CHIEF COMPLAINT: hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 19463**] is an 88 year old gentleman with a past medical
history significant for metastatic SCC with unknown primary,
CAD, AS, AF on coumadin, and a recent inguinal surgery
complicated by Pseudomonal and Enterococcal seroma on pip/tazo
and NSTEMI with newly depressed LVEF to 35% now admitted for
hypoxemic respiratory distress.  The patient was diagnosted with
a pneumonia on [**4-22**] by CXR after developing fever and dyspnea
while at rehab treated with vancomycin, azithro, and continued
on pip/tazo. This morning, he was noted to be febrile  at [**Doctor Last Name **]
house to 101.3 and hypoxemic with SaO2 88-92% NRB. Over the last
several days his SBPs were running 80s to 90s. He received 40 mg
lasix, and was transferred to [**Hospital1 18**] for further evaluation.
.
Of note, the patient was admitted to [**Hospital1 18**] [**Date range (1) 19464**] under
Surgery, after initially underoing right inguinal-femoral
lymphadenectomy complicated by seroma formation. At that time,
he was transferred to the ICU for hypotension, and was also
noted to have an atrial tachycardia and troponinemia felt to be
an NSTEMI with peak CK 567, MB 49, TnT 2.23.  He has undergone
IR drainage and drain placement, with serial cultures
demonstrating Pseudomonas and Enterococcus, with plan for
prolonged pip/tazo therapy with ID follow-up.
.
In the [**Hospital1 18**] ED, initial VS 98.1, 88, 101/57, 24 89%NRB. Labs
were notable for WBC 16, INR 3.8, and creatinine 1.7.  A CXR
demonstrated bilateral airspace opacities, he received cefepime,
and was briefly placed on NIPPV. He was then admitted to the
MICU for further management.
.
Currently, the patient continues to complain of dyspnea. He
denies any CP, palpitations, orthopnea, PND.

MEDICAL HISTORY: PMH:
 - metastatic squamous cell carcinoma (unknown primary lesion)
 - CAD s/p MI (remote), EF 50%
 - Aortic stenosis
 - Afib on coumadin
 - HTN
 - BPH
 - L retinal artery occlusion in [**2134**] (secondary to emoblic
disease)

MEDICATION ON ADMISSION: - Dexamethasone 4mg PO Q6H
- Furosemide 60mg PO daily
- Gabapentin 100 mg PO TID
- ASA 325 mg PO daily, stopped [**4-20**]
- Insulin glargine 20 units SQ HS
- SSI
- Sinemet 25/100 PO TID
- Albuterol nebs PRN
- Ferrous sulfate 325 mg PO daily
- Procrit
- Calcitonin
- MVI
- Vit B12
- Vit B1
- Thalomide
- Oxycodone
- Vicodin
- Trazadone
- Miralax
- Colace
- Senna
- Bisacodyl

ALLERGIES: Levsin / Shellfish

PHYSICAL EXAM: VS: 98 83 104/53 28 95%NRB
Gen: Mild respiratory distress
HEENT: NRB in place
CV: Nl S1+S2, II/VI systolic murmur loudest at the base. JVP
~8-10 cm
Pulm: Diffuse bilateral rales
Abd: S/NT/ND +bs
Ext: 3+ pitting edema, chronic per wife.
Neuro: AOx3. CN non-focal
Groin: Right groin with open wound, no purulence.
Skin: Right PICC in place.

FAMILY HISTORY: CAD in multiple family members

SOCIAL HISTORY: nonsmoker, lives with wife, no EtOH
Acute respiratory failure,Pneumonia, organism unspecified,Acute systolic heart failure,Infected postoperative seroma,Secondary and unspecified malignant neoplasm of lymph nodes of inguinal region and lower limb,Subendocardial infarction, subsequent episode of care,Atrial fibrillation,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Anemia in chronic kidney disease,Other malignant neoplasm without specification of site
Acute respiratry failure,Pneumonia, organism NOS,Ac systolic hrt failure,Infected postop seroma,Mal neo lymph-inguin/leg,Subendo infarct, subseq,Atrial fibrillation,Long-term use anticoagul,Crnry athrscl natve vssl,Aortic valve disorder,BPH w/o urinary obs/LUTS,Abn react-surg proc NEC,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Pseudomonas infect NOS,Anemia in chr kidney dis,Malignant neoplasm NOS
Admission Date:  [**2146-4-25**]              Discharge Date:   [**2146-4-30**]


Service: MEDICINE

Allergies:
Levsin / Shellfish

Attending:[**First Name3 (LF) 2763**]
Chief Complaint:
hypoxia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 19463**] is an 88 year old gentleman with a past medical
history significant for metastatic SCC with unknown primary,
CAD, AS, AF on coumadin, and a recent inguinal surgery
complicated by Pseudomonal and Enterococcal seroma on pip/tazo
and NSTEMI with newly depressed LVEF to 35% now admitted for
hypoxemic respiratory distress.  The patient was diagnosted with
a pneumonia on [**4-22**] by CXR after developing fever and dyspnea
while at rehab treated with vancomycin, azithro, and continued
on pip/tazo. This morning, he was noted to be febrile  at [**Doctor Last Name **]
house to 101.3 and hypoxemic with SaO2 88-92% NRB. Over the last
several days his SBPs were running 80s to 90s. He received 40 mg
lasix, and was transferred to [**Hospital1 18**] for further evaluation.
.
Of note, the patient was admitted to [**Hospital1 18**] [**Date range (1) 19464**] under
Surgery, after initially underoing right inguinal-femoral
lymphadenectomy complicated by seroma formation. At that time,
he was transferred to the ICU for hypotension, and was also
noted to have an atrial tachycardia and troponinemia felt to be
an NSTEMI with peak CK 567, MB 49, TnT 2.23.  He has undergone
IR drainage and drain placement, with serial cultures
demonstrating Pseudomonas and Enterococcus, with plan for
prolonged pip/tazo therapy with ID follow-up.
.
In the [**Hospital1 18**] ED, initial VS 98.1, 88, 101/57, 24 89%NRB. Labs
were notable for WBC 16, INR 3.8, and creatinine 1.7.  A CXR
demonstrated bilateral airspace opacities, he received cefepime,
and was briefly placed on NIPPV. He was then admitted to the
MICU for further management.
.
Currently, the patient continues to complain of dyspnea. He
denies any CP, palpitations, orthopnea, PND.


Past Medical History:
PMH:
 - metastatic squamous cell carcinoma (unknown primary lesion)
 - CAD s/p MI (remote), EF 50%
 - Aortic stenosis
 - Afib on coumadin
 - HTN
 - BPH
 - L retinal artery occlusion in [**2134**] (secondary to emoblic
disease)

PSH:
 - R inguinal lymph node dissection ([**2146-2-10**])
 - L inguinal hernia repair ([**2135**])


Social History:
nonsmoker, lives with wife, no EtOH


Family History:
CAD in multiple family members


Physical Exam:
VS: 98 83 104/53 28 95%NRB
Gen: Mild respiratory distress
HEENT: NRB in place
CV: Nl S1+S2, II/VI systolic murmur loudest at the base. JVP
~8-10 cm
Pulm: Diffuse bilateral rales
Abd: S/NT/ND +bs
Ext: 3+ pitting edema, chronic per wife.
Neuro: AOx3. CN non-focal
Groin: Right groin with open wound, no purulence.
Skin: Right PICC in place.


Pertinent Results:
[**2146-4-25**] 10:30AM   cTropnT-0.39*
[**2146-4-25**] 10:39AM   LACTATE-1.4
[**2146-4-25**] 11:05AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2146-4-25**] 10:30AM   WBC-16.3*# RBC-3.35* HGB-10.5* HCT-30.4*
MCV-91 MCH-31.4 MCHC-34.6 RDW-15.3
[**2146-4-25**] 10:30AM   CK-MB-3 proBNP-[**Numeric Identifier 19465**]*

Brief Hospital Course:
addmitted [**4-25**] with hypoxia and 3/29/11tolerating NRB mask with
troponin bump from 0.39 > 0.47 > 0.63 > 0.69, but flat CK
(cycling CE after likely tachycardia-induced anterior EKG
repolarization abnormalities). Outpatient cardiologist
recomended continuation of previous cardiac regimen. [**4-27**]
broadened to vanco/meropenem due to worsening pneumonia on CXR
per ID recs. Persistenly hypoxic, on BiPAP intermittently and
NRB, gas showing P02 60. Lasix for presumed element of CHF> goal
negative 1 liter. [**2146-4-28**] worsening CXR with possible ARDS pt
DNR/DNI after family meeting. 6L negative through hospital
course to this point. [**2146-4-29**] pt made CMO after conversation with
patient, his wife, and PCP [**Last Name (NamePattern4) **]. [**First Name (STitle) **]. Abx stopped, written for
morphine, increased dose overnight given increasing
discomfort/work of breathing. Pt expired [**4-30**] in morning after
cardiac arrest while recieving morphine for comfort.

Medications on Admission:
- Dexamethasone 4mg PO Q6H
- Furosemide 60mg PO daily
- Gabapentin 100 mg PO TID
- ASA 325 mg PO daily, stopped [**4-20**]
- Insulin glargine 20 units SQ HS
- SSI
- Sinemet 25/100 PO TID
- Albuterol nebs PRN
- Ferrous sulfate 325 mg PO daily
- Procrit
- Calcitonin
- MVI
- Vit B12
- Vit B1
- Thalomide
- Oxycodone
- Vicodin
- Trazadone
- Miralax
- Colace
- Senna
- Bisacodyl


Discharge Disposition:
Expired

Discharge Diagnosis:
ARDS

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2764**]

Completed by:[**2146-4-30**]
{'Acute respiratory failure,Pneumonia, organism unspecified,Acute systolic heart failure,Infected postoperative seroma,Secondary and unspecified malignant neoplasm of lymph nodes of inguinal region and lower limb,Subendocardial infarction, subsequent episode of care,Atrial fibrillation,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Anemia in chronic kidney disease,Other malignant neoplasm without specification of site'}


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: Mr. [**Known lastname 19463**] is an 88 year old gentleman with a past medical
history significant for metastatic SCC with unknown primary,
CAD, AS, AF on coumadin, and a recent inguinal surgery
complicated by Pseudomonal and Enterococcal seroma on pip/tazo
and NSTEMI with newly depressed LVEF to 35% now admitted for
hypoxemic respiratory distress.  The patient was diagnosted with
a pneumonia on [**4-22**] by CXR after developing fever and dyspnea
while at rehab treated with vancomycin, azithro, and continued
on pip/tazo. This morning, he was noted to be febrile  at [**Doctor Last Name **]
house to 101.3 and hypoxemic with SaO2 88-92% NRB. Over the last
several days his SBPs were running 80s to 90s. He received 40 mg
lasix, and was transferred to [**Hospital1 18**] for further evaluation.
.
Of note, the patient was admitted to [**Hospital1 18**] [**Date range (1) 19464**] under
Surgery, after initially underoing right inguinal-femoral
lymphadenectomy complicated by seroma formation. At that time,
he was transferred to the ICU for hypotension, and was also
noted to have an atrial tachycardia and troponinemia felt to be
an NSTEMI with peak CK 567, MB 49, TnT 2.23.  He has undergone
IR drainage and drain placement, with serial cultures
demonstrating Pseudomonas and Enterococcus, with plan for
prolonged pip/tazo therapy with ID follow-up.
.
In the [**Hospital1 18**] ED, initial VS 98.1, 88, 101/57, 24 89%NRB. Labs
were notable for WBC 16, INR 3.8, and creatinine 1.7.  A CXR
demonstrated bilateral airspace opacities, he received cefepime,
and was briefly placed on NIPPV. He was then admitted to the
MICU for further management.
.
Currently, the patient continues to complain of dyspnea. He
denies any CP, palpitations, orthopnea, PND.

MEDICAL HISTORY: PMH:
 - metastatic squamous cell carcinoma (unknown primary lesion)
 - CAD s/p MI (remote), EF 50%
 - Aortic stenosis
 - Afib on coumadin
 - HTN
 - BPH
 - L retinal artery occlusion in [**2134**] (secondary to emoblic
disease)

MEDICATION ON ADMISSION: - Dexamethasone 4mg PO Q6H
- Furosemide 60mg PO daily
- Gabapentin 100 mg PO TID
- ASA 325 mg PO daily, stopped [**4-20**]
- Insulin glargine 20 units SQ HS
- SSI
- Sinemet 25/100 PO TID
- Albuterol nebs PRN
- Ferrous sulfate 325 mg PO daily
- Procrit
- Calcitonin
- MVI
- Vit B12
- Vit B1
- Thalomide
- Oxycodone
- Vicodin
- Trazadone
- Miralax
- Colace
- Senna
- Bisacodyl

ALLERGIES: Levsin / Shellfish

PHYSICAL EXAM: VS: 98 83 104/53 28 95%NRB
Gen: Mild respiratory distress
HEENT: NRB in place
CV: Nl S1+S2, II/VI systolic murmur loudest at the base. JVP
~8-10 cm
Pulm: Diffuse bilateral rales
Abd: S/NT/ND +bs
Ext: 3+ pitting edema, chronic per wife.
Neuro: AOx3. CN non-focal
Groin: Right groin with open wound, no purulence.
Skin: Right PICC in place.

FAMILY HISTORY: CAD in multiple family members

SOCIAL HISTORY: nonsmoker, lives with wife, no EtOH 

### Response:
{'Acute respiratory failure,Pneumonia, organism unspecified,Acute systolic heart failure,Infected postoperative seroma,Secondary and unspecified malignant neoplasm of lymph nodes of inguinal region and lower limb,Subendocardial infarction, subsequent episode of care,Atrial fibrillation,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Anemia in chronic kidney disease,Other malignant neoplasm without specification of site'}
