CHIEF COMPLAINT: Respiratory distress.

PRESENT ILLNESS: 54 YO F with Hx of Asthma, COPD who is admitted with Respiratory
distress that required intubation. The following history was
obtained from her [**Last Name (un) 8317**].   2 days prior to admission, the
patient was supposed to go see a theatrical play. The patient
then developed a Fever of 102.5, Rhinorrhea, myalgias, chills.
Denies any cough or sputum.  This morning, the patient developed
worsening SOB, inability to walk down stairs this morning with
[**Last Name (un) 8317**] so went to ED by ambulance.
The patient has been around sick contacts at work. Pt recently
restarted smoking.  No Flu vaccine this year.
.
In ED, the pt was 102.9 and CXR did not show an infiltrate.  Pt
was intubated and received Levaquin, ativan and tylenol.

MEDICAL HISTORY: 1. Asthma.
2. ? COPD.

MEDICATION ON ADMISSION: 1. Albuterol
2. Advair

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 110  102/49  20  98% on Ventilator.  AC 600/12 60%.
Sedated, NAD
MMM, OP-clear, PERRL, ETT in place.
RR without m
Coarse BS but no wheezes
soft, NT, ND +BS
no C/C/E, warm, 2+ DP, no Rashes

FAMILY HISTORY: Not contributory.

SOCIAL HISTORY: She lives in [**Location (un) **]with [**Last Name (un) 8317**].
No EtOH, +recently restarted tobacco, no IVDU.
She works at [**Hospital1 2177**] as a Research Coordinator.
Acute respiratory failure,Chronic obstructive asthma with (acute) exacerbation,Urinary tract infection, site not specified,Influenza with other respiratory manifestations,Adenovirus infection in conditions classified elsewhere and of unspecified site,Dermatographic urticaria,Tobacco use disorder,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Anemia, unspecified
Acute respiratry failure,Ch obst asth w (ac) exac,Urin tract infection NOS,Flu w resp manifest NEC,Adenovirus infect NOS,Dermatographic urticaria,Tobacco use disorder,Pancreatic disorder NEC,Adv eff corticosteroids,Anemia NOS
Admission Date:  [**2123-3-2**]              Discharge Date:   [**2123-3-14**]

Date of Birth:  [**2069-8-15**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
Respiratory distress.

Major Surgical or Invasive Procedure:
Intubation
s/p intubation


History of Present Illness:
54 YO F with Hx of Asthma, COPD who is admitted with Respiratory
distress that required intubation. The following history was
obtained from her [**Last Name (un) 8317**].   2 days prior to admission, the
patient was supposed to go see a theatrical play. The patient
then developed a Fever of 102.5, Rhinorrhea, myalgias, chills.
Denies any cough or sputum.  This morning, the patient developed
worsening SOB, inability to walk down stairs this morning with
[**Last Name (un) 8317**] so went to ED by ambulance.
The patient has been around sick contacts at work. Pt recently
restarted smoking.  No Flu vaccine this year.
.
In ED, the pt was 102.9 and CXR did not show an infiltrate.  Pt
was intubated and received Levaquin, ativan and tylenol.

Past Medical History:
1. Asthma.
2. ? COPD.

Social History:
She lives in [**Location (un) **]with [**Last Name (un) 8317**].
No EtOH, +recently restarted tobacco, no IVDU.
She works at [**Hospital1 2177**] as a Research Coordinator.


Family History:
Not contributory.

Physical Exam:
110  102/49  20  98% on Ventilator.  AC 600/12 60%.
Sedated, NAD
MMM, OP-clear, PERRL, ETT in place.
RR without m
Coarse BS but no wheezes
soft, NT, ND +BS
no C/C/E, warm, 2+ DP, no Rashes

Pertinent Results:
Microbiology:
[**3-2**] Blood culture: no growth
[**3-2**] Urine culture: PROBABLE GARDNERELLA VAGINALIS.
10,000-100,000 ORGANISMS/ML.
[**3-2**] Rapid Respiratory Viral Screen & Culture:
Positive for Influenza A viral antigen.
.
Imaging:
[**3-2**] CXR:
Hyperinflated lungs.  No acute cardiopulmonary process.
.
Labs:
[**2123-3-2**] 08:13AM BLOOD WBC-5.6 RBC-4.95 Hgb-14.8 Hct-42.9 MCV-87
MCH-29.8 MCHC-34.4 RDW-13.3 Plt Ct-309
[**2123-3-13**] 06:00AM BLOOD WBC-11.4* RBC-3.67* Hgb-11.0* Hct-31.9*
MCV-87 MCH-30.0 MCHC-34.5 RDW-13.6 Plt Ct-297
[**2123-3-2**] 08:13AM BLOOD Neuts-78.7* Lymphs-14.7* Monos-4.6
Eos-1.6 Baso-0.5
[**2123-3-2**] 08:13AM BLOOD Plt Ct-309
[**2123-3-4**] 05:10AM BLOOD PT-11.9 PTT-28.5 INR(PT)-1.0
[**2123-3-11**] 05:22AM BLOOD PT-12.7 PTT-29.7 INR(PT)-1.1
[**2123-3-13**] 06:00AM BLOOD Plt Ct-297
[**2123-3-2**] 08:13AM BLOOD Glucose-113* UreaN-11 Creat-0.8 Na-143
K-3.9 Cl-107 HCO3-24 AnGap-16
[**2123-3-14**] 06:00AM BLOOD Glucose-93 UreaN-15 Creat-0.7 Na-140
K-3.7 Cl-105 HCO3-26 AnGap-13
[**2123-3-3**] 04:10AM BLOOD Calcium-8.2* Phos-3.2 Mg-2.1
[**2123-3-12**] 06:50AM BLOOD Calcium-8.9 Phos-4.4 Mg-2.0
[**2123-3-2**] 09:52AM BLOOD Type-ART pO2-95 pCO2-65* pH-7.17*
calHCO3-25 Base XS--5
[**2123-3-5**] 01:11PM BLOOD Type-[**Last Name (un) **] Temp-37.1 Rates-14/0 Tidal V-600
PEEP-5 FiO2-40 pO2-99 pCO2-42 pH-7.40 calHCO3-27 Base XS-0
Intubat-INTUBATED Vent-SPONTANEOU
[**2123-3-2**] 08:58AM BLOOD Lactate-1.9
[**2123-3-3**] 11:26AM BLOOD Glucose-136*
[**2123-3-4**] 10:27AM BLOOD O2 Sat-97
[**2123-3-4**] 01:18PM BLOOD O2 Sat-93

Brief Hospital Course:
54 yo woman with asthma who was admitted with respiratory
failure. The pt was diagnosed with influenza A and B,
parainfluenza 1,2,3 and adenovirus. She was intubated for
respiratory failure which was likely caused a severe COPD/asthma
exacerbation, compounded with severe viral infections. She
completed a course of Tamiflu. No evidence of an infectious
process was noted on CXR. She failed extubation twice, and did
well after being extubated. She was titrated down to room air
and maintained oxygen saturation in the 90s. She was started on
steroids and discharged on a tapering dose of steroids.
.
#. Respiratory Failure:
In the [**Name (NI) 153**], pt was extubated several hours after arrival.
Following extubation, pt became tachypneic with severe wheezes.
She received racemic epi and solumedrol but after no
improvement, she was reintubated. At this time, her
nasopharyngeal washes came back positive for influenza,
parainfluenza and adenovirus and she was started on Tamiflu.
Levaquin was discontinued, given low likelihood of pneumonia.
The following day, pt self extubated and was then reintubated
several hours later after she became tachypneic with diffuse
wheezes. Over the next few days, pt was transitioned from assist
control to pressure support. It was thought that she was failing
extubations secondary to laryngeal edema and she had a bedside
bronchoscopy. The bronchoscopy showed "near complete occlusion
of lingula, RLL, LLL with forced expiration due to mild
malacia." After no cuff leak was found, she was successfully
extubated on hospital day #9. Her solumedrol was slowly weaned.
She was called out to the floor on hopital day #10.  Her
steroids were tapered to prednisone and the frequency of her
nebs was decreased. She was transitioned to inhalers and her
steroids were tapered.  Her PFTs were obtained from her PCP and
showed an FEV1 of 70% and an FVC of 106% both of which did not
change with bronchodilators.  She was discharged with combivent
inhaler, advair and a rescue albuterol inhaler.  She was
recommended to see a Pulmonologist through her PCP. [**Name10 (NameIs) **] her
blood cultures came back negative.
.
# Hyperglycemia: Likely [**1-14**] steroids.  She was covered with an
insulin sliding scale.
.
# UTI: The pt's urine culture showed evidence of probable
Gardnerella Vaginalis (10,000-100,000 organisms/ml).
.
COde status: Full code.

Medications on Admission:
1. Albuterol
2. Advair

Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) puff Inhalation [**Hospital1 **] (2 times a day).
Disp:*qs inhaler* Refills:*0*
2. Prednisone 20 mg Tablet Sig: as directed Tablet PO DAILY
(Daily): Take:
40mg on [**4-15**], 20mg on [**4-17**].  Stop on [**3-20**].
Disp:*8 Tablet(s)* Refills:*0*
3. Combivent 103-18 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation [**Hospital1 **]-TID.
Disp:*2 inhalers* Refills:*0*
4. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation
every 4-6 hours as needed for shortness of breath or wheezing.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
1. Respiratory failure s/p intubation
2. Influenza
3. Parainfluenza, adenoviruses
4. Asthma/COPD exacerbation

Secondary Diagnosis:
1. Dermatographism


Discharge Condition:
good, satting in upper 90s on room air. Ambulating and taking
POs.


Discharge Instructions:
Please take all medications as prescribed.

Please go to all follow-up appointments.

Call your physician or go to the ER if you experience chest
pain, shortness of breath that does not improve with your
inhalers, problems breathing, fever >101.4, chills or any other
concern.

Followup Instructions:
We have called Dr.[**Name (NI) 34712**] office to schedule a follow-up
appointment.  They will call you on Monday to let you know whe
your appointment is.

You may want to see a pulmonologist for better control of your
asthma.  If you would like this, Dr. [**Last Name (STitle) **] can set this up.


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

Completed by:[**2123-3-15**]
{'Acute respiratory failure,Chronic obstructive asthma with (acute) exacerbation,Urinary tract infection, site not specified,Influenza with other respiratory manifestations,Adenovirus infection in conditions classified elsewhere and of unspecified site,Dermatographic urticaria,Tobacco use disorder,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Anemia, 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: Respiratory distress.

PRESENT ILLNESS: 54 YO F with Hx of Asthma, COPD who is admitted with Respiratory
distress that required intubation. The following history was
obtained from her [**Last Name (un) 8317**].   2 days prior to admission, the
patient was supposed to go see a theatrical play. The patient
then developed a Fever of 102.5, Rhinorrhea, myalgias, chills.
Denies any cough or sputum.  This morning, the patient developed
worsening SOB, inability to walk down stairs this morning with
[**Last Name (un) 8317**] so went to ED by ambulance.
The patient has been around sick contacts at work. Pt recently
restarted smoking.  No Flu vaccine this year.
.
In ED, the pt was 102.9 and CXR did not show an infiltrate.  Pt
was intubated and received Levaquin, ativan and tylenol.

MEDICAL HISTORY: 1. Asthma.
2. ? COPD.

MEDICATION ON ADMISSION: 1. Albuterol
2. Advair

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 110  102/49  20  98% on Ventilator.  AC 600/12 60%.
Sedated, NAD
MMM, OP-clear, PERRL, ETT in place.
RR without m
Coarse BS but no wheezes
soft, NT, ND +BS
no C/C/E, warm, 2+ DP, no Rashes

FAMILY HISTORY: Not contributory.

SOCIAL HISTORY: She lives in [**Location (un) **]with [**Last Name (un) 8317**].
No EtOH, +recently restarted tobacco, no IVDU.
She works at [**Hospital1 2177**] as a Research Coordinator. 

### Response:
{'Acute respiratory failure,Chronic obstructive asthma with (acute) exacerbation,Urinary tract infection, site not specified,Influenza with other respiratory manifestations,Adenovirus infection in conditions classified elsewhere and of unspecified site,Dermatographic urticaria,Tobacco use disorder,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Anemia, unspecified'}
