CHIEF COMPLAINT: Near drowning.

PRESENT ILLNESS: 47yo M with PMHx of alcochol dependence who presented from OSH
after being found face down in pool where at the OSH, the
patient was intubated, transferred to [**Hospital1 18**] for further
management and concern for ARDS.
Patient was found face down in pool by friends. [**Name (NI) **] family
report, the patient was done maybe a minute. He was pulled out
of the pool by other people. Patient's family is unsure of
whether the patient had been drinking that night. EMS was called
and per family report chest compressions were started. During
chest compressions, the family reports that blood was noted to
be coming from the patient's mouth. EMS attempted intubation in
the field, but was unsucessful. The patient was brought to OSH,
where the patient was intubed. He initially had a pressor
requirement with Levophed which was discontinued as the OSH. He
was noted to have EtOH intoxication with level of 400 and urine
tox screen returned positive for benzodiazepines. The patient
was transferred to the ICU for further management. Head CT,
Chest CT, abdominal CT were all negative at OSH. He was started
onceftriaxone and azithromycin. Patient was transferred to [**Hospital1 18**]
out of concern for ARDS.

MEDICAL HISTORY: History of excessive EtOH abuse, but reportedly none recently.
Multiple prior DUI's in the past.

MEDICATION ON ADMISSION: Aleeve prn pain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Discharge exam:
VS: T 97.6  BP 136/78  P 70  R 18  O2 94%RA
General: NAD, AAOx3
HEENT: EOMI, PERRL, Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: mild wheezing in upper lung fields, crackles LLQ
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Family history anuerysms (brain and thoracic).

SOCIAL HISTORY: Smokes 2ppd. Patient's family denies recent EtOH consumption,
but reports that in the past, the patient has had difficulty to
heavy EtOH consumption. Family denies illicit drug use.
Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Chronic or unspecified gastric ulcer with hemorrhage, with obstruction,Unspecified pleural effusion,Drowning and nonfatal submersion,Other accidental drowning or submersion,Other, mixed, or unspecified drug abuse, continuous,Coronary atherosclerosis of native coronary artery,Diaphragmatic hernia without mention of obstruction or gangrene,Postinflammatory pulmonary fibrosis,Duodenitis, without mention of hemorrhage
Acute respiratry failure,Food/vomit pneumonitis,Chr stom ulc w hem-obstr,Pleural effusion NOS,Drowning/nonfatal submer,Accidental drowning NEC,Drug abuse NEC-contin,Crnry athrscl natve vssl,Diaphragmatic hernia,Postinflam pulm fibrosis,Duodenitis w/o hmrhg
Admission Date:  [**2187-7-21**]              Discharge Date:   [**2187-7-23**]

Date of Birth:  [**2140-7-15**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1115**]
Chief Complaint:
Near drowning.

Major Surgical or Invasive Procedure:
Intubation
EGD


History of Present Illness:
47yo M with PMHx of alcochol dependence who presented from OSH
after being found face down in pool where at the OSH, the
patient was intubated, transferred to [**Hospital1 18**] for further
management and concern for ARDS.
Patient was found face down in pool by friends. [**Name (NI) **] family
report, the patient was done maybe a minute. He was pulled out
of the pool by other people. Patient's family is unsure of
whether the patient had been drinking that night. EMS was called
and per family report chest compressions were started. During
chest compressions, the family reports that blood was noted to
be coming from the patient's mouth. EMS attempted intubation in
the field, but was unsucessful. The patient was brought to OSH,
where the patient was intubed. He initially had a pressor
requirement with Levophed which was discontinued as the OSH. He
was noted to have EtOH intoxication with level of 400 and urine
tox screen returned positive for benzodiazepines. The patient
was transferred to the ICU for further management. Head CT,
Chest CT, abdominal CT were all negative at OSH. He was started
onceftriaxone and azithromycin. Patient was transferred to [**Hospital1 18**]
out of concern for ARDS.

On arrival to the MICU, patient is sedated, able to follow
commands.

Review of systems: Unable to obtain [**2-22**] intubation.

Past Medical History:
History of excessive EtOH abuse, but reportedly none recently.
Multiple prior DUI's in the past.


Social History:
Smokes 2ppd. Patient's family denies recent EtOH consumption,
but reports that in the past, the patient has had difficulty to
heavy EtOH consumption. Family denies illicit drug use.

Family History:
Family history anuerysms (brain and thoracic).

Physical Exam:
Discharge exam:
VS: T 97.6  BP 136/78  P 70  R 18  O2 94%RA
General: NAD, AAOx3
HEENT: EOMI, PERRL, Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: mild wheezing in upper lung fields, crackles LLQ
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema


Pertinent Results:
Admission labs:
[**2187-7-21**] 01:15AM BLOOD WBC-13.6* RBC-4.46* Hgb-12.9* Hct-38.8*
MCV-87 MCH-29.0 MCHC-33.4 RDW-13.2 Plt Ct-181
[**2187-7-21**] 01:15AM BLOOD PT-12.0 PTT-27.3 INR(PT)-1.1
[**2187-7-21**] 01:15AM BLOOD Glucose-109* UreaN-18 Creat-0.9 Na-147*
K-3.6 Cl-112* HCO3-27 AnGap-12
[**2187-7-21**] 01:15AM BLOOD ALT-53* AST-26 LD(LDH)-221 CK(CPK)-339*
AlkPhos-47 TotBili-0.4
[**2187-7-21**] 01:15AM BLOOD Albumin-3.6 Calcium-8.0* Phos-2.0* Mg-2.0
[**2187-7-21**] 01:37AM BLOOD Type-ART Temp-38.1 Rates-18/ Tidal V-450
PEEP-10 FiO2-100 pO2-301* pCO2-54* pH-7.36 calTCO2-32* Base XS-3
AADO2-353 REQ O2-64 Intubat-INTUBATED
[**2187-7-21**] 01:37AM BLOOD Lactate-1.3
[**2187-7-21**] 04:29AM BLOOD freeCa-1.11*

Discharge labs:
[**2187-7-23**] 07:16AM BLOOD WBC-7.9 RBC-4.49* Hgb-13.0* Hct-38.1*
MCV-85 MCH-28.9 MCHC-34.1 RDW-12.1 Plt Ct-214
[**2187-7-23**] 07:16AM BLOOD Glucose-97 UreaN-18 Creat-0.8 Na-143
K-3.7 Cl-107 HCO3-27 AnGap-13
[**2187-7-22**] 02:55AM BLOOD ALT-38 AST-19 CK(CPK)-166 AlkPhos-47
TotBili-1.0
[**2187-7-23**] 07:16AM BLOOD Calcium-8.7 Phos-3.6# Mg-2.0

Micro:
[**2187-7-21**] SEROLOGY/BLOOD HELICOBACTER PYLORI ANTIBODY
TEST-Negative
[**2187-7-21**] MRSA SCREEN MRSA SCREEN-Negative
[**2187-7-21**] URINE URINE CULTURE-Negative
[**2187-7-21**] BLOOD CULTURE Blood Culture, Routine-No growth at the
time of discharge
[**2187-7-21**] SPUTUM GRAM STAIN-FINAL; RESPIRATORY
CULTURE-Commensal respiratory flora

Imaging:
[**2187-7-21**] CXR: 1.  Endotracheal tube has its tip 5 cm above the
carina.  There is a nasogastric tube seen coursing below the
diaphragm with the tip not identified.  There is a 1.6-cm nodule
in the right lung base, which, given its density, would favor a
benign process such as a granuloma.  Comparison to remote chest
imaging to assess for stability would be advised.  In the
absence of these studies, followup imaging with chest plain film
in three months versus dedicated chest CT should be considered.
Otherwise, the lungs appear grossly clear.  No pleural effusions
or pneumothoraces.  No evidence of pulmonary edema.  Cardiac and
mediastinal contours are within normal limits.  No evidence of
focal airspace consolidation to suggest pneumonia.

[**2187-7-22**] CXR: Interval extubation and removal of nasogastric tube.
 New poorly defined opacities have developed at the left lung
base, and may be due to atelectasis or aspiration considering
recent extubation.  Lungs are otherwise clear except for a right
lower lobe calcified granuloma.

[**2187-7-23**] CT chest w/o contrast:
TECHNIQUE:  Volumetric, multidetector CT of the chest was
performed without
intravenous or oral contrast.  Images are presented for display
in the axial plane at 5-mm and 1.25-mm collimation.  A series of
multiplanar reformation images were also submitted for review.

FINDINGS:  A benign diffusely calcified granuloma is present
laterally in the right lung base measuring about 1 cm in
diameter and corresponding to the recent chest x-ray finding.
Within the right infrahilar region, a cluster of calcified
peribronchial lymph nodes are present, and results in some
extrinsic compression of the lateral segment bronchus.
Additional noncalcified nodes are present in this region as
well.
Multiple peribronchiolar nodules are present involving the left
lung to a
greater degree than the right, and accompanied by mild bronchial
wall
thickening.  Many of the opacities have a tree-in-[**Male First Name (un) 239**]
configuration,
particularly within the left lower lobe.  Additional involvement
is seen
within the left upper lobe, right lower lobe, and right upper
lobe.  Small,
dependent pleural effusions are present bilaterally, right
greater than left, with adjacent areas of dependent atelectasis.

Heart size is normal.  Focal coronary artery calcifications are
present.  No pericardial effusion.  Small hiatal hernia
incidentally noted.

Exam was not specifically tailored to evaluate the
subdiaphragmatic region,
but no concerning abnormalities are identified in this region on
this very
limited assessment.

No suspicious lytic or blastic skeletal lesions.

2.3 cm diameter low-attenuation well-circumscribed subcutaneous
lesion in the posterior chest wall to the right of midline is
likely a sebaceous cyst.

IMPRESSION:
1.  Benign calcified granuloma in right lower lobe requires no
further imaging followup.  Calcified and noncalcified right
infrahilar lymph nodes with extrinsic compression of lateral
segment bronchus, likely placing patient at risk for
broncholithiasis. Recommend monitoring for symptoms of this
condition such as hemoptysis, cough, lithoptysis and recurrent
infections.

2.  Multifocal peribronchiolar nodules accompanied by bronchial
wall
thickening, most marked in the left lower lobe. Findings are
consistent with either bronchiolar infection or aspiration.

3.  Small dependent pleural effusions, right greater than left.

[**2187-7-22**] EGD:
Ulcers in the antrum and stomach body
Abnormal mucosa in the antrum
Erythema and friability in the duodenal bulb compatible with
duodenitis
Otherwise normal EGD to third part of the duodenum

Brief Hospital Course:
47yo M with PMHx of alcochol dependence who presented from OSH
after being found face down in pool where at the OSH, the
patient was intubated, transferred to [**Hospital1 18**] for further
management and concern for ARDS, successfully extubated and
treated for pneumonia.

# Respiratory failure/Pneumonia: Patient intubated upon arrival
to the OSH after being found face down in pool for unknown
amount of time. Patient was extubated on day 2 of
hospitalization.  Initially broadly covered with
Vanc/CTX/Azithromycin.  CXR and CT chest concerning for
aspiration PNA.  Leukocytosis to 18 at OSH.  7.9 by discharge.
Patient with productive cough after extubation, but sputum
culture only showed respiratory flora.  Patient also does have
60+ year smoking history.  O2 sat on discharge was mid 90s on
room air.  Patient discharged on cefpodoxime (last day [**7-27**]) and
azithromycin (last day [**7-25**]) for a total of 7 day course.

# History of alcohol abuse: Patient's endorses remote EtOH
abuse, but reports this was an isolated incidence.  Social
worker provided support and education.  Patient initially
covered with CIWA, but did not have evidence of EtOH withdrawal.

# Bloody NGT output: Patient on pantoprazole at OSH 40mg IV
daily.  EGD showed gastric ulcers without evidence of active
bleed.  No hematemesis and Hct stable since extubation.  DC'd
home on PO pantoprazole.  Need PCP to help arrange repeat EGD in
[**6-29**] weeks.

# Lung nodule:  Granulomatous lung nodule seen on CXR.  CT chest
showed benign calcified nodule that require no additional
imaging followup.

# Transitional issues:
- code status: full
- follow up: with PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] in [**State 108**]
- new medications: Cefpodoxime, Azithromycin, pantoprazole
- pending studies: blood culture no growth at the time of
discharge
- follow up issues: needs repeat EGD in [**6-29**] weeks

Medications on Admission:
Aleeve prn pain

Discharge Medications:
1. Azithromycin 250 mg PO Q24H Duration: 3 Days
day 1= [**7-21**]
RX *azithromycin 250 mg 2 Tablet(s) by mouth daily Disp #*2
Tablet Refills:*0
2. Pantoprazole 40 mg PO DAILY
RX *pantoprazole 40 mg 1 Tablet(s) by mouth daily Disp #*30
Tablet Refills:*1
3. Cefpodoxime Proxetil 200 mg PO Q12H
RX *cefpodoxime 200 mg 1 Tablet(s) by mouth every twelve (12)
hours Disp #*8 Tablet Refills:*0


Discharge Disposition:
Home

Discharge Diagnosis:
Aspiration pneumonia
Drowning
Alcohol Abuse


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Mr. [**Known lastname 112528**],

It was a pleasure participating in your care at [**Hospital1 18**].  You were
admitted after you were found in a pool after drinking alcohol.
You were initially intubated (on a breathing machine) to help
you breath, and you were treated for pneumonia with antibiotics.
 Please continue antibiotics as listed below.  Please abstain
from alcohol to prevent this from occuring in the future.

We also found that you have stomach ulcers that are not actively
bleeding.  You should avoid medications such as Advil, Aleeve,
naproxen, ibuprofen, and only take tylenol as needed for pain.
Please take pantoprazole for this as directed.  You will need a
follow up EGD (endoscopy) in [**6-29**] weeks.  Please arrange this
with Dr. [**Last Name (STitle) **].

We made the following changes to your medications:
STARTED Cefpodoxime (last day [**2187-7-27**])
STARTED Azithromycin (last day [**2187-7-25**])
STARTED Pantoprazole daily
STOPPED Aleeve

Followup Instructions:
Please call Dr.[**Name (NI) 97678**] office at [**Telephone/Fax (1) 112529**] to schedule a
follow up appointment within a week of your discharge from the
hospital.



Completed by:[**2187-7-23**]
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Chronic or unspecified gastric ulcer with hemorrhage, with obstruction,Unspecified pleural effusion,Drowning and nonfatal submersion,Other accidental drowning or submersion,Other, mixed, or unspecified drug abuse, continuous,Coronary atherosclerosis of native coronary artery,Diaphragmatic hernia without mention of obstruction or gangrene,Postinflammatory pulmonary fibrosis,Duodenitis, without mention of hemorrhage'}


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: Near drowning.

PRESENT ILLNESS: 47yo M with PMHx of alcochol dependence who presented from OSH
after being found face down in pool where at the OSH, the
patient was intubated, transferred to [**Hospital1 18**] for further
management and concern for ARDS.
Patient was found face down in pool by friends. [**Name (NI) **] family
report, the patient was done maybe a minute. He was pulled out
of the pool by other people. Patient's family is unsure of
whether the patient had been drinking that night. EMS was called
and per family report chest compressions were started. During
chest compressions, the family reports that blood was noted to
be coming from the patient's mouth. EMS attempted intubation in
the field, but was unsucessful. The patient was brought to OSH,
where the patient was intubed. He initially had a pressor
requirement with Levophed which was discontinued as the OSH. He
was noted to have EtOH intoxication with level of 400 and urine
tox screen returned positive for benzodiazepines. The patient
was transferred to the ICU for further management. Head CT,
Chest CT, abdominal CT were all negative at OSH. He was started
onceftriaxone and azithromycin. Patient was transferred to [**Hospital1 18**]
out of concern for ARDS.

MEDICAL HISTORY: History of excessive EtOH abuse, but reportedly none recently.
Multiple prior DUI's in the past.

MEDICATION ON ADMISSION: Aleeve prn pain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Discharge exam:
VS: T 97.6  BP 136/78  P 70  R 18  O2 94%RA
General: NAD, AAOx3
HEENT: EOMI, PERRL, Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: mild wheezing in upper lung fields, crackles LLQ
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Family history anuerysms (brain and thoracic).

SOCIAL HISTORY: Smokes 2ppd. Patient's family denies recent EtOH consumption,
but reports that in the past, the patient has had difficulty to
heavy EtOH consumption. Family denies illicit drug use. 

### Response:
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Chronic or unspecified gastric ulcer with hemorrhage, with obstruction,Unspecified pleural effusion,Drowning and nonfatal submersion,Other accidental drowning or submersion,Other, mixed, or unspecified drug abuse, continuous,Coronary atherosclerosis of native coronary artery,Diaphragmatic hernia without mention of obstruction or gangrene,Postinflammatory pulmonary fibrosis,Duodenitis, without mention of hemorrhage'}
