM BLOOD Hapto-205*
[**2122-5-6**] 12:01PM BLOOD VitB12-456 Folate-GREATER TH
[**2122-5-6**] 04:17AM BLOOD calTIBC-161* Ferritn-380 TRF-124*
[**2122-5-7**] 03:20AM BLOOD freeCa-1.22

Brief Hospital Course:
# Hypoxia/PNA/COPD - Initially sustained on BIPAP in ED, but
became progressively lethargic with slowing of respiratory
effort shortly after arriving to MICU requiring intubation.
Saturations dramatically improved following intubation and
patient was maintained initially on AC vent. CXR showed likely
retrocardiac pna with severe underlying emphysematous changes,
and sputums showed picture of aspiration pneumonia w/initial
gram stain of gram pos/neg rods, gram pos cocci and diplococci.
Patient was started on levoflox, flagyl and vanc. Initially,
patient required frequent suctioning. Sputums later grew out
pseudomonas resistant to cipro so patient was switched to ceftaz
and vanco. Fevers resolved on day 2, but patients WBC remained
elevated between 14-16 during MICU stay, with surveliance cxr
and clinical picture dramatically improving over a course of 2
days. Patient developed a metabolic acidosis secondary to
aggressive fluid resucitation that limited early extubation.
Corrected with subsequent fluid restriction. Several trial weens
failed on days [**3-13**], but patient was sucessfully extubated on
[**2122-5-12**] and mainted sats on 2liters nc for >24 hours.  Patient
complained of mild respiratory discomfort following extubation,
which resolved while he was on the medicine floor. Patient
remained on 3L NC for the rest of his hospitalization.

# ARF - pre-renal, with rapidly correcting creatinine following
fluid resucitation in the MICU with increased urine output
thereafter. Urine cultures negative.

# [**Date Range **] - patient previously treated for [**Last Name (LF) **], [**First Name3 (LF) **] report, in
nursing home. On presentation complaining of diarrhea. Placed on
precautions and started empirically on Flagyl. Patient's stools
progressed from loose and frequent to formed and intermittent
during MICU stay. Patient had x3 negative stools for [**First Name3 (LF) **] prior
to discharge. Discontinued precautions.

#Abd pain - patient would intermittently complain of abdominal
discomfort which would resolve following bowel movements. KUB
was read as negative for ileus/obstruction w/unspecific air/gas
pattern throughout, though noted small calcification that was
worrisome for a kidney stone. CT abd/pelv obtained, which
revealed that calcification was from 5x6cm R iliac aneurysm, and
that pt's feeding tube had migrated all the way to the proximal
jejunum, causing an intussusception at that point. Gen [**Doctor First Name **] and
GI were consulted, both recommended deflating balloon and
pulling back PEJ. This was done, and on immediate reimaging the
intussusception had resolved. Patient was started back on tube
feeds without problem. Had no more abdominal pain.

#Right iliac artery aneurysm, AAA - [**Doctor First Name **] Surgery consulted,
felt that patient's disease was likely old in nature and did not
require emergent surgical management. They attempted to get old
films to compare size of aneurysms to see if they were stable or
enlarging. On discharge, patient was instructed to follow up and
have further imaging on an outpatient basis. It is unclear if he
would be a surgical candidate given his comorbidities.

#Anemia - uncertain etiology, labs consistent with anemia of
chronic disease. Patient had one day of guaic positive stools
w/o evidence of melena/hematochezia. Guaic positive stools
resolved spontaneously the next day. Patient's Hct responded
appropriately to transfusion, and remained at baseline following
transfusion while in MICU.

#Volume overload - patient intially requiring aggressive fluid
resusitation leaving him +6-7 liters positive for LOS. CXR
showed mild effusion consistent with CHF and
respiratory/ventilatory requirments mimicked additional fluid
stress. As patients ARF resolved he was supplemented with lasix
for a goal of -500cc/day showing improvment of respiratory
function with increasing diuresis.  On discharge from MICU
patient had been diuresed sucessfully to a +5liter balance for
his LOS. While on medicine [**Hospital1 **], continued diuresis until pt
became dehydrated with prerenal azotemia, which reversed with
gentle hydration.

#Hyperglycemia - Per report, patient had no history of DM
however during his MICU stay, he had increasing requirments of
his sliding scale insulin for glycemic control. Combination of
steroids plus infection could account for this elevation. As
patient is being tapered off steroids upon discharge, his sugars
will likely return to his baseline upon discharge.

#Ventral penis erosion - patient noted to have erosion by Foley
through ventral aspect of glans penis, unclear if new or present
on admission. Patient does not seem to be bothered by this, but
he should see Urology as an outpatient for further management
and should have his Foley catheter affixed to his leg by tape to
prevent further erosion as he moves in bed.


Medications on Admission:
tube feeds Jevity 1.2 cal 75cc/hr 6a-8p
home O2 2L NC
flagyl 500mg po qid started for [**Hospital1 **] d1 = [**2122-5-5**]
metoprolol 12.5mg po q24h
artificial tears
prevacid 30mg po q24h
flovent 110mcg 2 puffs q24h
reglan 10mg po tid
duoneb q6h
dulcolax PR prn
MOM prn
fleets enema prn
H2O flush 120cc qid

Discharge Medications:
1. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
injection Injection TID (3 times a day).
2. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
3. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
injection Injection ASDIR (AS DIRECTED).
4. Metoclopramide HCl 10 mg Tablet Sig: One (1) Tablet PO
QIDACHS (4 times a day (before meals and at bedtime)).
5. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours) as needed for shortness
of breath or wheezing.
6. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1) dose PO BID
(2 times a day).
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
9. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
10. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
11. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic  PRN
(as needed).
12. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  [**Hospital1 **]
(2 times a day) as needed for 2 weeks.
13. Metoprolol Tartrate 25 mg Tablet Sig: 0.25 Tablet PO BID (2
times a day): hold for SBP<100, HR<60.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 537**]- [**Location (un) 538**]

Discharge Diagnosis:
Respiratory failure / Hypoxia
Pneumonia
Acute Renal Failure
Chronic Renal Insufficiency
Diarrhea
Anemia
Severe COPD
Metabolic Acidosis
Metabolic Alkalosis
Hypomagnesium
Hypochloremia
Hypernatremia
Hyperglycemia
Volume overload
Intussusception
Abdominal aortic aneurysm
Right iliac artery aneurysm
Erosion of Foley through ventral glans


Discharge Condition:
Hemodynamically stable, breathing comfortably on 2L NC,
tolerating tube feeds

Discharge Instructions:
Please continue to take all medications as prescribed and to
follow up with your doctors. Continue your tube feeds as
tolerated. Continue home oxygen, titrated to keep SpO2>92%.

If you experience increasing SOB, fever, increasing production
of sputum or inability to clear sputum, drop in blood pressure,
severe diarrhea, or any other concerning symptoms seek medical
attention immediately.

Followup Instructions:
Patient should follow up with his primary care physician [**Name Initial (PRE) 176**]
3-5 days after discharge. Please keep the following appointments
as well.

Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Where: [**Hospital6 29**]
PULMONARY FUNCTION LAB Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2122-6-5**]
10:55

Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 611**]/DR. [**Last Name (STitle) **] Where: [**Hospital6 29**] MEDICAL
SPECIALTIES Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2122-6-5**] 11:10

We have scheduled the following appointment for you to follow up
on your recently diagnosed iliac artery aneurysm:

Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY Where: [**Last Name (NamePattern4) **]
SURGERY Date/Time:[**2122-6-4**] 10:00am  ([**Last Name (NamePattern1) 60739**], [**Location (un) **], [**Hospital1 18**]

You should also schedule an appointment with a Urologist to have
your penis evaluated, in particular the apparent erosion by the
Foley catheter through the ventral aspect of the head of your
penis.


                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Pneumonia due to Pseudomonas,Acute kidney failure, unspecified,Acidosis,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Intussusception,Other gastrostomy complications,Congestive heart failure, unspecified,Unspecified essential hypertension,Anemia of other chronic disease,Other specified disorders of pancreatic internal secretion,Aneurysm of iliac artery,Adrenal cortical steroids causing adverse effects in therapeutic use'}


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: Hypoxia

PRESENT ILLNESS: 72 yo M w/ hx COPD on home O2, CAD, dementia was noted to have
increasing dyspnea at NSH w/ hypoxia to 84% on 2L NC improved on
NRB w/ CXR read as b/l infiltrates. Pt was transferred to [**Hospital 4068**]
Hospital. Pt received levo/flagyl/vanco, KCl and IV NS and was
transferred to [**Hospital1 18**] for further evaluation and treatment.  Pt
has a PEG and is allowed to have nectar liquid shake under
supervision w/ family or staff. He has been NPO for the past few
days, however unclear whether pt's family has been feeding him
as well.
Pt reports increasing SOB over a week, no cough or fevers, no
dysuria. He also reports diarrhea x 1 week, now improving. He
reports no PO intake in the last week. He reports his breathing
was difficult, but slightly easier now compared w/ earlier.

MEDICAL HISTORY: ? [**Hospital1 **]
emphysema on home O2
HTN
CAD
Dementia
UTI
depression
PEG
h/o aspiration PNAs
[**Hospital1 **] negative on [**2122-4-23**]
Started on flagyl [**5-5**] emperically for C diff

MEDICATION ON ADMISSION: tube feeds Jevity 1.2 cal 75cc/hr 6a-8p
home O2 2L NC
flagyl 500mg po qid started for [**Hospital1 **] d1 = [**2122-5-5**]
metoprolol 12.5mg po q24h
artificial tears
prevacid 30mg po q24h
flovent 110mcg 2 puffs q24h
reglan 10mg po tid
duoneb q6h
dulcolax PR prn
MOM prn
fleets enema prn
H2O flush 120cc qid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
Tm 102.1 Tc 101.8 HR 101 100/65 27 (27-34) 100% 10L NRB
Gen: thin, cauc M sitting up on stretcher using accessory
muscles of respirations w/ end exp abdominal push;
HEENT: PERRL, arcus senilis, PERRL, poor dentition, OP clear, MM
dry
Heart: RRR, S1, S2, no m/r/g, distant HS
Lungs: mild exp wheezing, no rales or crackles, distant BS
Abd: PEG in place, S/NT/ND/no masses
Ext: no edema, thin
R chest several well healed scars, healed trach scar;

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives in Nursing home, spanish speaking w/some english. Family
involved. 

### Response:
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Pneumonia due to Pseudomonas,Acute kidney failure, unspecified,Acidosis,Intestinal infection due to Clostridium difficile,Urinary tract infection, site not specified,Obstructive chronic bronchitis with (acute) exacerbation,Intussusception,Other gastrostomy complications,Congestive heart failure, unspecified,Unspecified essential hypertension,Anemia of other chronic disease,Other specified disorders of pancreatic internal secretion,Aneurysm of iliac artery,Adrenal cortical steroids causing adverse effects in therapeutic use'}
