CHIEF COMPLAINT: Hypoxemic respiratory distress

PRESENT ILLNESS: Mrs. [**Known lastname 82433**] is a 57 year old female with a past medical history
significant asthma, HTN, and a recent admission to the [**Hospital Unit Name 196**]
service for hypertensive urgency and shortness of breath now
admitted to the MICU for dyspnea on CPAP. The patient was
initially admitted to [**Hospital Unit Name 196**] from [**Date range (1) 82616**] after presenting to
her PCP for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 82617**] cough and worsening shortness of
breath with a BP 200/100.  At that time, ECG demonstrate TWI in
the precordial leads. He was ruled out for ACS and felt to have
hypertension and a reactive airways disease component that led
to her wheezing.  She presented to [**Company 191**] on [**1-29**] for follow-up,
and at that time had a clear lung exam but noted chronic 2
pillow orthopnea. This morning, the patient reports that she
awoke with shortness of breath, subjective fevers, wheeze,
productive cough of white/yellowish sputum, and fatigue. She
denies any CP, palpitations, abdominal pain, diarrhea, sick
contacts, or recent travel.  Per EMS, the patient received a
combivent neb without benefit and was placed on CPAP.
.
In the [**Hospital1 18**] ED, initial VS 97.5 90 116/113 30 100%CPAP 40%. She
received 4 gram magnesium, 125 mg solumedrol, combiven nebs,
vancomycin 1 gram, and levofloxacin 750. She was continued on
CPAP with an FiO2 0.4 with an ABG demonstrating 7.39/44/100.
She was then admitted to the MICU for further management.
.
Currently, the patient is complaining of dyspnea and subjectve
fevers.

MEDICAL HISTORY: - Hypertension
- Asthma: Patient has been on albuterol for the past year. She
states that her breathing is particularly bad while cooking at a
Thai restaurant with hot oil.

MEDICATION ON ADMISSION: Albuterol MDI
Flovent MDI
HCTZ 25 daily
Lisinopril 40 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION:
VS: 96.9 74 124/69 27 94%4L nc
Gen: Mild respiratory distress
HEENT: PERRL, sclerae anicteric.  MM dry, OP clear without
lesions, exudate, or erythema. Neck supple.
CV: Nl S1+S2
Pulm: Bilateral expiratory wheezes, worst at the right bse.
Abd: S/NT/ND +bs
Ext: No c/c/e.
Neuro: AOx3, CN II-XII intact.
.
On transition to the floor:
VS: 97.2 HR 95 with frequemnt bigeminyon monitor 166/88 RR 20
sO2 98% on 2L O2
Gen: Settled
HEENT: PERRL, sclerae anicteric. MM moist, OP clear without
lesions, exudate, or erythema. Neck supple.
CV: Nl S1+S2 with some ectopcs and bigeminy at which point pulse
drops to 44/min SR JVP not elevated
Pulm: Bilateral mild scattered wheeze and harsh BS right base
Abd: S/NT/ND +bs
Ext: No c/c/e. Calves SNT.
Neuro: AOx3, CN II-XII normal. No focal deficits with normal
tone, power, reflexes and coordination( only tested in UE) and
plantars flexor bilat.

FAMILY HISTORY: Mother hypertension in her 80s. Father died of hypertension
around 61 and complications of it unclear although, younger
brother also has had high blood pressure. No family history of
early MI, arrhythmia, cardiomyopathies, or sudden cardiac death;
otherwise non-contributory.

SOCIAL HISTORY: She was living in [**Country 3396**] until [**2125**]. Her husband was
travelling in [**Country 3396**], they met there, got married, and she him
followed here, moved here in [**2125**]. She currently works in a Thai
restaurant, does not smoke. No alcohol use. She has a son who is
28, but he still lives in [**Country 3396**] and lives with her husband.
[**Name (NI) **] pets including birds.
Asthma, unspecified type, with (acute) exacerbation,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure, unspecified,Influenza with other respiratory manifestations,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Other chronic pulmonary heart diseases
Asthma NOS w (ac) exac,Other pulmonary insuff,Acute kidney failure NOS,Flu w resp manifest NEC,Hypertension NOS,Cardiac dysrhythmias NEC,Chr pulmon heart dis NEC
Admission Date:  [**2131-2-1**]              Discharge Date:   [**2131-2-5**]

Date of Birth:  [**2073-3-23**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Doctor First Name 2080**]
Chief Complaint:
Hypoxemic respiratory distress

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mrs. [**Known lastname 82433**] is a 57 year old female with a past medical history
significant asthma, HTN, and a recent admission to the [**Hospital Unit Name 196**]
service for hypertensive urgency and shortness of breath now
admitted to the MICU for dyspnea on CPAP. The patient was
initially admitted to [**Hospital Unit Name 196**] from [**Date range (1) 82616**] after presenting to
her PCP for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 82617**] cough and worsening shortness of
breath with a BP 200/100.  At that time, ECG demonstrate TWI in
the precordial leads. He was ruled out for ACS and felt to have
hypertension and a reactive airways disease component that led
to her wheezing.  She presented to [**Company 191**] on [**1-29**] for follow-up,
and at that time had a clear lung exam but noted chronic 2
pillow orthopnea. This morning, the patient reports that she
awoke with shortness of breath, subjective fevers, wheeze,
productive cough of white/yellowish sputum, and fatigue. She
denies any CP, palpitations, abdominal pain, diarrhea, sick
contacts, or recent travel.  Per EMS, the patient received a
combivent neb without benefit and was placed on CPAP.
.
In the [**Hospital1 18**] ED, initial VS 97.5 90 116/113 30 100%CPAP 40%. She
received 4 gram magnesium, 125 mg solumedrol, combiven nebs,
vancomycin 1 gram, and levofloxacin 750. She was continued on
CPAP with an FiO2 0.4 with an ABG demonstrating 7.39/44/100.
She was then admitted to the MICU for further management.
.
Currently, the patient is complaining of dyspnea and subjectve
fevers.


Past Medical History:
- Hypertension
- Asthma: Patient has been on albuterol for the past year. She
states that her breathing is particularly bad while cooking at a
Thai restaurant with hot oil.


Social History:
She was living in [**Country 3396**] until [**2125**]. Her husband was
travelling in [**Country 3396**], they met there, got married, and she him
followed here, moved here in [**2125**]. She currently works in a Thai
restaurant, does not smoke. No alcohol use. She has a son who is
28, but he still lives in [**Country 3396**] and lives with her husband.
[**Name (NI) **] pets including birds.


Family History:
Mother hypertension in her 80s. Father died of hypertension
around 61 and complications of it unclear although, younger
brother also has had high blood pressure. No family history of
early MI, arrhythmia, cardiomyopathies, or sudden cardiac death;
otherwise non-contributory.


Physical Exam:
ADMISSION:
VS: 96.9 74 124/69 27 94%4L nc
Gen: Mild respiratory distress
HEENT: PERRL, sclerae anicteric.  MM dry, OP clear without
lesions, exudate, or erythema. Neck supple.
CV: Nl S1+S2
Pulm: Bilateral expiratory wheezes, worst at the right bse.
Abd: S/NT/ND +bs
Ext: No c/c/e.
Neuro: AOx3, CN II-XII intact.
.
On transition to the floor:
VS: 97.2 HR 95 with frequemnt bigeminyon monitor 166/88 RR 20
sO2 98% on 2L O2
Gen: Settled
HEENT: PERRL, sclerae anicteric. MM moist, OP clear without
lesions, exudate, or erythema. Neck supple.
CV: Nl S1+S2 with some ectopcs and bigeminy at which point pulse
drops to 44/min SR JVP not elevated
Pulm: Bilateral mild scattered wheeze and harsh BS right base
Abd: S/NT/ND +bs
Ext: No c/c/e. Calves SNT.
Neuro: AOx3, CN II-XII normal. No focal deficits with normal
tone, power, reflexes and coordination( only tested in UE) and
plantars flexor bilat.


Pertinent Results:
ECG: Sinus with 1:1 conduction. Abnormal P waves, although may
be artifact. Incomplete RBBB. Unchanged compared to [**1-26**].

Admission labs:
[**2131-2-1**] 08:50PM BLOOD WBC-14.1* RBC-5.50* Hgb-14.0 Hct-41.9
MCV-76* MCH-25.4* MCHC-33.4 RDW-13.0 Plt Ct-336
[**2131-2-1**] 08:50PM BLOOD PT-13.2 PTT-28.6 INR(PT)-1.1
[**2131-2-1**] 08:50PM BLOOD Glucose-315* UreaN-15 Creat-1.2* Na-133
K-4.1 Cl-93* HCO3-26 AnGap-18
[**2131-2-1**] 08:50PM BLOOD ALT-27 AST-30 LD(LDH)-260* CK(CPK)-200
AlkPhos-94 TotBili-0.6
[**2131-2-1**] 08:50PM BLOOD Calcium-9.0 Phos-7.0* Mg-2.0
.
Other labs:
[**2131-2-1**] 08:50PM BLOOD CK-MB-3 cTropnT-<0.01 proBNP-642*
[**2131-2-1**] 11:51PM BLOOD D-Dimer-671*
[**2131-2-2**] 06:14AM BLOOD TSH-0.20*
[**2131-2-2**] 06:14AM BLOOD Free T4-1.2
.
ABG:
[**2131-2-1**] 09:42PM BLOOD Type-ART FiO2-40 pO2-100 pCO2-44 pH-7.39
calTCO2-28 Base XS-0 Intubat-NOT INTUBA
.
Discharge labs:
[**2131-2-5**] 07:30AM BLOOD WBC-14.9* RBC-5.30 Hgb-13.6 Hct-39.1
MCV-74* MCH-25.7* MCHC-34.8 RDW-13.2 Plt Ct-301
[**2131-2-5**] 07:30AM BLOOD Glucose-96 UreaN-16 Creat-0.8 Na-139
K-3.3 Cl-97 HCO3-34* AnGap-11
[**2131-2-5**] 07:30AM BLOOD Calcium-9.5 Phos-3.7 Mg-2.0
.
.
Urine
[**2131-2-5**] 07:30AM BLOOD Calcium-9.5 Phos-3.7 Mg-2.0
[**2131-2-2**] 04:24AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.011
[**2131-2-2**] 04:24AM URINE Blood-TR Nitrite-NEG Protein-30
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG
[**2131-2-2**] 04:24AM URINE RBC-3* WBC-12* Bacteri-FEW Yeast-NONE
Epi-1 TransE-<1
[**2131-2-2**] 04:24AM URINE CastHy-15*
[**2131-2-2**] 04:24AM URINE Mucous-RARE
[**2131-2-2**] 04:24AM URINE Eos-NEGATIVE
[**2131-2-2**] 04:24AM URINE Hours-RANDOM Creat-53 Na-127 K-64 Cl-147
[**2131-2-2**] 04:24AM URINE Osmolal-511
.
.
Microbiology:
[**2131-2-2**] 12:25 pm SPUTUM      Source: Expectorated.

                            **FINAL REPORT [**2131-2-2**]**

   GRAM STAIN (Final [**2131-2-2**]):
      <10 PMNs and >10 epithelial cells/100X field.
      Gram stain indicates extensive contamination with upper
respiratory
      secretions.
.
[**2131-2-2**] 12:36 am Influenza A/B by DFA
      Source: Nasopharyngeal swab.

                            **FINAL REPORT [**2131-2-2**]**

   DIRECT INFLUENZA A ANTIGEN TEST (Final [**2131-2-2**]):
      REPORTED BY PHONE TO [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 82618**] 11:55AM [**2131-2-2**].
      POSITIVE FOR INFLUENZA A VIRAL ANTIGEN.

   DIRECT INFLUENZA B ANTIGEN TEST (Final [**2131-2-2**]):
      Negative for Influenza B.
[**2131-2-2**]	URINE	Legionella Urinary Antigen - Negative
[**2131-2-2**]	URINE	URINE CULTURE No growth
[**2131-2-1**]	BLOOD CULTURE	Blood Culture, No growth at
time of writing
[**2131-2-1**]	BLOOD CULTURE	Blood Culture, No growth at
time of writing
.
.
Radiology:
CHEST (PORTABLE AP)	Study Date of [**2131-2-2**] 4:39 AM
Portable AP chest radiograph was compared to [**2-1**].

Cardiomediastinal silhouette is stable. The lungs are
essentially clear.
There is no appreciable pleural effusion or pneumothorax noted.
There is
prominence of the hila bilaterally which might potentially
represent large
pulmonary arteries, and hypertension as a result might be
considered.
.
TRAUMA #3 (PORT CHEST ONLY)	Study Date of [**2131-2-1**] 8:55 PM
FINDINGS: AP upright portable view of the chest was obtained.
Subtle
increased opacity projecting over the right lower lobe could
relate to
aspiration or early infectious process. Consider dedicated PA
and lateral
views when patient able for further evaluation. The left lung is
clear. No
pleural effusion or pneumothorax is seen. The cardiac and
mediastinal
silhouettes are unremarkable. Calcification is noted at the
aortic knob. No
overt pulmonary edema is seen.

IMPRESSION: Subtle increase in opacity projecting over the right
lower lobe,
underlying mild infectious process or aspiration cannot be
entirely excluded
in the appropriate clinical setting. Suggest dedicated PA and
lateral views
if patient able.
.
.
Cardiology:
ECG	Study Date of [**2131-2-1**]  9:00:24 PM

Normal sinus rhythm with right bundle-branch block. Non-specific
ST-T wave
abnormalities. Compared to the previous tracing of [**2131-1-27**].
TRACING #1

Read by:	[**Last Name (LF) **],[**First Name8 (NamePattern2) 2206**] [**Doctor Last Name **]
 	Intervals	Axes
Rate	PR	QRS	QT/QTc	P	QRS	T
84	166	114	404/446	19	80	29
.
Portable TTE (Complete) Done [**2131-2-2**] at 12:33:55 PM
Conclusions
The left atrium is normal in size. The estimated right atrial
pressure is 0-5 mmHg. There is mild symmetric left ventricular
hypertrophy with normal cavity size and regional/global systolic
function (LVEF>55%). The estimated cardiac index is normal
(>=2.5L/min/m2). Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets (?#) appear
structurally normal with good leaflet excursion. There is no
aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. No mass or vegetation is seen on the mitral
valve. Mild (1+) mitral regurgitation is seen. There is mild
pulmonary artery systolic hypertension. There is a
trivial/physiologic pericardial effusion.

IMPRESSION: Suboptimal image quality. Mild symmetric left
ventricular hypertrophy with preserved global and regional
biventricular systolic function. Mild mitral regurgitation.
Pulmonary artery systolic hypertension.
.
ECG	Study Date of [**2131-2-2**]  8:20:40 AM

Normal sinus rhythm with right bundle-branch block. Marked T
wave inversions in
leads I, aVL and V4-V6 suggest anterolateral myocardial ischemia
which is new
when compared to tracing #1. Clinical correlation is suggested.
TRACING #2

Read by:	[**Last Name (LF) **],[**First Name8 (NamePattern2) 2206**] [**Doctor Last Name **]
 	Intervals	Axes
Rate	PR	QRS	QT/QTc	P	QRS	T
81	180	126	428/464	79	77	-135

Brief Hospital Course:
57 year old female with a past medical history significant
asthma, HTN, and a recent admission to the [**Hospital Unit Name 196**] service for
hypertensive urgency and shortness of breath was admitted to the
MICU for dyspnea on CPAP which was quickly weaned. Patient was
foud to be influenza A positive and stsrted on Oseltamivir and
treated for reactive airways. Frequent bigeminy in the ICU.
Patient was transitioned to the floor and discharged with PCP
and pulmonology [**Name9 (PRE) 702**] on [**2131-2-5**].
.
.
# Hypoxemic respiratory distress/Influenza A: Likely secondary
to influenza infection superimposed on chronic asthma. Patient
admitted following SOB, wheeze and cough and was treated with
NIV by EMS. Continued CPAP in the ED and received IV Magnesium,
IV methylprednisolone, nebs and IV vancomycin and levofloxacin.
ABG on FiO2 demonstrated A-a gradient of 130. Patient was
transferred to the MICU for continued treatment and monitoring.
She initially continued treatment with NIPPV and was weaned to
nasal cannula. When DFA returned positive for influenza A she
was commenced on a 5 day course of oseltamavir and antibiotics
were discontinued. She also had an echo on [**2-2**] which showed
preserved biventricular function mild MR and pulmonary
hypertension. She was transitioned to the floor and weaned to
room air. She was feeling well and no longer wheezy and
discharged on Advair and  po prednisone with a tapered dose.
Ambulatory sats 96% on RA. She was discharged on [**2131-2-5**] with
outpatient pulmonology follow-up scheduled for [**2131-2-15**]. PCP
[**Name9 (PRE) 702**] on [**2131-2-8**].

# Acute kidney injury: Likely pre-renal with Cr 1.2 on admission
and  0.8 on discharge. Resolved after IVF challenge on
admission.
.
# Leukocytosis: Suggestive of inflammatory component in setting
of Influenza, with persistsent leukocytosis likely in setting of
systemic corticosteroids. She had no fever or other signs of
systemic illness and downtrended to 14.9 on discharge.
.
# Bigeminy: Patient was frequently in bigeminy in ICU and
clinically on the [**Hospital1 **] with pulse dropping to 40s and preserved
BP. This should be monitored by her PCP.
.
# HTN: Patient had a recent admission to the cardiology service
with hypertensive urgency. Initially anti-hypertensives were
held on admission, but restarted after patient stabilized. She
was latterly hypertensive and amlodipine was added to her
regimen. BP should be monitored on the community.


Medications on Admission:
Albuterol MDI
Flovent MDI
HCTZ 25 daily
Lisinopril 40 mg daily


Discharge Medications:
1. oseltamivir 75 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 3 doses.
Disp:*3 Capsule(s)* Refills:*0*
2. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 Disk with Device(s)* Refills:*2*
3. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. prednisone 10 mg Tablet Sig: Four (4) Tablet PO once a day
for 2 days: Take on [**2131-2-6**] and [**2131-2-7**] then to start lower
dose on [**2131-2-8**].
Disp:*8 Tablet(s)* Refills:*0*
5. prednisone 10 mg Tablet Sig: Two (2) Tablet PO once a day for
2 days: To take on [**2131-2-8**] and [**2131-2-9**] then to take lower
dos eon [**2131-2-10**].
Disp:*4 Tablet(s)* Refills:*0*
6. prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day for
2 days: To start on [**2131-2-10**] and take on [**2-10**] and [**2131-2-11**]
then to stop.
Disp:*2 Tablet(s)* Refills:*0*
7. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
9. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours) as needed for sob or
wheeze.


Discharge Disposition:
Home

Discharge Diagnosis:
Influenza A infection
Asthma exacerbation


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


Discharge Instructions:
Mrs. [**Known lastname 82433**],

It was a pleasure taking care of you during your stay at the
[**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **]. You presented to the
Emergency Department with increasing shortness of breath and
wheeze and initially required use of a breathing machine called
Non-Invasive ventilation (or CPAP) to help with your breathing.
You were initially admitted to the Intensive Care Unit to
continue use of this machine. You also required some oxygen and
this was decreased as you tolerated it. A test showed that you
had the flu (called Influenza A) and the reason why you were so
unwell is likely because the flu worsened your asthma. To treat
the flu we started Tamiflu (Osetamivir) which reduced the time
that you will have symptom sof the flu. To better treat your
asthma we started a new medication called Advair in place of
your Flovent. In addition, we started another medication to
decrease the airway inflammation, called prednisone (a steroid
tablet which reduced the inflammation that makes astham worse).
You felt better and were transferred to the [**Hospital1 **] and were
stable. Your blood pressure was also high and we added a new
blood pressure medication called amlodipine. You had an
ultrasound of your heart called an echocardiogram which was not
concerning. You improved and on discharge felt back to your
normal. We have organised for you to see your PCP [**Last Name (NamePattern4) **] [**2131-2-8**]
and in addition have organised an appointment to see the lung
doctors [**Last Name (NamePattern4) **] [**2131-2-15**].
.
After discharge please wear the mask provided at discharge when
in public or near other people for the next 48 hours.
.
Changes to medications:
We STOPPED flovent
We STARTED Advair to better treat your asthma
We STARTED amlodipine 5mg daily to treat your high blood
pressure
We STARTED Oseltamivir which you should continue for 1 more day
We STARTED Prednisone which you should take as a reducing dose
as prescribed starting at 40mg tomorrow for 2 days, then 20mg
for 2 days, then 10mg for 2 days then to stop
.
Please attend your out-patient appointments

Followup Instructions:
Department: [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 250**]
When: THURSDAY [**2131-2-8**] at 2:00 PM
With: Dr [**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 1520**] MD
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
This appointment is with a hospital-based doctor as part of your
transition from the hospital back to your primary care provider.
 [**Name10 (NameIs) 616**] this visit, you will see your              regular
primary care doctor in follow up.

Department: PULMONARY FUNCTION LAB
When: THURSDAY [**2131-2-15**] at 3:40 PM
With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: MEDICAL SPECIALTIES
When: THURSDAY [**2131-2-15**] at 4:00 PM
With: DR. [**Last Name (STitle) 4013**]/DR. [**Last Name (STitle) **] [**Telephone/Fax (1) 612**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Asthma, unspecified type, with (acute) exacerbation,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure, unspecified,Influenza with other respiratory manifestations,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Other chronic pulmonary heart diseases'}


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: Hypoxemic respiratory distress

PRESENT ILLNESS: Mrs. [**Known lastname 82433**] is a 57 year old female with a past medical history
significant asthma, HTN, and a recent admission to the [**Hospital Unit Name 196**]
service for hypertensive urgency and shortness of breath now
admitted to the MICU for dyspnea on CPAP. The patient was
initially admitted to [**Hospital Unit Name 196**] from [**Date range (1) 82616**] after presenting to
her PCP for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 82617**] cough and worsening shortness of
breath with a BP 200/100.  At that time, ECG demonstrate TWI in
the precordial leads. He was ruled out for ACS and felt to have
hypertension and a reactive airways disease component that led
to her wheezing.  She presented to [**Company 191**] on [**1-29**] for follow-up,
and at that time had a clear lung exam but noted chronic 2
pillow orthopnea. This morning, the patient reports that she
awoke with shortness of breath, subjective fevers, wheeze,
productive cough of white/yellowish sputum, and fatigue. She
denies any CP, palpitations, abdominal pain, diarrhea, sick
contacts, or recent travel.  Per EMS, the patient received a
combivent neb without benefit and was placed on CPAP.
.
In the [**Hospital1 18**] ED, initial VS 97.5 90 116/113 30 100%CPAP 40%. She
received 4 gram magnesium, 125 mg solumedrol, combiven nebs,
vancomycin 1 gram, and levofloxacin 750. She was continued on
CPAP with an FiO2 0.4 with an ABG demonstrating 7.39/44/100.
She was then admitted to the MICU for further management.
.
Currently, the patient is complaining of dyspnea and subjectve
fevers.

MEDICAL HISTORY: - Hypertension
- Asthma: Patient has been on albuterol for the past year. She
states that her breathing is particularly bad while cooking at a
Thai restaurant with hot oil.

MEDICATION ON ADMISSION: Albuterol MDI
Flovent MDI
HCTZ 25 daily
Lisinopril 40 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION:
VS: 96.9 74 124/69 27 94%4L nc
Gen: Mild respiratory distress
HEENT: PERRL, sclerae anicteric.  MM dry, OP clear without
lesions, exudate, or erythema. Neck supple.
CV: Nl S1+S2
Pulm: Bilateral expiratory wheezes, worst at the right bse.
Abd: S/NT/ND +bs
Ext: No c/c/e.
Neuro: AOx3, CN II-XII intact.
.
On transition to the floor:
VS: 97.2 HR 95 with frequemnt bigeminyon monitor 166/88 RR 20
sO2 98% on 2L O2
Gen: Settled
HEENT: PERRL, sclerae anicteric. MM moist, OP clear without
lesions, exudate, or erythema. Neck supple.
CV: Nl S1+S2 with some ectopcs and bigeminy at which point pulse
drops to 44/min SR JVP not elevated
Pulm: Bilateral mild scattered wheeze and harsh BS right base
Abd: S/NT/ND +bs
Ext: No c/c/e. Calves SNT.
Neuro: AOx3, CN II-XII normal. No focal deficits with normal
tone, power, reflexes and coordination( only tested in UE) and
plantars flexor bilat.

FAMILY HISTORY: Mother hypertension in her 80s. Father died of hypertension
around 61 and complications of it unclear although, younger
brother also has had high blood pressure. No family history of
early MI, arrhythmia, cardiomyopathies, or sudden cardiac death;
otherwise non-contributory.

SOCIAL HISTORY: She was living in [**Country 3396**] until [**2125**]. Her husband was
travelling in [**Country 3396**], they met there, got married, and she him
followed here, moved here in [**2125**]. She currently works in a Thai
restaurant, does not smoke. No alcohol use. She has a son who is
28, but he still lives in [**Country 3396**] and lives with her husband.
[**Name (NI) **] pets including birds. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure, unspecified,Influenza with other respiratory manifestations,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Other chronic pulmonary heart diseases'}
