CHIEF COMPLAINT: Severe left flank pain, LLL PNA

PRESENT ILLNESS: HPI:: 61 YO man with h/o COPD, hepatitis, IVDU (distant) whoe
presented to [**Hospital1 18**] after experiencing shortness of breath and
severe rib/flank pain.  the pain came on suddenly at midnight
while sleeping. He was seen by his pulmnologist Dr. [**Last Name (STitle) **]
approximately 4 days ago who prescribed telithromycin (ketec)
for presumed pneumonia given increaed sections.  The secretion
have since resolved.  Yeterday he did very heavy exercising
including upside down push ups, chin upts. He felt to be in his
usual state of health and went to sleep without symptoms. He
woke up at midnight with sharp, aching pain on his left side. He
could not take deep breaths and had difficulty moving around.
This morning he had chills which were relieved by motrin and a
sweat shirt.  He denies any headaches, diarrhea, nausea,
vomitting or abdominal pain.

MEDICAL HISTORY: Hypertension, IVDU, COPD

MEDICATION ON ADMISSION: Telithromycin (ketec), zestril 10mg, flovent, albuterol, spiriva

ALLERGIES: Sulfonamides

PHYSICAL EXAM: VS  99.8  84 98/60 20 96%RA
Gen: Pleasant elderly male in NAD
HEENT: PERRL, MMM, scleara anicteric
Neck: No lymphadenopathy
CV: nl s1s2 rrr no mrg
Chest [**Month (only) **]. BS at L base

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home, history of Etoh, 30yrs tobacco quit [**2172**]
Methicillin susceptible Staphylococcus aureus septicemia,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Unspecified viral hepatitis C without hepatic coma,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified essential hypertension,Tobacco use disorder,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Other specified cardiac dysrhythmias,Severe sepsis,Infection with microorganisms resistant to penicillins
Meth susc Staph aur sept,Acute kidney failure NOS,Chr airway obstruct NEC,Urin tract infection NOS,Hpt C w/o hepat coma NOS,Meth sus pneum d/t Staph,Hypertension NOS,Tobacco use disorder,Other staphylococcus,Cardiac dysrhythmias NEC,Severe sepsis,Inf mcrg rstn pncllins
Admission Date:  [**2181-2-10**]              Discharge Date:   [**2181-2-15**]

Date of Birth:  [**2119-2-19**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfonamides

Attending:[**First Name3 (LF) 5368**]
Chief Complaint:
Severe left flank pain, LLL PNA


Major Surgical or Invasive Procedure:
None

History of Present Illness:
HPI:: 61 YO man with h/o COPD, hepatitis, IVDU (distant) whoe
presented to [**Hospital1 18**] after experiencing shortness of breath and
severe rib/flank pain.  the pain came on suddenly at midnight
while sleeping. He was seen by his pulmnologist Dr. [**Last Name (STitle) **]
approximately 4 days ago who prescribed telithromycin (ketec)
for presumed pneumonia given increaed sections.  The secretion
have since resolved.  Yeterday he did very heavy exercising
including upside down push ups, chin upts. He felt to be in his
usual state of health and went to sleep without symptoms. He
woke up at midnight with sharp, aching pain on his left side. He
could not take deep breaths and had difficulty moving around.
This morning he had chills which were relieved by motrin and a
sweat shirt.  He denies any headaches, diarrhea, nausea,
vomitting or abdominal pain.


Past Medical History:
Hypertension, IVDU, COPD

Social History:
Lives at home, history of Etoh, 30yrs tobacco quit [**2172**]


Family History:
NC


Physical Exam:
VS  99.8  84 98/60 20 96%RA
Gen: Pleasant elderly male in NAD
HEENT: PERRL, MMM, scleara anicteric
Neck: No lymphadenopathy
CV: nl s1s2 rrr no mrg
Chest [**Month (only) **]. BS at L base

Pertinent Results:
CT CHEST W/O CONTRAST  [**2181-2-11**] 4:54 PM

CT CHEST W/O CONTRAST

Reason: pt with left hilar mass on CXR; please evaluate for
pericard
Field of view: 36

[**Hospital 93**] MEDICAL CONDITION:
61 year old man with hx of COPD, tobacco abuse who presents with
left chest pain, shortness of breath, hypotension
REASON FOR THIS EXAMINATION:
pt with left hilar mass on CXR; please evaluate for pericardial
involement as etiology of hypotension
CONTRAINDICATIONS for IV CONTRAST: ARF

PROCEDURE: Chest CT without contrast.

HISTORY: 61-year-old man with history of COPD, tobacco abuse who
presents with left chest pain, shortness of breath and
hypertension, please evaluate for pericardial involvement as
etiology of hypertension.

There are no prior cross-sectional studies available for
comparison.

TECHNIQUE: Multidetector CT images throughout the chest without
contrast.

CT OF THE CHEST WITHOUT IV CONTRAST: Important emphysematous
changes are seen throughout both lungs with some small areas of
scarring in both upper lungs. There is diffuse consolidation
opacity throughout the medial and posterior basal segments of
the left lower lobe associated with small left pleural effusion
consistent with diffuse pneumonia. There is no evidence to
suggest focal mass. The heart, pericardium and great vessels are
unremarkable. There are no pathologically enlarged axillary or
mediastinal lymph nodes. The airways are patent.

Very limited axial imaging throughout the upper abdomen
demonstrates no abnormalities.

BONE WINDOWS: There are no concerning bone lesions. Mild
degenerative changes are seen throughout the spine.

IMPRESSION:
1. Left basal pneumonia with small quantity of left pleural
effusion.
2. Important emphysematous changes throughout the rest of the
pulmonary parenchyma


[**2181-2-10**] Echocardiagram

Findings:

LEFT ATRIUM: Normal LA size.

LEFT VENTRICLE: Normal LV cavity size. Suboptimal technical
quality, a focal LV wall motion abnormality cannot be fully
excluded.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.
Resting
tachycardia (HR>100bpm). Emergency study performed by the
cardiology fellow on  call.

Conclusions:
The left atrium is normal in size. The left ventricular cavity
size is normal.  Views are technically suboptimal for assessment
of systolic function (grossly  preserved). Due to suboptimal
technical quality, a focal wall motion  abnormality cannot be
fully excluded. The right ventricle may be dilated. There is no
pericardial effusion.



[**2181-2-10**] 09:27AM URINE  HOURS-RANDOM CREAT-81 SODIUM-67
[**2181-2-10**] 09:27AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2181-2-10**] 09:27AM URINE  RBC-0-2 WBC-[**12-17**]* BACTERIA-FEW
YEAST-MOD EPI-[**7-7**] TRANS EPI-[**12-17**] RENAL EPI-[**4-1**]
[**2181-2-10**] 07:30AM   GLUCOSE-95 UREA N-32* CREAT-2.1*# SODIUM-138
POTASSIUM-4.4 CHLORIDE-106 TOTAL CO2-19* ANION GAP-17
[**2181-2-10**] 07:30AM   CALCIUM-8.9 PHOSPHATE-3.3 MAGNESIUM-1.4*
[**2181-2-10**] 07:30AM   WBC-12.2* RBC-4.30* HGB-13.8* HCT-37.7*
MCV-88 MCH-32.1* MCHC-36.6* RDW-13.7
[**2181-2-9**] 10:21PM   LACTATE-1.5
[**2181-2-9**] 10:19PM   NEUTS-87.8* BANDS-0 LYMPHS-7.8* MONOS-3.6
EOS-0.3 BASOS-0.6
[**2181-2-9**] 10:19PM   PLT COUNT-181

Brief Hospital Course:
61 YO with history of COPD, HTN, p/w LLL PNA and left sided pain


LLL PNA- He was admitted with shortness of breath and productive
cough. He initially was being treated with telithromycin but
noted no improvement. The patient on admission showed
progression of pneumonia on his admission xray. He was started
on ceftriaxone and azithromycin.  Ultimately his sputum culture
grew out MRSA and he was started on vancomycin.  Blood cultures
were taken and were all negative at time of discharge.  The
following day after admission, he developed hypotension and
associated shortness of breath. He had increasing oxygen
requirements and was transferred to the unit.  There was no
indications of pericardial tamponade or pulmonary embolism noted
on his ABG or ekg.  He blood pressure was stabilized in the
unit, and he was transferred back to the floor where, he treated
solely with vancomycin and nebulizers with good improvement in
his respiratory status with decreasing oxygen requirements and
he was weaned to room air.  He was discharged with a total 14
day course of antibiotics, he was discharged with linezolid.

Leukocytosis- This was likely associated with his pneumonia and
returned to baseline limits at time of discharge.

ARF:  This was likely prerenal as with hydration it returned to
a baseline 0.9.  Although his FeNA was 1.26 not suggestive of a
prerenal acute renal failure.

Hypotension: On the floor, pt's initial BP was 100/70 with a HR
of 116. Over the next few hours, his BP dropped to 80s/40s with
an increase in his heart rate to the 130s. An EKG showed sinus
tach with low voltage. He was given 2.5L of NS and BP response
was poor. It remained in the 70s-80s for the next several hours
and pt was transferred to the ICU for further care. In CCU, SBP
110, given 3L IVF (total 4-5 L during MICU stay.) There was no
demonstration of pericardial tamponade on echocardiagram and
after his blood pressure was stabilized he was returned to the
floor with no more episodes of hypotension.

COPD-  He was continued on his outpatient regiemtn of flovent,
albuterol and spiriva.


Medications on Admission:
Telithromycin (ketec), zestril 10mg, flovent, albuterol, spiriva


Discharge Medications:
1. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO qd () for 1
days.
Disp:*3 Tablet(s)* Refills:*0*
2. Prednisone 5 mg Tablet Sig: Three (3) Tablet PO qd  () for 3
days: Start on [**2181-2-17**].
Disp:*9 Tablet(s)* Refills:*0*
3. Prednisone 5 mg Tablet Sig: One (1) Tablet PO qd  () for 3
days: [**2181-2-20**].
Disp:*3 Tablet(s)* Refills:*0*
4. Linezolid 600 mg Tablet Sig: One (1) Tablet PO twice a day
for 11 days.
Disp:*22 Tablet(s)* Refills:*0*
5. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
Disp:*1 unit* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Pneumonia
MRSA


Discharge Condition:
Stable


Discharge Instructions:
If you experience increased shortness of breath, fevers, chills
or other concerning symptoms please call your PCP

Please take your medications as instructed

Please follow up with the doctors listed below

Followup Instructions:
Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 250**] at [**2181-2-22**] 1:40pm

Provider: [**First Name11 (Name Pattern1) 8122**] [**Last Name (NamePattern4) 8123**], M.D. Phone:[**Telephone/Fax (1) 2977**]
Date/Time:[**2181-3-13**] 3:00

Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Phone:[**Telephone/Fax (1) 612**]
Date/Time:[**2181-5-7**] 9:15

Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 612**]
Date/Time:[**2181-5-7**] 9:35
{'Methicillin susceptible Staphylococcus aureus septicemia,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Unspecified viral hepatitis C without hepatic coma,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified essential hypertension,Tobacco use disorder,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Other specified cardiac dysrhythmias,Severe sepsis,Infection with microorganisms resistant to penicillins'}


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: Severe left flank pain, LLL PNA

PRESENT ILLNESS: HPI:: 61 YO man with h/o COPD, hepatitis, IVDU (distant) whoe
presented to [**Hospital1 18**] after experiencing shortness of breath and
severe rib/flank pain.  the pain came on suddenly at midnight
while sleeping. He was seen by his pulmnologist Dr. [**Last Name (STitle) **]
approximately 4 days ago who prescribed telithromycin (ketec)
for presumed pneumonia given increaed sections.  The secretion
have since resolved.  Yeterday he did very heavy exercising
including upside down push ups, chin upts. He felt to be in his
usual state of health and went to sleep without symptoms. He
woke up at midnight with sharp, aching pain on his left side. He
could not take deep breaths and had difficulty moving around.
This morning he had chills which were relieved by motrin and a
sweat shirt.  He denies any headaches, diarrhea, nausea,
vomitting or abdominal pain.

MEDICAL HISTORY: Hypertension, IVDU, COPD

MEDICATION ON ADMISSION: Telithromycin (ketec), zestril 10mg, flovent, albuterol, spiriva

ALLERGIES: Sulfonamides

PHYSICAL EXAM: VS  99.8  84 98/60 20 96%RA
Gen: Pleasant elderly male in NAD
HEENT: PERRL, MMM, scleara anicteric
Neck: No lymphadenopathy
CV: nl s1s2 rrr no mrg
Chest [**Month (only) **]. BS at L base

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home, history of Etoh, 30yrs tobacco quit [**2172**] 

### Response:
{'Methicillin susceptible Staphylococcus aureus septicemia,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Unspecified viral hepatitis C without hepatic coma,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified essential hypertension,Tobacco use disorder,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Other specified cardiac dysrhythmias,Severe sepsis,Infection with microorganisms resistant to penicillins'}
