CHIEF COMPLAINT: Transferred from BIDN ED with SOB.

PRESENT ILLNESS: 80 year old male with met lung CA to brain/ bone, COPD presented
to [**Hospital1 **] [**Location (un) 620**] for increased dyspnea/ fever for 2-3 days. There
the patient was in moderate respiratory distress with initial O2
Sat at 87 improving to 87-90 on 3l of oxygen. His CXR showed
progression of his disease and probable new infiltrate. The pt
was unable to tolerate BIPAP 2/2 good mental status. He was
treated with CTX/azithro, nebs with some improvement. Extensive
d/w family (son and daughter) and patient and pt confirmed to be
DNR/DNI.
.
He was transferred to our ED for further care and admission to
the oncology service. VS on arrival to the ED POX93% RR 3l HR 97
BP 98/61. Patient received nebs and ativan for anxiety and was
admitted to OMED.
.
On arrival to the oncology floor, T 98.3 111/74 98 28 90% on 5L
NC
ABG 7.21/77/76 with lactate 0.7. Goals of care readdressed with
family and wishes were for reattempt at non-invasive
ventilation. Patient was transferred to the [**Hospital Unit Name 153**].
.
On arrival to the [**Hospital Unit Name 153**], patient was deep suctioned with good
effect and placed on non-invasive ventilation. Further details
of presentation where unable to be confirmed with patient.
.
Review of sytems:  unable to obtain [**2-29**] mental
status/non-invasive ventilation

MEDICAL HISTORY: Abdominal Aortic Anerysm
-PVD s/p L fem [**Doctor Last Name **] '[**16**]
-COPD on 2L home O2
-Hyperlipidemia
-s/p Zenker's diverticulum repair x2
- bilateral DVT's
- BPH
- B12 deficiency and anemia
Right hip fracture.
ONCOLOGIC HISTORY:
-NSCLC: thoracoscopic left upper lobectomy for a pathologic
stage T2, N0 adenocarcinoma of the lung in [**2147**] s/p [**Doctor Last Name **] and
Taxol. He was also treated for TB at that time.
In [**2148**], he had recurrence in his lung and new disease in his
sacrum, for which he received radiation. He has received Alimta.
On [**2151-9-12**], he fell and had a right proximal femur fracture
which  required fixation and was also noted to be metastatic
disease. Brain mets were found [**7-5**] s/p cyberknife XRT.

MEDICATION ON ADMISSION: Symbicort (budesonide, formoterol) 160/4.5 2 puffs [**Hospital1 **]
Combivent 2 puffs [**Hospital1 **]
Albuterol PRN
Restoril 15mg [**Hospital1 **]
Senna
Dilantin 300mg [**Hospital1 **]
Prilosec 20mg daily
Neurontin 300mg daily
Hytrin 5mg [**Name (NI) **]
MOM
Tylenol
[**Name2 (NI) **] 81mg daily
Decadron 2mg daily
Artifical eye gtt

ALLERGIES: Levaquin / Ethambutol

PHYSICAL EXAM: General: Drowsy, in respiratory distress
HEENT: Sclera anicteric, MMD, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: coarse expiratory wheezing throughout on non-invasive
mask ventilation
CV: Regular rate and rhythm, HS distant
Abdomen: 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, multiple ecchymoses

FAMILY HISTORY: Father died age 64- ?MI
Mother healthy until 84-died stroke
Sister- DM
3 children, 3 grandchildren healthy

SOCIAL HISTORY: Married, lives w/ wife. 3 children, 3 grandchildren, smoker 1ppd
for 45 years, quit [**2117**].
Pneumonia, organism unspecified,Acute respiratory failure,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of bronchus and lung, unspecified,Personal history of tobacco use,Chronic airway obstruction, not elsewhere classified
Pneumonia, organism NOS,Acute respiratry failure,Secondary malig neo lung,Sec mal neo brain/spine,Mal neo bronch/lung NOS,History of tobacco use,Chr airway obstruct NEC
Admission Date:  [**2152-3-30**]              Discharge Date:   [**2152-4-2**]

Date of Birth:  [**2072-1-21**]             Sex:   M

Service: MEDICINE

Allergies:
Levaquin / Ethambutol

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Transferred from BIDN ED with SOB.

Major Surgical or Invasive Procedure:
none

History of Present Illness:
80 year old male with met lung CA to brain/ bone, COPD presented
to [**Hospital1 **] [**Location (un) 620**] for increased dyspnea/ fever for 2-3 days. There
the patient was in moderate respiratory distress with initial O2
Sat at 87 improving to 87-90 on 3l of oxygen. His CXR showed
progression of his disease and probable new infiltrate. The pt
was unable to tolerate BIPAP 2/2 good mental status. He was
treated with CTX/azithro, nebs with some improvement. Extensive
d/w family (son and daughter) and patient and pt confirmed to be
DNR/DNI.
.
He was transferred to our ED for further care and admission to
the oncology service. VS on arrival to the ED POX93% RR 3l HR 97
BP 98/61. Patient received nebs and ativan for anxiety and was
admitted to OMED.
.
On arrival to the oncology floor, T 98.3 111/74 98 28 90% on 5L
NC
ABG 7.21/77/76 with lactate 0.7. Goals of care readdressed with
family and wishes were for reattempt at non-invasive
ventilation. Patient was transferred to the [**Hospital Unit Name 153**].
.
On arrival to the [**Hospital Unit Name 153**], patient was deep suctioned with good
effect and placed on non-invasive ventilation. Further details
of presentation where unable to be confirmed with patient.
.
Review of sytems:  unable to obtain [**2-29**] mental
status/non-invasive ventilation

Past Medical History:
Abdominal Aortic Anerysm
-PVD s/p L fem [**Doctor Last Name **] '[**16**]
-COPD on 2L home O2
-Hyperlipidemia
-s/p Zenker's diverticulum repair x2
- bilateral DVT's
- BPH
- B12 deficiency and anemia
Right hip fracture.
ONCOLOGIC HISTORY:
-NSCLC: thoracoscopic left upper lobectomy for a pathologic
stage T2, N0 adenocarcinoma of the lung in [**2147**] s/p [**Doctor Last Name **] and
Taxol. He was also treated for TB at that time.
In [**2148**], he had recurrence in his lung and new disease in his
sacrum, for which he received radiation. He has received Alimta.
On [**2151-9-12**], he fell and had a right proximal femur fracture
which  required fixation and was also noted to be metastatic
disease. Brain mets were found [**7-5**] s/p cyberknife XRT.

Social History:
Married, lives w/ wife. 3 children, 3 grandchildren, smoker 1ppd
for 45 years, quit [**2117**].


Family History:
Father died age 64- ?MI
Mother healthy until 84-died stroke
Sister- DM
3 children, 3 grandchildren healthy


Physical Exam:
General: Drowsy, in respiratory distress
HEENT: Sclera anicteric, MMD, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: coarse expiratory wheezing throughout on non-invasive
mask ventilation
CV: Regular rate and rhythm, HS distant
Abdomen: 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, multiple ecchymoses

Pertinent Results:
Labs:  OSH
WBC   RBC   HGB  HCT  MCV   MCH  MCHC  PLT  [**First Name9 (NamePattern2) **]  [**Last Name (un) **] MON EO BAS
11.8  4.28 13.4 41.7  97.3 31.4  32.3  175 79.7 6.8 7.4  5.9
0.2

ABG7.30/60.0/ 82.0
lactate 1.4
CHEM7
NA 139 K5.4 CL98 HCO3 33.8 GLu 93 BUN 22 CRT 0.9 CA 7.2 ALb 3.3
TP 6.7 Bili 0.25 AP 267 ALT 27 AST 21
.
Micro:
OSH blood Cx - pending

CXR - IMPRESSION:
DEVELOPMENT OF PATCHY BILATERAL DENSITIES MOST SUSPICIOUS FOR
PNEUMONIA. SUBSEGMENTAL ATELECTASIS. BILATERAL PULMONARY NODULES

CONSISTENT WITH METASTATIC DISEASE. REDEMONSTRATION OF AN
OSTEOBLASTIC LESION IN THE LEFT 7TH RIB.

Brief Hospital Course:
Mr. [**Known lastname **] is an 80 yo M with metastatic small cell lung Ca to
brain and bone who presented from home with increased dyspnea
and fever x2-3 days with imaging concerning for infiltrate and
hypercarbic/hypoxic respiratory failure.

The patient was initially admitted to the Oncology Service for
treatment of pneumonia and hypoxia. Earlier in the day, the
patient had been seen at an OSH for fever and respiratory
distress and was found to have a leukocytosis and new pulmonary
infiltrate. There, he failed a trial of BiPAP before being
transferred to the [**Hospital1 18**]. On admission, the patient was placed
on broad spectrum antibiotics, stress dose steroids, nebulizer
treatments, and supplemental oxygen, but he remained
persistently hypoxic and hypercarbic on 100% facemask.  After
discussion with his family, he was transferred to the MICU to
attempt a second trial of BiPAP. In the MICU, the patient was
again, unable to tolerate BiPAP despite numerous attempts. After
discussion with his family, who reiterated the patient's wish
not to be intubated, they requested that he be placed on a
Morphine gtt for comfort while his antibiotic and supportive
therapy continued. This treatment approach was employed, but he
did not improve clinically and passed away on HD4. The family
consented to an autopsy.

Code: DNR/DNI

Communication: Son [**Name (NI) **] H:[**Telephone/Fax (1) 51005**], C: [**Telephone/Fax (1) 51006**]
Daughter [**Name (NI) 17**] [**Telephone/Fax (1) 51007**]


Medications on Admission:
Symbicort (budesonide, formoterol) 160/4.5 2 puffs [**Hospital1 **]
Combivent 2 puffs [**Hospital1 **]
Albuterol PRN
Restoril 15mg [**Hospital1 **]
Senna
Dilantin 300mg [**Hospital1 **]
Prilosec 20mg daily
Neurontin 300mg daily
Hytrin 5mg [**Name (NI) **]
MOM
Tylenol
[**Name2 (NI) **] 81mg daily
Decadron 2mg daily
Artifical eye gtt


Discharge Disposition:
Expired

Discharge Diagnosis:
Pneumonia
Metastatic Lung cancer
COPD


Discharge Condition:
expired


Discharge Instructions:
expired

Followup Instructions:
expire


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Pneumonia, organism unspecified,Acute respiratory failure,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of bronchus and lung, unspecified,Personal history of tobacco use,Chronic airway obstruction, not elsewhere classified'}


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 BIDN ED with SOB.

PRESENT ILLNESS: 80 year old male with met lung CA to brain/ bone, COPD presented
to [**Hospital1 **] [**Location (un) 620**] for increased dyspnea/ fever for 2-3 days. There
the patient was in moderate respiratory distress with initial O2
Sat at 87 improving to 87-90 on 3l of oxygen. His CXR showed
progression of his disease and probable new infiltrate. The pt
was unable to tolerate BIPAP 2/2 good mental status. He was
treated with CTX/azithro, nebs with some improvement. Extensive
d/w family (son and daughter) and patient and pt confirmed to be
DNR/DNI.
.
He was transferred to our ED for further care and admission to
the oncology service. VS on arrival to the ED POX93% RR 3l HR 97
BP 98/61. Patient received nebs and ativan for anxiety and was
admitted to OMED.
.
On arrival to the oncology floor, T 98.3 111/74 98 28 90% on 5L
NC
ABG 7.21/77/76 with lactate 0.7. Goals of care readdressed with
family and wishes were for reattempt at non-invasive
ventilation. Patient was transferred to the [**Hospital Unit Name 153**].
.
On arrival to the [**Hospital Unit Name 153**], patient was deep suctioned with good
effect and placed on non-invasive ventilation. Further details
of presentation where unable to be confirmed with patient.
.
Review of sytems:  unable to obtain [**2-29**] mental
status/non-invasive ventilation

MEDICAL HISTORY: Abdominal Aortic Anerysm
-PVD s/p L fem [**Doctor Last Name **] '[**16**]
-COPD on 2L home O2
-Hyperlipidemia
-s/p Zenker's diverticulum repair x2
- bilateral DVT's
- BPH
- B12 deficiency and anemia
Right hip fracture.
ONCOLOGIC HISTORY:
-NSCLC: thoracoscopic left upper lobectomy for a pathologic
stage T2, N0 adenocarcinoma of the lung in [**2147**] s/p [**Doctor Last Name **] and
Taxol. He was also treated for TB at that time.
In [**2148**], he had recurrence in his lung and new disease in his
sacrum, for which he received radiation. He has received Alimta.
On [**2151-9-12**], he fell and had a right proximal femur fracture
which  required fixation and was also noted to be metastatic
disease. Brain mets were found [**7-5**] s/p cyberknife XRT.

MEDICATION ON ADMISSION: Symbicort (budesonide, formoterol) 160/4.5 2 puffs [**Hospital1 **]
Combivent 2 puffs [**Hospital1 **]
Albuterol PRN
Restoril 15mg [**Hospital1 **]
Senna
Dilantin 300mg [**Hospital1 **]
Prilosec 20mg daily
Neurontin 300mg daily
Hytrin 5mg [**Name (NI) **]
MOM
Tylenol
[**Name2 (NI) **] 81mg daily
Decadron 2mg daily
Artifical eye gtt

ALLERGIES: Levaquin / Ethambutol

PHYSICAL EXAM: General: Drowsy, in respiratory distress
HEENT: Sclera anicteric, MMD, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: coarse expiratory wheezing throughout on non-invasive
mask ventilation
CV: Regular rate and rhythm, HS distant
Abdomen: 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, multiple ecchymoses

FAMILY HISTORY: Father died age 64- ?MI
Mother healthy until 84-died stroke
Sister- DM
3 children, 3 grandchildren healthy

SOCIAL HISTORY: Married, lives w/ wife. 3 children, 3 grandchildren, smoker 1ppd
for 45 years, quit [**2117**]. 

### Response:
{'Pneumonia, organism unspecified,Acute respiratory failure,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of bronchus and lung, unspecified,Personal history of tobacco use,Chronic airway obstruction, not elsewhere classified'}
