CHIEF COMPLAINT: Pleuritic chest pain

PRESENT ILLNESS: 85M with a PMh s/f severe COPD on chronic O2, complete heart
block s/p PMP [**7-21**], PVD s/p bilateral carotid endarterectomies
in [**2111**], HTN, HLD presents to presented to [**Hospital3 7569**]
w/chief complaint of chest pain and shortness of breath since
the AM. He had a recent hospitalization for MI and PNA, and had
completed a 2 week course of PNA on Sunday. At home, he denied
any F, C, N/V, but endorsed pleureitic L sided chest pain and
shortness of breath.
.
He initally was taken to [**Hospital3 **], and was given nitro
gtt, briefly was on a heparin gtt, and was given Levofloxacin
for a worsening LLL PNA. The plan was then to transfer to [**Hospital1 **]
since this is where he receives his cardiology care, for sats
70's-80's on facemask prior to switching to nrb, then improved
to low 90s for a cards evalulation. While he was in the
ambulance, radiology at [**Location (un) **] stat notified our ED of a
finding of a 30% left PTX. The ambulance was thus directed to
the nearest hospital, which turned out to be [**Hospital1 **]. At
[**Hospital1 **], his left PTX was relieved with a Heimlich valve device,
which on our repeat CXR shows resolution. The patient then
reported improved SOB, but still some mild L CP with
inspiration.
.
In the ED, initial VS were:  99.0 110 170/91 20 98% cont neb
.
Labs were notable for HCT 36.2, INR 1.4.
.
He was given Aspirin 325mg, and 4 mg Morphine Sulfate.
.
CXR was notable for interval resolution of the PTX.
  .
On arrival to the MICU, he is AAOx3, surrounded by his family,
and comfortable. His family says that he had a slightly worse
cough,a lthough he has a chronic cough at baseline, although he
denies his cough is any worse.

MEDICAL HISTORY: Severe COPD on chronic oxygen treatment
Complete heart block, status post pacemaker implantation in
[**7-/2116**], peripheral vascular disease, status post bilateral
carotid endarterectomies in [**2111**].
Hyperlipidemia
HTN

MEDICATION ON ADMISSION: Oxygen 3-liters/hr
aspirin 81 mg Daily
Alphagan 0.15% Eye dropps 1 [**Hospital1 **]
Plavix 75 mg Daily
Advair 250-50 1 inh [**Hospital1 **]
Lasix 20 mg QAM
Lasix 10 mg QPM
Prinivil 10 mg Daily
Multivitamin 1 capsule
Mirapex 0.5 mg QHS
Zocor 10 mg Daily
Atenolol 50 mg PO/NG DAILY
Tiotropium Bromide 1 CAP IH DAILY
Terazosin 2.5 mg PO DAILY

ALLERGIES: Penicillins

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Vitals: T:afebrile BP:142/63 P:90 R:20 O2:96% 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, poor dentition,
R eye corneal scar, L lower eye lid scar from prior surgery
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: distant heart sounds, Regular rate and rhythm, normal S1 +
S2, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
GU:foley in place
.
DISCHARGE PHYSICAL EXAM
Vitals: T:96.2 BP:90s-110s/40s-60s P:70s-80s R:18 O2:95% 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, poor dentition,
R eye corneal scar, L lower eye lid scar from prior surgery
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: distant heart sounds, Regular rate and rhythm, normal S1 +
S2, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
GU:foley in place

FAMILY HISTORY: Mother and father passed from CAD.

SOCIAL HISTORY: He is married.  His wife lives at home.  He has a former 40
pack-year history of smoking; he has not smoked for 19 years.
He has rare alcohol intake.
Other pneumothorax,Chronic airway obstruction, not elsewhere classified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Other specified retention of urine,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Edema,Restless legs syndrome (RLS),Abnormal coagulation profile,Other nonspecific abnormal finding of lung field,Unspecified essential hypertension,Anemia, unspecified,Other dependence on machines, supplemental oxygen,Cardiac pacemaker in situ
Other pneumothorax,Chr airway obstruct NEC,BPH w urinary obs/LUTS,Oth spcf retention urine,Hyperlipidemia NEC/NOS,Athscl extrm ntv art NOS,Edema,Restless legs syndrome,Abnrml coagultion prfile,Ot nonsp ab fnd lung fld,Hypertension NOS,Anemia NOS,Depend-supplement oxygen,Status cardiac pacemaker
Admission Date:  [**2120-2-26**]              Discharge Date:   [**2120-2-28**]

Date of Birth:  [**2034-8-16**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Pleuritic chest pain


Major Surgical or Invasive Procedure:
Heimlich valve at [**Hospital3 3765**] for PTX

History of Present Illness:
85M with a PMh s/f severe COPD on chronic O2, complete heart
block s/p PMP [**7-21**], PVD s/p bilateral carotid endarterectomies
in [**2111**], HTN, HLD presents to presented to [**Hospital3 7569**]
w/chief complaint of chest pain and shortness of breath since
the AM. He had a recent hospitalization for MI and PNA, and had
completed a 2 week course of PNA on Sunday. At home, he denied
any F, C, N/V, but endorsed pleureitic L sided chest pain and
shortness of breath.
.
He initally was taken to [**Hospital3 **], and was given nitro
gtt, briefly was on a heparin gtt, and was given Levofloxacin
for a worsening LLL PNA. The plan was then to transfer to [**Hospital1 **]
since this is where he receives his cardiology care, for sats
70's-80's on facemask prior to switching to nrb, then improved
to low 90s for a cards evalulation. While he was in the
ambulance, radiology at [**Location (un) **] stat notified our ED of a
finding of a 30% left PTX. The ambulance was thus directed to
the nearest hospital, which turned out to be [**Hospital1 **]. At
[**Hospital1 **], his left PTX was relieved with a Heimlich valve device,
which on our repeat CXR shows resolution. The patient then
reported improved SOB, but still some mild L CP with
inspiration.
.
In the ED, initial VS were:  99.0 110 170/91 20 98% cont neb
.
Labs were notable for HCT 36.2, INR 1.4.
.
He was given Aspirin 325mg, and 4 mg Morphine Sulfate.
.
CXR was notable for interval resolution of the PTX.
  .
On arrival to the MICU, he is AAOx3, surrounded by his family,
and comfortable. His family says that he had a slightly worse
cough,a lthough he has a chronic cough at baseline, although he
denies his cough is any worse.


Past Medical History:
Severe COPD on chronic oxygen treatment
Complete heart block, status post pacemaker implantation in
[**7-/2116**], peripheral vascular disease, status post bilateral
carotid endarterectomies in [**2111**].
Hyperlipidemia
HTN


Social History:
He is married.  His wife lives at home.  He has a former 40
pack-year history of smoking; he has not smoked for 19 years.
He has rare alcohol intake.


Family History:
Mother and father passed from CAD.


Physical Exam:
ADMISSION PHYSICAL EXAM:
Vitals: T:afebrile BP:142/63 P:90 R:20 O2:96% 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, poor dentition,
R eye corneal scar, L lower eye lid scar from prior surgery
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: distant heart sounds, Regular rate and rhythm, normal S1 +
S2, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
GU:foley in place
.
DISCHARGE PHYSICAL EXAM
Vitals: T:96.2 BP:90s-110s/40s-60s P:70s-80s R:18 O2:95% 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, poor dentition,
R eye corneal scar, L lower eye lid scar from prior surgery
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: distant heart sounds, Regular rate and rhythm, normal S1 +
S2, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
GU:foley in place


Pertinent Results:
[**2120-2-26**] 08:35PM   GLUCOSE-133* UREA N-18 CREAT-0.9 SODIUM-137
POTASSIUM-3.8 CHLORIDE-100 TOTAL CO2-26 ANION GAP-15
[**2120-2-26**] 08:35PM   cTropnT-<0.01
[**2120-2-26**] 08:35PM   ALBUMIN-4.0
[**2120-2-26**] 08:35PM   WBC-11.0 RBC-4.23* HGB-12.1* HCT-36.2* MCV-86
MCH-28.7 MCHC-33.5 RDW-14.5
[**2120-2-26**] 08:35PM   NEUTS-85.6* LYMPHS-9.1* MONOS-4.5 EOS-0.6
BASOS-0.2
[**2120-2-26**] 08:35PM   PLT COUNT-259
[**2120-2-26**] 08:35PM   PT-14.5* PTT-37.2* INR(PT)-1.4*

CXR [**2-26**]:
IMPRESSION: Bibasilar opacities, left greater than right, raises
concern for an infection/pneumonia and/or aspiration. Blunting
of the left costophrenic angle may be due to a small pleural
effusion. Bibasilar atelectasis.

A tubular structure/catheter extending into the left lung apex
with possible tiny left apical pneumothorax remaining. However,
suggest followup with removal of external artifact for better
evaluation. Upright PA and lateral views may be helpful for
further evaluation when/if patient able.

CHEST (PORTABLE AP) Study Date of [**2120-2-28**]
The left pigtail is in place. The left lower lobe consolidation
has
substantially improved. Heart size and mediastinum are overall
unchanged.
The assessment of the lung bases still demonstrate bilateral
pleural effusion, small on the right and most likely small to
moderate on the left.



Brief Hospital Course:
85M with a PMh s/f severe COPD on chronic O2, complete heart
block s/p PMP [**7-21**], PVD s/p bilateral carotid endarterectomies
in [**2111**], HTN, HLD presents with pleuritic pain and found to have
a L PTX.

# PTX/Chest Pain: Has remained hemodynamically stable since
arrival to the hosptial. Has a Heimlich valve device in place,
and is oxygenating well, without new development of PTX. Most
likely the pt developed a PTX from the bursting of a bleb as a
complication of severe COPD. The pt was ruled out for an MI with
CE. He was weaned down to 2L of O2 NC which is his home O2
requirement. Interventional pulmonology removed the Heimlich
valve without complication.
.
# LLL infiltrate: CXR this hospitalization shows a LLL opacity.
The pt just completed a two week course of antibiotics
prescribed by his PCP for treatment of pneumonia. The pt was
afebrile, without a leukocytosis and cough. There was no
evidence of infection currently and most likely this
radiographic reminence from resolving prior pneumonia. No
further antibiotics were given during this hospitalization.
.
# Acute Urinary Retention: The pt has known BPH and is on
Terazosin at home. He claims that for prior hospitalizations he
has required urinary catheterization for obstruction as well. He
was having difficulty voiding during this hospitalization. A
bladder scan revealed >1L of urine in his bladder. A foley
catheter was placed to relieve this obstruction. It was then
removed and a repeat voiding trial was obtained which showed him
to be retaining 600cc of urine in his bladder. A foley catheter
was re-inserted and a follow up appointment was made with
Urology for removal. We increased his dose of Terazosin from 2mg
to 5mg daily prior to discharge.
.
# Severe COPD on chronic oxygen treatment: Patient was quickly
weaned back down to home O2 requirements (2-3L 02 NC), without
any extra wheezing on exam.  We continued his home Advair,
Tiotroprium and nebulizers prn.
.
# Elevated INR: Chronic problem noted in this pt seen on labs
from [**2111**] where is INR was also noted to be 1.4. Pt is not on
warfarin currently. His albumin was wnl and there was no active
signs of bleeding.
.
# Hyperlipidemia/PVD: We continued
aspirin 81 mg Daily
Plavix 75 mg Daily
Zocor 10 mg Daily
Lisinopril 10 mg Daily
.
# Chronic Lower Extremity Edema- we continued
Lasix 20 mg QAM
Lasix 10 mg QPM
.
# Restless Leg Syndrome: continued
Mirapex 0.5 mg QHS
.
# Transitional- Prior to discharge a urinary catheter was placed
to relieve his urinary obstruction from BPH. He has a follow up
appointment with urology to have this removed. He also has a
follow up appointment with his PCP as well.


Medications on Admission:
Oxygen 3-liters/hr
aspirin 81 mg Daily
Alphagan 0.15% Eye dropps 1 [**Hospital1 **]
Plavix 75 mg Daily
Advair 250-50 1 inh [**Hospital1 **]
Lasix 20 mg QAM
Lasix 10 mg QPM
Prinivil 10 mg Daily
Multivitamin 1 capsule
Mirapex 0.5 mg QHS
Zocor 10 mg Daily
Atenolol 50 mg PO/NG DAILY
Tiotropium Bromide 1 CAP IH DAILY
Terazosin 2.5 mg PO DAILY


Discharge Medications:
1. Home Oxygen 3L / hr
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
4. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
6. furosemide 20 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
7. furosemide 20 mg Tablet Sig: 0.5 Tablet PO QPM (once a day
(in the evening)).
8. lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
9. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. pramipexole 0.5 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
11. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
13. terazosin 5 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*2*
14. atenolol 50 mg Tablet Sig: One (1) Tablet PO at bedtime.
15. fluticasone 50 mcg/actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
Disp:*1 bottle* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
Primary Diagnosis:
Pneumothorax
Urinary Retention

Secondary Diagnosis:
Hyperlipidemia
Peripheral Vascular Disease
Lower Extremity Edema
Chronic Obstructive Pulmonary Disease


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Mr. [**Known lastname **],
It was a pleasure taking care of you at [**Hospital1 827**]. You were admitted to the hospital after having a
chest tube placed at [**Hospital3 **] for a collapsed lung. The
chest tube was removed and your lung has remained inflated. We
also discovered that you are not completely empyting your
bladder with urination. We placed a urinary catheter to help
relieve this obstruction. We have made a follow up appointment
for you with urology regarding this matter.

The following changes have been made to your medications:
INCREASE Terazosin 5mg daily
START Fluticasone Propionate 1 spray per nostril daily for nasal
congestion

Please see below for follow up appointments that have been made
on your behalf.

Please call Dr. [**Last Name (STitle) 1911**] to schedule follow up.

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name8 (NamePattern2) 2515**] [**Last Name (NamePattern1) **] JR.
Location: [**Name2 (NI) **] FAMILY MEDICINE
Address: [**Apartment Address(1) 17034**], [**University/College **],[**Numeric Identifier 17035**]
Phone: [**Telephone/Fax (1) 17030**]
When: Wednesday, [**2119-3-7**]:30 AM

Department: SURGICAL SPECIALTIES
When: WEDNESDAY [**2120-3-6**] at 4:30 PM
With: [**First Name8 (NamePattern2) 161**] [**Name6 (MD) 162**] [**Name8 (MD) 163**], MD [**Telephone/Fax (1) 164**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Other pneumothorax,Chronic airway obstruction, not elsewhere classified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Other specified retention of urine,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Edema,Restless legs syndrome (RLS),Abnormal coagulation profile,Other nonspecific abnormal finding of lung field,Unspecified essential hypertension,Anemia, unspecified,Other dependence on machines, supplemental oxygen,Cardiac pacemaker in situ'}


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: Pleuritic chest pain

PRESENT ILLNESS: 85M with a PMh s/f severe COPD on chronic O2, complete heart
block s/p PMP [**7-21**], PVD s/p bilateral carotid endarterectomies
in [**2111**], HTN, HLD presents to presented to [**Hospital3 7569**]
w/chief complaint of chest pain and shortness of breath since
the AM. He had a recent hospitalization for MI and PNA, and had
completed a 2 week course of PNA on Sunday. At home, he denied
any F, C, N/V, but endorsed pleureitic L sided chest pain and
shortness of breath.
.
He initally was taken to [**Hospital3 **], and was given nitro
gtt, briefly was on a heparin gtt, and was given Levofloxacin
for a worsening LLL PNA. The plan was then to transfer to [**Hospital1 **]
since this is where he receives his cardiology care, for sats
70's-80's on facemask prior to switching to nrb, then improved
to low 90s for a cards evalulation. While he was in the
ambulance, radiology at [**Location (un) **] stat notified our ED of a
finding of a 30% left PTX. The ambulance was thus directed to
the nearest hospital, which turned out to be [**Hospital1 **]. At
[**Hospital1 **], his left PTX was relieved with a Heimlich valve device,
which on our repeat CXR shows resolution. The patient then
reported improved SOB, but still some mild L CP with
inspiration.
.
In the ED, initial VS were:  99.0 110 170/91 20 98% cont neb
.
Labs were notable for HCT 36.2, INR 1.4.
.
He was given Aspirin 325mg, and 4 mg Morphine Sulfate.
.
CXR was notable for interval resolution of the PTX.
  .
On arrival to the MICU, he is AAOx3, surrounded by his family,
and comfortable. His family says that he had a slightly worse
cough,a lthough he has a chronic cough at baseline, although he
denies his cough is any worse.

MEDICAL HISTORY: Severe COPD on chronic oxygen treatment
Complete heart block, status post pacemaker implantation in
[**7-/2116**], peripheral vascular disease, status post bilateral
carotid endarterectomies in [**2111**].
Hyperlipidemia
HTN

MEDICATION ON ADMISSION: Oxygen 3-liters/hr
aspirin 81 mg Daily
Alphagan 0.15% Eye dropps 1 [**Hospital1 **]
Plavix 75 mg Daily
Advair 250-50 1 inh [**Hospital1 **]
Lasix 20 mg QAM
Lasix 10 mg QPM
Prinivil 10 mg Daily
Multivitamin 1 capsule
Mirapex 0.5 mg QHS
Zocor 10 mg Daily
Atenolol 50 mg PO/NG DAILY
Tiotropium Bromide 1 CAP IH DAILY
Terazosin 2.5 mg PO DAILY

ALLERGIES: Penicillins

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Vitals: T:afebrile BP:142/63 P:90 R:20 O2:96% 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, poor dentition,
R eye corneal scar, L lower eye lid scar from prior surgery
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: distant heart sounds, Regular rate and rhythm, normal S1 +
S2, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
GU:foley in place
.
DISCHARGE PHYSICAL EXAM
Vitals: T:96.2 BP:90s-110s/40s-60s P:70s-80s R:18 O2:95% 2L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, poor dentition,
R eye corneal scar, L lower eye lid scar from prior surgery
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: distant heart sounds, Regular rate and rhythm, normal S1 +
S2, no murmurs, rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
GU:foley in place

FAMILY HISTORY: Mother and father passed from CAD.

SOCIAL HISTORY: He is married.  His wife lives at home.  He has a former 40
pack-year history of smoking; he has not smoked for 19 years.
He has rare alcohol intake. 

### Response:
{'Other pneumothorax,Chronic airway obstruction, not elsewhere classified,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Other specified retention of urine,Other and unspecified hyperlipidemia,Atherosclerosis of native arteries of the extremities, unspecified,Edema,Restless legs syndrome (RLS),Abnormal coagulation profile,Other nonspecific abnormal finding of lung field,Unspecified essential hypertension,Anemia, unspecified,Other dependence on machines, supplemental oxygen,Cardiac pacemaker in situ'}
