CHIEF COMPLAINT: Status Asthmaticus

PRESENT ILLNESS: as above

MEDICAL HISTORY: 1. Asthma.
2. Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: as above

FAMILY HISTORY: Asthma

SOCIAL HISTORY: Approximately 15 pack years tobacco history.Quit 2 months ago.
Occasional alcohol. Employed as anauto mechanic, married and has
two children.
Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Asthma, unspecified type, with status asthmaticus,Toxic myopathy,Other specified gastritis, with hemorrhage,Long-term (current) use of steroids,Other abnormal blood chemistry,Esophageal reflux,Anemia, unspecified
Acute respiratry failure,Meth sus pneum d/t Staph,Asthma w status asthmat,Toxic myopathy,Oth spf gastrt w hmrhg,Long-term use steroids,Abn blood chemistry NEC,Esophageal reflux,Anemia NOS
Name:  [**Known lastname **],[**Known firstname 77**] C                  Unit No:   [**Numeric Identifier 14754**]

Admission Date:  [**2170-7-8**]              Discharge Date:   [**2170-7-25**]

Date of Birth:  [**2133-6-10**]             Sex:   M

Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 1225**]
Chief Complaint:
Status Asthmaticus


Major Surgical or Invasive Procedure:
right and left SC lines
4 bronchoscopies


History of Present Illness:
as above

Past Medical History:
1. Asthma.
2. Gastroesophageal reflux disease.


Social History:
Approximately 15 pack years tobacco history.Quit 2 months ago.
Occasional alcohol. Employed as anauto mechanic, married and has
two children.

Family History:
Asthma

Physical Exam:
as above

Pertinent Results:
as above

Brief Hospital Course:
as above

Discharge Medications:
1. Ipratropium Bromide 0.02 % Solution Sig: Two (2)  Inhalation
Q6H (every 6 hours).
Disp:*qs * Refills:*2*
2. Albuterol Sulfate 0.083 % Solution Sig: Two (2)  Inhalation
Q3H (every 3 hours).
Disp:*qs * Refills:*2*
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO QD (once a day) as needed.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q1-2H () as needed for asthma.
Disp:*qs * Refills:*0*
5. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Six (6)
Puff Inhalation Q2-4H (every 2 to 4 hours) as needed for asthma.
Disp:*qs * Refills:*0*
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
Disp:*qs ML(s)* Refills:*0*
7. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours).
Disp:*60 ML(s)* Refills:*2*
8. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation [**Hospital1 **] (2 times a day).
Disp:*qs * Refills:*2*
9. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO QD (once a
day).
Disp:*20Tablet(s)* Refills:*0*.  Take this for 5 days.  Then 2
tablets by mouth once a day.
10. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24
hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
11. Linezolid 600 mg Tablet Sig: One (1) Tablet PO twice a day
for 5 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 6219**] - [**Location (un) 2653**]

Discharge Diagnosis:
Status Asthmaticus secondary to MRSA pneumonia


Discharge Condition:
Good

Discharge Instructions:
Frequent suctioning
Aggressive PT/OT
Continued nebs, antibiotics as below.
Continue chest physiotherapy

Pt to taper steroids as follows:  5 days at 40 mg po qD then
stay at 20 mg po qD until pt meets with Dr.[**Last Name (STitle) 14757**]

After pt finishes rehab, he should make an appointment with
orthopedics, in their clinic at [**Hospital1 8**], for further evaluation of
L achilles heal rupture.

Followup Instructions:
Dr.[**Last Name (STitle) 14757**]


                             [**Known firstname 77**] [**Last Name (NamePattern4) 1226**] MD [**Last Name (un) 1227**]

Completed by:[**2170-7-25**]

Admission Date:  [**2170-7-8**]              Discharge Date:   [**2170-7-25**]

Date of Birth:  [**2133-6-10**]             Sex:   M

Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 297**]
Chief Complaint:
status asthmaticus

Major Surgical or Invasive Procedure:
R and L subclavian lines
Numerous bronchoscopies

History of Present Illness:
This is a 34 year old African
American male with a history of severe asthma, who presents
with progressive shortness of breath and wheezing for three
to four days. The patient has a long history of asthma
consisting of more than 90 admissions as well as Intensive
Care Unit stays and intubations. The patient was last
admitted to the [**Hospital1 69**] in [**2168-3-28**] and discharged on a Prednisone taper. Pt reports
progressively worsening wheezing, shortness of breath and
cough. The cough has been nonproductive and the patient
denies any fevers, chills, chest pain or sputum production.
Normal peak flows for the patient is in the range of 400 to
600.

Past Medical History:
1. Asthma.
2. Gastroesophageal reflux disease.


Social History:
Approximately 15 pack years tobacco history.
Quit 2 months ago. Occasional alcohol. Employed as an
auto mechanic, married and has two children.


Family History:
Asthma

Physical Exam:
Gen:  NAD, A& O X 3, confined to bed because of weakness
Heent:  R eye diplopia, PERRL, MMM
Neck:  No JVD
Heart:  RRR, no mrg
Lungs:  Few wheezing and rhonchi, much improved from admission
Abd:  soft, nt/nd, + BS
Ext:  R knee pain, L achilles tendon pain (after rupture)
Neuro:  Able to move all extremities but only 2/5 strength B UE,
and 3/5 strength B LE.  Normal reflexes.

Pertinent Results:
[**2170-7-24**] 04:30AM BLOOD WBC-10.6 RBC-3.33* Hgb-10.4* Hct-30.2*
MCV-91 MCH-31.2 MCHC-34.4 RDW-16.1* Plt Ct-152
[**2170-7-8**] 10:46PM BLOOD WBC-16.9*# RBC-4.50* Hgb-13.6* Hct-41.0
MCV-91 MCH-30.2 MCHC-33.1 RDW-12.4 Plt Ct-247
[**2170-7-19**] 12:03PM BLOOD WBC-42.3* RBC-3.59* Hgb-11.2* Hct-33.2*
MCV-93 MCH-31.2 MCHC-33.7 RDW-15.0 Plt Ct-259
[**2170-7-21**] 03:58AM BLOOD Neuts-69 Bands-12* Lymphs-8* Monos-8
Eos-0 Baso-0 Atyps-1* Metas-2* Myelos-0
[**2170-7-21**] 03:58AM BLOOD Hypochr-NORMAL Anisocy-NORMAL
Poiklo-NORMAL Macrocy-2+ Microcy-NORMAL Polychr-1+
[**2170-7-24**] 04:30AM BLOOD Plt Ct-152
[**2170-7-21**] 03:58AM BLOOD PT-13.0 PTT-27.9 INR(PT)-1.1
[**2170-7-24**] 04:30AM BLOOD Glucose-71 UreaN-22* Creat-0.6 Na-140
K-3.8 Cl-107 HCO3-23 AnGap-14
[**2170-7-19**] 04:00AM BLOOD ALT-51* AST-65* LD(LDH)-593*
CK(CPK)-1091* AlkPhos-57 TotBili-0.4
[**2170-7-14**] 11:24AM BLOOD CK(CPK)-1066*
[**2170-7-15**] 04:06AM BLOOD ALT-50* AST-68* LD(LDH)-378* AlkPhos-67
TotBili-0.3
[**2170-7-14**] 11:32PM BLOOD CK-MB-3 cTropnT-<0.01
[**2170-7-14**] 05:18PM BLOOD CK-MB-4 cTropnT-<0.01
[**2170-7-14**] 11:24AM BLOOD CK-MB-3 cTropnT-<0.01
[**2170-7-24**] 04:30AM BLOOD Calcium-8.2* Phos-3.7 Mg-2.2
[**2170-7-16**] 11:54AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE
HBcAb-NEGATIVE
[**2170-7-21**] 11:28AM BLOOD Type-ART Temp-37.2 Tidal V-1000 PEEP-0
O2-40 pO2-117* pCO2-35 pH-7.49* calHCO3-27 Base XS-4
Intubat-INTUBATED Vent-SPONTANEOU
[**2170-7-20**] 07:28AM BLOOD Type-ART Temp-37.1 Tidal V-880 PEEP-8
O2-60 pO2-55* pCO2-35 pH-7.41 calHCO3-23 Base XS--1
Intubat-INTUBATED
[**2170-7-15**] 02:41PM BLOOD Type-ART Temp-37.2 Rates-/17 Tidal V-550
PEEP-12 O2-80 pO2-96 pCO2-80* pH-7.33* calHCO3-44* Base XS-11
AADO2-406 REQ O2-70 Intubat-INTUBATED Vent-CONTROLLED
[**2170-7-14**] 10:49AM BLOOD Type-ART Temp-37.8 pO2-90 pCO2-93*
pH-7.29* calHCO3-47* Base XS-13
[**2170-7-12**] 05:31PM BLOOD Type-ART Temp-37.0 Rates-12/ Tidal V-920
PEEP-5 O2-40 pO2-65* pCO2-54* pH-7.47* calHCO3-40* Base XS-13
Intubat-INTUBATED
[**2170-7-15**] 06:52AM URINE Blood-NEG Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-SM Urobiln-1 pH-6.5 Leuks-NEG

[**2170-7-13**] 12:05 pm BRONCHOALVEOLAR LAVAGE
      r/o Influenza A & B, RSV.

   GRAM STAIN (Final [**2170-7-13**]):
      4+   (>10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      3+  (5-10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.

   RESPIRATORY CULTURE (Final [**2170-7-16**]):
      SPARSE GROWTH OROPHARYNGEAL FLORA.
      STAPH AUREUS COAG +.    HEAVY GROWTH.  OF TWO COLONIAL
MORPHOLOGIES.
         Oxacillin RESISTANT Staphylococci MUST be reported as
also
         RESISTANT to other penicillins, cephalosporins,
carbacephems,
         carbapenems, and beta-lactamase inhibitor combinations.

         Rifampin should not be used alone for therapy.


Brief Hospital Course:
1.  Status Asthmaticus / Respiratory failure:  Pt was
transferred intubated (on steroids and paralytics), started on
125 mg IV solumedrol, emperic antibiotics (levofloxacin and
vancomycin), mdi's (q2-4 hours) and aggressive suctioning.  His
paralytics were discontinued.  The pt remained bronchospastic
and quite difficult to ventilate and oxygenate during this
hospitalization.  His secretions were thick and difficult to
suction, requiring 4 bronchoscopies.  He also had a negative CTA
for acute PE.  Subsequent to these therapeutic bronchoscopies,
his oxygenation temporarily improved, for, on average, 24 hours.
 He is now on PO prednisone and will continue nebs, and
linezolid for a total of 14 days.

2.  MRSA:  The pt also had florid 3+ MRSA growing from sputum
cultures and BAL's.  He was treated with vancomycin, then
linezolid for this.  His WBC count elevated to a max of 42 with
a significant bandemia and left shift, including myelocytes and
promeylocytes.  Hematology was consulted and evaluated his
peripheral smear, which showed no evidence of myeloproliferative
disorder.  This leukomoid reaction was attributed to a
combination of steroids and MRSA tracheobronchitis.  He had an
extensive workup including numerous chest CT's, abdominal CT,
head CT, sinus CT, CTA.  The pt's leukocytosis and low grade
fevers were not resolving on vancomycin and ID recomended
linezolid for better pulmonary penetrence.  He was also treated
emperically for C.diff colitis with PO flagyl, but this was
eventually stopped after numerous negative C.diff stool assays
(however, he still has a C.diff toxin pending that was a send
out lab).  On linezolid, the pt defervesced after 4 days, and
his leukocytosis resolved (of note, this is also when the pt's
IV solumedrol was rapidly tapered and eventually switched to PO
prednisone).  Currently pt is without signs/symptoms of active
infection, although he does still have some watery secretions.
ID also recommended imipenim to cover emperically for gram
negative bacteria, for a 7 day course.

3.  Steroid Myopathy:  Once the pt was extubated, he was found
to be extremely weak, not able to lift his hands, arms, legs,
feet or head from the bed. This was attributed to steroid
myopathy, with CK's >1000.  He was not treated emperically for
rhabdomyolesis because his CK's were not at the level one would
expect in rhabdo (i.e. > [**Numeric Identifier 961**]) and he had no associated
electrolyte abnormalities.  He will need extensive PT/OT to help
get back to his independant status.  His myopathy appears to be
dose-dependant to steroids and is now improving daily.  The pt
did have a previous episode of similar weakness after being
intubated for a prolonged period also.

4.  Hyperglycemia:  Pt developed steroid induced hyperglycemia
while in the MICU.  He was covered effectively with insulin drip
and then SC insulin SS when the dosage decreased.

5.  Access:  Pt had an A-line, Right and Left subclavian lines
placed during his MICU stay.  Now, he still has a R-SC line for
antibiotics (imipenim).  Will contact ID and discuss the
possibility of stopping imipenim today (day [**5-4**]) so this line
can come out (it was placed 5 days ago).

6. Anemia:  Hct down to 30.  Pt developed occultly heme positive
stools after he was extubated.  This was thought to be due to
stress-gastritis, uncompletely covered with PPI.  He will be
D/C'd with PO protonix 40 mg po QD.  No transfusion
requirements.  No longer heme positive.

7. Tachycardia:  Pt developed a tachycardia during his MICU
stay.  This was thought to be due to beta-agonists and
anticholinergics (nebs), infection, and hyperadrenergic response
[**1-29**] intubation.  This resolved once the pt was extubated.  He
had no troponin leak or dynamic EKG changes during his
tachycardic episodes.

Full CODE

Discharge Medications:
1. Ipratropium Bromide 0.02 % Solution Sig: Two (2)  Inhalation
Q6H (every 6 hours).
Disp:*qs * Refills:*2*
2. Albuterol Sulfate 0.083 % Solution Sig: Two (2)  Inhalation
Q3H (every 3 hours).
Disp:*qs * Refills:*2*
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO QD (once a day) as needed.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q1-2H () as needed for asthma.
Disp:*qs * Refills:*0*
5. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Six (6)
Puff Inhalation Q2-4H (every 2 to 4 hours) as needed for asthma.
Disp:*qs * Refills:*0*
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
Disp:*qs ML(s)* Refills:*0*
7. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours).
Disp:*60 ML(s)* Refills:*2*
8. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation [**Hospital1 **] (2 times a day).
Disp:*qs * Refills:*2*
9. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO QD (once a
day).
Disp:*10 Tablet(s)* Refills:*0*
10. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24
hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
11. Linezolid 600 mg Tablet Sig: One (1) Tablet PO twice a day
for 5 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 54351**] - [**Location (un) 5503**]

Discharge Diagnosis:
Status Asthmaticus secondary to MRSA pneumonia


Discharge Condition:
Good

Discharge Instructions:
Frequent suctioning
Aggressive PT/OT
Continued nebs, antibiotics as below.
Continue chest physiotherapy

Followup Instructions:
Dr.[**Last Name (STitle) 21714**]



Completed by:[**2170-7-25**]
{'Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Asthma, unspecified type, with status asthmaticus,Toxic myopathy,Other specified gastritis, with hemorrhage,Long-term (current) use of steroids,Other abnormal blood chemistry,Esophageal reflux,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: Status Asthmaticus

PRESENT ILLNESS: as above

MEDICAL HISTORY: 1. Asthma.
2. Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: as above

FAMILY HISTORY: Asthma

SOCIAL HISTORY: Approximately 15 pack years tobacco history.Quit 2 months ago.
Occasional alcohol. Employed as anauto mechanic, married and has
two children. 

### Response:
{'Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Asthma, unspecified type, with status asthmaticus,Toxic myopathy,Other specified gastritis, with hemorrhage,Long-term (current) use of steroids,Other abnormal blood chemistry,Esophageal reflux,Anemia, unspecified'}
