CHIEF COMPLAINT: respiratory failure

PRESENT ILLNESS: This is a 86 y/o M w/ PMH of diet controlled DM, h/o CVA, and
colon ca s/p colectomy, who presented to OSH on Monday with
altered MS. [**Name13 (STitle) **] had a severe cough and went to the doctor 10 days
prior to admission and was given flonase and the cough subsided
considerably after three days. A week later, went to hospital
because he was acting erratically. He was found to have an O2
sat of 88% on RA and his CXR showed a multiple opacities. He was
initially treated on the medical [**Hospital1 **] with Levofloxacin and he
initially was 94% on 2L. He was somewhat agitated, removed his
mask, and required 50% FM overnight. In the morning, he was
switched to 2 L and was found by the doctor [**First Name (Titles) **] [**Last Name (Titles) 62356**] to be
cyanotic and satting 79%. Though patient was initially DNR/DNI,
this code status was reversed and patient was eventually
intubated for increasing hypoxia and agitation. After being
intubated, patient had significant oxygen requirements and some
hypotension after fentanyl boluses and was transferred to [**Hospital1 18**]
for further ventilator management.

MEDICAL HISTORY: 1. colon cancer s/p partial colectomy 3 years ago, no chemo
2. CVA [**06**] years ago with residual garbled speech, altered
smell/taste
3. Left occluded carotid
4. glaucoma
5. DM (diet controlled)
6. heart murmur

MEDICATION ON ADMISSION: 1. Bitoptic eye drops
2. Naproxen 500 [**Hospital1 **] x 2 weeks
3. ASA rarely
4. flonase

ALLERGIES: Penicillins

PHYSICAL EXAM: PE: VS T   BP 128/44 HR 103 92%
Vent: AC 550 x 28 PEEP 10 Fi 100%, 1st ABG 7.15/65/72  currently
7.30/43/92
GEN: chronically ill appearing, sedated, intubated
HEENT: PERRL, NCAT
NECK: supple
CV: RRR S1S2 [**5-11**] holosystolic murmur harsh best LUSB, radiates
to carotid, PMI not displaced
LUNGS: course breath sounds bilaterally, L>R
ABD: midline scar, soft, nt, bs+
EXT: 2+ pitting edema, cool bluish extremities but with dps
dopplerable

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives year round with wife on [**Hospital3 4298**]. Retired
production engineer. Smoked remotely for 6 years only. No
significant EtOH use. Does not like to seek medical care or take
medications.
Unspecified septicemia,Septic shock,Acute and chronic respiratory failure,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Aortic valve disorders,Atheroembolism of lower extremity,Critical illness polyneuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema of male genital organs,Severe sepsis,Unspecified essential hypertension,Personal history of malignant neoplasm of gastrointestinal tract, unspecified
Septicemia NOS,Septic shock,Acute & chronc resp fail,Pneumonia, organism NOS,Acute kidney failure NOS,Aortic valve disorder,Atheroembolism,lower ext,Crit illness neuropathy,DMII wo cmp nt st uncntr,Edema, male genital orgn,Severe sepsis,Hypertension NOS,Hx of GI malignancy NOS
Admission Date:  [**2191-10-12**]              Discharge Date:   [**2191-10-26**]


Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 297**]
Chief Complaint:
respiratory failure

Major Surgical or Invasive Procedure:
R subclavian line [**10-12**]

History of Present Illness:
This is a 86 y/o M w/ PMH of diet controlled DM, h/o CVA, and
colon ca s/p colectomy, who presented to OSH on Monday with
altered MS. [**Name13 (STitle) **] had a severe cough and went to the doctor 10 days
prior to admission and was given flonase and the cough subsided
considerably after three days. A week later, went to hospital
because he was acting erratically. He was found to have an O2
sat of 88% on RA and his CXR showed a multiple opacities. He was
initially treated on the medical [**Hospital1 **] with Levofloxacin and he
initially was 94% on 2L. He was somewhat agitated, removed his
mask, and required 50% FM overnight. In the morning, he was
switched to 2 L and was found by the doctor [**First Name (Titles) **] [**Last Name (Titles) 62356**] to be
cyanotic and satting 79%. Though patient was initially DNR/DNI,
this code status was reversed and patient was eventually
intubated for increasing hypoxia and agitation. After being
intubated, patient had significant oxygen requirements and some
hypotension after fentanyl boluses and was transferred to [**Hospital1 18**]
for further ventilator management.


Past Medical History:
1. colon cancer s/p partial colectomy 3 years ago, no chemo
2. CVA [**06**] years ago with residual garbled speech, altered
smell/taste
3. Left occluded carotid
4. glaucoma
5. DM (diet controlled)
6. heart murmur

Social History:
Lives year round with wife on [**Hospital3 4298**]. Retired
production engineer. Smoked remotely for 6 years only. No
significant EtOH use. Does not like to seek medical care or take
medications.

Family History:
NC

Physical Exam:
PE: VS T   BP 128/44 HR 103 92%
Vent: AC 550 x 28 PEEP 10 Fi 100%, 1st ABG 7.15/65/72  currently
7.30/43/92
GEN: chronically ill appearing, sedated, intubated
HEENT: PERRL, NCAT
NECK: supple
CV: RRR S1S2 [**5-11**] holosystolic murmur harsh best LUSB, radiates
to carotid, PMI not displaced
LUNGS: course breath sounds bilaterally, L>R
ABD: midline scar, soft, nt, bs+
EXT: 2+ pitting edema, cool bluish extremities but with dps
dopplerable

Pertinent Results:
WBC 18.8 88.3% poly, 0 bands 5.2 lymphs 1.5 monos 4.9 eos
Hct 43.3
Plt 195
inr 1.5 pt 14.8 ptt 31.1
na 141 k 5.3 cl 108 co2 23 bun 45 cr 1.8 glu 174
lactate 1.6
free ca 1.14

alt 18 ast 21 ldh 327 ck 166 alk phos 100 tbili 0.3
ckmb 12 mbi 7.2 tropt .13

CXR: RUL infiltrate, LUL/lingular infiltrate, retrocardiac
opacity

Echo: prelim, LVH, EF 75%-80% hyperdynamic AS, [**Location (un) 109**]<1.0, mean
gradient 40, pulm HTN

OSH lab results:
bnp 213
trop i .18
bun 49
cr 2.0
alb 2.8

ekg sinus 100, LAD, [**Street Address(2) **] dep v5-v6


Brief Hospital Course:
86 y/o M with h/o colon ca s/p partial colectomy 3 years ago,
remote CVA, diabetes, who was transferred from an OSH intubated
with a multilobar pneumonia.  Patient was admitted in
respiratory failure, intubated and sedated.  His hypotension was
initially fluid responsive, and periodically required presor
support with levophed.  He was treated with levofloxacin and
ceftriaxone for pneumonia.

The patient was unable to be weaned from the ventilator as
pneumonia progressed, and secondary to pressor support, also
develop ischemic digits. He also developed a periodic paralysis
likely secondary to steroid admisinstration.  After 13 days in
the MICU, the patient's wife and family decided to make the
patient CMO, and he expired one day later.


Medications on Admission:
1. Bitoptic eye drops
2. Naproxen 500 [**Hospital1 **] x 2 weeks
3. ASA rarely
4. flonase

On transfer:
Fentanyl
Versed
Neo gtt
Levofloxacin
Ativan

Discharge Medications:
None.

Discharge Disposition:
Expired

Discharge Diagnosis:
Pneumonia

Discharge Condition:
Expired.

Discharge Instructions:
None.

Followup Instructions:
None.
{'Unspecified septicemia,Septic shock,Acute and chronic respiratory failure,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Aortic valve disorders,Atheroembolism of lower extremity,Critical illness polyneuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema of male genital organs,Severe sepsis,Unspecified essential hypertension,Personal history of malignant neoplasm of gastrointestinal tract, 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: respiratory failure

PRESENT ILLNESS: This is a 86 y/o M w/ PMH of diet controlled DM, h/o CVA, and
colon ca s/p colectomy, who presented to OSH on Monday with
altered MS. [**Name13 (STitle) **] had a severe cough and went to the doctor 10 days
prior to admission and was given flonase and the cough subsided
considerably after three days. A week later, went to hospital
because he was acting erratically. He was found to have an O2
sat of 88% on RA and his CXR showed a multiple opacities. He was
initially treated on the medical [**Hospital1 **] with Levofloxacin and he
initially was 94% on 2L. He was somewhat agitated, removed his
mask, and required 50% FM overnight. In the morning, he was
switched to 2 L and was found by the doctor [**First Name (Titles) **] [**Last Name (Titles) 62356**] to be
cyanotic and satting 79%. Though patient was initially DNR/DNI,
this code status was reversed and patient was eventually
intubated for increasing hypoxia and agitation. After being
intubated, patient had significant oxygen requirements and some
hypotension after fentanyl boluses and was transferred to [**Hospital1 18**]
for further ventilator management.

MEDICAL HISTORY: 1. colon cancer s/p partial colectomy 3 years ago, no chemo
2. CVA [**06**] years ago with residual garbled speech, altered
smell/taste
3. Left occluded carotid
4. glaucoma
5. DM (diet controlled)
6. heart murmur

MEDICATION ON ADMISSION: 1. Bitoptic eye drops
2. Naproxen 500 [**Hospital1 **] x 2 weeks
3. ASA rarely
4. flonase

ALLERGIES: Penicillins

PHYSICAL EXAM: PE: VS T   BP 128/44 HR 103 92%
Vent: AC 550 x 28 PEEP 10 Fi 100%, 1st ABG 7.15/65/72  currently
7.30/43/92
GEN: chronically ill appearing, sedated, intubated
HEENT: PERRL, NCAT
NECK: supple
CV: RRR S1S2 [**5-11**] holosystolic murmur harsh best LUSB, radiates
to carotid, PMI not displaced
LUNGS: course breath sounds bilaterally, L>R
ABD: midline scar, soft, nt, bs+
EXT: 2+ pitting edema, cool bluish extremities but with dps
dopplerable

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives year round with wife on [**Hospital3 4298**]. Retired
production engineer. Smoked remotely for 6 years only. No
significant EtOH use. Does not like to seek medical care or take
medications. 

### Response:
{'Unspecified septicemia,Septic shock,Acute and chronic respiratory failure,Pneumonia, organism unspecified,Acute kidney failure, unspecified,Aortic valve disorders,Atheroembolism of lower extremity,Critical illness polyneuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema of male genital organs,Severe sepsis,Unspecified essential hypertension,Personal history of malignant neoplasm of gastrointestinal tract, unspecified'}
