CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: Mr. [**Known lastname **] is a 70 year old man with multiple medical problems
including COPD (2L home 02), DM2, GERD, HTN, HLD, CAD s/p NSTEMI
[**2126**], recurrent PNA, AAA, recent pneumothorax, CHF (EF=20-25%),
AS (valve area of 0.9cm2 and valve gradient of 38) AF on
coumadin, who is transferred from [**Hospital1 **] ICU to [**Hospital1 18**]
for increasing  pulmonary edema and hypotension.
.
On [**2133-12-8**], he presented to OSH with SOB, orthopnea, and PND,
similar to multiple admissions over the past years. Admitted
with a diagnosis of CHF exacerbation (BNP>500) in the context of
likely COPD flare, then transferred to [**Hospital1 18**].  Cardiac cath/TTE
showed severe aortic stenosis (valve area of 0.9cm2 and valve
gradient of 38).  His cardiac output was also preserved, at
5.4L/min.  Cardiac surgery and Pulmonary was consulted to
comment on his candidacy for AVR and he was deemed to be a poor
open surgical candidate due to his existing comorbidities, but
possibly for percutaneous valve replacement in the future.  He
was not aggressively diuresed, due to his preload dependence and
he was discharged to rehab on his daily 10mg predisone after
completing a 7-day taper.
.
The patient had a previous admission at NWH from [**2040-12-28**] was
initially admittted because of severe dywspnea and concerns for
an NSTEMI. At OSH lab studies were notable for acardiac enzyme
peak CK of 115 and MB of 10.7, with a peak troponin of 4.33.
Microbiology was notable for a urine culture which grew 2 types
of pseudomonas, subswuqently changed foley. His SOB was initally
believed to be [**2-17**] COPD flare/pneumonia than CHF. The patient
improved on IV solumedrol.
.
On his most recent admission on [**2134-1-11**], the patient noted that
he woke up this AM feeling SOB. He was given an albuterol neb,
which per pt worsened his SOB. In OSH ED he recieved adenosine
18 mg total which failed to break his tachypnea, and he was also
noted to be tachycardic into the 150s; he also recieved IV
lopressor and was transferred to ICU where he was placed on
BIPAP and given dilt 10 mg IV which [**Last Name (un) 4662**] HR down to 120s. The
patient was given abx for possible pneumonia in the setting of
elevated WBC to 26. Patient given iv lasix. methylprednisolone,
pantroprazole, and fluticasone/sealmeterol, tiotropium, insulin,
vancomycin, imipenem-calastin. Today the patient developed
acture respiratory distress that was not responsive to IV lasix
80s or a Lasix gtt; the team felt that his [**Last Name **] problem was
likely cardiac and mechanical, he should be transferred to
[**Hospital1 18**].
.
.
Upon arrival at [**Hospital1 18**], patient had an a line placed c sbp in the
140/70, noted tachypnia at 33, and face mask o2 at 12 L. HR 114.
He appears uncomfortable with accewssory muscle use, and was
transitioned to BIPAP.
.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes +, Dyslipidemia +,
Hypertension +
2. CARDIAC HISTORY:
-Atrial fibrillation on Coumadin
-Congestive heart failure. EF 20-25%
-inferior NSTEMI [**2126**]
-Severe aortic stenosis (valve area 0.9)
-CABG: N/A
-PERCUTANEOUS CORONARY INTERVENTIONS: N/A
.
3. OTHER PAST MEDICAL HISTORY:
-Chronic obstructive pulmonary disease, 2L home O2
-Noninsulin dependent diabetes mellitus
-Questionable history of syncope
-History of pulmonary embolus in [**2120**]
-GERD
-left femoral aneurysm repaired [**7-/2133**] [**Hospital1 2025**]
-AAA, infrarenal evaluated at 4.5cm on [**2133-7-16**] CT
-recurrent pneumonia
-lung nodules, stable
-large pneumothorax requiring chest tube post-bronch [**2133**]

MEDICATION ON ADMISSION: 1. Glucotrol XL 10 mg Tablet Extended Rel 24 hr Sig: One (1)
Tablet Extended Rel 24 hr PO once a day.
2. Mucinex 1,200 mg Tab, Multiphasic Release 12 hr Sig: One (1)
Tab, Multiphasic Release 12 hr PO twice a day.
3. levalbuterol HCl 0.31 mg/3 mL Solution for Nebulization Sig:
One (1) nebulizer Inhalation every 4-6 hours as needed for
shortness of breath or wheezing.
4. mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
6. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
7. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
packet PO DAILY (Daily) as needed for constipation.
8. ProAir HFA 90 mcg/Actuation HFA Aerosol Inhaler Sig: [**1-17**]
Inhalation every 4-6 hours.
9. Tylenol 325 mg Tablet Sig: Two (2) Tablet PO every six (6)
hours as needed for pain: not to exceed 4 grams daily.
10. alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
11. ascorbic acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
12. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Cardizem CD 120 mg Capsule, Sust. Release 24 hr Sig: One (1)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T 96.3 BP 140/80 HR= 114 RR= 32 O2 sat= 94% on BIPAP.
GENERAL: Tachypneic. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother died age 72 of a "neck spinal cord injury." No knowledge
of father. Grandmother thromboembolic CVA.

SOCIAL HISTORY: The patient is divorced. He is retired . He currently lives
alone. He reports 5ppd and stopped 8 months ago. He reports rare
alcohol use, however, reported daily alcohol use at the age of
20 for approximately ten years
Acute and chronic respiratory failure,Pneumonia due to Klebsiella pneumoniae,Acute on chronic systolic heart failure,Intestinal infection due to Clostridium difficile,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Ventilator associated pneumonia,Do not resuscitate status,Chronic airway obstruction, not elsewhere classified,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Cardiogenic shock,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Old myocardial infarction,Personal history of venous thrombosis and embolism,Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Personal history of tobacco use
Acute & chronc resp fail,K. pneumoniae pneumonia,Ac on chr syst hrt fail,Int inf clstrdium dfcile,Hyperosmolality,Acute kidney failure NOS,Ventltr assoc pneumonia,Do not resusctate status,Chr airway obstruct NEC,Aortic valve disorder,DMII wo cmp nt st uncntr,Atrial fibrillation,Cardiogenic shock,Hypertension NOS,Long-term use anticoagul,Old myocardial infarct,Hx-ven thrombosis/embols,Abdom aortic aneurysm,Hyperlipidemia NEC/NOS,History of tobacco use
Admission Date:  [**2134-1-11**]              Discharge Date:   [**2134-1-23**]

Date of Birth:  [**2063-9-16**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
Dyspnea


Major Surgical or Invasive Procedure:
Intubation

History of Present Illness:
Mr. [**Known lastname **] is a 70 year old man with multiple medical problems
including COPD (2L home 02), DM2, GERD, HTN, HLD, CAD s/p NSTEMI
[**2126**], recurrent PNA, AAA, recent pneumothorax, CHF (EF=20-25%),
AS (valve area of 0.9cm2 and valve gradient of 38) AF on
coumadin, who is transferred from [**Hospital1 **] ICU to [**Hospital1 18**]
for increasing  pulmonary edema and hypotension.
.
On [**2133-12-8**], he presented to OSH with SOB, orthopnea, and PND,
similar to multiple admissions over the past years. Admitted
with a diagnosis of CHF exacerbation (BNP>500) in the context of
likely COPD flare, then transferred to [**Hospital1 18**].  Cardiac cath/TTE
showed severe aortic stenosis (valve area of 0.9cm2 and valve
gradient of 38).  His cardiac output was also preserved, at
5.4L/min.  Cardiac surgery and Pulmonary was consulted to
comment on his candidacy for AVR and he was deemed to be a poor
open surgical candidate due to his existing comorbidities, but
possibly for percutaneous valve replacement in the future.  He
was not aggressively diuresed, due to his preload dependence and
he was discharged to rehab on his daily 10mg predisone after
completing a 7-day taper.
.
The patient had a previous admission at NWH from [**2040-12-28**] was
initially admittted because of severe dywspnea and concerns for
an NSTEMI. At OSH lab studies were notable for acardiac enzyme
peak CK of 115 and MB of 10.7, with a peak troponin of 4.33.
Microbiology was notable for a urine culture which grew 2 types
of pseudomonas, subswuqently changed foley. His SOB was initally
believed to be [**2-17**] COPD flare/pneumonia than CHF. The patient
improved on IV solumedrol.
.
On his most recent admission on [**2134-1-11**], the patient noted that
he woke up this AM feeling SOB. He was given an albuterol neb,
which per pt worsened his SOB. In OSH ED he recieved adenosine
18 mg total which failed to break his tachypnea, and he was also
noted to be tachycardic into the 150s; he also recieved IV
lopressor and was transferred to ICU where he was placed on
BIPAP and given dilt 10 mg IV which [**Last Name (un) 4662**] HR down to 120s. The
patient was given abx for possible pneumonia in the setting of
elevated WBC to 26. Patient given iv lasix. methylprednisolone,
pantroprazole, and fluticasone/sealmeterol, tiotropium, insulin,
vancomycin, imipenem-calastin. Today the patient developed
acture respiratory distress that was not responsive to IV lasix
80s or a Lasix gtt; the team felt that his [**Last Name **] problem was
likely cardiac and mechanical, he should be transferred to
[**Hospital1 18**].
.
.
Upon arrival at [**Hospital1 18**], patient had an a line placed c sbp in the
140/70, noted tachypnia at 33, and face mask o2 at 12 L. HR 114.
He appears uncomfortable with accewssory muscle use, and was
transitioned to BIPAP.
.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes +, Dyslipidemia +,
Hypertension +
2. CARDIAC HISTORY:
-Atrial fibrillation on Coumadin
-Congestive heart failure. EF 20-25%
-inferior NSTEMI [**2126**]
-Severe aortic stenosis (valve area 0.9)
-CABG: N/A
-PERCUTANEOUS CORONARY INTERVENTIONS: N/A
.
3. OTHER PAST MEDICAL HISTORY:
-Chronic obstructive pulmonary disease, 2L home O2
-Noninsulin dependent diabetes mellitus
-Questionable history of syncope
-History of pulmonary embolus in [**2120**]
-GERD
-left femoral aneurysm repaired [**7-/2133**] [**Hospital1 2025**]
-AAA, infrarenal evaluated at 4.5cm on [**2133-7-16**] CT
-recurrent pneumonia
-lung nodules, stable
-large pneumothorax requiring chest tube post-bronch [**2133**]

Social History:
The patient is divorced. He is retired . He currently lives
alone. He reports 5ppd and stopped 8 months ago. He reports rare
alcohol use, however, reported daily alcohol use at the age of
20 for approximately ten years


Family History:
Mother died age 72 of a "neck spinal cord injury." No knowledge
of father. Grandmother thromboembolic CVA.

Physical Exam:
VS: T 96.3 BP 140/80 HR= 114 RR= 32 O2 sat= 94% on BIPAP.
GENERAL: Tachypneic. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 14 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. Difficult to ascultate any murmur
secondary to heavy breath sounds.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were labored with accessory muscle use. Lungs are diffusely
wheezy with crackles at the bases.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

Pertinent Results:
CXR [**2134-1-11**]
IMPRESSION: AP chest compared to [**12-16**]:
Extensive opacification in right lower lung probably due to
pulmonary edema in the setting of chronic emphysema. Previous
pneumonia in the axillary subsegments of the left upper lobe
appears to have improved but there may be bronchietasis in its
wake. Heart is top normal size. Left PIC line ends at the origin
of the left brachiocephalic vein. No pneumothorax. Small
bilateral pleural effusions are present.
.
CXR [**2134-1-12**]
ET tube in standard placement. Left PIC line ends in the left
brachiocephalic vein and a nasogastric tube passes into the
stomach and out of view.  Heterogeneous opacification in the
right mid and lower lung zone has improved, probably due to
decreasing edema in the setting of severe emphysema, but the
asymmetry still raises concern for extensive pneumonia
particularly due to aspiration. Volume loss in the left lower
lobe is improving. Small bilateral pleural effusions are
presumed. No pneumothorax
.
CXR [**2134-1-13**]
1. Worsening left lower lobe atelectasis and mild interval
increase in size of bilateral pleural effusions, small on the
right, small-to-moderate on the left.
2. Resolving right pulmonary heterogenous opacity, either
represents
pulmonary edema or pneumonia.
.
CXR [**2134-1-14**]
IMPRESSION: Stable left lower lobe atelectasis and small left
pleural
effusion.
.
CXR [**2134-1-15**] Lines and tubes are stable. There are unchanged
bilateral pleural effusions, left side worse than right. Hazy
left retrocardiac opacity is also seen.  There is some
coarsening of the interstitial markings; however, no overt
pulmonary edema is identified.
.
CXR [**2133-1-16**]
Tracheal and nasogastric tube have been removed. There is a
right IJ central venous line with the distal lead tip in the mid
SVC. There is coarsening of the bronchovascular markings which
has worsened since previous. These are more confluent within the
right base. This may represent developing infiltrate or an
element of pulmonary edema. There is unchanged left-sided
pleural effusion.


Brief Hospital Course:
# Respiratory failure: Patient presented with large right-sided
infiltrates, pulmonary edema, and baseline end-stage COPD on
admission.  On admission he failed BIPAP trial prompting
intubation.  He was aggressively diuresed with IV lasix gtt and
then transitioned to IV lasix on [**1-15**]. Initial extubation
postponed secondary to significant aggitation.  Successful
extubation on [**2134-1-15**] with transition to BIPAP and then face
mask. He continued to be aggitated off sedation, olanzapine was
traded for haldol around the On [**1-16**] while having CVL replaced
and lying flat, developed significant dypsnea and increasing O2
requirement requiring re-intubation.  Repeat CXR consistent with
right-sided pleural effusion and increase in pulmonary vascular
markings consistent with likely flash pulmonary edema.  Patient
was extubated several days later, and initally did well.  After
speaking with his health care proxy, his daughter, it was
decided to make patient DNR/DNI.  48 hours post-extubation, he
continued to be dependent on BiPAP, looking increasingly
uncomfortable.  After speaking with patient's daughter, decision
was made to take patient off BiPAP and make him CMO.  He expired
roughly 45 minutes after removal of BiPAP.
.
# Pump: Initially presented in acute on chronic CHF with likely
multifactorial etiology including depressed EF, critical AS, and
poor baseline contractility.  Aggressively diuresed with lasix
gtt. It was determined that due to his multiple comorbidities,
his increasing deconditioned status, as well as information
gathered from family and friends stating he would not want to be
institutionalized for a prolonged period of time, he would not
be a candidate for valvuloplasty and/or percutaneous valve
replacement.
.
# Rhythm:  Presented with a history of atrial fibrillation on
coumadin. Coumadin was held and he placed on a heparin gtt. He
became persistently tachycardic throughout hospilization,
worsening with extubation and fever.  On HD 5, EKG revealed
Atrial fibrillation with RVR that was unresponsive to IV
metoprolol.  He was loaded on a diltiazem drip and heparin gtt
with heart rates persistently in the 130s and SBPs in the
120-130s.  On HD 5 he was put on amiodarone gtt.  He was D/C
cardioverted and remained in sinus rhythm until he expired.


Medications on Admission:
1. Glucotrol XL 10 mg Tablet Extended Rel 24 hr Sig: One (1)
Tablet Extended Rel 24 hr PO once a day.
2. Mucinex 1,200 mg Tab, Multiphasic Release 12 hr Sig: One (1)
Tab, Multiphasic Release 12 hr PO twice a day.
3. levalbuterol HCl 0.31 mg/3 mL Solution for Nebulization Sig:
One (1) nebulizer Inhalation every 4-6 hours as needed for
shortness of breath or wheezing.
4. mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
6. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
7. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
packet PO DAILY (Daily) as needed for constipation.
8. ProAir HFA 90 mcg/Actuation HFA Aerosol Inhaler Sig: [**1-17**]
Inhalation every 4-6 hours.
9. Tylenol 325 mg Tablet Sig: Two (2) Tablet PO every six (6)
hours as needed for pain: not to exceed 4 grams daily.
10. alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
11. ascorbic acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
12. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Cardizem CD 120 mg Capsule, Sust. Release 24 hr Sig: One (1)

Capsule, Sust. Release 24 hr PO twice a day.
14. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
15. ferrous sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO BID (2 times a day).
16. fluticasone-salmeterol 500-50 mcg/dose Disk with Device Sig:

One (1) puff Inhalation [**Hospital1 **] (2 times a day).
17. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
18. prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day.
19. Januvia 100 mg Tablet Sig: One (1) Tablet PO once a day.
20. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
21. trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.
22. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day.
23. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable

PO DAILY (Daily).
24. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*3*
25. metoprolol succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*3*
26. Outpatient Lab Work
27. Outpatient Lab Work
28. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
29. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO twice a day.

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Primary: Respiratory Failure
Secondary: End-stage COPD
Tertiary: Aortic Stenosis

Discharge Condition:
Expired
{'Acute and chronic respiratory failure,Pneumonia due to Klebsiella pneumoniae,Acute on chronic systolic heart failure,Intestinal infection due to Clostridium difficile,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Ventilator associated pneumonia,Do not resuscitate status,Chronic airway obstruction, not elsewhere classified,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Cardiogenic shock,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Old myocardial infarction,Personal history of venous thrombosis and embolism,Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Personal history of tobacco 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: Dyspnea

PRESENT ILLNESS: Mr. [**Known lastname **] is a 70 year old man with multiple medical problems
including COPD (2L home 02), DM2, GERD, HTN, HLD, CAD s/p NSTEMI
[**2126**], recurrent PNA, AAA, recent pneumothorax, CHF (EF=20-25%),
AS (valve area of 0.9cm2 and valve gradient of 38) AF on
coumadin, who is transferred from [**Hospital1 **] ICU to [**Hospital1 18**]
for increasing  pulmonary edema and hypotension.
.
On [**2133-12-8**], he presented to OSH with SOB, orthopnea, and PND,
similar to multiple admissions over the past years. Admitted
with a diagnosis of CHF exacerbation (BNP>500) in the context of
likely COPD flare, then transferred to [**Hospital1 18**].  Cardiac cath/TTE
showed severe aortic stenosis (valve area of 0.9cm2 and valve
gradient of 38).  His cardiac output was also preserved, at
5.4L/min.  Cardiac surgery and Pulmonary was consulted to
comment on his candidacy for AVR and he was deemed to be a poor
open surgical candidate due to his existing comorbidities, but
possibly for percutaneous valve replacement in the future.  He
was not aggressively diuresed, due to his preload dependence and
he was discharged to rehab on his daily 10mg predisone after
completing a 7-day taper.
.
The patient had a previous admission at NWH from [**2040-12-28**] was
initially admittted because of severe dywspnea and concerns for
an NSTEMI. At OSH lab studies were notable for acardiac enzyme
peak CK of 115 and MB of 10.7, with a peak troponin of 4.33.
Microbiology was notable for a urine culture which grew 2 types
of pseudomonas, subswuqently changed foley. His SOB was initally
believed to be [**2-17**] COPD flare/pneumonia than CHF. The patient
improved on IV solumedrol.
.
On his most recent admission on [**2134-1-11**], the patient noted that
he woke up this AM feeling SOB. He was given an albuterol neb,
which per pt worsened his SOB. In OSH ED he recieved adenosine
18 mg total which failed to break his tachypnea, and he was also
noted to be tachycardic into the 150s; he also recieved IV
lopressor and was transferred to ICU where he was placed on
BIPAP and given dilt 10 mg IV which [**Last Name (un) 4662**] HR down to 120s. The
patient was given abx for possible pneumonia in the setting of
elevated WBC to 26. Patient given iv lasix. methylprednisolone,
pantroprazole, and fluticasone/sealmeterol, tiotropium, insulin,
vancomycin, imipenem-calastin. Today the patient developed
acture respiratory distress that was not responsive to IV lasix
80s or a Lasix gtt; the team felt that his [**Last Name **] problem was
likely cardiac and mechanical, he should be transferred to
[**Hospital1 18**].
.
.
Upon arrival at [**Hospital1 18**], patient had an a line placed c sbp in the
140/70, noted tachypnia at 33, and face mask o2 at 12 L. HR 114.
He appears uncomfortable with accewssory muscle use, and was
transitioned to BIPAP.
.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes +, Dyslipidemia +,
Hypertension +
2. CARDIAC HISTORY:
-Atrial fibrillation on Coumadin
-Congestive heart failure. EF 20-25%
-inferior NSTEMI [**2126**]
-Severe aortic stenosis (valve area 0.9)
-CABG: N/A
-PERCUTANEOUS CORONARY INTERVENTIONS: N/A
.
3. OTHER PAST MEDICAL HISTORY:
-Chronic obstructive pulmonary disease, 2L home O2
-Noninsulin dependent diabetes mellitus
-Questionable history of syncope
-History of pulmonary embolus in [**2120**]
-GERD
-left femoral aneurysm repaired [**7-/2133**] [**Hospital1 2025**]
-AAA, infrarenal evaluated at 4.5cm on [**2133-7-16**] CT
-recurrent pneumonia
-lung nodules, stable
-large pneumothorax requiring chest tube post-bronch [**2133**]

MEDICATION ON ADMISSION: 1. Glucotrol XL 10 mg Tablet Extended Rel 24 hr Sig: One (1)
Tablet Extended Rel 24 hr PO once a day.
2. Mucinex 1,200 mg Tab, Multiphasic Release 12 hr Sig: One (1)
Tab, Multiphasic Release 12 hr PO twice a day.
3. levalbuterol HCl 0.31 mg/3 mL Solution for Nebulization Sig:
One (1) nebulizer Inhalation every 4-6 hours as needed for
shortness of breath or wheezing.
4. mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
6. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
7. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
packet PO DAILY (Daily) as needed for constipation.
8. ProAir HFA 90 mcg/Actuation HFA Aerosol Inhaler Sig: [**1-17**]
Inhalation every 4-6 hours.
9. Tylenol 325 mg Tablet Sig: Two (2) Tablet PO every six (6)
hours as needed for pain: not to exceed 4 grams daily.
10. alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
11. ascorbic acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
12. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Cardizem CD 120 mg Capsule, Sust. Release 24 hr Sig: One (1)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T 96.3 BP 140/80 HR= 114 RR= 32 O2 sat= 94% on BIPAP.
GENERAL: Tachypneic. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother died age 72 of a "neck spinal cord injury." No knowledge
of father. Grandmother thromboembolic CVA.

SOCIAL HISTORY: The patient is divorced. He is retired . He currently lives
alone. He reports 5ppd and stopped 8 months ago. He reports rare
alcohol use, however, reported daily alcohol use at the age of
20 for approximately ten years 

### Response:
{'Acute and chronic respiratory failure,Pneumonia due to Klebsiella pneumoniae,Acute on chronic systolic heart failure,Intestinal infection due to Clostridium difficile,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Ventilator associated pneumonia,Do not resuscitate status,Chronic airway obstruction, not elsewhere classified,Aortic valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Cardiogenic shock,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Old myocardial infarction,Personal history of venous thrombosis and embolism,Abdominal aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Personal history of tobacco use'}
