CHIEF COMPLAINT: hypoxia

PRESENT ILLNESS: HISTORY OF PRESENT ILLNESS:
Pt is a 57 y.o female with no prior PMH who presentns with
R.upper CP,cough, weakness, and poor po intake. She presented to
[**Location (un) 620**] where she was found to have hypotension (baseline in
90's, have ARF (cr 3.8) and CT/CXR finding of RUL consolidation,
with multiple opacities in both lobes and extensive adenopathy.
Pt was given azithromycin and CTX and transferred to [**Hospital1 18**] ED.
.
Time Pain Temp HR BP RR Pox
+ 19:33 5 97.4 97 88/49 20 98
recent vitals: 93 97/50 22 98% 2L
AT [**Hospital1 18**] [**Name (NI) **], pt was given levaquin and thought to have been
given ~5L IVF. Pt with 2 PIVs (18 and 20). Spiked to 101 in ED.

MEDICAL HISTORY: GERD

MEDICATION ON ADMISSION: protonix-1 Tablet, Delayed Release (E.C.)(s) Twice Daily
(ordered [**Hospital1 **], but insurance only covers QD)
Clonazepam 0.5 mg Tab Oral
1 Tablet(s) Once Daily, at bedtime, as needed

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Ceftriaxone

PHYSICAL EXAM: VITAL SIGNS:
T.97.1, BP 101/37, HR 98, sat 95% on 2L
.
PHYSICAL EXAM
GENERAL: Pleasant, able to speak in full sentences, NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. dry MM. OP clear. Neck Supple, No
LAD, No thyromegagly, supple.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP=not elevated.
LUNGS: b/l ae, decreased BS, RUL and RML, no w/c/
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. 5/5 strength throughout. [**11-24**]+ reflexes,
equal BL. Normal coordination. Gait assessment deferred
PSYCH: Listens and responds to questions appropriately, pleasant

FAMILY HISTORY: father died from MI/cancer, mother hemorrhagic brain lesion.

SOCIAL HISTORY: Lives at home with 2 sons and daughter. +smoking history, quit 1
month ago, smoked since 15yrs, denies ETOH, drug use, husband
died 1.5 [**Name2 (NI) 1686**] ago.
.
Unspecified septicemia,Septic shock,Bacterial pneumonia, unspecified,Acute kidney failure, unspecified,Severe sepsis,Esophageal reflux,Dermatitis due to drugs and medicines taken internally,Atrial fibrillation,Goiter, unspecified,Hypoxemia,Hypopotassemia,Other nonspecific findings on examination of urine,Cephalosporin group causing adverse effects in therapeutic use,Personal history of tobacco use
Septicemia NOS,Septic shock,Bacterial pneumonia NOS,Acute kidney failure NOS,Severe sepsis,Esophageal reflux,Drug dermatitis NOS,Atrial fibrillation,Goiter NOS,Hypoxemia,Hypopotassemia,Abn urine findings NEC,Adv eff cephalosporin,History of tobacco use
Admission Date:  [**2170-12-19**]              Discharge Date:   [**2170-12-27**]

Date of Birth:  [**2113-1-29**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics) / Ceftriaxone

Attending:[**First Name3 (LF) 1828**]
Chief Complaint:
hypoxia

Major Surgical or Invasive Procedure:
None


History of Present Illness:
HISTORY OF PRESENT ILLNESS:
Pt is a 57 y.o female with no prior PMH who presentns with
R.upper CP,cough, weakness, and poor po intake. She presented to
[**Location (un) 620**] where she was found to have hypotension (baseline in
90's, have ARF (cr 3.8) and CT/CXR finding of RUL consolidation,
with multiple opacities in both lobes and extensive adenopathy.
Pt was given azithromycin and CTX and transferred to [**Hospital1 18**] ED.
.
Time Pain Temp HR BP RR Pox
+ 19:33 5 97.4 97 88/49 20 98
recent vitals: 93 97/50 22 98% 2L
AT [**Hospital1 18**] [**Name (NI) **], pt was given levaquin and thought to have been
given ~5L IVF. Pt with 2 PIVs (18 and 20). Spiked to 101 in ED.

Per pt, she reports fever to 101, chills, all over headache, ST
starting fri night. She then developed fatigue and weakness, dry
cough, rhinorrhea and nauseas 2 days ago. She denies
photophobia, blurred vision, new neck stiffness, paresthesias,
weakness. However, she does report constant, sharp R.upper chest
pain that is worse with movement, but not associated with
sob/LH/diaphoresis/radiation/palp. Headache and CP are relieved
by NSAIDs. She denies abd
pain/n/v/d/c/melena/brbpr/dysuria/joint pain/skin rash. She
reports she has been lying in bed since saturday and is thirsty.
She reports travel to [**Location (un) 20309**], Az end [**Month (only) **]-beg [**Month (only) **] and that she
received the H1N1 ~1.5 wks ago. She reports recent increases in
NSAID use.


Past Medical History:
GERD

Social History:
Lives at home with 2 sons and daughter. +smoking history, quit 1
month ago, smoked since 15yrs, denies ETOH, drug use, husband
died 1.5 [**Name2 (NI) 1686**] ago.
.


Family History:
father died from MI/cancer, mother hemorrhagic brain lesion.


Physical Exam:
VITAL SIGNS:
T.97.1, BP 101/37, HR 98, sat 95% on 2L
.
PHYSICAL EXAM
GENERAL: Pleasant, able to speak in full sentences, NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. dry MM. OP clear. Neck Supple, No
LAD, No thyromegagly, supple.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP=not elevated.
LUNGS: b/l ae, decreased BS, RUL and RML, no w/c/
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. 5/5 strength throughout. [**11-24**]+ reflexes,
equal BL. Normal coordination. Gait assessment deferred
PSYCH: Listens and responds to questions appropriately, pleasant



Pertinent Results:
[**2170-12-19**] 09:34PM   LACTATE-1.4
[**2170-12-19**] 08:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.008
[**2170-12-19**] 08:30PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-25
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2170-12-19**] 08:30PM URINE  RBC-0-2 WBC-[**5-2**]* BACTERIA-FEW
YEAST-NONE EPI-0-2 TRANS EPI-0-2
.
cxr-Portable AP chest radiograph was reviewed with no prior
studies
available for comparison. There is right upper lobe atelectasis
with questionable right hilar mass that potentially may
represent Golden S sign suggesting central obstruction due to
mass. The right lower lobe and the left lung are unremarkable.
Minimal bibasilar atelectasis is present. Note is madethat the
costophrenic sulci were not included in the field of view
bilaterally. Thus a significant amount of pleural effusion
cannot be excluded. Cardiomediastinal silhouette otherwise is
unremarkable. A further evaluation with chest CT with contrast
is recommended. Findings were
discussed with Dr. [**Last Name (STitle) 3271**] over the phone by Dr. [**Last Name (STitle) **] at
the
time of dictation with the recommendation to proceed with chest
CT
.
CT chest-IMPRESSION:EXTENSIVE RIGHT UPPER LOBE CONSOLIDATION AS
WELL AS AREAS OF MULTIFOCAL OPACITIES IN THE SUPERIOR SEGMENT OF
THE RIGHT LOWER LOBE AND TO A LESSER EXTENT IN LEFT UPPER AND
LEFT LOWER LOBE. THE FINDINGS ARE CONCERNING FOR WIDESPREAD
INFECTION. GIVEN THE PRESENCe OF SOME DEGREE OF ATELECTASIS EVEN
IN THE ABSENCE OF DEMONSTRATION OF OBSTRUCTIVE AIRWAYS CENTRAL
OBSTRUCTING MASS WITH PARTIAL ATELECTASIS CAN NOT BE EXCLUDED.
EXTENSIVE LYMPHADENOPATHY IS PRESENT WHICH POTENTIALLY [**Month (only) **] BE
REACTIVE TO THE INFECTIOUS PROCESS. FOLLOW-UP OF THE PATIENT IN
2 TO 3 WEEKS WITH CHEST RADIOGRAPH WITH RECOMMENDATION OF
IMPROVEMENT OF THE ABOVE DESCRIBED FINDINGS IS RECOMMENDED. IF
PATIENT CLINICALLY IS IMPROVING AND THE CHEST RADIOGRAPHS SHOWS
IMPROVEMENT THEN EVALUATION WITH CHEST CT IN 3
MONTHS IS RECOMMENDED. OTHERWISE FURTHER EVALUATION WITH
BRONCHOSCOPY
WOULD BE CONSIDERED.


Brief Hospital Course:
Ms. [**Known lastname **] is a 57 year old woman with a history of GERD who
presented to [**Location (un) 620**]-ED with antecedent URI symptoms, taking
ibuprofen, found to be febrile, hypotensive, with multifocal
pneumonia and acute renal failure.  She was transferred to the
[**Hospital1 18**] [**Hospital Ward Name 332**] ICU and was treated with aggressive volume
resuscitation (9-10 L) but averted intubation and pressor
support.  She was treated with Unasyn, Vanco and Levofloxacin
empirically.   She ruled out for influenza by DFA and her rapid
viral screen/culture was also negative.  Legionella antigen was
negative.  Her renal function rapidly improved.  She developed
atrial fibrillation with rapid ventricular response (CHADS score
= 0).  A TTE showed normal function. She was treated with
diltiazem for rate control and converted to normal sinus rhythm.
 She was transferred out of the ICU on [**12-20**] where she has
continued to have fevers and feel generally unwell.  Unasyn was
discontinued.  Consideration of discontinuing Vancomycin was
made, but due to concerns re: her fever, it was stopped
transiently but resumed shortly therafter.     A CT of the chest
was ordered and showed no obvious changes from prior.  It did
show an incidentally noted enlarged right lobe of her thyroid
for which outpatient ultrasound is recommended.  She has not
been able to produce sputum, despite attempts with inducing it.
ID recommended Vanc/Levo and Ceftriaxone on [**12-24**].  She received 1
dose of ceftriaxone and developed a rash and lip swelling.  This
was discontinued.  She was been continued on the levoflox and
vancomycin.  On [**12-26**], given persistently negative cultures and
inability to produce sputum, Vanco was d/c'd in consultation
with Infectious disease.  She had mildly abnormal LFTs and a RUQ
ultrasound was obtained.  Preliminarily it showed no
abnormalities.   Towards the end of her hospitalization she was
noted to run low bps in the range of 80/50 at the lowest,
asymptomatic, but dltiazem was persistently being held and so
the decision was made to discharge her not on the diltiazem.

Medications on Admission:
protonix-1 Tablet, Delayed Release (E.C.)(s) Twice Daily
(ordered [**Hospital1 **], but insurance only covers QD)
Clonazepam 0.5 mg Tab Oral
1 Tablet(s) Once Daily, at bedtime, as needed

Discharge Medications:
1. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
2. protonix-1 Tablet, Delayed Release (E.C.)(s) Twice Daily
(ordered [**Hospital1 **], but insurance only covers QD)
3.  Clonazepam 0.5 mg Tab Oral
1 Tablet(s) Once Daily, at bedtime, as needed

Discharge Disposition:
Home

Discharge Diagnosis:
Pneumonia, bacterial
Afib with RVR
GERD
Enlarged Thyroid (right lobe)


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


Discharge Instructions:
You were admitted with a severe pneumonia.  You were given
antibiotics and will need to complete a course of levofloxacin x
6 more days (until [**1-2**])
.
Please do NOT take ibuprofen or other NSAIDs due to your recent
kidney failure.

Followup Instructions:
MD: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Specialty: Internal Medicine-Primary Care
Date/ Time: [**2170-12-31**] 11:00am
Location: [**Street Address(2) 39796**], [**Location (un) 13588**] MA
Phone number: [**Telephone/Fax (1) 31529**]
- You should have a follow-up ultrasound of your thyroid as an
outpatient.  This can be arranged by Dr. [**Last Name (STitle) **]
[**Name (STitle) 39797**] atrial fibrillation episod with Dr. [**Last Name (STitle) 39798**]
{'Unspecified septicemia,Septic shock,Bacterial pneumonia, unspecified,Acute kidney failure, unspecified,Severe sepsis,Esophageal reflux,Dermatitis due to drugs and medicines taken internally,Atrial fibrillation,Goiter, unspecified,Hypoxemia,Hypopotassemia,Other nonspecific findings on examination of urine,Cephalosporin group causing adverse effects in therapeutic use,Personal history of tobacco use'}


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: hypoxia

PRESENT ILLNESS: HISTORY OF PRESENT ILLNESS:
Pt is a 57 y.o female with no prior PMH who presentns with
R.upper CP,cough, weakness, and poor po intake. She presented to
[**Location (un) 620**] where she was found to have hypotension (baseline in
90's, have ARF (cr 3.8) and CT/CXR finding of RUL consolidation,
with multiple opacities in both lobes and extensive adenopathy.
Pt was given azithromycin and CTX and transferred to [**Hospital1 18**] ED.
.
Time Pain Temp HR BP RR Pox
+ 19:33 5 97.4 97 88/49 20 98
recent vitals: 93 97/50 22 98% 2L
AT [**Hospital1 18**] [**Name (NI) **], pt was given levaquin and thought to have been
given ~5L IVF. Pt with 2 PIVs (18 and 20). Spiked to 101 in ED.

MEDICAL HISTORY: GERD

MEDICATION ON ADMISSION: protonix-1 Tablet, Delayed Release (E.C.)(s) Twice Daily
(ordered [**Hospital1 **], but insurance only covers QD)
Clonazepam 0.5 mg Tab Oral
1 Tablet(s) Once Daily, at bedtime, as needed

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Ceftriaxone

PHYSICAL EXAM: VITAL SIGNS:
T.97.1, BP 101/37, HR 98, sat 95% on 2L
.
PHYSICAL EXAM
GENERAL: Pleasant, able to speak in full sentences, NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. dry MM. OP clear. Neck Supple, No
LAD, No thyromegagly, supple.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP=not elevated.
LUNGS: b/l ae, decreased BS, RUL and RML, no w/c/
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. 5/5 strength throughout. [**11-24**]+ reflexes,
equal BL. Normal coordination. Gait assessment deferred
PSYCH: Listens and responds to questions appropriately, pleasant

FAMILY HISTORY: father died from MI/cancer, mother hemorrhagic brain lesion.

SOCIAL HISTORY: Lives at home with 2 sons and daughter. +smoking history, quit 1
month ago, smoked since 15yrs, denies ETOH, drug use, husband
died 1.5 [**Name2 (NI) 1686**] ago.
. 

### Response:
{'Unspecified septicemia,Septic shock,Bacterial pneumonia, unspecified,Acute kidney failure, unspecified,Severe sepsis,Esophageal reflux,Dermatitis due to drugs and medicines taken internally,Atrial fibrillation,Goiter, unspecified,Hypoxemia,Hypopotassemia,Other nonspecific findings on examination of urine,Cephalosporin group causing adverse effects in therapeutic use,Personal history of tobacco use'}
