CHIEF COMPLAINT: respiratory distress

PRESENT ILLNESS: 51 yo woman h/o T1-T2 paraplegia following MVC [**1-4**], chronic
obstructive pulmonary disease and recent admission [**Date range (1) 49732**] for
COPD exacerbation (t/w rapid prednisone taper and 7-day course
of levofloxacin) who is admitted to the ICU for respiratory
distress and hypotension. History was taken from patient and her
friend [**Name (NI) **], who was present during the majority of the
interview.
.
Per patient, she was in her USOH until morning of admission.
When she awoke she felt "foggy" mentally, and she was coughing
up large amounts of clear sputum. She came to the ED where her
inital vitals were remarkable for hypotension to 90/60,
afebrile, with HR 55. She required non-rebreather to maintain
sats in the 90s. CXR was done which showed RLL pneumonia. Due to
the fact that she had difficult access and was hypotensive, a
right IJ was placed. She was given vancomycin, ceftriaxone and
levofloxacin, and she was started on norepinephrine drip. Prior
to transfer to MICU, she had received about 2L IVF.
.
By the time she arrived to the MICU, she felt much better from a
respiratory standpoint. She denied chest pain or pressure,
lightheadedness, dizziness, headache, nausea or vomiting. She
denied abdominal pain, diarrhea, dysuria or hematuria. She
denied joint pain, fever, or chills. Per patient and friend, her
mental status overall was much improved.
.
REVIEW OF SYSTEMS: as per HPI above.

MEDICAL HISTORY: - T1-T2 paraplegia following MVC [**1-4**]
- Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
- HCV, viral load suppressed
- H/o recurrent PNAs: MRSA, pan-sensitive Kleb
- Anxiety
- DVT in [**2142**] -IVC filter placed in [**2142**]
- Pulmonary nodules
- Hypothyroidism
- Chronic pain
- Chronic gastritis
- H/o obstructive lung disease
- Anemia of chronic disease
- S/p PEA arrest during last hospitalization in [**2147-10-3**]

MEDICATION ON ADMISSION: - albuterol nebs q4-6h prn
- baclofen 10 mg up to 5 tabs daily
- citalopram 40 mg daily
- clonazepam 1 mg ([**2-3**] at night for insomnia)
- Combivent 2 puffs tid
- levothyroxine 75 mcg qday
- lidocaine patch qday
- methadone 5 mg tid
- omeprazole 20 mg [**Hospital1 **]
- oxybutynin 5 mg up to five tabs daily
- oxycodone 5 mg tid prn
- pregabalin 150 mg tid
- sucralfate 1 g qid
- trazodone 200 mg qhs
- calcium carbonate 500 mg [**Hospital1 **]
- loratadine 10 mg daily prn
- nicotine patch 21 mg daily
- polyethylene glycol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 95.7, HR 72, BP 100/66, RR 17-24, sat 100% on venti mask 50%
Total in: 4L
Total out: 1L urine output
General: awake, alert and oriented x3, no distress. Attention
normal.
Lungs: diffuse expiratory wheezes and coarse inspiratory sounds
anterior fields.
Heart: RRR, normal s1/s2, no murmurs
[**Last Name (un) **]: soft, non-tender
Extremities: trace PE to ankles, warm and well-perfused

FAMILY HISTORY: Family History:
- No history of lung disease
.

SOCIAL HISTORY: Social History:
- Lives at home wiht her husband and 2 adolescent children
- Tobacco: 35 pack years, no longer smoking
- etOH: Denies
- Illicits: Denies
.
Pneumonia, organism unspecified,Paraplegia,Chronic obstructive asthma, unspecified,Hypotension, unspecified,Chronic hepatitis C without mention of hepatic coma,Late effect of spinal cord injury,Late effects of motor vehicle accident,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Other chronic pain,Other specified anemias,Other diseases of lung, not elsewhere classified,Anxiety state, unspecified,Tobacco use disorder,Personal history, urinary (tract) infection,Personal history of venous thrombosis and embolism
Pneumonia, organism NOS,Paraplegia NOS,Chronic obst asthma NOS,Hypotension NOS,Chrnc hpt C wo hpat coma,Late eff spinal cord inj,Late eff motor vehic acc,Hypothyroidism NOS,Atrph gastrtis w/o hmrhg,Chronic pain NEC,Anemia NEC,Other lung disease NEC,Anxiety state NOS,Tobacco use disorder,Personal history UTI,Hx-ven thrombosis/embols
Admission Date:  [**2148-5-29**]              Discharge Date:   [**2148-5-31**]

Date of Birth:  [**2096-10-22**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3151**]
Chief Complaint:
respiratory distress

Major Surgical or Invasive Procedure:
none

History of Present Illness:
51 yo woman h/o T1-T2 paraplegia following MVC [**1-4**], chronic
obstructive pulmonary disease and recent admission [**Date range (1) 49732**] for
COPD exacerbation (t/w rapid prednisone taper and 7-day course
of levofloxacin) who is admitted to the ICU for respiratory
distress and hypotension. History was taken from patient and her
friend [**Name (NI) **], who was present during the majority of the
interview.
.
Per patient, she was in her USOH until morning of admission.
When she awoke she felt "foggy" mentally, and she was coughing
up large amounts of clear sputum. She came to the ED where her
inital vitals were remarkable for hypotension to 90/60,
afebrile, with HR 55. She required non-rebreather to maintain
sats in the 90s. CXR was done which showed RLL pneumonia. Due to
the fact that she had difficult access and was hypotensive, a
right IJ was placed. She was given vancomycin, ceftriaxone and
levofloxacin, and she was started on norepinephrine drip. Prior
to transfer to MICU, she had received about 2L IVF.
.
By the time she arrived to the MICU, she felt much better from a
respiratory standpoint. She denied chest pain or pressure,
lightheadedness, dizziness, headache, nausea or vomiting. She
denied abdominal pain, diarrhea, dysuria or hematuria. She
denied joint pain, fever, or chills. Per patient and friend, her
mental status overall was much improved.
.
REVIEW OF SYSTEMS: as per HPI above.


Past Medical History:
- T1-T2 paraplegia following MVC [**1-4**]
- Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
- HCV, viral load suppressed
- H/o recurrent PNAs: MRSA, pan-sensitive Kleb
- Anxiety
- DVT in [**2142**] -IVC filter placed in [**2142**]
- Pulmonary nodules
- Hypothyroidism
- Chronic pain
- Chronic gastritis
- H/o obstructive lung disease
- Anemia of chronic disease
- S/p PEA arrest during last hospitalization in [**2147-10-3**]


Social History:
Social History:
- Lives at home wiht her husband and 2 adolescent children
- Tobacco: 35 pack years, no longer smoking
- etOH: Denies
- Illicits: Denies
.


Family History:
Family History:
- No history of lung disease
.


Physical Exam:
T 95.7, HR 72, BP 100/66, RR 17-24, sat 100% on venti mask 50%
Total in: 4L
Total out: 1L urine output
General: awake, alert and oriented x3, no distress. Attention
normal.
Lungs: diffuse expiratory wheezes and coarse inspiratory sounds
anterior fields.
Heart: RRR, normal s1/s2, no murmurs
[**Last Name (un) **]: soft, non-tender
Extremities: trace PE to ankles, warm and well-perfused


Pertinent Results:
[**2148-5-29**] 07:30PM BLOOD WBC-6.1 RBC-3.31* Hgb-9.2* Hct-28.7*
MCV-87 MCH-27.7 MCHC-31.9 RDW-15.1 Plt Ct-157
[**2148-5-30**] 05:31AM BLOOD WBC-4.9 RBC-2.94* Hgb-8.4* Hct-26.1*
MCV-89 MCH-28.6 MCHC-32.2 RDW-14.9 Plt Ct-113*
[**2148-5-29**] 07:30PM BLOOD Neuts-65.3 Lymphs-26.6 Monos-3.1 Eos-4.3*
Baso-0.7
[**2148-5-30**] 05:31AM BLOOD Plt Ct-113*
[**2148-5-30**] 05:31AM BLOOD PT-13.2 PTT-31.8 INR(PT)-1.1
[**2148-5-30**] 05:31AM BLOOD Glucose-97 UreaN-8 Creat-0.2* Na-144
K-3.9 Cl-111* HCO3-30 AnGap-7*
[**2148-5-29**] 07:30PM BLOOD Glucose-100 UreaN-8 Creat-0.3* Na-141
K-4.0 Cl-100 HCO3-35* AnGap-10
[**2148-5-30**] 05:31AM BLOOD proBNP-852*
[**2148-5-30**] 05:31AM BLOOD Calcium-7.8* Phos-3.2 Mg-1.6
[**2148-5-29**] 09:27PM BLOOD Lactate-0.5
.
Wed [**5-29**]: IMPRESSION:
1. Increased right base opacity with blunting of the right
costophrenic angle may represent a combination of pleural fluid
and right lower lobe pneumonia.  Patchy lateral left lung
opacity may reflect atelectasis. 2. Persistently enlarged
cardiac silhouette could be due to cardiomyopathy and/or
pericardial effusion.



Brief Hospital Course:
51 yo F with COPD, h/o recurrent pneumonias, presents with
respiratory distress, hypoxia, hypotension, and altered mental
status in setting of likely RLL pneumonia
.
# Respiratory distress - differential includes pneumonia vs
bronchitis/bronchospasm. Rapid improvement after nebs in the
emergency room would be more consistent with the latter.
Patient initially admitted to ICU given hypotension.  Was
transiently on a norepinephrine drip, but was quickly weaned
off.  Received IV vanc, ceftriaxone, and levofloxacin in the ICU
but was transitioned to just PO levafloxacin on call out to the
floor.  Patient tested negative for Legionella.  Anxiety also
likely played a large part in her shortness of breath as she
went up in her O2 requirement every time she became anxious on
this admission.  Patient was discharged to complete a 7 day
course of oral levofloxacin and a fast prednisone taper.
Patient will continue on her home regimen of inhalers.
.
# Altered mental status - resolved following nebulizers, likely
secondary to hypoxemia/hypercarbia from respiratory distress
.
# Hypotension - required norepi drip while in the ICU, but
quickly weaned off.  Patient was discharged to complete a 7 day
course of levofloxacin.
.
# Chronic pain - patient was continued on methadone, oxycodone,
and pregabalin per home regimen
.
# Hypothyroidism - patient continued on levothyroxine
.
# Chronic gastritis - patient continued on omeprazole
.
# Anxiety - patient continued on citalopram and klonopin
.
# Smoking history - patient continued on nicotine patch

Medications on Admission:
- albuterol nebs q4-6h prn
- baclofen 10 mg up to 5 tabs daily
- citalopram 40 mg daily
- clonazepam 1 mg ([**2-3**] at night for insomnia)
- Combivent 2 puffs tid
- levothyroxine 75 mcg qday
- lidocaine patch qday
- methadone 5 mg tid
- omeprazole 20 mg [**Hospital1 **]
- oxybutynin 5 mg up to five tabs daily
- oxycodone 5 mg tid prn
- pregabalin 150 mg tid
- sucralfate 1 g qid
- trazodone 200 mg qhs
- calcium carbonate 500 mg [**Hospital1 **]
- loratadine 10 mg daily prn
- nicotine patch 21 mg daily
- polyethylene glycol prn


Discharge Medications:
1. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital1 **]: One (1) nebulizer Inhalation Q4H (every 4
hours) as needed for shortness of breath or wheezing.
2. Baclofen 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID (3 times a
day).
3. Citalopram 20 mg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY (Daily).

4. Clonazepam 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO at bedtime as
needed for insomnia.
5. Combivent 18-103 mcg/Actuation Aerosol [**Hospital1 **]: Two (2) puffs
Inhalation three times a day.
6. Levothyroxine 75 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
7. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Hospital1 **]:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
8. Methadone 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID (3 times a
day).
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) [**Hospital1 **]: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
10. Oxybutynin Chloride 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID
(3 times a day).
11. Pregabalin 75 mg Capsule [**Hospital1 **]: Two (2) Capsule PO TID (3
times a day).
12. Sucralfate 1 gram Tablet [**Hospital1 **]: One (1) Tablet PO QID (4 times
a day).
13. Trazodone 100 mg Tablet [**Hospital1 **]: Two (2) Tablet PO at bedtime.
14. Calcium 500 500 mg (1,250 mg) Tablet [**Hospital1 **]: One (1) Tablet PO
twice a day.
15. Loratadine 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day as
needed for allergy symptoms.
16. Miralax 17 gram/dose Powder [**Hospital1 **]: Seventeen (17) grams PO
once a day as needed for constipation.
17. Nicotine 7 mg/24 hr Patch 24 hr [**Hospital1 **]: One (1) patch
Transdermal once a day.
Disp:*30 patches* Refills:*0*
18. Prednisone 20 mg Tablet [**Hospital1 **]: as directed Tablet PO DAILY
(Daily) for 6 days: [**Date range (1) **] - 3 tablets daily
[**Date range (1) 18023**] - 2 tablets daily
[**Date range (1) 55074**] - 1 tablet daily.
Disp:*12 Tablet(s)* Refills:*0*
19. Levofloxacin 250 mg Tablet [**Date range (1) **]: Three (3) Tablet PO DAILY
(Daily) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Primary diagnosis:
- Pneumonia
Secondary Diagnosis:
- T1-T2 paraplegia following MVC [**1-4**]
- Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
- HCV, viral load suppressed
- H/o recurrent PNAs: MRSA, pan-sensitive Kleb
- Anxiety
- DVT in [**2142**] -IVC filter placed in [**2142**]
- Pulmonary nodules
- Hypothyroidism
- Chronic pain
- Chronic gastritis
- H/o obstructive lung disease
- Anemia of chronic disease
- S/p PEA arrest during last hospitalization in [**2147-10-3**]


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


Discharge Instructions:
You were admitted with shortness of breath and confusion.  You
were found to have a pneumonia, which we treated with
antibiotics.  You will need to complete a course of antibiotics
after discharge from the hospital.

The following changes were made to your medications:
- new: levofloxacin (levaquin) 750 mg daily for 6 days
- new: prednisone - please take as detailed below:
[**Date range (1) **] - 60 mg daily
[**Date range (1) 18023**] - 40 mg daily
[**Date range (1) 55074**] - 20 mg daily
- please decrease your nicotine patch from 21 mg to 7 mg daily

The rest of your medications have not changed.  Please continue
to take them as originally prescribed.

Followup Instructions:
Department: [**Hospital3 249**]
When: WEDNESDAY [**2148-6-5**] at 1:30 PM
With: [**First Name8 (NamePattern2) 1409**] [**Last Name (NamePattern1) **], NP [**Telephone/Fax (1) 250**]
Building: [**Hospital6 29**] [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Pneumonia, organism unspecified,Paraplegia,Chronic obstructive asthma, unspecified,Hypotension, unspecified,Chronic hepatitis C without mention of hepatic coma,Late effect of spinal cord injury,Late effects of motor vehicle accident,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Other chronic pain,Other specified anemias,Other diseases of lung, not elsewhere classified,Anxiety state, unspecified,Tobacco use disorder,Personal history, urinary (tract) infection,Personal history of venous thrombosis and embolism'}


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: 51 yo woman h/o T1-T2 paraplegia following MVC [**1-4**], chronic
obstructive pulmonary disease and recent admission [**Date range (1) 49732**] for
COPD exacerbation (t/w rapid prednisone taper and 7-day course
of levofloxacin) who is admitted to the ICU for respiratory
distress and hypotension. History was taken from patient and her
friend [**Name (NI) **], who was present during the majority of the
interview.
.
Per patient, she was in her USOH until morning of admission.
When she awoke she felt "foggy" mentally, and she was coughing
up large amounts of clear sputum. She came to the ED where her
inital vitals were remarkable for hypotension to 90/60,
afebrile, with HR 55. She required non-rebreather to maintain
sats in the 90s. CXR was done which showed RLL pneumonia. Due to
the fact that she had difficult access and was hypotensive, a
right IJ was placed. She was given vancomycin, ceftriaxone and
levofloxacin, and she was started on norepinephrine drip. Prior
to transfer to MICU, she had received about 2L IVF.
.
By the time she arrived to the MICU, she felt much better from a
respiratory standpoint. She denied chest pain or pressure,
lightheadedness, dizziness, headache, nausea or vomiting. She
denied abdominal pain, diarrhea, dysuria or hematuria. She
denied joint pain, fever, or chills. Per patient and friend, her
mental status overall was much improved.
.
REVIEW OF SYSTEMS: as per HPI above.

MEDICAL HISTORY: - T1-T2 paraplegia following MVC [**1-4**]
- Recurrent UTIs: [**Month/Year (2) 40097**] klebsiella
- HCV, viral load suppressed
- H/o recurrent PNAs: MRSA, pan-sensitive Kleb
- Anxiety
- DVT in [**2142**] -IVC filter placed in [**2142**]
- Pulmonary nodules
- Hypothyroidism
- Chronic pain
- Chronic gastritis
- H/o obstructive lung disease
- Anemia of chronic disease
- S/p PEA arrest during last hospitalization in [**2147-10-3**]

MEDICATION ON ADMISSION: - albuterol nebs q4-6h prn
- baclofen 10 mg up to 5 tabs daily
- citalopram 40 mg daily
- clonazepam 1 mg ([**2-3**] at night for insomnia)
- Combivent 2 puffs tid
- levothyroxine 75 mcg qday
- lidocaine patch qday
- methadone 5 mg tid
- omeprazole 20 mg [**Hospital1 **]
- oxybutynin 5 mg up to five tabs daily
- oxycodone 5 mg tid prn
- pregabalin 150 mg tid
- sucralfate 1 g qid
- trazodone 200 mg qhs
- calcium carbonate 500 mg [**Hospital1 **]
- loratadine 10 mg daily prn
- nicotine patch 21 mg daily
- polyethylene glycol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 95.7, HR 72, BP 100/66, RR 17-24, sat 100% on venti mask 50%
Total in: 4L
Total out: 1L urine output
General: awake, alert and oriented x3, no distress. Attention
normal.
Lungs: diffuse expiratory wheezes and coarse inspiratory sounds
anterior fields.
Heart: RRR, normal s1/s2, no murmurs
[**Last Name (un) **]: soft, non-tender
Extremities: trace PE to ankles, warm and well-perfused

FAMILY HISTORY: Family History:
- No history of lung disease
.

SOCIAL HISTORY: Social History:
- Lives at home wiht her husband and 2 adolescent children
- Tobacco: 35 pack years, no longer smoking
- etOH: Denies
- Illicits: Denies
. 

### Response:
{'Pneumonia, organism unspecified,Paraplegia,Chronic obstructive asthma, unspecified,Hypotension, unspecified,Chronic hepatitis C without mention of hepatic coma,Late effect of spinal cord injury,Late effects of motor vehicle accident,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Other chronic pain,Other specified anemias,Other diseases of lung, not elsewhere classified,Anxiety state, unspecified,Tobacco use disorder,Personal history, urinary (tract) infection,Personal history of venous thrombosis and embolism'}
