CHIEF COMPLAINT: Chest pain, empyema

PRESENT ILLNESS: 34yr old female with hx of substance abuse, hepatitis C who
developed back pain 5 days prior to admission.  Over the next 2
days, the pain became pleuritic and she developed increasing
shortness of breath and a productive cough.  She noted fevers to
102.  Pt used cocaine to numb her pain but any movement made the
pain worse.  She denied chest pain, orthopnea, PND, edema,
weight loss and night sweats.  Pt called EMS and was brought to
[**Hospital6 **].  There, pt was found to have an effusion
and PNA on CXR.  Given that the effusion was loculated, it was
tapped using CT guidance.  The thoracentesis revealed 20 cc of
turbid fluid with gelatinous appearance.  Based on lab results
(see below), effusion consistent with a parapneumonic effusion
vs empyema.  Pt was then started on clinda/flagyl/ceftriaxone
transferred to [**Hospital1 18**] for VATS procedure.
.
On arrival to [**Hospital1 18**], pt was evaluated by surgery and scheduled
for VATS on [**8-6**].  On the day following admission, pt was doing
well, satting in the low 90s on RA.  However, during the
evening, pt's pain increased, she began splinting, breathing at
30-40 and her room air sats dropped to 70%.  She was placed on a
NRB and her sats improved to 90s.  She was then transferred to
the MICU for elective intubation and pain control prior to VATS.
.
Allergies: NKDA

MEDICAL HISTORY: 1. Polysubstance abuse - currently on methadone, recent cocaine
use
2. Hepatitis C
3. Spontaneous Abortion ([**Month (only) 116**]) with persistent spotting, inc
b-HCG
4. Asthma
5. Nephrolithiasis
6. s/p appendectomy

MEDICATION ON ADMISSION: 1. Docusate 100 mg [**Hospital1 **]
2. Methadone 60 mg daily
3. Metoclopramide 10 mg IV Q6H
4. Pantoprazole 40 mg daily
5. Zosyn 4.5 mg IV Q8H
6. Vancomycin 1000 mg Q12H
7. SC heparin TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam: temp 100.3, BP 114/79, HR 90, RR 36, O2 71% RA --> 94% on
NRB
Gen: sleepy but arousable to voice, answers questions
appropriately; tachypneic
HEENT: PERRL, EOMI, MM dry, scabbed ulcer on upper left lip
CV: RRR, no murmurs
Chest: short insp breaths [**3-5**] pain, crackles heard throughout,
decreased on right side [**2-3**] way up chest
Abd: +BS, soft, NTND, obese
Back: tender over right lower back
Ext: no edema, 2+ DP
Skin: multiple track marks on both hands; no splinter
hemorrhages or [**Doctor Last Name **] spots

FAMILY HISTORY: father with lung cancer

SOCIAL HISTORY: Pt lives with a friend. She has a three year old daughter who is
currently in the custody of the DSS. Pt has a mother but did not
want her involved regarding the details of her care. Pt used
heroin in the past but reported only IV cocaine use prior to
admission. Denies ETOH. Current tobacco use.
- Current PSA: on needle exchange, current cocaine use, prior
heroin use, on methadone
- has been in jail multiple times
- denied TB exposure
Empyema without mention of fistula,Acute respiratory failure,Iatrogenic pneumothorax,Chronic hepatitis C without mention of hepatic coma,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Laparoscopic surgical procedure converted to open procedure,Cocaine dependence, in remission,Anemia, unspecified
Empyema w/o fistula,Acute respiratry failure,Iatrogenic pneumothorax,Chrnc hpt C wo hpat coma,Mth sus Stph aur els/NOS,Lap surg convert to open,Cocaine depend-remiss,Anemia NOS
Admission Date:  [**2188-8-4**]              Discharge Date:   [**2188-8-14**]

Date of Birth:  [**2154-3-29**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2181**]
Chief Complaint:
Chest pain, empyema

Major Surgical or Invasive Procedure:
[**2188-8-4**]: Transfer to MICU and Intubation
[**2188-8-6**]: VATS procedure with placement of three chest tubes
07-[**Numeric Identifier 64404**]: Placement of right IJ line
[**2188-8-11**]: Extubation and removal of three chest tubes
[**2188-8-14**]: Removal of Right IJ line

History of Present Illness:
34yr old female with hx of substance abuse, hepatitis C who
developed back pain 5 days prior to admission.  Over the next 2
days, the pain became pleuritic and she developed increasing
shortness of breath and a productive cough.  She noted fevers to
102.  Pt used cocaine to numb her pain but any movement made the
pain worse.  She denied chest pain, orthopnea, PND, edema,
weight loss and night sweats.  Pt called EMS and was brought to
[**Hospital6 **].  There, pt was found to have an effusion
and PNA on CXR.  Given that the effusion was loculated, it was
tapped using CT guidance.  The thoracentesis revealed 20 cc of
turbid fluid with gelatinous appearance.  Based on lab results
(see below), effusion consistent with a parapneumonic effusion
vs empyema.  Pt was then started on clinda/flagyl/ceftriaxone
transferred to [**Hospital1 18**] for VATS procedure.
.
On arrival to [**Hospital1 18**], pt was evaluated by surgery and scheduled
for VATS on [**8-6**].  On the day following admission, pt was doing
well, satting in the low 90s on RA.  However, during the
evening, pt's pain increased, she began splinting, breathing at
30-40 and her room air sats dropped to 70%.  She was placed on a
NRB and her sats improved to 90s.  She was then transferred to
the MICU for elective intubation and pain control prior to VATS.
.
Allergies: NKDA

Past Medical History:
1. Polysubstance abuse - currently on methadone, recent cocaine
use
2. Hepatitis C
3. Spontaneous Abortion ([**Month (only) 116**]) with persistent spotting, inc
b-HCG
4. Asthma
5. Nephrolithiasis
6. s/p appendectomy


Social History:
Pt lives with a friend. She has a three year old daughter who is
currently in the custody of the DSS. Pt has a mother but did not
want her involved regarding the details of her care. Pt used
heroin in the past but reported only IV cocaine use prior to
admission. Denies ETOH. Current tobacco use.
- Current PSA: on needle exchange, current cocaine use, prior
heroin use, on methadone
- has been in jail multiple times
- denied TB exposure

Family History:
father with lung cancer

Physical Exam:
Exam: temp 100.3, BP 114/79, HR 90, RR 36, O2 71% RA --> 94% on
NRB
Gen: sleepy but arousable to voice, answers questions
appropriately; tachypneic
HEENT: PERRL, EOMI, MM dry, scabbed ulcer on upper left lip
CV: RRR, no murmurs
Chest: short insp breaths [**3-5**] pain, crackles heard throughout,
decreased on right side [**2-3**] way up chest
Abd: +BS, soft, NTND, obese
Back: tender over right lower back
Ext: no edema, 2+ DP
Skin: multiple track marks on both hands; no splinter
hemorrhages or [**Doctor Last Name **] spots


Pertinent Results:
OSH labs:
** Pleural fluid:
yellow cloudy fluid
WBC 560, 95% neuts, 4% lymphs
RBC 1110
TP 5.3
LDH 942
Glucose 2
Culture: no growth
.
.
[**Hospital1 18**] Labs:
Admission Labs:
[**2188-8-5**] 02:30AM BLOOD WBC-15.6* RBC-3.76* Hgb-10.3* Hct-30.4*
MCV-81* MCH-27.2 MCHC-33.8 RDW-11.9 Plt Ct-289
[**2188-8-5**] 02:30AM BLOOD Neuts-84.9* Lymphs-10.0* Monos-3.9
Eos-0.8 Baso-0.3
[**2188-8-5**] 02:30AM BLOOD PT-12.9 PTT-26.1 INR(PT)-1.1
[**2188-8-5**] 02:30AM BLOOD Glucose-122* UreaN-10 Creat-0.5 Na-141
K-3.7 Cl-107 HCO3-25 AnGap-13
[**2188-8-5**] 02:30AM BLOOD Calcium-8.3* Phos-3.8 Mg-1.8
[**2188-8-5**] 02:30AM BLOOD HCG-22
[**2188-8-5**] 08:40AM BLOOD HIV Ab-NEGATIVE

Microbiology:
Blood cultures:
[**8-11**]- No growth
[**8-10**]- No growth
[**8-9**]- No growth
[**8-8**]- No growth
[**8-5**]- No growth
.
HIV ([**8-5**])- Negative
.
Pleural tissue:
[**8-6**]- Gram stain with 2+ PMNs and no organisms- Cultures
pending.
[**8-6**]- Sparse oxacillin resistant coag + staph aureus.
.
.
Radiology:
[**2188-8-5**]: CXR: similar to prior though with worse inspiration:
Findings most likely consistent with pneumonia.  Loculated
pleural effusion to suggest empyema.
[**2188-8-11**]: The heart size and mediastinal contours are unchanged.
 There has been interval removal of the right-sided chest tubes.
 Interval increase in size of a right pneumothorax.  Stable
right pleural effusion layering within the fissure and stable
bibasilar atelectasis.  The osseous structures appear unchanged.

[**2188-8-13**]: Since the previous examination of [**8-13**], the right
subclavian
venous access catheter appears in unchanged position.  There is
stable
enlargement of the cardiac silhouette.  No pulmonary edema.
Bilateral pleural effusions, more prominent on the right and
bibasilar atelectasis appear similar.  No pneumothorax.
.
Chest CT: [**2188-8-5**]
1.  Multifocal pulmonary and parenchymal consolidation, most
prominent within the right lower lobe, consistent with
pneumonia.
2.  Bilateral pleural effusions.  The right pleural effusion is
loculated with suggestion of peripheral enhancement, indicating
the possibility of infected effusion/empyema.
3.  Mild cardiomegaly and possible mild congestive heart
failure.
.
.
Discharge Labs:
[**2188-8-13**] 05:26AM BLOOD WBC-9.7 RBC-3.93* Hgb-10.4* Hct-31.1*
MCV-79* MCH-26.5* MCHC-33.4 RDW-12.3 Plt Ct-625*
[**2188-8-13**] 05:26AM BLOOD Neuts-61.9 Lymphs-25.6 Monos-5.9 Eos-6.0*
Baso-0.6
[**2188-8-13**] 05:26AM BLOOD Plt Ct-625*
[**2188-8-12**] 06:33AM BLOOD Glucose-88 UreaN-6 Creat-0.5 Na-140 K-4.1
Cl-102 HCO3-30 AnGap-12
[**2188-8-13**] 04:12PM BLOOD ALT-13 AST-15 LD(LDH)-173 AlkPhos-63
Amylase-40 TotBili-0.3

Brief Hospital Course:
1. Empyema: Patient was admitted to [**Hospital1 18**] on [**2188-8-4**] with known
diagnosis of empyema from OSH. She was admitted for planned VATS
and drainage of infected fluid.On the day of admission. Upon
admission she was receiving ceftriaxone, flagyl, and clindamycin
which was continued upon admission. The patient was evaluated by
thoracic surgery with planned Right thoracotomy and  vats
procedure for loculated right pleural effusion. However, the
patient became increasingly tachypnic on the floor with
decreasing O2 saturation requiring intubation and transfer to
the MICU and Flagyl was discontinued. ON [**2188-8-6**] the patient
underwent VATS with decortication and placement of three chest
tubes. Patient failed original weaining trials secondary to
sedation. Additionally, as the patient continued to spike
despite abx coverage, the patient was changed from ceftiaxone
and clindamycin to zosyn and vancomycin for broadened coverage.
The patient was successfully extubated on [**2188-8-11**] and the
patient's chest tubes were removed without complication. The
patient was transferred back to the medical service after
successful extubation, afebrile with a resolving leukocytosis
and all blood cultures with no growth. However, pathology from
pleural tissue removed from the VATS demonstrated oxacillin
resistant staph aureus. The patient was continued on Zosyn and
Vancomycin and remained afebrile while on the floor. The patient
was found additionally to have a small pneumothorax s/p removal
of chest tubes which remained stable with some resolution while
patient was on medicine service. The patient remained afebrile
and clinically stable with good Os sats without O2 support. The
patient was discharged to home with Linezolid 600mg [**Hospital1 **] for 1
week for coverage of her known MRSA infection. The patient was
discharged with plans to follow up with her PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] for
blood work and follow up.
.
2. Back/Chest Pain: The patient was in significant pain upon
admission and was thought to be splinting which contributed to
her respiratory distress. The patient was electively intubated
as described above and given adequate pain control while
intubated. After extubation, the patient was given her usual
methadone dose of 60mg po daily as well os percocet 1-2 tabs
every 4 to 6 hours with adequate control.
.
3. Substance Abuse: Prior to admission the patient was planned
to undergo a methadone taper. She was continued on a maintenance
dose of 60mg po qd while in house, but contact was made with her
methadone clinic to make them aware of her dosing as well as her
recent cocaine use.
.
4. Pneumothorax: S/p extubation and chest tube withdrawal on
[**2188-8-11**] the patient was noted to have a small pneumothorax. This
was followed daily and assessed to be stable with some
resolution. The patient was instructed to follow up with her PCP
and ensure full resolution.
.
5. Gyn: Patient was known to have recent miscarriage and ongoing
spotty bleeding. The patient' B-HCG was 25, down from 970 in
[**Month (only) 116**]. Gyn was consulted and advised that the B-HCG was consistent
with resolving from previous miscarriag rather than an ongoing
ectopic and signed off with advise that a follow up HCG be
performed in a week. The patient upon discharge was advised to
have a repeat b-HCG performed when she went to see her PCP.

Medications on Admission:
1. Docusate 100 mg [**Hospital1 **]
2. Methadone 60 mg daily
3. Metoclopramide 10 mg IV Q6H
4. Pantoprazole 40 mg daily
5. Zosyn 4.5 mg IV Q8H
6. Vancomycin 1000 mg Q12H
7. SC heparin TID

Discharge Medications:
1. Linezolid 600 mg Tablet Sig: One (1) Tablet PO twice a day
for 1 weeks: Please complete entrie course of antibiotics,even
if feeling better. Thank you.
Disp:*14 Tablet(s)* Refills:*0*
2. Methadone 10 mg Tablet Sig: Six (6) Tablet PO DAILY (Daily):
You will need to obtain this through your methadone treatment
center.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
Disp:*60 Capsule(s)* Refills:*0*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for 1 weeks.
Disp:*25 Tablet(s)* Refills:*0*
5. Outpatient Lab Work
Please check a CBC on [**8-21**]. Thanks.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
Right sided empyema and paraneumonic effusion

Secondary diagnosis:
Drug abuse- IV cocaine
Hepatitis C
Asthma


Discharge Condition:
Stable. Patient's oxygen saturation mid to high 90's on room
air. Patient afebrile. Patient with small stable right
pneumothorax s/p removal of three chest tubes on [**2188-8-11**].

Discharge Instructions:
1. Please keep all follow up appointments.

2. Please take all medications as prescribed.

3. Seek medical attention for fevers, chills, chest pain,
shortness of breath, bleeding from the chest tube sites, or any
other concerning symptoms.

4. You must follow up at [**Hospital **] Community Health Center on [**8-21**]. It is very important that you have lab tests while on the
linezolid. You will have a lab draw and a physician's
appointment on [**8-21**].

5. It is extremely important that you avoid all drugs and
alcohol. You have been very sick and these could slow your
recovery.

Followup Instructions:
1. Please follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Last Name (NamePattern1) **] Community
Health Center on Thurs [**8-21**] at 9:45. If you have any
questions or need to change this appointment time, please call
[**Telephone/Fax (1) 64405**].

2. It is very important that you follow up in cardiothoracic
surgery clinic. I have called and they will be contacting you
with an appointment within the next two weeks. If you do not
hear from them with an appointment time within two days, please
call [**Telephone/Fax (1) 170**].
{'Empyema without mention of fistula,Acute respiratory failure,Iatrogenic pneumothorax,Chronic hepatitis C without mention of hepatic coma,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Laparoscopic surgical procedure converted to open procedure,Cocaine dependence, in remission,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: Chest pain, empyema

PRESENT ILLNESS: 34yr old female with hx of substance abuse, hepatitis C who
developed back pain 5 days prior to admission.  Over the next 2
days, the pain became pleuritic and she developed increasing
shortness of breath and a productive cough.  She noted fevers to
102.  Pt used cocaine to numb her pain but any movement made the
pain worse.  She denied chest pain, orthopnea, PND, edema,
weight loss and night sweats.  Pt called EMS and was brought to
[**Hospital6 **].  There, pt was found to have an effusion
and PNA on CXR.  Given that the effusion was loculated, it was
tapped using CT guidance.  The thoracentesis revealed 20 cc of
turbid fluid with gelatinous appearance.  Based on lab results
(see below), effusion consistent with a parapneumonic effusion
vs empyema.  Pt was then started on clinda/flagyl/ceftriaxone
transferred to [**Hospital1 18**] for VATS procedure.
.
On arrival to [**Hospital1 18**], pt was evaluated by surgery and scheduled
for VATS on [**8-6**].  On the day following admission, pt was doing
well, satting in the low 90s on RA.  However, during the
evening, pt's pain increased, she began splinting, breathing at
30-40 and her room air sats dropped to 70%.  She was placed on a
NRB and her sats improved to 90s.  She was then transferred to
the MICU for elective intubation and pain control prior to VATS.
.
Allergies: NKDA

MEDICAL HISTORY: 1. Polysubstance abuse - currently on methadone, recent cocaine
use
2. Hepatitis C
3. Spontaneous Abortion ([**Month (only) 116**]) with persistent spotting, inc
b-HCG
4. Asthma
5. Nephrolithiasis
6. s/p appendectomy

MEDICATION ON ADMISSION: 1. Docusate 100 mg [**Hospital1 **]
2. Methadone 60 mg daily
3. Metoclopramide 10 mg IV Q6H
4. Pantoprazole 40 mg daily
5. Zosyn 4.5 mg IV Q8H
6. Vancomycin 1000 mg Q12H
7. SC heparin TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam: temp 100.3, BP 114/79, HR 90, RR 36, O2 71% RA --> 94% on
NRB
Gen: sleepy but arousable to voice, answers questions
appropriately; tachypneic
HEENT: PERRL, EOMI, MM dry, scabbed ulcer on upper left lip
CV: RRR, no murmurs
Chest: short insp breaths [**3-5**] pain, crackles heard throughout,
decreased on right side [**2-3**] way up chest
Abd: +BS, soft, NTND, obese
Back: tender over right lower back
Ext: no edema, 2+ DP
Skin: multiple track marks on both hands; no splinter
hemorrhages or [**Doctor Last Name **] spots

FAMILY HISTORY: father with lung cancer

SOCIAL HISTORY: Pt lives with a friend. She has a three year old daughter who is
currently in the custody of the DSS. Pt has a mother but did not
want her involved regarding the details of her care. Pt used
heroin in the past but reported only IV cocaine use prior to
admission. Denies ETOH. Current tobacco use.
- Current PSA: on needle exchange, current cocaine use, prior
heroin use, on methadone
- has been in jail multiple times
- denied TB exposure 

### Response:
{'Empyema without mention of fistula,Acute respiratory failure,Iatrogenic pneumothorax,Chronic hepatitis C without mention of hepatic coma,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Laparoscopic surgical procedure converted to open procedure,Cocaine dependence, in remission,Anemia, unspecified'}
