CHIEF COMPLAINT: Transferred for management of cryptogenic organizing pneumonia

PRESENT ILLNESS: 64 yo female w PMH of bilat pulm emboli in [**2147**] and in [**1-3**],
chronic bronchitis, transfer from [**Hospital1 **] [**Location (un) 620**] to [**Hospital1 18**] with
VATS confirmed cryptogentic organizing pneun on [**4-23**], with
increased FI02 requirments, increased PEEP and concern of
developing ARDS.
.
She initailly presented to OSH on [**4-11**] with c/o SOB/ DOE and
treated presumptively for pneumonia. She was started on
levofloxacin 500mg a day. Repeat x-rays showed increased
bilateral infiltrates. Despite antibiotics and inhalers, she
continued to have worsening shortness ofbreath. Sputum was sent
for culture that was negative. Influenza culturewas also
negative. The patient continued to do worse with saturations
dropping as low as 86% on two liters nasal cannula. By [**2150-4-13**],she was increasingly hypoxic and uncomfortable with
tachypnea. A repeatchest CT scan was done showing interval
development of interstitial consolidation and ground glass
bilaterally as well as bilateral effusions. There was no
evidence of new pulmonary emboli. The patient was transferred to
the intensive care unit for closer monitoring. Later that night,
she developed hypoxic respiratory failure and was intubated.
Repeat cultures were sent and the patient's antibiotic coverage
waschanged to Zosyn. Pulmonary and infectious disease were also
involved atthis point. Azithromycin was started for empiric
coverage of legionella which turned out to be negative. In
addition, human immunodeficiency virus and quantitative IgG were
checked to rule out immunocompromisedstated. Both were within
normal limits. The patient was started on empiric steroids which
did over some improvement. A bronchoscopy was done, cultures
from which remain negative including acid fast bacilli and
Pneumocystis carinii pneumonia. A few days later, steroids
wereabruptly discontinued because of concerns of intraabdominal
process.  The patient self-extubated on [**2150-4-17**]. She
initially did well with 97%-98% on two to three liters nasal
cannula. However, over the course of several days, she continued
to have bilateral infiltrates and was not responding to
antibiotics. Ultimately, on [**2150-4-22**], the patient
underwent VATS: notable for an nflammatory process and negative
for an infectious process. Subsequent
to biopsy, the patient was restarted on high-dosed steroids. She
remains intubated with increasing hypoxic failure. Currently,
she is requiringincreasing amounts and PEEP and chest x-rays
show bilateral infiltrates onsistent with bronchiolitis
obliterans with organizing pneumonia,interstitial process, or
adult respiratory distress syndrome. Of note, antibiotics have
been changed from Zosyn to imipenem because of rash. Today, it
was noted that she developed a rash to Imipenum dose at 1:00am
and at 6:00am.

MEDICAL HISTORY: Pulmonary embolism [**1-3**]
chronic bronchitis
HTN
ulcerative colitis
chronic bronchitis
pneumonia
degenerative back
depression

MEDICATION ON ADMISSION: coumadin, lipitor, pentasa, prozac, cartia, albuterol, flovent,
HCTZ/triamterene, wellbutrin, protonix

ALLERGIES: Hydrocodone / Imipenem/Cilastatin Sodium / Zosyn

PHYSICAL EXAM: GEN: lying in bed in NAD
HEENT: no JVD, MMM, ETT in place
CV: RR, no Murmur
Lung: CTAB; minimal crackles diffusely
Abd: soft, NT/ND, +bs
Ext: no C/C/E, +2DP pulses bilat

FAMILY HISTORY: breast cancer in aunt, sister,
stomach cancer and lung cancer in mom

SOCIAL HISTORY: retired teacher, now runs a daycare center with her daughter;
+15 yr of tobacco hx quit 15 yrs ago
Cryptococcosis,Pneumonia in other systemic mycoses,Methicillin susceptible Staphylococcus aureus septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Methicillin susceptible pneumonia due to Staphylococcus aureus,Empyema without mention of fistula,Unspecified protein-calorie malnutrition,Iron deficiency anemia secondary to blood loss (chronic),Chronic airway obstruction, not elsewhere classified,Infection with microorganisms resistant to penicillins,Other and unspecified complications of medical care, not elsewhere classified,Unspecified essential hypertension
Cryptococcosis,Pneum in oth sys mycoses,Meth susc Staph aur sept,Severe sepsis,Acute respiratry failure,Septic shock,Meth sus pneum d/t Staph,Empyema w/o fistula,Protein-cal malnutr NOS,Chr blood loss anemia,Chr airway obstruct NEC,Inf mcrg rstn pncllins,Complic med care NEC/NOS,Hypertension NOS
Admission Date:  [**2150-4-25**]              Discharge Date:   [**2150-5-15**]

Date of Birth:  [**2085-10-25**]             Sex:   F

Service: MEDICINE

Allergies:
Hydrocodone / Imipenem/Cilastatin Sodium / Zosyn

Attending:[**First Name3 (LF) 297**]
Chief Complaint:
Transferred for management of cryptogenic organizing pneumonia

Major Surgical or Invasive Procedure:
VATS

History of Present Illness:
64 yo female w PMH of bilat pulm emboli in [**2147**] and in [**1-3**],
chronic bronchitis, transfer from [**Hospital1 **] [**Location (un) 620**] to [**Hospital1 18**] with
VATS confirmed cryptogentic organizing pneun on [**4-23**], with
increased FI02 requirments, increased PEEP and concern of
developing ARDS.
.
She initailly presented to OSH on [**4-11**] with c/o SOB/ DOE and
treated presumptively for pneumonia. She was started on
levofloxacin 500mg a day. Repeat x-rays showed increased
bilateral infiltrates. Despite antibiotics and inhalers, she
continued to have worsening shortness ofbreath. Sputum was sent
for culture that was negative. Influenza culturewas also
negative. The patient continued to do worse with saturations
dropping as low as 86% on two liters nasal cannula. By [**2150-4-13**],she was increasingly hypoxic and uncomfortable with
tachypnea. A repeatchest CT scan was done showing interval
development of interstitial consolidation and ground glass
bilaterally as well as bilateral effusions. There was no
evidence of new pulmonary emboli. The patient was transferred to
the intensive care unit for closer monitoring. Later that night,
she developed hypoxic respiratory failure and was intubated.
Repeat cultures were sent and the patient's antibiotic coverage
waschanged to Zosyn. Pulmonary and infectious disease were also
involved atthis point. Azithromycin was started for empiric
coverage of legionella which turned out to be negative. In
addition, human immunodeficiency virus and quantitative IgG were
checked to rule out immunocompromisedstated. Both were within
normal limits. The patient was started on empiric steroids which
did over some improvement. A bronchoscopy was done, cultures
from which remain negative including acid fast bacilli and
Pneumocystis carinii pneumonia. A few days later, steroids
wereabruptly discontinued because of concerns of intraabdominal
process.  The patient self-extubated on [**2150-4-17**]. She
initially did well with 97%-98% on two to three liters nasal
cannula. However, over the course of several days, she continued
to have bilateral infiltrates and was not responding to
antibiotics. Ultimately, on [**2150-4-22**], the patient
underwent VATS: notable for an nflammatory process and negative
for an infectious process. Subsequent
to biopsy, the patient was restarted on high-dosed steroids. She
remains intubated with increasing hypoxic failure. Currently,
she is requiringincreasing amounts and PEEP and chest x-rays
show bilateral infiltrates onsistent with bronchiolitis
obliterans with organizing pneumonia,interstitial process, or
adult respiratory distress syndrome. Of note, antibiotics have
been changed from Zosyn to imipenem because of rash. Today, it
was noted that she developed a rash to Imipenum dose at 1:00am
and at 6:00am.


Past Medical History:
Pulmonary embolism [**1-3**]
chronic bronchitis
HTN
ulcerative colitis
chronic bronchitis
pneumonia
degenerative back
depression


Social History:
retired teacher, now runs a daycare center with her daughter;
+15 yr of tobacco hx quit 15 yrs ago

Family History:
breast cancer in aunt, sister,
stomach cancer and lung cancer in mom


Physical Exam:
GEN: lying in bed in NAD
HEENT: no JVD, MMM, ETT in place
CV: RR, no Murmur
Lung: CTAB; minimal crackles diffusely
Abd: soft, NT/ND, +bs
Ext: no C/C/E, +2DP pulses bilat


Pertinent Results:
[**2150-4-25**] 04:14PM   WBC-20.2*# RBC-3.67* HGB-10.6* HCT-33.1*
MCV-90 MCH-28.7 MCHC-31.9 RDW-14.5
[**2150-4-25**] 04:14PM   PLT COUNT-300
[**2150-4-25**] 04:14PM   GLUCOSE-143* UREA N-25* CREAT-0.7 SODIUM-145
POTASSIUM-4.2 CHLORIDE-109* TOTAL CO2-33* ANION GAP-7*
[**2150-4-25**] 04:14PM   CALCIUM-8.5 PHOSPHATE-3.9 MAGNESIUM-2.1
[**2150-4-25**] 04:14PM   CK-MB-NotDone cTropnT-<0.01
[**2150-4-25**] 04:14PM   PT-15.9* PTT-21.5* INR(PT)-1.6
[**2150-4-25**] 04:34PM   freeCa-1.23
[**2150-4-25**] 04:34PM   GLUCOSE-146* LACTATE-1.0
.
[**2150-4-30**] 11:20 am SPUTUM      Source: Endotracheal.
   GRAM STAIN (Final [**2150-4-30**]):
      >25 PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
   RESPIRATORY CULTURE (Final [**2150-5-2**]):
      STAPH AUREUS COAG +.    MODERATE GROWTH.
      SENSITIVITIES: MIC expressed in MCG/ML
________________________________________________________
                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------   =>8 R
ERYTHROMYCIN----------   =>8 R
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------   =>8 R
OXACILLIN-------------   =>4 R
PENICILLIN------------ =>0.5 R
RIFAMPIN-------------- <=0.5 S
TETRACYCLINE----------   <=1 S
VANCOMYCIN------------   <=1 S
.
CHEST (PORTABLE AP)  [**2150-4-26**] 11:16 PM
AP SUPINE VIEW OF THE CHEST: There is a right-sided IJ line
terminating in the distal SVC. There is a right-sided chest tube
terminating in the region overlying the right upper lung zone.
The ET tube is in satisfactory position within the thoracic
inlet. The NG tube terminates in the stomach. There are diffuse
bilateral patchy alveolar opacities. No evidence of
pneumothorax. There is no pleural effusion. Degenerative changes
with scoliotic curvature of the spine are noted.
IMPRESSION: Bilateral diffuse alveolar opacities with an
appearance consistent with ARDS.
.
PORTABLE ABDOMEN  [**2150-5-2**] 3:41 PM
SINGLE SUPINE PORTABLE VIEW OF THE ABDOMEN: A feeding tube is
demonstrated overlying the distal second portion of duodenum. A
nonspecific bowel gas pattern is noted. There is a scoliotic
curvature of the spine with degenerative changes, convex to the
right.
.


Brief Hospital Course:
64 year old female with a history of pulmonary embolus, who was
transfered from an OSH after VATS confirmed cryptogenic
organizing pneumonia (COP).  Initially, her respiratory failure
was thought to be related to cryptogenic organizing pneumonia
(COP).  However, it was likely multifactorial due to a component
of pneumonia and CHF as well.  She was continued on prednisone
for COP, and diuresed to a goal negative 1000cc per day.  She
was eventually found to have a MRSA pneumonia and empyema for
which antibiotics and chest tube placed for treatment.  She was
continued on assist control mechanical ventilation with
increased PEEP and FiO2 requirements.  Eventually, it was clear
that she would not be able to wean from the ventilator due to
her deompensated respiratory status.  It also became clear that
she could no longer be sustained on the ventilator.  Given her
grim prognosis, her family members, including Health Care Proxy,
decided to withdraw care and remove the patient from the
ventilator.  She was extubated, made comfortable with narcotics,
and passed away within an hour of ET tube removal.


Medications on Admission:
coumadin, lipitor, pentasa, prozac, cartia, albuterol, flovent,
HCTZ/triamterene, wellbutrin, protonix

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
n/a

Discharge Condition:
deceased

Discharge Instructions:
n/a

Followup Instructions:
n/a
{'Cryptococcosis,Pneumonia in other systemic mycoses,Methicillin susceptible Staphylococcus aureus septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Methicillin susceptible pneumonia due to Staphylococcus aureus,Empyema without mention of fistula,Unspecified protein-calorie malnutrition,Iron deficiency anemia secondary to blood loss (chronic),Chronic airway obstruction, not elsewhere classified,Infection with microorganisms resistant to penicillins,Other and unspecified complications of medical care, not elsewhere classified,Unspecified essential hypertension'}


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 for management of cryptogenic organizing pneumonia

PRESENT ILLNESS: 64 yo female w PMH of bilat pulm emboli in [**2147**] and in [**1-3**],
chronic bronchitis, transfer from [**Hospital1 **] [**Location (un) 620**] to [**Hospital1 18**] with
VATS confirmed cryptogentic organizing pneun on [**4-23**], with
increased FI02 requirments, increased PEEP and concern of
developing ARDS.
.
She initailly presented to OSH on [**4-11**] with c/o SOB/ DOE and
treated presumptively for pneumonia. She was started on
levofloxacin 500mg a day. Repeat x-rays showed increased
bilateral infiltrates. Despite antibiotics and inhalers, she
continued to have worsening shortness ofbreath. Sputum was sent
for culture that was negative. Influenza culturewas also
negative. The patient continued to do worse with saturations
dropping as low as 86% on two liters nasal cannula. By [**2150-4-13**],she was increasingly hypoxic and uncomfortable with
tachypnea. A repeatchest CT scan was done showing interval
development of interstitial consolidation and ground glass
bilaterally as well as bilateral effusions. There was no
evidence of new pulmonary emboli. The patient was transferred to
the intensive care unit for closer monitoring. Later that night,
she developed hypoxic respiratory failure and was intubated.
Repeat cultures were sent and the patient's antibiotic coverage
waschanged to Zosyn. Pulmonary and infectious disease were also
involved atthis point. Azithromycin was started for empiric
coverage of legionella which turned out to be negative. In
addition, human immunodeficiency virus and quantitative IgG were
checked to rule out immunocompromisedstated. Both were within
normal limits. The patient was started on empiric steroids which
did over some improvement. A bronchoscopy was done, cultures
from which remain negative including acid fast bacilli and
Pneumocystis carinii pneumonia. A few days later, steroids
wereabruptly discontinued because of concerns of intraabdominal
process.  The patient self-extubated on [**2150-4-17**]. She
initially did well with 97%-98% on two to three liters nasal
cannula. However, over the course of several days, she continued
to have bilateral infiltrates and was not responding to
antibiotics. Ultimately, on [**2150-4-22**], the patient
underwent VATS: notable for an nflammatory process and negative
for an infectious process. Subsequent
to biopsy, the patient was restarted on high-dosed steroids. She
remains intubated with increasing hypoxic failure. Currently,
she is requiringincreasing amounts and PEEP and chest x-rays
show bilateral infiltrates onsistent with bronchiolitis
obliterans with organizing pneumonia,interstitial process, or
adult respiratory distress syndrome. Of note, antibiotics have
been changed from Zosyn to imipenem because of rash. Today, it
was noted that she developed a rash to Imipenum dose at 1:00am
and at 6:00am.

MEDICAL HISTORY: Pulmonary embolism [**1-3**]
chronic bronchitis
HTN
ulcerative colitis
chronic bronchitis
pneumonia
degenerative back
depression

MEDICATION ON ADMISSION: coumadin, lipitor, pentasa, prozac, cartia, albuterol, flovent,
HCTZ/triamterene, wellbutrin, protonix

ALLERGIES: Hydrocodone / Imipenem/Cilastatin Sodium / Zosyn

PHYSICAL EXAM: GEN: lying in bed in NAD
HEENT: no JVD, MMM, ETT in place
CV: RR, no Murmur
Lung: CTAB; minimal crackles diffusely
Abd: soft, NT/ND, +bs
Ext: no C/C/E, +2DP pulses bilat

FAMILY HISTORY: breast cancer in aunt, sister,
stomach cancer and lung cancer in mom

SOCIAL HISTORY: retired teacher, now runs a daycare center with her daughter;
+15 yr of tobacco hx quit 15 yrs ago 

### Response:
{'Cryptococcosis,Pneumonia in other systemic mycoses,Methicillin susceptible Staphylococcus aureus septicemia,Severe sepsis,Acute respiratory failure,Septic shock,Methicillin susceptible pneumonia due to Staphylococcus aureus,Empyema without mention of fistula,Unspecified protein-calorie malnutrition,Iron deficiency anemia secondary to blood loss (chronic),Chronic airway obstruction, not elsewhere classified,Infection with microorganisms resistant to penicillins,Other and unspecified complications of medical care, not elsewhere classified,Unspecified essential hypertension'}
