CHIEF COMPLAINT: Shortness of Breath

PRESENT ILLNESS: 48yoM with h/o bipolar d/o transferred from [**Hospital3 3583**] with
acute lung injury after "PermiDri" chemical inhalation.
Initially, pt was spraying chemical in enclosed camper, exposed
for about 20minutes. He came out of the camper complaining of
dizziness and diaphoresis, and 911 was called. He was taken to
[**Hospital3 3583**] where O2 sat 92% on non-rebreather. He was
intubated for hypoxemia and airway protection. Prior to this
incidenct he was well.
.

MEDICAL HISTORY: Bipolar disorder

MEDICATION ON ADMISSION: Lamotrigine 100mg 2 tablets po BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:99.1 BP:124-150/82-87 RR:18 O2sats:93%RA
I/O: foley d/c'd at 0200, DTV at 10:00AM
Gen: A/O, NAD
HEENT: NCAT, MMM, taking PO
CV: RRR, si, s2, no M/G/R
RESP: Slight crackles heard at R base.
ABD: soft, NT/ND, no masses
Ext: warm, well perfused, no edema, no rashes

FAMILY HISTORY: Uncle with MI, Grandmother with MI

SOCIAL HISTORY: SHx: works as in telecommunication, lives with his wife
+tob use, 1PPD; no EtOH or illicits
Toxic effect of other specified gases, fumes, or vapors,Acute respiratory failure,Bronchitis and pneumonitis due to fumes and vapors,Accidental poisoning by other specified gases and vapors,Bipolar I disorder, most recent episode (or current) unspecified
Toxic eff gas/vapor NEC,Acute respiratry failure,Fum/vapor bronc/pneumon,Acc poison-gas/vapor NEC,Bipolor I current NOS
Admission Date:  [**2160-6-20**]              Discharge Date:   [**2160-6-23**]

Date of Birth:  [**2112-4-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2159**]
Chief Complaint:
Shortness of Breath

Major Surgical or Invasive Procedure:
Intubation for two days in ICU


History of Present Illness:
48yoM with h/o bipolar d/o transferred from [**Hospital3 3583**] with
acute lung injury after "PermiDri" chemical inhalation.
Initially, pt was spraying chemical in enclosed camper, exposed
for about 20minutes. He came out of the camper complaining of
dizziness and diaphoresis, and 911 was called. He was taken to
[**Hospital3 3583**] where O2 sat 92% on non-rebreather. He was
intubated for hypoxemia and airway protection. Prior to this
incidenct he was well.
.


Past Medical History:
Bipolar disorder

Social History:
SHx: works as in telecommunication, lives with his wife
+tob use, 1PPD; no EtOH or illicits


Family History:
Uncle with MI, Grandmother with MI

Physical Exam:
T:99.1 BP:124-150/82-87 RR:18 O2sats:93%RA
I/O: foley d/c'd at 0200, DTV at 10:00AM
Gen: A/O, NAD
HEENT: NCAT, MMM, taking PO
CV: RRR, si, s2, no M/G/R
RESP: Slight crackles heard at R base.
ABD: soft, NT/ND, no masses
Ext: warm, well perfused, no edema, no rashes


Pertinent Results:
Labs on Admission:
.
[**2160-6-19**] 11:00PM   WBC-30.4* RBC-4.59* HGB-15.0 HCT-41.0 MCV-89
MCH-32.7* MCHC-36.6* RDW-13.1
[**2160-6-19**] 11:00PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2160-6-19**] 11:00PM   NEUTS-81* BANDS-6* LYMPHS-7* MONOS-6 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2160-6-19**] 11:00PM   PLT COUNT-277
[**2160-6-19**] 11:00PM   GLUCOSE-117* UREA N-14 CREAT-0.8 SODIUM-142
POTASSIUM-3.5 CHLORIDE-105 TOTAL CO2-26 ANION GAP-15
[**2160-6-19**] 11:39PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
.
ABGS:
.
[**2160-6-20**] 12:10AM BLOOD Type-ART Rates-14/ Tidal V-600 FiO2-100
pO2-276* pCO2-53* pH-7.32* calTCO2-29 Base XS-0 AADO2-401 REQ
O2-69 -ASSIST/CON Intubat-INTUBATED
[**2160-6-20**] 07:56PM BLOOD Type-ART pO2-169* pCO2-44 pH-7.39
calTCO2-28 Base XS-1
[**2160-6-21**] 02:20PM BLOOD Type-ART Temp-36.9 FiO2-40 pO2-104
pCO2-38 pH-7.41 calTCO2-25 Base XS-0 Intubat-NOT INTUBA
.
Blood Culutres: NGTD
Urine Culture: NG1
Sputum Grm Stain: [**2160-6-20**] 11:52 pm SPUTUM     Site:
ENDOTRACHEAL

   GRAM STAIN (Final [**2160-6-21**]):
      >25 PMNs and <10 epithelial cells/100X field.
      3+  (5-10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CHAINS.

   RESPIRATORY CULTURE (Preliminary):    SPARSE GROWTH
OROPHARYNGEAL FLORA.
.
Labs on discharge:
.
[**2160-6-23**] 05:25AM BLOOD WBC-18.3* RBC-4.47* Hgb-14.2 Hct-40.5
MCV-91 MCH-31.8 MCHC-35.0 RDW-12.9 Plt Ct-280
[**2160-6-23**] 05:25AM BLOOD Glucose-84 UreaN-12 Creat-0.8 Na-141
K-3.8 Cl-104 HCO3-26 AnGap-15
[**2160-6-22**] 05:30AM BLOOD Calcium-8.8 Phos-3.7 Mg-2.1


Brief Hospital Course:
The patient was admitted to the MICU. ICU Course: In the ICU,
the patient was started on the ARDS Net protocol (low TVs).
Steroids were given at outside hospital, but were not continued
once at [**Hospital1 18**]. The patient's Arterial blood [**Last Name (un) **] measurments
improved throughout the ventilator course (2days).  His Chest
X-ray showed mild pulm edema which improved throughout the ICU
stay. Pt was extubated successfully after passing spontaneous
breathing trial.  He was transfered to the floor.  His oxygen
saturation on the floor remained > 93% on RA while at rest and
while ambulating.

Blood culutres and uring cultures remained negative.  Sputum gm
stain showed g+ cocci in pairs and chains and preliminary
culutre showed mixed oropharyngeal flora growth. The patient
remained afebrile, and weas given Insentive spirometry while on
the floor.

The patient was discharged to home with a followup appointment
with his PCP for the day after discharge.  A CBC will be drawn
at that time to ensure that it is trending down.

Medications on Admission:
Lamotrigine 100mg 2 tablets po BID

Escitalopram 10mg one Tablet po Q day


Discharge Medications:
1. Lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Respiratory Failure [**12-27**] acute inhalational lung injury
.
Secondary:
Bipolar


Discharge Condition:
good


Discharge Instructions:
Please take all medications as prescribed.  Attend all follow pu
appointments.
If you experience further shortenss of breath, fever, chills, or
increased coughing report back to the emergency department.

Followup Instructions:
Please follow up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 69477**] on [**2160-6-24**] at
6:45 pm
It will be important to obtain a follow up CBC at or near the
time of your visit to document the trending down of your white
blood cell count.
{'Toxic effect of other specified gases, fumes, or vapors,Acute respiratory failure,Bronchitis and pneumonitis due to fumes and vapors,Accidental poisoning by other specified gases and vapors,Bipolar I disorder, most recent episode (or current) unspecified'}


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: Shortness of Breath

PRESENT ILLNESS: 48yoM with h/o bipolar d/o transferred from [**Hospital3 3583**] with
acute lung injury after "PermiDri" chemical inhalation.
Initially, pt was spraying chemical in enclosed camper, exposed
for about 20minutes. He came out of the camper complaining of
dizziness and diaphoresis, and 911 was called. He was taken to
[**Hospital3 3583**] where O2 sat 92% on non-rebreather. He was
intubated for hypoxemia and airway protection. Prior to this
incidenct he was well.
.

MEDICAL HISTORY: Bipolar disorder

MEDICATION ON ADMISSION: Lamotrigine 100mg 2 tablets po BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:99.1 BP:124-150/82-87 RR:18 O2sats:93%RA
I/O: foley d/c'd at 0200, DTV at 10:00AM
Gen: A/O, NAD
HEENT: NCAT, MMM, taking PO
CV: RRR, si, s2, no M/G/R
RESP: Slight crackles heard at R base.
ABD: soft, NT/ND, no masses
Ext: warm, well perfused, no edema, no rashes

FAMILY HISTORY: Uncle with MI, Grandmother with MI

SOCIAL HISTORY: SHx: works as in telecommunication, lives with his wife
+tob use, 1PPD; no EtOH or illicits 

### Response:
{'Toxic effect of other specified gases, fumes, or vapors,Acute respiratory failure,Bronchitis and pneumonitis due to fumes and vapors,Accidental poisoning by other specified gases and vapors,Bipolar I disorder, most recent episode (or current) unspecified'}
