CHIEF COMPLAINT: dyspnea, fatigue

PRESENT ILLNESS: 78 F with h/o asthma seen at [**Hospital1 18**] ED on [**1-7**] and found to have
LLL pneumonia.  Pt was sent home on antibiotics and asked to
return on [**1-8**] were she was found to be increasingly dyspneic,
tachycardic 120's , and hypoxic 50% (RA).  Pt was immediately
intubated in the ED and found to have ABG of 71.5/69/556 after
intubation.  Pt was transfered to the ICU for hypercarbic
respitory failure on [**1-8**].

MEDICAL HISTORY: 1. asthma
2. cataracts
3. severe bilateral hearing loss
4. allergic rhinitis

MEDICATION ON ADMISSION: albuterol
flonase
calcium
multivitamins
vit E

ALLERGIES: Sulfonamides / Motrin / Erythromycin Base

PHYSICAL EXAM: T 98.9   BP 121/60  HR 120  RR 16
A/C 400x18  PEEP 8  FI02 50%
Gen: intubated, sedated
HEENT: PERRL
Neck: supple, no LAD
Lungs: diffuse b/l wheezing; R>L
CV: S1, S2, tachycardia, no murmurs
Abd: BS present, soft, ND
Ext: no edema, warm,
Neuro: responsive to pain

FAMILY HISTORY: no cancer or diabetes

SOCIAL HISTORY: Lives alone in [**Location (un) **] MA.  She is a widow.  She has one
daughter that lives in [**Location 652**], CA.  Her phone #
[**Telephone/Fax (1) 4577**].  She does not smoke or drink EtOH.
Acute respiratory failure,Asthma, unspecified type, with (acute) exacerbation,Influenza with pneumonia,Gastroesophageal laceration-hemorrhage syndrome,Dermatitis due to drugs and medicines taken internally,Quinoline and hydroxyquinoline derivatives causing adverse effects in therapeutic use,Anemia, unspecified,Hypotension, unspecified,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Delirium due to conditions classified elsewhere
Acute respiratry failure,Asthma NOS w (ac) exac,Influenza with pneumonia,Mallory-weiss syndrome,Drug dermatitis NOS,Adv eff quinoline,Anemia NOS,Hypotension NOS,Pancreatic disorder NEC,Adv eff corticosteroids,Delirium d/t other cond
Admission Date:  [**2140-1-8**]              Discharge Date:   [**2140-1-14**]

Date of Birth:  [**2060-1-20**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfonamides / Motrin / Erythromycin Base

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
dyspnea, fatigue

Major Surgical or Invasive Procedure:
central line placement


History of Present Illness:
78 F with h/o asthma seen at [**Hospital1 18**] ED on [**1-7**] and found to have
LLL pneumonia.  Pt was sent home on antibiotics and asked to
return on [**1-8**] were she was found to be increasingly dyspneic,
tachycardic 120's , and hypoxic 50% (RA).  Pt was immediately
intubated in the ED and found to have ABG of 71.5/69/556 after
intubation.  Pt was transfered to the ICU for hypercarbic
respitory failure on [**1-8**].


Past Medical History:
1. asthma
2. cataracts
3. severe bilateral hearing loss
4. allergic rhinitis

Social History:
Lives alone in [**Location (un) **] MA.  She is a widow.  She has one
daughter that lives in [**Location 652**], CA.  Her phone #
[**Telephone/Fax (1) 4577**].  She does not smoke or drink EtOH.

Family History:
no cancer or diabetes


Physical Exam:
T 98.9   BP 121/60  HR 120  RR 16
A/C 400x18  PEEP 8  FI02 50%
Gen: intubated, sedated
HEENT: PERRL
Neck: supple, no LAD
Lungs: diffuse b/l wheezing; R>L
CV: S1, S2, tachycardia, no murmurs
Abd: BS present, soft, ND
Ext: no edema, warm,
Neuro: responsive to pain


Pertinent Results:
[**2140-1-8**] 04:10AM   WBC-7.2 RBC-4.74 HGB-15.4 HCT-46.2 MCV-98
MCH-32.6* MCHC-33.4 RDW-12.3
[**2140-1-8**] 04:10AM   PLT COUNT-282
[**2140-1-8**] 04:10AM   NEUTS-40.4* LYMPHS-43.2* MONOS-4.7 EOS-11.0*
BASOS-0.9
[**2140-1-8**] 04:10AM   GLUCOSE-159* UREA N-17 CREAT-0.7 SODIUM-140
POTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-31* ANION GAP-11
[**2140-1-8**] 07:29PM   LACTATE-2.1*
[**2140-1-8**] 08:48PM   TYPE-ART PO2-556* PCO2-69* PH-7.15* TOTAL
CO2-25 BASE XS--6

Brief Hospital Course:
Her medical ICU course is summarized by briefly by problems:
1. resp failure - pt was treated with levofloxacin initially
(later changed to ceftriaxone/azithromycin [**2-3**] rash) for
community acquired pneumonia and high dose intravenous steroids
for asthma exacerbation.  Direct florescent antibody testing
showed infection with influenza A.  Pt's pulmonary status
improved and she was extubated on [**2140-1-12**].

2. GI bleeding - after transfer to ICU she was noted to have
bright red blood from NGT.  It did not clear with several
hundred mL of lavage and pt eventually became hypotensive
requiring pressors and several liters of fluids.  Emergent EGD
was performed on [**1-9**] showing [**Doctor First Name **]-[**Doctor Last Name **] tear with evidence
of blood in fundus.  Hemostasis was achieved after epinephrine
injection.  Serial hematocrit were stable during the remainder
of the ICU course.  Pt required 3 units of pRBC.

3. Hyperglycemia - shortly after initiation of high dose
steroids pt's blood sugars were elevated requiring insulin gtt.
Levels were well controlled following insulin drip and
eventually euglycemia was maintained after transition to sliding
scale insulin.

Pt was transferred to the medical floor on [**2140-1-13**] for
continued care.  Her medical issues as mentioned above were
resolved.  At the time of dictation she has good oxygen
saturation (95% 2L), Hct is stable (42), and her blood sugars
are in the 130's.  However, post extubation she exhibited
confusion and agitation consistent with delirium.  She has not
been communicative dispite Japanese interpreter.  Pt has
required tube feeds via dohoff secondary to delirium.  In
addition she has required soft restraints and anti-psychotics
for agitation.

Medications on Admission:
albuterol
flonase
calcium
multivitamins
vit E

Discharge Medications:
1. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed.
2. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q1-2H () as needed for wheezing.
3. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q4H (every 4 hours).
4. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q4H (every 4 hours).
5. Olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
6. Haloperidol Lactate 5 mg/mL Solution Sig: One (1)  Injection
TID (3 times a day) as needed.
7. Salmeterol Xinafoate 50 mcg/Dose Disk with Device Sig: One
(1) Disk with Device Inhalation Q12H (every 12 hours).
8. Insulin Lispro (Human) 100 unit/mL Solution Sig: One (1)
Subcutaneous ASDIR (AS DIRECTED): may discontinue when steroid
taper complete.
9. Prednisone 10 mg Tablets, Dose Pack Sig: One (1) Tablets,
Dose Pack PO once a day: start at 50 mg on [**2139-1-14**] then 40 mg
on [**1-16**] and [**1-17**], then 30 mg [**1-18**] and [**1-19**], then 20 mg on
[**1-20**] and [**1-21**], then 10 on [**1-22**] and [**1-23**].
10. Pantoprazole Sodium 40 mg Recon Soln Sig: One (1) Recon Soln
Intravenous  Q12H (every 12 hours).
11. Ceftriaxone Sodium in D5W 20 mg/mL Piggyback Sig: One (1)
Intravenous  Q24H (every 24 hours): until [**2140-1-23**].
12. Metoclopramide HCl 5 mg/mL Solution Sig: One (1)  Injection
Q8H (every 8 hours).
13. Azithromycin 500 mg Recon Soln Sig: One (1) Recon Soln
Intravenous  Q24H (every 24 hours): until [**2139-1-22**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
1. asthma flare
2. influenza A
3. pneumonia
4. GI bleeding [**2-3**] [**Doctor First Name **]-[**Doctor Last Name **] tear
5. delirium
6. steroid induced hyperglycemia


Discharge Condition:
fair

Discharge Instructions:
1. continue steroid taper
2. discontinue antibiotics for two week course on [**2140-1-23**]
3. check blood sugars and give insulin appropriately

Followup Instructions:
see PCP in the next 2 weeks for follow up.
{'Acute respiratory failure,Asthma, unspecified type, with (acute) exacerbation,Influenza with pneumonia,Gastroesophageal laceration-hemorrhage syndrome,Dermatitis due to drugs and medicines taken internally,Quinoline and hydroxyquinoline derivatives causing adverse effects in therapeutic use,Anemia, unspecified,Hypotension, unspecified,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Delirium due to conditions classified elsewhere'}


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, fatigue

PRESENT ILLNESS: 78 F with h/o asthma seen at [**Hospital1 18**] ED on [**1-7**] and found to have
LLL pneumonia.  Pt was sent home on antibiotics and asked to
return on [**1-8**] were she was found to be increasingly dyspneic,
tachycardic 120's , and hypoxic 50% (RA).  Pt was immediately
intubated in the ED and found to have ABG of 71.5/69/556 after
intubation.  Pt was transfered to the ICU for hypercarbic
respitory failure on [**1-8**].

MEDICAL HISTORY: 1. asthma
2. cataracts
3. severe bilateral hearing loss
4. allergic rhinitis

MEDICATION ON ADMISSION: albuterol
flonase
calcium
multivitamins
vit E

ALLERGIES: Sulfonamides / Motrin / Erythromycin Base

PHYSICAL EXAM: T 98.9   BP 121/60  HR 120  RR 16
A/C 400x18  PEEP 8  FI02 50%
Gen: intubated, sedated
HEENT: PERRL
Neck: supple, no LAD
Lungs: diffuse b/l wheezing; R>L
CV: S1, S2, tachycardia, no murmurs
Abd: BS present, soft, ND
Ext: no edema, warm,
Neuro: responsive to pain

FAMILY HISTORY: no cancer or diabetes

SOCIAL HISTORY: Lives alone in [**Location (un) **] MA.  She is a widow.  She has one
daughter that lives in [**Location 652**], CA.  Her phone #
[**Telephone/Fax (1) 4577**].  She does not smoke or drink EtOH. 

### Response:
{'Acute respiratory failure,Asthma, unspecified type, with (acute) exacerbation,Influenza with pneumonia,Gastroesophageal laceration-hemorrhage syndrome,Dermatitis due to drugs and medicines taken internally,Quinoline and hydroxyquinoline derivatives causing adverse effects in therapeutic use,Anemia, unspecified,Hypotension, unspecified,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Delirium due to conditions classified elsewhere'}
