CHIEF COMPLAINT: asthma exacerbation

PRESENT ILLNESS: 24F with h/o asthma who presented with asthma exacerbation,
transfered from [**Hospital Unit Name 153**]. Over the past week, the patient had
presented to [**Hospital1 18**] EW 3 times for asthma flare. She was started
on advair and given a 3-day prednisone [**Hospital1 15123**]. 3 days ago she
presented with continued difficulty breathing and was admitted
for IV solumedrol. Her peak flow in EW was 240. She was placed
on continuous nebs x one hour and her peak flow improved to 340.
ABG x 2 (second one done on room air after neb treatment)
normal.
.
Pt states she was diagnosed with asthma at age 7 and was
hospitalized at that time. Since then, she has never been
hospitalized for her asthma and has never been intubated. She
normally uses her albuterol inhaler 10 times per day and 3 times
per night. She denies recent URI or other exacerbating factors
of her asthma. She has never seen a pulmonologist an nor had
PFTs. Her baseline peak flow is ~300

MEDICAL HISTORY: * asthma since age 7, no intubations
* seasonal allergies

MEDICATION ON ADMISSION: Albuterol MDI
Serevent (just started [**10-25**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: V: 98.1 98.6 BP 138/70, HR 80, R 18, O2 98% RA
Gen: Markedly wheezy young female, breathing mildly labored,
soft voice, with moderate accessory muscle use
HEENT: EOMI, sclera anicteric.  Oropharynx clear.
Neck: supple, no JVP at 90 degrees.
CV: Tachycardic but regular, with normal S1, S2 with physiologic
split, no murmurs, rubs or extra heart sounds.
Chest: Reduced at bases, polyphonic inspiratory and expiratory
wheezes scattered across chest.
Abd: +BS, soft, nontender, nondistended.
Ext: no edema. 2+ pulses throughout

FAMILY HISTORY: Significant for asthma, DM, hypertension, CAD.

SOCIAL HISTORY: Employed in administrative work.  No tobacco, no etoh.
Asthma, unspecified type, with (acute) exacerbation,Urinary tract infection, site not specified,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site
Asthma NOS w (ac) exac,Urin tract infection NOS,Proteus infection NOS
Admission Date:  [**2189-10-30**]              Discharge Date:   [**2189-11-3**]

Date of Birth:  [**2165-9-16**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
asthma exacerbation


Major Surgical or Invasive Procedure:
none


History of Present Illness:
24F with h/o asthma who presented with asthma exacerbation,
transfered from [**Hospital Unit Name 153**]. Over the past week, the patient had
presented to [**Hospital1 18**] EW 3 times for asthma flare. She was started
on advair and given a 3-day prednisone [**Hospital1 15123**]. 3 days ago she
presented with continued difficulty breathing and was admitted
for IV solumedrol. Her peak flow in EW was 240. She was placed
on continuous nebs x one hour and her peak flow improved to 340.
ABG x 2 (second one done on room air after neb treatment)
normal.
.
Pt states she was diagnosed with asthma at age 7 and was
hospitalized at that time. Since then, she has never been
hospitalized for her asthma and has never been intubated. She
normally uses her albuterol inhaler 10 times per day and 3 times
per night. She denies recent URI or other exacerbating factors
of her asthma. She has never seen a pulmonologist an nor had
PFTs. Her baseline peak flow is ~300


Past Medical History:
* asthma since age 7, no intubations
* seasonal allergies


Social History:
Employed in administrative work.  No tobacco, no etoh.

Family History:
Significant for asthma, DM, hypertension, CAD.

Physical Exam:
V: 98.1 98.6 BP 138/70, HR 80, R 18, O2 98% RA
Gen: Markedly wheezy young female, breathing mildly labored,
soft voice, with moderate accessory muscle use
HEENT: EOMI, sclera anicteric.  Oropharynx clear.
Neck: supple, no JVP at 90 degrees.
CV: Tachycardic but regular, with normal S1, S2 with physiologic
split, no murmurs, rubs or extra heart sounds.
Chest: Reduced at bases, polyphonic inspiratory and expiratory
wheezes scattered across chest.
Abd: +BS, soft, nontender, nondistended.
Ext: no edema. 2+ pulses throughout


Pertinent Results:
[**2189-10-30**] 12:50PM   GLUCOSE-153* UREA N-13 CREAT-0.7 SODIUM-135
POTASSIUM-3.9 CHLORIDE-99 TOTAL CO2-22 ANION GAP-18
[**2189-10-30**] 12:50PM   WBC-8.7 RBC-3.86* HGB-11.9* HCT-34.1* MCV-88
MCH-30.8 MCHC-34.9 RDW-13.3
[**2189-10-30**] 12:50PM   PLT COUNT-256
[**2189-10-30**] 01:11AM   TYPE-ART PO2-109* PCO2-29* PH-7.53* TOTAL
CO2-25 BASE XS-3
[**2189-10-29**] 10:15PM   WBC-10.0# RBC-4.37 HGB-13.1 HCT-39.6 MCV-91
MCH-29.9 MCHC-33.0 RDW-13.3
[**2189-10-29**] 10:15PM   NEUTS-81.4* LYMPHS-14.7* MONOS-3.7 EOS-0
BASOS-0.1
[**2189-10-29**] 10:15PM   D-DIMER-297

Brief Hospital Course:
#Asthma exacerbation:
It was felt that the patient's symptoms of chest tightness,
wheeze, and difficulty breathing were consistent with an
exacerbation of her asthma.  Initial evaluation in the emergency
department included a negative D-dimer, chest X-ray which was
clear, and blood gas which revealed normal oxygenation.  The
history obtained did not identify a clear precipitant to the
flare.  However, given the patient's repeated evaluations for
this asthma flare in the past week, it was felt that admission
for IV steroids, MDI teaching, and optimization of outpatient
regimen was warranted.  Her acute management involved albuterol
nebs q2h and IV solumedrol 80 mg q8h which was transitioned to
po prednisone 120 mg on the first hospital day.
Fluticasone/salmeterol had been recently added the previous week
to the patient's regimen; this was continued in house.  Peak
flows rapidly improved on this therapy.
The patient was educated about the proper use of MDI, and she
was arranged for outpatient pulmonology and PCP followup to
further optimize her outpatient regimen.
The patient was discharged on a slow prednisone [**Month/Day/Year 15123**].  She was
then transferred to the [**Hospital Unit Name 153**] in respiratory distress with
audible wheezing, agitation, and peak flows of 150s
(baseline~300s).  She failed 5 nebulizer treatments on the floor
and was transferred to [**Hospital Unit Name 153**].  Upon admission to [**Hospital Unit Name 153**], she was in
visible respiratory distress, not able to speak in complete
sentences, just able to whisper.
.
In the [**Hospital Unit Name 153**], the patient was started on IV solumedrol 60 q 8 and
q2 standing nebs.  She was also started on Advair and Singulair.
 She markedly improved with this treatment, able to speak
adequately, w/o SOB, with peak flows reaching into 320s.  The
next morning, she was saturating 96% on room air, with only few
diffuse exp wheezes remaining.  On day 2 of the [**Hospital Unit Name 153**], she was
given a dose of IV solumedrol and started on Prednisone 60 PO
qd.  She was called out to the floor.
.
On the floor, the patient tolerated Q4 hour nebs and denied
shortness of breath at rest.  She did complain of new onset
vertigo, felt to be labyrnthitis.  She was started on meclizine
and was able to ambulate and tolerate PO.  The patient also
complained of dysuria and a urine culture grew out P.mirablis.
She was given a 3 day course of bactrum.  Since the patient had
neither a PCP nor [**Name Initial (PRE) **] pulmonologist, she was arranged to see Dr.
[**Last Name (STitle) **] in [**Hospital 191**] clinic and Dr. [**Last Name (STitle) **] in Pulmonology clinic as an
outpatient.  She is to return to clinic this week for check-up
and obtain PFTs before her appointment with Dr. [**Last Name (STitle) **].  She
was administered Pneumovax before discharge.  She was sent home
on a 10 day prednisone [**Last Name (LF) 15123**], [**First Name3 (LF) **] asthma action plan, a peak flow
meter, and advair prescriptions.

Medications on Admission:
Albuterol MDI
Serevent (just started [**10-25**])

Discharge Medications:
1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4-6H (every 4 to 6 hours) as needed.
2. Calcium Carbonate 500 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*90 Capsule(s)* Refills:*2*
3. Vitamin D 400 unit Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
4. Prednisone 10 mg Tablet Sig: One (1) Tablet PO Q24 () for 10
doses: Please take 5 pills for 2 days, then 4 pills for the next
2 days, then 3 pills for the next 2 days, then 2 pills for the
next 2 days, and then 1 pill for the next 2 days.
Disp:*30 Tablet(s)* Refills:*0*
5. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 Disk with Device(s)* Refills:*2*
6. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) for 2 weeks.
Disp:*42 Tablet(s)* Refills:*0*
8. Bactrim DS 160-800 mg Tablet Sig: One (1) Tablet PO twice a
day for 3 days.
Disp:*6 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Asthma exacerbation
UTI


Discharge Condition:
good, breathing comfortably on room air.  some dyspnea with
exertion.  some vertigo with head movement.


Discharge Instructions:
Please call or return if you have an increase in shortness of
breath, wheezing, or dizziness.
.
Please take all medications as prescribed.  You have also been
prescribed an antibiotic for a UTI.  You should use your peak
flow meter daily and use your asthma action plan to treat
yourself.
.
Please follow up with your doctors (see info below).  You will
see me in clinic in [**Month (only) **] as a new patient visit; however you
should go to clinic this Friday for a check-up.
.
You received a flu vaccine (Pneumovax) while in the hospital.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Where: [**Hospital6 29**]
[**Hospital3 249**] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2189-11-6**]
11:00
.
Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Where: [**Hospital6 29**]
PULMONARY FUNCTION LAB Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2189-11-20**]
9:40
.
Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] PULMONARY EXAM ROOM IS (NO CHARGE) Where:
IS (NO CHARGE) Date/Time:[**2189-11-20**] 10:00
.
[**2189-12-29**]  02:00p   [**Last Name (LF) 7869**],[**First Name3 (LF) **] [**Hospital 191**] MEDICAL UNIT


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]
{'Asthma, unspecified type, with (acute) exacerbation,Urinary tract infection, site not specified,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}


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: asthma exacerbation

PRESENT ILLNESS: 24F with h/o asthma who presented with asthma exacerbation,
transfered from [**Hospital Unit Name 153**]. Over the past week, the patient had
presented to [**Hospital1 18**] EW 3 times for asthma flare. She was started
on advair and given a 3-day prednisone [**Hospital1 15123**]. 3 days ago she
presented with continued difficulty breathing and was admitted
for IV solumedrol. Her peak flow in EW was 240. She was placed
on continuous nebs x one hour and her peak flow improved to 340.
ABG x 2 (second one done on room air after neb treatment)
normal.
.
Pt states she was diagnosed with asthma at age 7 and was
hospitalized at that time. Since then, she has never been
hospitalized for her asthma and has never been intubated. She
normally uses her albuterol inhaler 10 times per day and 3 times
per night. She denies recent URI or other exacerbating factors
of her asthma. She has never seen a pulmonologist an nor had
PFTs. Her baseline peak flow is ~300

MEDICAL HISTORY: * asthma since age 7, no intubations
* seasonal allergies

MEDICATION ON ADMISSION: Albuterol MDI
Serevent (just started [**10-25**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: V: 98.1 98.6 BP 138/70, HR 80, R 18, O2 98% RA
Gen: Markedly wheezy young female, breathing mildly labored,
soft voice, with moderate accessory muscle use
HEENT: EOMI, sclera anicteric.  Oropharynx clear.
Neck: supple, no JVP at 90 degrees.
CV: Tachycardic but regular, with normal S1, S2 with physiologic
split, no murmurs, rubs or extra heart sounds.
Chest: Reduced at bases, polyphonic inspiratory and expiratory
wheezes scattered across chest.
Abd: +BS, soft, nontender, nondistended.
Ext: no edema. 2+ pulses throughout

FAMILY HISTORY: Significant for asthma, DM, hypertension, CAD.

SOCIAL HISTORY: Employed in administrative work.  No tobacco, no etoh. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Urinary tract infection, site not specified,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}
