CHIEF COMPLAINT: SOB

PRESENT ILLNESS: Briefly, this is a 59 yo lady with severe COPD on 4L home O2,
s/p several hospitalizations for exacerbations in the recent
past at [**Hospital1 2177**] with intubation, who now presented from [**Hospital 5346**] with yet another COPD exacerbation most likely due to
infection.
The pt was intubated in the MICU for hypercarbic respiratory
failure after inital trial of BIPAP. She received Azithromycin
as well as Prednisone, Fluticasone-Salmeterol, Albuterol and
Tiotropium. Extubation on [**2199-1-26**] with subsequent BIPAP. Now on
3L nasal cannula saturating at 91%, but still with desaturation
on ambulation to 85%.

MEDICAL HISTORY: 1. COPD (intubated in the past)
2. Asthma
3. DM type 2
4. Depression
5. hx of + PPD treated
6. history of MVA

MEDICATION ON ADMISSION: MEDS at rehab:
Seroquel
Senna
Advair
Albuterol
Calcium
Vitamin D
Zoloft
Trazadone
Spiriva
Flonase
.
Meds on tranfer from MICU:
Insulin SC
Azithromycin 500 mg PO Q24H
Prednisone 60 mg PO
Fluticasone-Salmeterol (250/50)  1 INH IH [**Hospital1 **]
Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN
Haloperidol 1-2 mg IV BID:PRN
Pantoprazole 40 mg IV Q24H
Heparin 5000 UNIT SC TID
Hydrocodone-Acetaminophen [**1-28**] TAB PO Q4-6H:PRN
Acetaminophen 325-650 mg PO Q4-6H:PRN
Lorazepam 0.5 mg PO Q4-6H:PRN
Beclomethasone Dipro. AQ (Nasal) 1 SPRY NU [**Hospital1 **]  12
Tiotropium Bromide 1 CAP IH DAILY
traZODONE HCl 50 mg PO HS
Sertraline HCl 150 mg PO DAILY
Vitamin D 400 UNIT PO DAILY
Calcium Carbonate 500 mg PO TID W/MEALS
Albuterol [**1-28**] PUFF IH Q4H:PRN
Albuterol [**1-28**] PUFF IH Q6H
Bisacodyl 10 mg PO DAILY:PRN
Senna 1 TAB PO BID:PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 97.7, HR 101/ 78-108, BP 131/67, 25, 91% 3L
Gen: mild respiratory distress, stops to breath in between
words, pursed lip breathing
HEENT: MMM, OP clear, PERRL
Lungs: CTA bilaterally, decreased BS bilaterally, no wheezes,
use of accessory muscles
CV: RRR, nl S1S2, no murmurs
Abd: soft, ND, positive BS, pain on palpation in R upper
quadrant, + [**Doctor Last Name **] sign
Ext: no edema
Neuro: moving all extremities, 2+ reflexes bilaterally, AAOx3

FAMILY HISTORY: no heart and lung disease
Mother died of CVA

SOCIAL HISTORY: h/o of tobacco abuse, 40pyrs, quit this year, no ETOH, lives
alone, has one daughter
Chronic obstructive asthma with (acute) exacerbation,Acute respiratory failure,Congestive heart failure, unspecified,Postinflammatory pulmonary fibrosis,Acidosis,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia of other chronic disease
Ch obst asth w (ac) exac,Acute respiratry failure,CHF NOS,Postinflam pulm fibrosis,Acidosis,Cardiac dysrhythmias NEC,DMII wo cmp nt st uncntr,Anemia-other chronic dis
Admission Date:  [**2199-1-25**]              Discharge Date:   [**2199-2-1**]

Date of Birth:  [**2139-12-11**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
intubation


History of Present Illness:
Briefly, this is a 59 yo lady with severe COPD on 4L home O2,
s/p several hospitalizations for exacerbations in the recent
past at [**Hospital1 2177**] with intubation, who now presented from [**Hospital 5346**] with yet another COPD exacerbation most likely due to
infection.
The pt was intubated in the MICU for hypercarbic respiratory
failure after inital trial of BIPAP. She received Azithromycin
as well as Prednisone, Fluticasone-Salmeterol, Albuterol and
Tiotropium. Extubation on [**2199-1-26**] with subsequent BIPAP. Now on
3L nasal cannula saturating at 91%, but still with desaturation
on ambulation to 85%.

Past Medical History:
1. COPD (intubated in the past)
2. Asthma
3. DM type 2
4. Depression
5. hx of + PPD treated
6. history of MVA


Social History:
h/o of tobacco abuse, 40pyrs, quit this year, no ETOH, lives
alone, has one daughter

Family History:
no heart and lung disease
Mother died of CVA

Physical Exam:
VS 97.7, HR 101/ 78-108, BP 131/67, 25, 91% 3L
Gen: mild respiratory distress, stops to breath in between
words, pursed lip breathing
HEENT: MMM, OP clear, PERRL
Lungs: CTA bilaterally, decreased BS bilaterally, no wheezes,
use of accessory muscles
CV: RRR, nl S1S2, no murmurs
Abd: soft, ND, positive BS, pain on palpation in R upper
quadrant, + [**Doctor Last Name **] sign
Ext: no edema
Neuro: moving all extremities, 2+ reflexes bilaterally, AAOx3

Pertinent Results:
[**2199-1-25**] 11:43AM   freeCa-1.23
[**2199-1-25**] 11:43AM   LACTATE-0.8 K+-4.0
[**2199-1-25**] 11:43AM   TYPE-ART TEMP-36.7 O2-95 O2 FLOW-4 PO2-71*
PCO2-93* PH-7.27* TOTAL CO2-45* BASE XS-11 AADO2-513 REQ O2-86
INTUBATED-NOT INTUBA
[**2199-1-25**] 12:00PM   PT-12.0 PTT-22.7 INR(PT)-1.0
[**2199-1-25**] 12:00PM   PLT COUNT-238
[**2199-1-25**] 12:00PM   NEUTS-87.2* LYMPHS-9.9* MONOS-1.8* EOS-0.9
BASOS-0.2
[**2199-1-25**] 12:00PM   WBC-11.9* RBC-3.58* HGB-10.3* HCT-32.9*
MCV-92 MCH-28.9 MCHC-31.4 RDW-13.2
[**2199-1-25**] 12:00PM   CALCIUM-9.4 PHOSPHATE-4.8* MAGNESIUM-1.8
[**2199-1-25**] 12:00PM   GLUCOSE-123* UREA N-10 CREAT-0.5 SODIUM-139
POTASSIUM-4.2 CHLORIDE-93* TOTAL CO2-37* ANION GAP-13

Brief Hospital Course:
# Hypercarbic respiratory Failure - Pt was intubated initially
for hypercarbic respiratory failure after a failed trial of
BIPAP. Nebulizers albuterol and Ipratropium Q6h were continued,
as well as fluticasone and spiriva. High dose prednisone 60mg
was started. Azithromycin was started. Rapid improvement on
intubation. Hypercarbia at baseline with PCO2 of around 70-80,
bicarbonate of around 36.  Pt extubated [**2199-1-27**]. Sputum culture
with gram-neg rods, sparse growth, no further specification
possible. Azithromycin was stopped and Levofloxacin was started
on [**1-28**] and should be continued for 10 days. The pt continued
to have a tenous respiratory status on the floor but slowly
improved with continued therapy. She was back to her baseline on
the day of discharge. Dr. [**Last Name (STitle) 52730**] at [**Hospital1 2177**] was informed about the
pt's stay at the [**Hospital1 18**].
.
# New finding of nodule on inital CXR. Chest CT: Multiple small,
less than 5 mm, noncalcified pulmonary nodules, which are likely
of benign etiology, and a followup CT could be obtained in one
year. 4 Calcified granuloma seen in the left upper lobe.
.
# Tachycardia: supraventricular tachycardia consistent with
multilocal atrial tachycardia. Also component of Albuterol and
anxiety. Started on Diltiazem, short acting, then switched to
120mg QD. Also started on Clonazepam. Will need outpatient ECHO
to look for structural heart disease. Lasix po 10mg was started
for clinically suspected right sided heart failure.
.
# Diabetes, usually controlled with diet, hemoglobin A1c 6.5.
Will need FS QID while on steroids. Covered with ISSC while on
steroids. Also started on Glyburide 1.25mg [**Hospital1 **]. The pt should
receive diabetes training at Rehab.
.
# Anemia: Low iron with normal TIBC and low normal Ferritin.
Component of anemia of chronic disease and iron deficiency. Iron
supplements were started. Hct stable. Vit B12/Folate wnl.
.
# Depression, Anxiety: Continue Seroquel, Trazadone, and Zoloft
at out-patient doses. Started on CLonazepam TID in addition.
.


Medications on Admission:
MEDS at rehab:
Seroquel
Senna
Advair
Albuterol
Calcium
Vitamin D
Zoloft
Trazadone
Spiriva
Flonase
.
Meds on tranfer from MICU:
Insulin SC
Azithromycin 500 mg PO Q24H
Prednisone 60 mg PO
Fluticasone-Salmeterol (250/50)  1 INH IH [**Hospital1 **]
Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN
Haloperidol 1-2 mg IV BID:PRN
Pantoprazole 40 mg IV Q24H
Heparin 5000 UNIT SC TID
Hydrocodone-Acetaminophen [**1-28**] TAB PO Q4-6H:PRN
Acetaminophen 325-650 mg PO Q4-6H:PRN
Lorazepam 0.5 mg PO Q4-6H:PRN
Beclomethasone Dipro. AQ (Nasal) 1 SPRY NU [**Hospital1 **]  12
Tiotropium Bromide 1 CAP IH DAILY
traZODONE HCl 50 mg PO HS
Sertraline HCl 150 mg PO DAILY
Vitamin D 400 UNIT PO DAILY
Calcium Carbonate 500 mg PO TID W/MEALS
Albuterol [**1-28**] PUFF IH Q4H:PRN
Albuterol [**1-28**] PUFF IH Q6H
Bisacodyl 10 mg PO DAILY:PRN
Senna 1 TAB PO BID:PRN

Discharge Medications:
1. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
Disp:*180 Tablet(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
Disp:*30 Tablet(s)* Refills:*2*
4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
5. Sertraline 50 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
7. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
8. Beclomethasone Diprop Monohyd 0.042 % Aerosol, Spray Sig: One
(1) Spray Nasal [**Hospital1 **] (2 times a day).
Disp:*qs * Refills:*2*
9. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed: do not exceed 4g/d.
Disp:*30 Tablet(s)* Refills:*0*
10. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day): continue until ambulating > 3x/d.
Disp:*qs * Refills:*2*
11. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 Disk with Device(s)* Refills:*2*
12. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**1-28**] Sprays Nasal
QID (4 times a day) as needed.
Disp:*qs * Refills:*0*
13. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
14. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
Disp:*qs * Refills:*2*
15. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
Disp:*qs * Refills:*2*
16. Prednisone 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
17. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*90 Tablet(s)* Refills:*2*
18. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
19. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
20. Glyburide 1.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*30 Tablet(s)* Refills:*0*
21. Lasix 20 mg Tablet Sig: 0.5 Tablet PO once a day.
Disp:*15 Tablet(s)* Refills:*2*
22. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
Disp:*30 Capsule, Sustained Release(s)* Refills:*2*
23. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 672**] Hospital

Discharge Diagnosis:
1 severe COPD
2 hypercarbic respiratory failure
3 Multiple small, less than 5 mm, noncalcified pulmonary
nodules, which are likely of benign etiology, and a followup CT
could be obtained in one year.
4 Calcified granuloma seen in the left upper lobe


Discharge Condition:
stable


Discharge Instructions:
Please come back to the hospital or see your primary care
physician if you experience worsening shortness of breath, chest
pain, fever, chills or any other concerns.
.
Please take all medications as instructed.

Followup Instructions:
Please f/u with Dr. [**Last Name (STitle) 52730**] at the [**Hospital6 **].
.
Please make sure that a copy of the discharge summary is
forwarded to Pulmonary Fellow, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 52730**] at [**Hospital 2082**] Doctor's Office Building.  He will need copy of
reports documenting pulmonary nodule for follow-up.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]
{'Chronic obstructive asthma with (acute) exacerbation,Acute respiratory failure,Congestive heart failure, unspecified,Postinflammatory pulmonary fibrosis,Acidosis,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia of other chronic disease'}


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: SOB

PRESENT ILLNESS: Briefly, this is a 59 yo lady with severe COPD on 4L home O2,
s/p several hospitalizations for exacerbations in the recent
past at [**Hospital1 2177**] with intubation, who now presented from [**Hospital 5346**] with yet another COPD exacerbation most likely due to
infection.
The pt was intubated in the MICU for hypercarbic respiratory
failure after inital trial of BIPAP. She received Azithromycin
as well as Prednisone, Fluticasone-Salmeterol, Albuterol and
Tiotropium. Extubation on [**2199-1-26**] with subsequent BIPAP. Now on
3L nasal cannula saturating at 91%, but still with desaturation
on ambulation to 85%.

MEDICAL HISTORY: 1. COPD (intubated in the past)
2. Asthma
3. DM type 2
4. Depression
5. hx of + PPD treated
6. history of MVA

MEDICATION ON ADMISSION: MEDS at rehab:
Seroquel
Senna
Advair
Albuterol
Calcium
Vitamin D
Zoloft
Trazadone
Spiriva
Flonase
.
Meds on tranfer from MICU:
Insulin SC
Azithromycin 500 mg PO Q24H
Prednisone 60 mg PO
Fluticasone-Salmeterol (250/50)  1 INH IH [**Hospital1 **]
Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN
Haloperidol 1-2 mg IV BID:PRN
Pantoprazole 40 mg IV Q24H
Heparin 5000 UNIT SC TID
Hydrocodone-Acetaminophen [**1-28**] TAB PO Q4-6H:PRN
Acetaminophen 325-650 mg PO Q4-6H:PRN
Lorazepam 0.5 mg PO Q4-6H:PRN
Beclomethasone Dipro. AQ (Nasal) 1 SPRY NU [**Hospital1 **]  12
Tiotropium Bromide 1 CAP IH DAILY
traZODONE HCl 50 mg PO HS
Sertraline HCl 150 mg PO DAILY
Vitamin D 400 UNIT PO DAILY
Calcium Carbonate 500 mg PO TID W/MEALS
Albuterol [**1-28**] PUFF IH Q4H:PRN
Albuterol [**1-28**] PUFF IH Q6H
Bisacodyl 10 mg PO DAILY:PRN
Senna 1 TAB PO BID:PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 97.7, HR 101/ 78-108, BP 131/67, 25, 91% 3L
Gen: mild respiratory distress, stops to breath in between
words, pursed lip breathing
HEENT: MMM, OP clear, PERRL
Lungs: CTA bilaterally, decreased BS bilaterally, no wheezes,
use of accessory muscles
CV: RRR, nl S1S2, no murmurs
Abd: soft, ND, positive BS, pain on palpation in R upper
quadrant, + [**Doctor Last Name **] sign
Ext: no edema
Neuro: moving all extremities, 2+ reflexes bilaterally, AAOx3

FAMILY HISTORY: no heart and lung disease
Mother died of CVA

SOCIAL HISTORY: h/o of tobacco abuse, 40pyrs, quit this year, no ETOH, lives
alone, has one daughter 

### Response:
{'Chronic obstructive asthma with (acute) exacerbation,Acute respiratory failure,Congestive heart failure, unspecified,Postinflammatory pulmonary fibrosis,Acidosis,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia of other chronic disease'}
