CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 69 F with h/o COPD (4L NC at home at baseline; frequent
admissions for exacerbations) and h/o small cell lung CA with
post-XRT fibrosis of the right lung who presents with 1 week of
fatigue, lethargic, increasing shortness of breath, sleeping
much more than usual, "not functioning normally" --not
participating in household activities. Per her husband, she has
had no fevers, no cough, no urinary sx.
.
In the ED: Tmax 100.7, BP 90s/50s, satting 88% on 4L (on 4L NC
at home) but then desatted to 90% on a NRB. She was quite
tachypnic w/ RR in 40s, therefore was intubated due to
respiratory distress.  CXR notable for "white out" of R lung.
Given levofloxacin 750mg IV, 2L NS.
.
No further history is available as pt is intubated on arrival to
the ICU.

MEDICAL HISTORY: PMH:
1. Small cell lung CA
-- diagnosed ~14 years ago
-- s/p XRT and chemo (cisplatinum).
2. COPD, on 4L NC home oxygen.
3. History of atrial fibrillation
4. History of perforated diverticulum status post colostomy.
5. History of peptic ulcer disease.
6. Hypertension.
7. Severe pulmonary hypertension on Viagra.
8. Status post ASD repair.
9. Status post ventral hernia repair.
10. Status post appendectomy.
11. Depression
12. Chronic PE in the right middle lobe of the PA

MEDICATION ON ADMISSION: Warfarin 3 mg daily
Sildenafil 50 mg [**Hospital1 **]
Digoxin 125 mcg
Paroxetine HCl 20 mg daily
Combivent 18-103 mcg QID
Albuterol 90 mcg PRN
Montelukast 10 mg daily
Alprazolam 0.25-0.5 mg qHS
Sotalol 40 mg qAM, 80 mg qPM
CALCIUM 500+D
Lasix 80 mg daily
Spironolactone 25 mg [**Hospital1 **]
Tylenol #3 two tabs TID
Prednisone 20 mg daily
Atovaquone [Mepron] 750 mg/5 mL Suspension 1 tsp PO BID
Flonase 50 mcg

ALLERGIES: Bactrim Ds

PHYSICAL EXAM: VS: 75/43, 78, 90% on AC 500x14, 60%FiO2 with 5 of PEEP
Gen: intubated, sedated
HEENT: MMM, PERRL
CV: RRR, harsh SM
PULM: absence of breath sounds on the R, rhonchi on L
ABD: soft, nt/nd
ext: 2+ edema b/l

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: History of tobacco; quit over 10 years ago. Drinks a glass of
wine a day. Immigrated from [**Location (un) 311**] in [**2120**]. Used ot be a nanny.
Has one son
Unspecified septicemia,Acute respiratory failure,Septic shock,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Primary pulmonary hypertension,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants
Septicemia NOS,Acute respiratry failure,Septic shock,Pneumonia, organism NOS,Mal neo bronch/lung NEC,Prim pulm hypertension,Severe sepsis,Chr airway obstruct NEC,Atrial fibrillation,Hypertension NOS,Hx-ven thrombosis/embols,Long-term use anticoagul
Admission Date:  [**2167-8-2**]              Discharge Date:   [**2167-8-4**]

Date of Birth:  [**2097-12-31**]             Sex:   F

Service: MEDICINE

Allergies:
Bactrim Ds

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
Intubation
Central venous line placement
bronchoscopy x2
arterial line placement

History of Present Illness:
69 F with h/o COPD (4L NC at home at baseline; frequent
admissions for exacerbations) and h/o small cell lung CA with
post-XRT fibrosis of the right lung who presents with 1 week of
fatigue, lethargic, increasing shortness of breath, sleeping
much more than usual, "not functioning normally" --not
participating in household activities. Per her husband, she has
had no fevers, no cough, no urinary sx.
.
In the ED: Tmax 100.7, BP 90s/50s, satting 88% on 4L (on 4L NC
at home) but then desatted to 90% on a NRB. She was quite
tachypnic w/ RR in 40s, therefore was intubated due to
respiratory distress.  CXR notable for "white out" of R lung.
Given levofloxacin 750mg IV, 2L NS.
.
No further history is available as pt is intubated on arrival to
the ICU.


Past Medical History:
PMH:
1. Small cell lung CA
-- diagnosed ~14 years ago
-- s/p XRT and chemo (cisplatinum).
2. COPD, on 4L NC home oxygen.
3. History of atrial fibrillation
4. History of perforated diverticulum status post colostomy.
5. History of peptic ulcer disease.
6. Hypertension.
7. Severe pulmonary hypertension on Viagra.
8. Status post ASD repair.
9. Status post ventral hernia repair.
10. Status post appendectomy.
11. Depression
12. Chronic PE in the right middle lobe of the PA


Social History:
History of tobacco; quit over 10 years ago. Drinks a glass of
wine a day. Immigrated from [**Location (un) 311**] in [**2120**]. Used ot be a nanny.
Has one son


Family History:
Non-contributory.

Physical Exam:
VS: 75/43, 78, 90% on AC 500x14, 60%FiO2 with 5 of PEEP
Gen: intubated, sedated
HEENT: MMM, PERRL
CV: RRR, harsh SM
PULM: absence of breath sounds on the R, rhonchi on L
ABD: soft, nt/nd
ext: 2+ edema b/l

Pertinent Results:
[**2167-8-2**] 06:11PM   WBC-10.5 RBC-3.79* HGB-10.5* HCT-33.6* MCV-89
MCH-27.8 MCHC-31.2 RDW-14.8
[**2167-8-2**] 06:11PM   NEUTS-93.3* LYMPHS-2.6* MONOS-3.8 EOS-0.3
BASOS-0.1
[**2167-8-2**] 06:11PM   PLT COUNT-368
[**2167-8-2**] 06:22PM   LACTATE-1.9
[**2167-8-2**] 06:11PM   GLUCOSE-135* UREA N-23* CREAT-1.0 SODIUM-137
POTASSIUM-3.8 CHLORIDE-91* TOTAL CO2-40* ANION GAP-10
.
[**2167-8-2**] 7:28 pm SPUTUM

   GRAM STAIN (Final [**2167-8-2**]):
      [**9-19**] PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

Admission CXR
AP UPRIGHT CHEST: Volume loss in right hemithorax has worsened
in the interim
with likely compensatory enlarging right pleural effusion. The
rightward
mediastinal shift is therefore stable. There is no evidence of
pneumothorax.
The left lung is grossly clear. Known spiculated right upper
lobe lesion is
not well evaluated on this study. Moderate cardiomegaly is
unchanged. Cerclage
wires and surgical clips are unchanged.

IMPRESSION: Increasing volume loss and effusion on the right.
Stable
mediastinal shift.


Brief Hospital Course:
Mrs [**Known lastname 15427**] was a 69 F with h/o severe COPD (4L NC at home at
baseline) severe pulmonary artery hypertension and a h/o small
cell lung CA with post-XRT fibrosis of the right lung who was
admitted to the MICU with hypoxic respiratory failure and
septic shock due to pneumonia.  She was intubated in the ED.
Her condition deteriorated, and she required pressors for
hemodynamic support, as well as urgent bronchoscopy x 2 for
mucous plugging.   Her prognosis was poor. Her family felt that
she would not want an extended course on life support, and
decided to make her comfort measures only on [**2167-8-4**].  She died
shortly after extubation.  Her family and PCP are aware.  An
autopsy was declined.


Medications on Admission:
Warfarin 3 mg daily
Sildenafil 50 mg [**Hospital1 **]
Digoxin 125 mcg
Paroxetine HCl 20 mg daily
Combivent 18-103 mcg QID
Albuterol 90 mcg PRN
Montelukast 10 mg daily
Alprazolam 0.25-0.5 mg qHS
Sotalol 40 mg qAM, 80 mg qPM
CALCIUM 500+D
Lasix 80 mg daily
Spironolactone 25 mg [**Hospital1 **]
Tylenol #3 two tabs TID
Prednisone 20 mg daily
Atovaquone [Mepron] 750 mg/5 mL Suspension 1 tsp PO BID
Flonase 50 mcg


Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
Primary: Respiratory failure, Pneumonia, Sepsis
Secondary: COPD, Pulmonary artery hypertension


Discharge Condition:
Expired.

Discharge Instructions:
NA

Followup Instructions:
NA
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Primary pulmonary hypertension,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}


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: 69 F with h/o COPD (4L NC at home at baseline; frequent
admissions for exacerbations) and h/o small cell lung CA with
post-XRT fibrosis of the right lung who presents with 1 week of
fatigue, lethargic, increasing shortness of breath, sleeping
much more than usual, "not functioning normally" --not
participating in household activities. Per her husband, she has
had no fevers, no cough, no urinary sx.
.
In the ED: Tmax 100.7, BP 90s/50s, satting 88% on 4L (on 4L NC
at home) but then desatted to 90% on a NRB. She was quite
tachypnic w/ RR in 40s, therefore was intubated due to
respiratory distress.  CXR notable for "white out" of R lung.
Given levofloxacin 750mg IV, 2L NS.
.
No further history is available as pt is intubated on arrival to
the ICU.

MEDICAL HISTORY: PMH:
1. Small cell lung CA
-- diagnosed ~14 years ago
-- s/p XRT and chemo (cisplatinum).
2. COPD, on 4L NC home oxygen.
3. History of atrial fibrillation
4. History of perforated diverticulum status post colostomy.
5. History of peptic ulcer disease.
6. Hypertension.
7. Severe pulmonary hypertension on Viagra.
8. Status post ASD repair.
9. Status post ventral hernia repair.
10. Status post appendectomy.
11. Depression
12. Chronic PE in the right middle lobe of the PA

MEDICATION ON ADMISSION: Warfarin 3 mg daily
Sildenafil 50 mg [**Hospital1 **]
Digoxin 125 mcg
Paroxetine HCl 20 mg daily
Combivent 18-103 mcg QID
Albuterol 90 mcg PRN
Montelukast 10 mg daily
Alprazolam 0.25-0.5 mg qHS
Sotalol 40 mg qAM, 80 mg qPM
CALCIUM 500+D
Lasix 80 mg daily
Spironolactone 25 mg [**Hospital1 **]
Tylenol #3 two tabs TID
Prednisone 20 mg daily
Atovaquone [Mepron] 750 mg/5 mL Suspension 1 tsp PO BID
Flonase 50 mcg

ALLERGIES: Bactrim Ds

PHYSICAL EXAM: VS: 75/43, 78, 90% on AC 500x14, 60%FiO2 with 5 of PEEP
Gen: intubated, sedated
HEENT: MMM, PERRL
CV: RRR, harsh SM
PULM: absence of breath sounds on the R, rhonchi on L
ABD: soft, nt/nd
ext: 2+ edema b/l

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: History of tobacco; quit over 10 years ago. Drinks a glass of
wine a day. Immigrated from [**Location (un) 311**] in [**2120**]. Used ot be a nanny.
Has one son 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Primary pulmonary hypertension,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}
