CHIEF COMPLAINT: transferred from rehab for fever, hypotension, and recurrent
pneumonias x 1 month

PRESENT ILLNESS: Pt is a 68 yo male with angioimmunoblastic T cell Lymphoma
diagnosed [**9-26**] s/p 6 cycles of CHOP chemotherapy, Atrial
fibrillation, COPD, CAD s/p MI, DM who presented to the ED from
rehab with fever and hypotension. Pt had been discharged from
[**Hospital1 **] to rehab on [**2145-7-29**] after presenting from OSH in [**Month (only) 116**] with
increasing hypoxia, orthopnea, weakness, and increasing
abdominal girth necessitating [**Hospital Unit Name 153**] admission; he remained in the
ICU for 6 weeks with complicated hospital course.  He was
thought to be in decompensated CHF but did not improve with
adequate diuresis. He was covered broadly for pneumonia with
ceftriaxone, azithromycin, bactrim, vancomycin, and
voriconazole. Was on Vanco/CTX/Azithro/Vori x 14 days([**Date range (1) 62192**]),
on Zosyn for increased fever and secretions, 7 day course ([**7-1**]-
[**7-8**]). Bronchoscopy/BAL was performed and was negative for AFB,
PCP or bacterial microorganisms. Pt was trached and was able to
be weaned off of the ventilator after many weeks intubated, but
complicated by MRSA tracheobronchitis treated with Vanc and
acute renal failure with peak Cr 4.6. Additionally, paracentesis
at OSH prior to transfer was consistent with both malignancy and
SBP and pt was treated with ceftriaxone. Pt was discharged to
rehab on [**2145-7-29**]
.
Pt presented to the [**Hospital1 18**] ED today with reported BP in the 60s,
temperature to 104 at rehab.  VS in ED were: T: 96.8; HR: 115;
BP: 99/60; RR: 18; O2: 96 4L.  Per ED resident, pt was placed
horizontally for central line and pressure fell to 65 systolic.
He was unable to maintain secretion
.
In ED given, levaquin 500 IV x 1, flagyl 500 mg x 1, Decadron 10
IV x 1, Linezolid 600 mg IV x 1.

MEDICAL HISTORY: 1. Angioimmunoblastic T cell lymphoma s/p 6 cycles of chop
diagnosed in late [**2144-9-23**] due to symptoms of night sweats,
weight loss and bulky adenopathy in the neck.
2 COPD with FEV1/FVC 124% predicted, FEV1 42%, FVC 34%, TLC 76 %
predicted
3 atrial fibrillation
4. coronary artery disease
5. diabetes mellitus
6. CRI
7. Nephrolithiasis
8. CHF  (EF variable reported 35-60%)

MEDICATION ON ADMISSION: KCl 30mEq [**Hospital1 **]
Ibuprofen PRN
RISS
Procrit [**Numeric Identifier **] U SC qweekly
Warfarin 3mg PO qd
Cardizem 240mg PO BID
ASA EC 81mg PO qd
Lopressor 75 PO TID
Lasix 60mg PO BID
Flagyl 500 TID 2nd course started [**2145-9-13**]
Protonix 40mg PO qd
Colace 100mg PO qd

ALLERGIES: Vancomycin / Cefepime

PHYSICAL EXAM: VS: BP 107/76; HR 128; T  ; 100% sat on
GEN: Portuguese speaking male, sedated, intubated, responsive to
verbal stimuli
HEENT: Left subclavian line in place C/D/I. No appreciable JVD
CV: distant HS, muffled by ventilator, S1 S2, irregularly
irregular
LUNGS: Coarse rhonchi B/L anterior fields
ABD: soft, Nt. mild distension. BS normoactive. No appreciable
organomegaly.
EXT: Cold extremities. No C/C/E. Symmetric 1+ pulses

FAMILY HISTORY: mother died of trauma, father died of old age

SOCIAL HISTORY: retired and lives with his wife.  previously smoked 1 ppd, no
etoh or ivda.  Originally from [**Country 6257**]
Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Atrial fibrillation,Mycosis fungoides, lymph nodes of head, face, and neck,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Severe sepsis,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Unspecified disorder of kidney and ureter,Old myocardial infarction
Septicemia NOS,Pneumonia, organism NOS,Acute respiratry failure,Acute kidney failure NOS,Atrial fibrillation,Mycosis fungoides head,Chr airway obstruct NEC,CHF NOS,Severe sepsis,Hypotension NOS,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Renal & ureteral dis NOS,Old myocardial infarct
Admission Date:  [**2145-9-15**]              Discharge Date:   [**2145-9-17**]

Date of Birth:  [**2077-5-8**]             Sex:   M

Service: MEDICINE

Allergies:
Vancomycin / Cefepime

Attending:[**First Name3 (LF) 14385**]
Chief Complaint:
transferred from rehab for fever, hypotension, and recurrent
pneumonias x 1 month

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
Pt is a 68 yo male with angioimmunoblastic T cell Lymphoma
diagnosed [**9-26**] s/p 6 cycles of CHOP chemotherapy, Atrial
fibrillation, COPD, CAD s/p MI, DM who presented to the ED from
rehab with fever and hypotension. Pt had been discharged from
[**Hospital1 **] to rehab on [**2145-7-29**] after presenting from OSH in [**Month (only) 116**] with
increasing hypoxia, orthopnea, weakness, and increasing
abdominal girth necessitating [**Hospital Unit Name 153**] admission; he remained in the
ICU for 6 weeks with complicated hospital course.  He was
thought to be in decompensated CHF but did not improve with
adequate diuresis. He was covered broadly for pneumonia with
ceftriaxone, azithromycin, bactrim, vancomycin, and
voriconazole. Was on Vanco/CTX/Azithro/Vori x 14 days([**Date range (1) 62192**]),
on Zosyn for increased fever and secretions, 7 day course ([**7-1**]-
[**7-8**]). Bronchoscopy/BAL was performed and was negative for AFB,
PCP or bacterial microorganisms. Pt was trached and was able to
be weaned off of the ventilator after many weeks intubated, but
complicated by MRSA tracheobronchitis treated with Vanc and
acute renal failure with peak Cr 4.6. Additionally, paracentesis
at OSH prior to transfer was consistent with both malignancy and
SBP and pt was treated with ceftriaxone. Pt was discharged to
rehab on [**2145-7-29**]
.
Pt presented to the [**Hospital1 18**] ED today with reported BP in the 60s,
temperature to 104 at rehab.  VS in ED were: T: 96.8; HR: 115;
BP: 99/60; RR: 18; O2: 96 4L.  Per ED resident, pt was placed
horizontally for central line and pressure fell to 65 systolic.
He was unable to maintain secretion
.
In ED given, levaquin 500 IV x 1, flagyl 500 mg x 1, Decadron 10
IV x 1, Linezolid 600 mg IV x 1.

Past month with recurrent febrile PNAs (MRSA [**8-22**], Chlamydia
[**8-27**]) s/p numerous Abx treatments including doxycycline and
linezolid (last dose 8/15), and treatment for C. diff on [**8-16**]
treated with Flagyl.

Past Medical History:
1. Angioimmunoblastic T cell lymphoma s/p 6 cycles of chop
diagnosed in late [**2144-9-23**] due to symptoms of night sweats,
weight loss and bulky adenopathy in the neck.
2 COPD with FEV1/FVC 124% predicted, FEV1 42%, FVC 34%, TLC 76 %
predicted
3 atrial fibrillation
4. coronary artery disease
5. diabetes mellitus
6. CRI
7. Nephrolithiasis
8. CHF  (EF variable reported 35-60%)


Social History:
retired and lives with his wife.  previously smoked 1 ppd, no
etoh or ivda.  Originally from [**Country 6257**]


Family History:
mother died of trauma, father died of old age

Physical Exam:
VS: BP 107/76; HR 128; T  ; 100% sat on
GEN: Portuguese speaking male, sedated, intubated, responsive to
verbal stimuli
HEENT: Left subclavian line in place C/D/I. No appreciable JVD
CV: distant HS, muffled by ventilator, S1 S2, irregularly
irregular
LUNGS: Coarse rhonchi B/L anterior fields
ABD: soft, Nt. mild distension. BS normoactive. No appreciable
organomegaly.
EXT: Cold extremities. No C/C/E. Symmetric 1+ pulses

Pertinent Results:
[**2145-9-16**] 04:55PM BLOOD WBC-31.0* RBC-2.88* Hgb-8.6* Hct-27.5*
MCV-95 MCH-29.7 MCHC-31.2 RDW-18.1* Plt Ct-428
[**2145-9-16**] 01:15PM BLOOD Neuts-61 Bands-22* Lymphs-6* Monos-0
Eos-7* Baso-0 Atyps-1* Metas-3* Myelos-0
[**2145-9-16**] 04:55PM BLOOD Plt Ct-428
[**2145-9-16**] 04:55PM BLOOD FDP-10-40
[**2145-9-16**] 04:55PM BLOOD Glucose-219* UreaN-26* Creat-1.4* Na-139
K-4.1 Cl-107 HCO3-11* AnGap-25*
[**2145-9-16**] 01:15PM BLOOD ALT-5 AST-14 CK(CPK)-17* AlkPhos-195*
TotBili-0.3
[**2145-9-16**] 04:55PM BLOOD Albumin-2.1* Calcium-6.6* Phos-4.5 Mg-1.7
[**2145-9-16**] 05:24PM BLOOD Type-ART Temp-38.3 Tidal V-600 PEEP-5
FiO2-100 pO2-78* pCO2-40 pH-7.12* calHCO3-14* Base XS--16
AADO2-601 REQ O2-97
[**2145-9-16**] 02:46PM BLOOD Type-ART Temp-39.9 Tidal V-600 pO2-95*
pCO2-38* pH-7.18* calHCO3-15* Base XS--13 Intubat-INTUBATED
Vent-CONTROLLED
[**2145-9-16**] 01:02PM BLOOD Type-ART Temp-40.0 Rates-20/11 Tidal
V-600 PEEP-5 FiO2-50 pO2-78* pCO2-42 pH-7.15* calHCO3-15* Base
XS--13 -ASSIST/CON Intubat-INTUBATED

Brief Hospital Course:
Patient was admitted to the [**Hospital Unit Name 153**] intubated, on levophed for
pressor support, with diagnosis of sepsis. CXR showed bilateral
infiltrates and overall respiratory demise with WBC of 23.5.
Given complicated medical history, recent [**Hospital Unit Name 153**] hopsitalization
(> 2 months), and several respiratory infections (MRSA
tracheobronchitis, chlamydia pneumonia), patient was started on
Linezolid, Meropenem, and Ciprofloxacin for broad-spectrum
antibiotics coverage. Voriconazole was added to regimen later in
the morning. Given severity of condition, activated protein C
was considered; however, patient had INR of 3.7, and given risks
of bleeding, APC was not administered. Patient remained stable
on pressor overnight. Diltiazem drip was started for control of
Atrial fibrillation as patient was tachcardic to 140s. HR was
[**Last Name (un) 4662**] under control, and patient remained stable on Diltiazem
drip and Levophed drip that was weaned off by the morning.
Insulin drip was started for tight glucose control. In the
morning, patient went into rapid Atrial fibrilation that did not
respond to Lopressor IV 5mg x 2. Esmolol drip was started.
Patient became hypotensive to 80s requiring aggressive fluid
resuscitation. Esmolol and Diltiazem drips were discontinued.
Patient underwent electrical cardioversion. Phenylephrine drip
was started for hypotension. Patient continued to be in pressure
demise, and vasopressin was added. Patient also became hypoxic
requiring increase in ventilator settings. ABG showed pH of
7.12.  Patient's condition continued to deteriorate and required
continued use of dual pressors and high ventilator settings, and
patient expired later the next morning due to overwhelming
sepsis and multi-organ failure.

Medications on Admission:
KCl 30mEq [**Hospital1 **]
Ibuprofen PRN
RISS
Procrit [**Numeric Identifier **] U SC qweekly
Warfarin 3mg PO qd
Cardizem 240mg PO BID
ASA EC 81mg PO qd
Lopressor 75 PO TID
Lasix 60mg PO BID
Flagyl 500 TID 2nd course started [**2145-9-13**]
Protonix 40mg PO qd
Colace 100mg PO qd


Discharge Medications:
Patient expired.

Discharge Disposition:
Expired

Discharge Diagnosis:
Sepsis, Respiratory Failure, Pneumonia, Atrial Fibrillation,
Hypotension

Discharge Condition:
deceased


Completed by:[**2145-9-18**]
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Atrial fibrillation,Mycosis fungoides, lymph nodes of head, face, and neck,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Severe sepsis,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Unspecified disorder of kidney and ureter,Old myocardial infarction'}


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: transferred from rehab for fever, hypotension, and recurrent
pneumonias x 1 month

PRESENT ILLNESS: Pt is a 68 yo male with angioimmunoblastic T cell Lymphoma
diagnosed [**9-26**] s/p 6 cycles of CHOP chemotherapy, Atrial
fibrillation, COPD, CAD s/p MI, DM who presented to the ED from
rehab with fever and hypotension. Pt had been discharged from
[**Hospital1 **] to rehab on [**2145-7-29**] after presenting from OSH in [**Month (only) 116**] with
increasing hypoxia, orthopnea, weakness, and increasing
abdominal girth necessitating [**Hospital Unit Name 153**] admission; he remained in the
ICU for 6 weeks with complicated hospital course.  He was
thought to be in decompensated CHF but did not improve with
adequate diuresis. He was covered broadly for pneumonia with
ceftriaxone, azithromycin, bactrim, vancomycin, and
voriconazole. Was on Vanco/CTX/Azithro/Vori x 14 days([**Date range (1) 62192**]),
on Zosyn for increased fever and secretions, 7 day course ([**7-1**]-
[**7-8**]). Bronchoscopy/BAL was performed and was negative for AFB,
PCP or bacterial microorganisms. Pt was trached and was able to
be weaned off of the ventilator after many weeks intubated, but
complicated by MRSA tracheobronchitis treated with Vanc and
acute renal failure with peak Cr 4.6. Additionally, paracentesis
at OSH prior to transfer was consistent with both malignancy and
SBP and pt was treated with ceftriaxone. Pt was discharged to
rehab on [**2145-7-29**]
.
Pt presented to the [**Hospital1 18**] ED today with reported BP in the 60s,
temperature to 104 at rehab.  VS in ED were: T: 96.8; HR: 115;
BP: 99/60; RR: 18; O2: 96 4L.  Per ED resident, pt was placed
horizontally for central line and pressure fell to 65 systolic.
He was unable to maintain secretion
.
In ED given, levaquin 500 IV x 1, flagyl 500 mg x 1, Decadron 10
IV x 1, Linezolid 600 mg IV x 1.

MEDICAL HISTORY: 1. Angioimmunoblastic T cell lymphoma s/p 6 cycles of chop
diagnosed in late [**2144-9-23**] due to symptoms of night sweats,
weight loss and bulky adenopathy in the neck.
2 COPD with FEV1/FVC 124% predicted, FEV1 42%, FVC 34%, TLC 76 %
predicted
3 atrial fibrillation
4. coronary artery disease
5. diabetes mellitus
6. CRI
7. Nephrolithiasis
8. CHF  (EF variable reported 35-60%)

MEDICATION ON ADMISSION: KCl 30mEq [**Hospital1 **]
Ibuprofen PRN
RISS
Procrit [**Numeric Identifier **] U SC qweekly
Warfarin 3mg PO qd
Cardizem 240mg PO BID
ASA EC 81mg PO qd
Lopressor 75 PO TID
Lasix 60mg PO BID
Flagyl 500 TID 2nd course started [**2145-9-13**]
Protonix 40mg PO qd
Colace 100mg PO qd

ALLERGIES: Vancomycin / Cefepime

PHYSICAL EXAM: VS: BP 107/76; HR 128; T  ; 100% sat on
GEN: Portuguese speaking male, sedated, intubated, responsive to
verbal stimuli
HEENT: Left subclavian line in place C/D/I. No appreciable JVD
CV: distant HS, muffled by ventilator, S1 S2, irregularly
irregular
LUNGS: Coarse rhonchi B/L anterior fields
ABD: soft, Nt. mild distension. BS normoactive. No appreciable
organomegaly.
EXT: Cold extremities. No C/C/E. Symmetric 1+ pulses

FAMILY HISTORY: mother died of trauma, father died of old age

SOCIAL HISTORY: retired and lives with his wife.  previously smoked 1 ppd, no
etoh or ivda.  Originally from [**Country 6257**] 

### Response:
{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Atrial fibrillation,Mycosis fungoides, lymph nodes of head, face, and neck,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Severe sepsis,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Unspecified disorder of kidney and ureter,Old myocardial infarction'}
