CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Patient is a 29 yo female with asthma, hx of 2 icu admissions in
the past, no intubations who presents with asthma exacerbation
since 8pm last night.  She is unable to give a full history but
believes that the triggers are environmental allergies.
.
Denies cp/n/v/d/abd pain/urinary/bowel symptoms
.
In ed rec'd steroids, cont nebs, magnesium heliox from 12 am to
4:30 am with minimal effect.  PF was initially 200, increased to
250 with nebs.  Patient was transferred to MICU for increased
work of breathing.
.
pcp: [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] at [**Hospital1 756**]

MEDICAL HISTORY: asthma
gerd
anemia
migraines
ptsd
hypothyroid
fibromyalgia
uti's
legally blind--secondary to optic neuritis at age 10
chronic pelvic pain
chronic low back pain

MEDICATION ON ADMISSION: advair
albuterol
flovent
protonix
rhinocort
xolair
celebrex
meropex
synthroid 100 mcg'
zantac
celexa 80

ALLERGIES: Tramadol

PHYSICAL EXAM: 97.9 HR 146 sinus tach BP 121/42 O2 96-98% on 2L, pf 330
GEN: anxious, tachypneic
HEENT: PERLLA, EOMI, jvp flat, no erythema/exudate
Lungs: insp wheezes in all quadrants with moderate air flow,
right worse than left
Heart: s1 s2 tach, no m/r/g
Abd: obese, soft, +bs, rlq tenderness, no r/g
Ext: no c/c/e
Neuro: AOx3

FAMILY HISTORY: +asthma in father, cervical, [**Name2 (NI) 24817**] ca in grandparents

SOCIAL HISTORY: no smoking, etoh, drugs. lives alone with guiding eye dog, on
disability. Hx of sexual abuse.
Asthma, unspecified type, with (acute) exacerbation,Alkalosis,Acute sinusitis, unspecified,Profound impairment, both eyes, impairment level not further specified,Iron deficiency anemia, unspecified,Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Posttraumatic stress disorder,Esophageal reflux
Asthma NOS w (ac) exac,Alkalosis,Acute sinusitis NOS,Both eyes blind-who def,Iron defic anemia NOS,Myalgia and myositis NOS,Hypothyroidism NOS,Posttraumatic stress dis,Esophageal reflux
Admission Date:  [**2138-7-3**]              Discharge Date:   [**2138-7-6**]

Date of Birth:  [**2108-12-12**]             Sex:   F

Service: MEDICINE

Allergies:
Tramadol

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Patient is a 29 yo female with asthma, hx of 2 icu admissions in
the past, no intubations who presents with asthma exacerbation
since 8pm last night.  She is unable to give a full history but
believes that the triggers are environmental allergies.
.
Denies cp/n/v/d/abd pain/urinary/bowel symptoms
.
In ed rec'd steroids, cont nebs, magnesium heliox from 12 am to
4:30 am with minimal effect.  PF was initially 200, increased to
250 with nebs.  Patient was transferred to MICU for increased
work of breathing.
.
pcp: [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] at [**Hospital1 756**]

Past Medical History:
asthma
gerd
anemia
migraines
ptsd
hypothyroid
fibromyalgia
uti's
legally blind--secondary to optic neuritis at age 10
chronic pelvic pain
chronic low back pain

Social History:
no smoking, etoh, drugs. lives alone with guiding eye dog, on
disability. Hx of sexual abuse.

Family History:
+asthma in father, cervical, [**Name2 (NI) 24817**] ca in grandparents

Physical Exam:
97.9 HR 146 sinus tach BP 121/42 O2 96-98% on 2L, pf 330
GEN: anxious, tachypneic
HEENT: PERLLA, EOMI, jvp flat, no erythema/exudate
Lungs: insp wheezes in all quadrants with moderate air flow,
right worse than left
Heart: s1 s2 tach, no m/r/g
Abd: obese, soft, +bs, rlq tenderness, no r/g
Ext: no c/c/e
Neuro: AOx3

Pertinent Results:
Admission Labs:

[**2138-7-3**] 04:47AM   TYPE-ART O2 FLOW-2 PO2-110* PCO2-16* PH-7.49*
TOTAL CO2-13* BASE XS--7 INTUBATED-NOT INTUBA COMMENTS-NASAL
[**Last Name (un) 154**]
[**2138-7-3**] 01:04AM   GLUCOSE-118* UREA N-11 CREAT-0.8 SODIUM-142
POTASSIUM-3.5 CHLORIDE-108 TOTAL CO2-20* ANION GAP-18
[**2138-7-3**] 01:04AM   CALCIUM-9.2 PHOSPHATE-2.6* MAGNESIUM-2.0
[**2138-7-3**] 01:04AM   TSH-5.9*
[**2138-7-3**] 01:04AM   FREE T4-0.97
[**2138-7-3**] 01:04AM   ASA-NEG
[**2138-7-3**] 01:04AM   WBC-7.8# RBC-4.33 HGB-11.7* HCT-33.2*
MCV-77*# MCH-27.0# MCHC-35.2* RDW-16.6*
[**2138-7-3**] 01:04AM   D-DIMER-515*
.
CXR: IMPRESSION: No acute cardiopulmonary abnormality
.
LENIs: Using linear probe, [**Doctor Last Name 352**] scale and color Doppler
son[**Name (NI) 1417**] of the common femoral, superficial femoral, and
popliteal vessels were performed bilaterally. Study is limited
by large body habitus. Allowing for limitations, there is no
intraluminal thrombus. Vessels demonstrate normal flow,
compressibility, respiratory variability, and augmentation.


Brief Hospital Course:
Patient is a 29 yo legally blind female with h/o asthma and
anxiety presenting with respiratory distress.
.
1. Shortness of breath: the patient was treated for an asthma
flare with immediate improvement in her peak flow, symptoms and
oxygen requirement.  There was a strong anxiety component to her
presentation.  After obtaining [**Hospital1 112**] records, we learned that the
patient also has paradoxical vocal cord motion and
severe/difficult to control GERD which are also contributing to
her presentation.  The patient had negative LENIs and a d-dimer
of 515.  The patient was discharged to complete a 2 week steroid
taper and with the addition of Singuair to her outpatient
regimen of Advair, Albuterol, Flovent, Rhinocort, and Xolair. We
recommended she follow up with her Pulmonologist and ENT.  She
was to complete a 10 day course of Amoxicillin for sinusitis.
.
2. Tachycardia: related to anxiety and albuterol. Quickly
improved with spacing out nebulizer treatments.  Negative LENIs
and no clinical evidence or history of PE or cardiac pathology.
.
4. GERD: continued on protonix and famotidine. The patient has
an outpatient pH monitoring soon for further evaluation of this
chronic problem.
.
5. Iron deficiency anemia-continue patient on ferrous sulfate
.
6.  Respiratory alkalosis- 1) partially compensated primary
respiratory alkalosis, or (2) acute superimposed on chronic
Primary Respiratory Alkalosis, or (3) mixed acute respiratory
alkalosis with a small metabolic acidosis. Pt appears to be a
chronic hyperventilator given anxiety.
.
7. fibromyalgia/ptsd- cont nsaids, celexa. Ativan given in house
with good effect.
.
8. Hospital:
-prophylaxis: sq heparin, ppi/h2 blocker
-code: full
-disposition: discharged home to complete 2 week steroid taper.
She will need PCP, [**Name10 (NameIs) 17329**] and ENT follow up.


Medications on Admission:
advair
albuterol
flovent
protonix
rhinocort
xolair
celebrex
meropex
synthroid 100 mcg'
zantac
celexa 80

Discharge Medications:
1. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
neb Inhalation Q4-6H (every 4 to 6 hours) as needed.
2. Amoxicillin 500 mg Tablet Sig: Two (2) Tablet PO three times
a day for 7 days.
Disp:*0 Tablet(s)* Refills:*0*
3. Celexa 40 mg Tablet Sig: Two (2) Tablet PO once a day.
4. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Rhinocort Aqua 32 mcg/Actuation Spray, Non-Aerosol Sig: One
(1) inh Nasal twice a day.
6. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] ().
7. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
10. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
11. Prednisone 10 mg Tablet Sig: variable Tablet PO once a day:
-take 4 tabs (40 mg) daily from [**Date range (1) 24818**], then
-take 3 tabs (30 mg) daily from [**Date range (1) 24819**], then
-take 2 tabs (20 mg) daily from [**Date range (1) 24820**], then
-take 1 tab (10 mg) daily from [**Date range (1) 24821**], then stop. .
Disp:*36 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Primary:
Asthma exacerbation
Anxiety

Secondary:
Sinusitis
Gastroesophageal reflux disease
Iron deficiency anemia
Migraines
Post-traumatic stress disorder
Legal blindness
Fibromyalgia
Hypothyroidism
Recurrent Urinary Tract Infection


Discharge Condition:
Stable, on room air, on steroid taper.


Discharge Instructions:
You were admitted with an asthma exacerbation.  You were treated
with steroids and nebulizer treatments with improvement in your
symptoms. It is important that you take all of your medications
and make and keep all of your follow up appointments.  Please
return to the ED if you develop worsening shortness of breath,
fever, chills, chest pain, worsening peak flow or any other
concerning symptom.
.
Please continue to take all of your medications as you were
prior to admission. This includes completing your course of
Amoxicillin 1000 mg by mouth three times daily for 6 additional
days. Your last day of antibiotics should be [**2138-7-12**].  The
additions to your home regimen include:
1. Singulair 10 mg daily
2. Prednisone, according to the following taper:
-A. Take 40 mg (4 tabs) daily from [**2138-7-7**] through [**2138-7-9**], then
-B. Take 30 mg (3 tabs) daily from [**2138-7-10**] through [**2138-7-13**], then
-C. Take 20 mg (2 tabs) daily from [**2138-7-14**] through [**2138-7-17**], then
-D. Take 10 mg (1 tab) daily from [**2138-7-18**] through [**2138-7-21**], then
stop.

Followup Instructions:
Provider: [**Name10 (NameIs) 24822**] you do not have an appointment with your
outpatient ENT, please call [**7-7**] for an appointment.

Please call for an appointment with your primary care doctor,
Dr. [**Last Name (STitle) **], [**Telephone/Fax (1) 24823**], for 1-2 weeks after hospital discharge
to discuss your recent hospitalization and for evaluation of
your progress.
{'Asthma, unspecified type, with (acute) exacerbation,Alkalosis,Acute sinusitis, unspecified,Profound impairment, both eyes, impairment level not further specified,Iron deficiency anemia, unspecified,Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Posttraumatic stress disorder,Esophageal reflux'}


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: Patient is a 29 yo female with asthma, hx of 2 icu admissions in
the past, no intubations who presents with asthma exacerbation
since 8pm last night.  She is unable to give a full history but
believes that the triggers are environmental allergies.
.
Denies cp/n/v/d/abd pain/urinary/bowel symptoms
.
In ed rec'd steroids, cont nebs, magnesium heliox from 12 am to
4:30 am with minimal effect.  PF was initially 200, increased to
250 with nebs.  Patient was transferred to MICU for increased
work of breathing.
.
pcp: [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] at [**Hospital1 756**]

MEDICAL HISTORY: asthma
gerd
anemia
migraines
ptsd
hypothyroid
fibromyalgia
uti's
legally blind--secondary to optic neuritis at age 10
chronic pelvic pain
chronic low back pain

MEDICATION ON ADMISSION: advair
albuterol
flovent
protonix
rhinocort
xolair
celebrex
meropex
synthroid 100 mcg'
zantac
celexa 80

ALLERGIES: Tramadol

PHYSICAL EXAM: 97.9 HR 146 sinus tach BP 121/42 O2 96-98% on 2L, pf 330
GEN: anxious, tachypneic
HEENT: PERLLA, EOMI, jvp flat, no erythema/exudate
Lungs: insp wheezes in all quadrants with moderate air flow,
right worse than left
Heart: s1 s2 tach, no m/r/g
Abd: obese, soft, +bs, rlq tenderness, no r/g
Ext: no c/c/e
Neuro: AOx3

FAMILY HISTORY: +asthma in father, cervical, [**Name2 (NI) 24817**] ca in grandparents

SOCIAL HISTORY: no smoking, etoh, drugs. lives alone with guiding eye dog, on
disability. Hx of sexual abuse. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Alkalosis,Acute sinusitis, unspecified,Profound impairment, both eyes, impairment level not further specified,Iron deficiency anemia, unspecified,Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Posttraumatic stress disorder,Esophageal reflux'}
