CHIEF COMPLAINT: Respiratory distress.

PRESENT ILLNESS: The patient is a 62-year-old
African-American male with a history of severe chronic
obstructive pulmonary disease and asthma (on home oxygen and
steroids) and a history of coronary artery disease who
presented to the Emergency Room on [**3-2**] after being found
by a neighbor in respiratory distress.

MEDICAL HISTORY: 1.  Asthma.
2.  Chronic obstructive pulmonary disease (requiring home
oxygen of 2 liters and chronic steroids at 20 mg p.o. per
day).
3.  History of a seizure disorder.
4.  History of non-Q-wave myocardial infarction.
5.  History of hypertension.
6.  Question history of cerebrovascular accident.

MEDICATION ON ADMISSION: (Medications on admission
included)
 1.  Lipitor 10 mg p.o. q.d.
 2.  Verapamil 120 mg p.o. b.i.d.
 3.  Prednisone 20 mg p.o. q.d.
 4.  Mysoline 50 mg p.o. q.h.s.
 5.  Imdur 30 mg p.o. q.d.
 6.  Albuterol 2 puffs inhaled b.i.d. as needed.
 7.  Serevent 2 puffs inhaled q.d.
 8.  Singulair 10 mg p.o. q.d.
 9.  Pulmicort 2 puffs inhaled q.d.
10.  Albuterol nebulizers.
11.  [**Doctor First Name **] 60 mg p.o. q.d.
12.  Advair 2 puffs inhaled b.i.d.
13.  Aspirin 325 mg p.o. q.d.
14.  Home oxygen (2 liters).
15.  Calcium 500 mg p.o. q.d.
16.  Vitamin D 400 units p.o. q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone at the [**Doctor Last Name 5395**] House
in [**Location (un) **] which is an independent living facility for the
homeless people with illnesses.  He has a daughter in
[**Location (un) 686**].  He has a 40-year smoking history of two to three
packs per day.  He quit seven years ago.  No current alcohol
use; although, extensive alcohol in the past which he
discontinued in [**2175**].  He denies any intravenous drug use and
has used marijuana in the past.
Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Other convulsions,Subendocardial infarction, initial episode of care,Pneumonia due to other gram-negative bacteria,Unspecified essential hypertension,Anemia of other chronic disease,Hypotension, unspecified
Obs chr bronc w(ac) exac,Acute respiratry failure,Convulsions NEC,Subendo infarct, initial,Pneumo oth grm-neg bact,Hypertension NOS,Anemia-other chronic dis,Hypotension NOS
Admission Date:  [**2180-3-2**]       Discharge Date:  [**2180-3-10**]

Date of Birth:   [**2118-2-15**]       Sex:  M

Service:  [**Hospital6 733**] East

CHIEF COMPLAINT:  Respiratory distress.

HISTORY OF PRESENT ILLNESS:  The patient is a 62-year-old
African-American male with a history of severe chronic
obstructive pulmonary disease and asthma (on home oxygen and
steroids) and a history of coronary artery disease who
presented to the Emergency Room on [**3-2**] after being found
by a neighbor in respiratory distress.

The patient remembers being sick with a cold for the week
prior to admission; a cold which was productive of cough,
headache, fatigue, and worsening shortness of breath and
wheezing.  The patient noted he was using his inhalers and
nebulizers more frequently over that time and not gaining
relief of his symptoms.  He denied any palpitations, but he
did not some lightheadedness.  He also recalled some episodes
of chest tightness associated with his shortness of breath
and not associated with exertion.  He noted he tried some
sublingual nitroglycerin tablets which relieved some of the
pain.

On the night prior to admission, the patient again noted an
episode of pain in his chest which was relieved with
nitroglycerin.  He also remembers having significant
respiratory distress, and that is the last thing he
remembers.  He was apparently found by a neighbor calling for
help and was brought into the Emergency Room.

In the Emergency Room, he was noted to be in significant
respiratory distress with an arterial blood gas which showed
a pH of 6.96, a PCO2 of 180, and a PO2 of 112.  The patient
was sedated and intubated.  He was transferred to the
Intensive Care Unit.  He was then transferred to the Medical
team on [**3-7**] after being extubated for two days.

PAST MEDICAL HISTORY:
1.  Asthma.
2.  Chronic obstructive pulmonary disease (requiring home
oxygen of 2 liters and chronic steroids at 20 mg p.o. per
day).
3.  History of a seizure disorder.
4.  History of non-Q-wave myocardial infarction.
5.  History of hypertension.
6.  Question history of cerebrovascular accident.

MEDICATIONS ON ADMISSION:  (Medications on admission
included)
 1.  Lipitor 10 mg p.o. q.d.
 2.  Verapamil 120 mg p.o. b.i.d.
 3.  Prednisone 20 mg p.o. q.d.
 4.  Mysoline 50 mg p.o. q.h.s.
 5.  Imdur 30 mg p.o. q.d.
 6.  Albuterol 2 puffs inhaled b.i.d. as needed.
 7.  Serevent 2 puffs inhaled q.d.
 8.  Singulair 10 mg p.o. q.d.
 9.  Pulmicort 2 puffs inhaled q.d.
10.  Albuterol nebulizers.
11.  [**Doctor First Name **] 60 mg p.o. q.d.
12.  Advair 2 puffs inhaled b.i.d.
13.  Aspirin 325 mg p.o. q.d.
14.  Home oxygen (2 liters).
15.  Calcium 500 mg p.o. q.d.
16.  Vitamin D 400 units p.o. q.d.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient lives alone at the [**Doctor Last Name 5395**] House
in [**Location (un) **] which is an independent living facility for the
homeless people with illnesses.  He has a daughter in
[**Location (un) 686**].  He has a 40-year smoking history of two to three
packs per day.  He quit seven years ago.  No current alcohol
use; although, extensive alcohol in the past which he
discontinued in [**2175**].  He denies any intravenous drug use and
has used marijuana in the past.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on admission to the Medical Intensive Care Unit revealed
vital signs with a blood pressure of 125/66, heart rate was
108, temperature was 97, oxygen saturation was 95% on a
ventilator set at 500/14 positive end-expiratory pressure of
5 and 100% of FIO2.   The patient was intubated and sedated.
Head, eyes, ears, nose, and throat examination revealed
normocephalic and atraumatic.  Pupils were equally round and
reactive to light.  They went from 4 mm to 3 mm.  The
oropharynx was moist and pink.  No tongue lacerations.  Neck
revealed no jugular venous distention.  No lymphadenopathy.
Lung examination revealed prolonged expiratory phase with
significant expiratory wheezes (right greater than left), and
coarse breath sounds bilaterally.  Cardiovascular examination
revealed a regular rate and rhythm.  Normal first heart
sounds and second heart sounds.  No murmurs, rubs, or
gallops.  The abdomen was firm, nontender, and nondistended.
Positive bowel sounds.  Extremity examination revealed no
edema, but clubbing was present.  Neurologically, the patient
was sedated, grimacing to sternal rub, not responding to
verbal stimuli, and was moving upper extremities
spontaneously.  No reflexes were able to be elicited.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Laboratory
studies on admission revealed white blood cell count was 9
(with 38% neutrophils, 45% lymphocytes, and 11% monocytes),
hematocrit was 44, and platelets were 113.  Sodium was 141,
potassium was 4.5, chloride was 100, bicarbonate was 33,
blood urea nitrogen was 9, creatinine was 0.8, and blood
glucose was 150.  Creatine kinase was 364, MB was 1.8,
troponin was less than 0.3.  Free calcium was 1.36.  Arterial
blood gas revealed 6.96, with a PCO2 of 180, and a PO2 of
112.

PERTINENT RADIOLOGY/IMAGING:  Electrocardiogram on admission
was sinus with normal intervals, axis was -90, with
P-pulmonale, and low voltage in precordium.  No ST-T wave
changes.

A chest x-ray showed hyperinflation and ETT about 10 cm above
the carina.

HOSPITAL COURSE BY ISSUE/SYSTEM:   The patient is a
62-year-old male with severe chronic obstructive pulmonary
disease who comes in with a chronic obstructive pulmonary
disease exacerbation requiring intubation and Intensive Care
Unit stay.

1.  PULMONARY ISSUES:  The patient was intubated for
hypercarbic respiratory failure.  He was treated with a
ventilator, with nebulizers, and with intravenous steroids.
He received medication for sedation so that he did not fight
the ventilator.

A chest x-ray after several days of admission revealed an
infiltrate, and sputum grew out Moraxella.  The patient was
started on levofloxacin 500 mg q.d. on [**3-5**] and was to
continue for a 10-day course.  The patient had significant
amounts of thick sputum.

The patient was extubated on [**3-6**].  His respiratory
status continued to improve with around the clock nebulizers
and continued inhaler use.  He was put on prednisone 40 mg
and kept there.  Upon discharge, the patient was q.4h. Around
the clock albuterol and Atrovent nebulizers with his inhalers
in between.  The patient was also receiving guaifenesin and
Mucomyst for his sputum.  His pneumonia was being treated
with levofloxacin and was to continue for a total of 10 days.
He has been seen by Respiratory Therapy who recommended a
flutter valve for the patient to help with his secretion
mobilization.

2.  CARDIOVASCULAR SYSTEM:  The patient has a history of
coronary artery disease with a non-Q-wave myocardial
infarction in the past.  He was continued on aspirin and
Lipitor.  His antihypertensive medications were held due to
some hypotension while he was ventilated, and initially
status post extubation.

The patient ended up having a positive creatine kinase with a
troponin leak of 2.  He also had electrocardiogram changes
with his electrocardiogram revealing T wave inversions in the
inferior leads as well as V3 through V6.  These were new
changes.

He was seen by Cardiology, who recommended a dobutamine
stress test when the patient's respiratory status has
improved.  They also recommended continuing full-strength
aspirin of 325 mg, low-dose Lopressor at 6.25 mg p.o. b.i.d.,
and continuing Imdur 30 mg p.o. q.d.

They recommended an echocardiogram, which the patient
received.  This echocardiogram revealed an ejection fraction
of greater than 55%.  The left atrium was normal in size.
Normal right ventricular wall thickness.  Left ventricular
cavity size was normal.  Left ventricular wall motion was
normal.  The right ventricular free wall was hypertrophied.
The right ventricular cavity was markedly dilated.  There was
severe global right ventricular free wall hypokinesis.  The
aortic root was mildly dilated.  Trivial mitral regurgitation
was seen.  There was moderate pulmonary artery systolic
hypertension.  There was no pericardial effusion.

The patient should follow up in the Cardiology Clinic for a
stress test as an outpatient for evaluation of his coronary
artery disease.

3.  RENAL SYSTEM:  The patient with a stable blood urea
nitrogen and creatinine and good urine output.

4.  ENDOCRINE SYSTEM:  The patient was initially started on
intravenous steroids and changed to prednisone 40 mg p.o.
q.d.  A slow taper should be planned, and the patient is on
chronic doses of 20 mg p.o. q.d.   He was getting
sliding-scale insulin while on the steroids.  He was
continued on his calcium and vitamin D.

5.  FLUIDS/ELECTROLYTES/NUTRITION ISSUES:  The patient with a
metabolic alkalosis; most likely due to volume depletion.  He
received intravenous fluids while nothing by mouth, and his
oral intake improved over his hospital stay.

6.  HEMATOLOGIC ISSUES:  On admission, the patient had a
hematocrit of 44, which fell to 32 on [**3-3**]., and dropped
to 29 on [**3-7**].  His hematocrit then improved 37.6
spontaneously on the day prior to discharge.  He had a mean
cell volume of 74.

7.  INFECTIOUS DISEASE ISSUES:  The patient was found to have
a Moraxella pneumonia.  He was treated with levofloxacin for
a total of a 10-day course.  Blood cultures and urine
cultures have been negative.

DISCHARGE DISPOSITION:  The patient was to be discharged to
[**Hospital6 310**].  Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] been in contact
with the patient's primary care physician, [**Name10 (NameIs) **] she is aware
of the events of his hospital stay.

DISCHARGE DIAGNOSES:
1.  Chronic obstructive pulmonary disease flare.
2.  Moraxella pneumonia.
3.  Non-Q-wave myocardial infarction.
4.  Coronary artery disease.
5.  History of a seizure disorder.

MEDICATIONS ON DISCHARGE:  (Medications on discharge
included)
 1.  Tylenol p.o. as needed
 2.  Lipitor 10 mg p.o. q.h.s.
 3.  Primidone 50 mg p.o. q.h.s.
 4.  Vitamin D 400 units p.o. q.d.
 5.  Salmeterol inhaler 2 puffs inhaled b.i.d.
 6.  Levaquin 500 mg p.o. q.d. (times five more days).
 7.  Senna two tablets p.o. q.d.
 8.  Bisacodyl 10 mg p.o. q.d.
 9.  Colace 100 mg p.o. b.i.d.
10.  Prednisone 40 mg p.o. q.d.
11.  Albuterol inhaler 2 puffs inhaled q.4h.
12.  Atrovent inhaler 2 puffs inhaled q.4h.
13.  Aspirin 325 mg p.o. q.d.
14.  Metoprolol 6.25 mg p.o. b.i.d.
15.  Imdur 30 mg p.o. q.d.
16.  Nitroglycerin 0.3 mg sublingually q.5min. as needed (for
chest pain).
17.  Albuterol nebulizers q.4h. around the clock.
18.  Atrovent nebulizers q.4h. around the clock.
19.  Guaifenesin 5 cc to 10 cc q.4-6h. as needed.
20.  Calcium carbonate 500 mg p.o. q.d.
21.  Mucomyst nebulizers q.4-6h. as needed.
22.  Ambien 5 mg p.o. q.h.s. as needed (for sleep).





                            [**Doctor Last Name **] [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5712**]

Dictated By:[**Name8 (MD) 2069**]
MEDQUIST36

D:  [**2180-3-9**]  18:13
T:  [**2180-3-9**]  18:54
JOB#:  [**Job Number 34619**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Other convulsions,Subendocardial infarction, initial episode of care,Pneumonia due to other gram-negative bacteria,Unspecified essential hypertension,Anemia of other chronic disease,Hypotension, unspecified'}


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: Respiratory distress.

PRESENT ILLNESS: The patient is a 62-year-old
African-American male with a history of severe chronic
obstructive pulmonary disease and asthma (on home oxygen and
steroids) and a history of coronary artery disease who
presented to the Emergency Room on [**3-2**] after being found
by a neighbor in respiratory distress.

MEDICAL HISTORY: 1.  Asthma.
2.  Chronic obstructive pulmonary disease (requiring home
oxygen of 2 liters and chronic steroids at 20 mg p.o. per
day).
3.  History of a seizure disorder.
4.  History of non-Q-wave myocardial infarction.
5.  History of hypertension.
6.  Question history of cerebrovascular accident.

MEDICATION ON ADMISSION: (Medications on admission
included)
 1.  Lipitor 10 mg p.o. q.d.
 2.  Verapamil 120 mg p.o. b.i.d.
 3.  Prednisone 20 mg p.o. q.d.
 4.  Mysoline 50 mg p.o. q.h.s.
 5.  Imdur 30 mg p.o. q.d.
 6.  Albuterol 2 puffs inhaled b.i.d. as needed.
 7.  Serevent 2 puffs inhaled q.d.
 8.  Singulair 10 mg p.o. q.d.
 9.  Pulmicort 2 puffs inhaled q.d.
10.  Albuterol nebulizers.
11.  [**Doctor First Name **] 60 mg p.o. q.d.
12.  Advair 2 puffs inhaled b.i.d.
13.  Aspirin 325 mg p.o. q.d.
14.  Home oxygen (2 liters).
15.  Calcium 500 mg p.o. q.d.
16.  Vitamin D 400 units p.o. q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone at the [**Doctor Last Name 5395**] House
in [**Location (un) **] which is an independent living facility for the
homeless people with illnesses.  He has a daughter in
[**Location (un) 686**].  He has a 40-year smoking history of two to three
packs per day.  He quit seven years ago.  No current alcohol
use; although, extensive alcohol in the past which he
discontinued in [**2175**].  He denies any intravenous drug use and
has used marijuana in the past. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Other convulsions,Subendocardial infarction, initial episode of care,Pneumonia due to other gram-negative bacteria,Unspecified essential hypertension,Anemia of other chronic disease,Hypotension, unspecified'}
