CHIEF COMPLAINT: hemoptysis

PRESENT ILLNESS: Pt is a 82 yo male with a history of COPD/asthma(on home
O2-3LNC), HTN presented to [**Hospital3 **] with shortness of
breath. History obtained per medical records from outside
hospital. He was given nebs and lasix with little improvement.
Also complained of chest pain on initial presentation. He then
required intubation given tenuous respiratory status. Emergent
bronch was done which demonstrated exophytic mass. Pulm at
outside hospital felt that he needed argon laser therapy and was
thus transferred to [**Hospital1 18**]. After intubation and Rt subclavian
central line placement his SBP dropped into the 70-80 range. He
was bolused and started on levophed which was titrated off. He
was also given azithromycin, vanco, and ceftrizaxone and high
dose steroids for possible PNA dn COPD exacerbation.
.
Per discussion with his wife he has been having worsening SOB
for the last week with increased and cough with yellow sputum.
Has been having trouble sleeping at night. He has been eating
well. No recent weight loss. No chest pain except for what was
noted on admission. No nausea, vomiting, diarrhea, melena,
BRBPR.
.
Here he is a arousable and responds to voice. He denies any pain
at this time including any chest pain or abd pain. Feels as if
his breathing is comfortable.

MEDICAL HISTORY: - COPD/asthma- h/o being intubated and on home O2
- Hypercholesterolemia
- HTN
- CAD s/p MI 6 yrs ago, angina
- Chronic LE edema
- + MRSA in sputum
- Laryngeal Polyps
- CHF- EF unknown

MEDICATION ON ADMISSION: Hydralazine
Advair
Albuterol
Lasix 80mg qday
Ibuprofen 800mg [**Hospital1 **]
Isordil 80mg qday
SLNTG prn
Paroxetine 20mg qday
Pravastatin 20mg qhs
Omeprazole 40mg qday
Singulair 10mg qhs
Spirnolactone 25mg qday
Zyrtec
ASA 81mg qday
Tylenol prn
MVI
.
Meds on Transfer:
Ceftriaxone 1gm x1
Vancomycin 1gm x1
Albuterol
Azithromycin 500mg x1
Solumedrol 125mg IV
Panotprazole 40mg IV
Singulair 10mg PO
Claritin
Fentanyl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.9 BP 92/58 HR 65 RR 24 O2sats 99%
Vent 500/24/5/60%
Gen: Intubated but opens eyes to voice, able to answer yes/no
questions
HEENT: PERRL, EOMI, anicteric, mmm, + bloody secretions, OGtube
in place
Neck: No obvious JVD
Lungs: Expiratory wheezes on the right, left side clear
Heart: Very distant heart sounds no obvious murmurs
Abd: Protuberant, soft, NT, + BS
Ext: 2+ pitting edema in LE
Neuro: Moving all 4 extremities and following simple commands

FAMILY HISTORY: No history of lung cancer. + DM.

SOCIAL HISTORY: Former smoker, quit 30 years ago. 1ppd for 30 yrs. No alcohol or
illicit drug use. Lives with wife at home. Worked for Proctor
Gamble. In the Navy.
Acute respiratory failure,Pneumonia, organism unspecified,Unspecified septicemia,Sepsis,Cardiogenic shock,Chronic obstructive asthma with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Benign neoplasm of trachea,Other diseases of trachea and bronchus,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery
Acute respiratry failure,Pneumonia, organism NOS,Septicemia NOS,Sepsis,Cardiogenic shock,Ch obst asth w (ac) exac,CHF NOS,Atrial fibrillation,Benign neo trachea,Trachea & bronch dis NEC,Hypertension NOS,Pure hypercholesterolem,Crnry athrscl natve vssl
Admission Date:  [**2122-3-15**]              Discharge Date:   [**2122-3-20**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
hemoptysis

Major Surgical or Invasive Procedure:
bronchoscopy

History of Present Illness:
Pt is a 82 yo male with a history of COPD/asthma(on home
O2-3LNC), HTN presented to [**Hospital3 **] with shortness of
breath. History obtained per medical records from outside
hospital. He was given nebs and lasix with little improvement.
Also complained of chest pain on initial presentation. He then
required intubation given tenuous respiratory status. Emergent
bronch was done which demonstrated exophytic mass. Pulm at
outside hospital felt that he needed argon laser therapy and was
thus transferred to [**Hospital1 18**]. After intubation and Rt subclavian
central line placement his SBP dropped into the 70-80 range. He
was bolused and started on levophed which was titrated off. He
was also given azithromycin, vanco, and ceftrizaxone and high
dose steroids for possible PNA dn COPD exacerbation.
.
Per discussion with his wife he has been having worsening SOB
for the last week with increased and cough with yellow sputum.
Has been having trouble sleeping at night. He has been eating
well. No recent weight loss. No chest pain except for what was
noted on admission. No nausea, vomiting, diarrhea, melena,
BRBPR.
.
Here he is a arousable and responds to voice. He denies any pain
at this time including any chest pain or abd pain. Feels as if
his breathing is comfortable.


Past Medical History:
- COPD/asthma- h/o being intubated and on home O2
- Hypercholesterolemia
- HTN
- CAD s/p MI 6 yrs ago, angina
- Chronic LE edema
- + MRSA in sputum
- Laryngeal Polyps
- CHF- EF unknown


Social History:
Former smoker, quit 30 years ago. 1ppd for 30 yrs. No alcohol or
illicit drug use. Lives with wife at home. Worked for Proctor
Gamble. In the Navy.

Family History:
 No history of lung cancer. + DM.

Physical Exam:
T 98.9 BP 92/58 HR 65 RR 24 O2sats 99%
Vent 500/24/5/60%
Gen: Intubated but opens eyes to voice, able to answer yes/no
questions
HEENT: PERRL, EOMI, anicteric, mmm, + bloody secretions, OGtube
in place
Neck: No obvious JVD
Lungs: Expiratory wheezes on the right, left side clear
Heart: Very distant heart sounds no obvious murmurs
Abd: Protuberant, soft, NT, + BS
Ext: 2+ pitting edema in LE
Neuro: Moving all 4 extremities and following simple commands


Pertinent Results:
Outside Labs
UA [**3-15**]- negative
Sputum Culture [**3-15**]- Gram stain 2+ gram positive cocci
Bronchial Culture [**3-15**]- Gram stain 1+ gram positive cocci
.
[**3-15**]
Na 143 K 4.8 Cl 96 CO2 37 BUN 41 Cr 1.3 Glucose 200
Ca 9.3 Alb 4.4 ASt 33 ALT 43 Alkphos 96 Tbili 0.3 TP 7.7
Trop I 0.13(normal <0.1) CPK 131 MB 7.3
BNP 716
WBC 26.3 Hg 12.9 Hct 38.1 plts 375
N 66 B 8 L 14 Mono 12
PT 12.6 PTT 23.8 INR 0.9
.
ECG- NSR at 98, borderline RAD, IVCD, significant artifact in V2
thus this lead is uninterpretable, Twave inversion in inferior
leads, Twave flattening in lateral leads. No olds for
comparison.
.
CXR- outside report- Right subclavian in good position.
Infiltrates in right mid/lower lobes
.
CXR- Bilateral lower lobe infiltrates Rt>Lt. Bilateral hilar
fullness. ETT 8cm above carina. Right subclavian in SVC.


Bronch [**2122-3-17**]: Large fungating papillary mass, suggestive of
papillomatosis involving L mainstem and L arytenoid.


Brief Hospital Course:
 82 yo M with COPD/asthma presents with respiratory failure,
probably due to COPD/papillomatosis.
.
Respiratory Failure- Appeared to be multifactorial from
multifocal pneumonia in RLL field, COPD, and obstructing mass in
bronchi.
OSH culture = Moraxella, beta-lactamase producing.  Was started
on CTX/Azithro, and vanco was added.   Aggressive
Bronchodilators, steroid taper was also begun.
Bronchoscopy by IP showed mass to be pappilomatosis, caused by
HPV.  They removed the largest of the masses, and referred the
patient to
.
 Hypotension- Occurred after intubation in the setting of
sedation and mechanical ventilation. Also concern for septic
picture given possible pneumonia and elevated WBC. However
hypotension likely related to sedation and autoPEEP
levophed was started for MAPs<65 -> Off [**2122-3-16**].

On hospital day 4, the patient developed tachycardia with an
atrial fibrillation rhythm.  Attempts were made to decrease his
heart rate with lopressor and diltiazem.  His blood pressure
began to drift slowly down, and amiodarone was begun to try to
chemically convert him to a sinus rhythm.  On the amiodarone
bolus, his blood pressure dropped to the 60s for 15 minutes.
The amio was stopped.  Nor-epinephrine was started, with no
effect.  Levophed was then begun, with a rise in his blood
pressure.  A few hours later, on HD 5, the patietn's blodd
pressure again dropped and he developed bradycardia.  A short
period of CPR was begun, with return to a perfusing rhythm.  The
patient's family decided at this time that the patient would not
wish to be maintained on the ventilator or have CPR performed.
Pressors were maxed out, and when this appeared to be
unsuccessful, the patietn was  extubated at the wishes of his
family, and he expired 20 minutes later.
.
.


Medications on Admission:
Hydralazine
Advair
Albuterol
Lasix 80mg qday
Ibuprofen 800mg [**Hospital1 **]
Isordil 80mg qday
SLNTG prn
Paroxetine 20mg qday
Pravastatin 20mg qhs
Omeprazole 40mg qday
Singulair 10mg qhs
Spirnolactone 25mg qday
Zyrtec
ASA 81mg qday
Tylenol prn
MVI
.
Meds on Transfer:
Ceftriaxone 1gm x1
Vancomycin 1gm x1
Albuterol
Azithromycin 500mg x1
Solumedrol 125mg IV
Panotprazole 40mg IV
Singulair 10mg PO
Claritin
Fentanyl


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
none

Followup Instructions:
none
{'Acute respiratory failure,Pneumonia, organism unspecified,Unspecified septicemia,Sepsis,Cardiogenic shock,Chronic obstructive asthma with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Benign neoplasm of trachea,Other diseases of trachea and bronchus,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery'}


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: hemoptysis

PRESENT ILLNESS: Pt is a 82 yo male with a history of COPD/asthma(on home
O2-3LNC), HTN presented to [**Hospital3 **] with shortness of
breath. History obtained per medical records from outside
hospital. He was given nebs and lasix with little improvement.
Also complained of chest pain on initial presentation. He then
required intubation given tenuous respiratory status. Emergent
bronch was done which demonstrated exophytic mass. Pulm at
outside hospital felt that he needed argon laser therapy and was
thus transferred to [**Hospital1 18**]. After intubation and Rt subclavian
central line placement his SBP dropped into the 70-80 range. He
was bolused and started on levophed which was titrated off. He
was also given azithromycin, vanco, and ceftrizaxone and high
dose steroids for possible PNA dn COPD exacerbation.
.
Per discussion with his wife he has been having worsening SOB
for the last week with increased and cough with yellow sputum.
Has been having trouble sleeping at night. He has been eating
well. No recent weight loss. No chest pain except for what was
noted on admission. No nausea, vomiting, diarrhea, melena,
BRBPR.
.
Here he is a arousable and responds to voice. He denies any pain
at this time including any chest pain or abd pain. Feels as if
his breathing is comfortable.

MEDICAL HISTORY: - COPD/asthma- h/o being intubated and on home O2
- Hypercholesterolemia
- HTN
- CAD s/p MI 6 yrs ago, angina
- Chronic LE edema
- + MRSA in sputum
- Laryngeal Polyps
- CHF- EF unknown

MEDICATION ON ADMISSION: Hydralazine
Advair
Albuterol
Lasix 80mg qday
Ibuprofen 800mg [**Hospital1 **]
Isordil 80mg qday
SLNTG prn
Paroxetine 20mg qday
Pravastatin 20mg qhs
Omeprazole 40mg qday
Singulair 10mg qhs
Spirnolactone 25mg qday
Zyrtec
ASA 81mg qday
Tylenol prn
MVI
.
Meds on Transfer:
Ceftriaxone 1gm x1
Vancomycin 1gm x1
Albuterol
Azithromycin 500mg x1
Solumedrol 125mg IV
Panotprazole 40mg IV
Singulair 10mg PO
Claritin
Fentanyl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.9 BP 92/58 HR 65 RR 24 O2sats 99%
Vent 500/24/5/60%
Gen: Intubated but opens eyes to voice, able to answer yes/no
questions
HEENT: PERRL, EOMI, anicteric, mmm, + bloody secretions, OGtube
in place
Neck: No obvious JVD
Lungs: Expiratory wheezes on the right, left side clear
Heart: Very distant heart sounds no obvious murmurs
Abd: Protuberant, soft, NT, + BS
Ext: 2+ pitting edema in LE
Neuro: Moving all 4 extremities and following simple commands

FAMILY HISTORY: No history of lung cancer. + DM.

SOCIAL HISTORY: Former smoker, quit 30 years ago. 1ppd for 30 yrs. No alcohol or
illicit drug use. Lives with wife at home. Worked for Proctor
Gamble. In the Navy. 

### Response:
{'Acute respiratory failure,Pneumonia, organism unspecified,Unspecified septicemia,Sepsis,Cardiogenic shock,Chronic obstructive asthma with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Benign neoplasm of trachea,Other diseases of trachea and bronchus,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery'}
