CHIEF COMPLAINT: Respiratory distress.

PRESENT ILLNESS: The patient is a 78 year old
male with a history of chronic obstructive pulmonary disease,
esophageal cancer, status post resection, parotid mass,
status post resection and neck dissection, who presents with
acute shortness of breath.  The patient was found by daughter
earlier on the evening of admission sitting on front porch
with his head slumped over.  The patient was able to answer
questions but was lethargic.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease on home oxygen at
five liters nasal cannula.
2.  Meningitis.
3.  History of esophageal carcinoma, status post resection in
[**2150**].
4.  Status post right parotidectomy.
5.  Status post right radical neck dissection with cervical
advancement flap in [**10-25**].

MEDICATION ON ADMISSION: 1.  Colace.
2.  Remeron.
3.  Nicoderm.
4.  Prednisone 20 mg p.o. q.d.
5.  Lasix 20 mg p.o. q.d.
6.  Albuterol.
7.  Atrovent.
8.  Flovent.
9.  Tremerase 25 mg.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Brother who died of liver or pancreatic
cancer.  Father died of "old age".

SOCIAL HISTORY: The patient is widowed and lives alone in
[**Location (un) 86**].  Positive tobacco, three packs per day, and positive
ETOH, quit in [**2144**].
Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Acute kidney failure, unspecified,Hyperpotassemia,Congestive heart failure, unspecified,Personal history of malignant neoplasm of esophagus,Personal history of tobacco use
Acute respiratry failure,Chr airway obstruct NEC,Acute kidney failure NOS,Hyperpotassemia,CHF NOS,Hx-esophageal malignancy,History of tobacco use
Admission Date:  [**2168-5-11**]     Discharge Date:  [**2168-5-13**]


Service:  ICU

CHIEF COMPLAINT:  Respiratory distress.

HISTORY OF PRESENT ILLNESS:  The patient is a 78 year old
male with a history of chronic obstructive pulmonary disease,
esophageal cancer, status post resection, parotid mass,
status post resection and neck dissection, who presents with
acute shortness of breath.  The patient was found by daughter
earlier on the evening of admission sitting on front porch
with his head slumped over.  The patient was able to answer
questions but was lethargic.

Per daughter, the patient has been complaining of increasing
shortness of breath times two weeks prior to admission and
also productive cough.  EMS was called, and the patient was
brought to the Emergency Department for further evaluation.
EMS gave the patient nebulizers and placed on high flow
oxygen.  Oxygen saturation was 90 to 94%.

The Emergency Department immediately placed the patient on
CPAP for "hypoxemia" without arterial blood gases.  The
patient was given Levofloxacin 500 mg intravenous times one
in the Emergency Department.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease on home oxygen at
five liters nasal cannula.
2.  Meningitis.
3.  History of esophageal carcinoma, status post resection in
[**2150**].
4.  Status post right parotidectomy.
5.  Status post right radical neck dissection with cervical
advancement flap in [**10-25**].

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Colace.
2.  Remeron.
3.  Nicoderm.
4.  Prednisone 20 mg p.o. q.d.
5.  Lasix 20 mg p.o. q.d.
6.  Albuterol.
7.  Atrovent.
8.  Flovent.
9.  Tremerase 25 mg.

FAMILY HISTORY:  Brother who died of liver or pancreatic
cancer.  Father died of "old age".

SOCIAL HISTORY:  The patient is widowed and lives alone in
[**Location (un) 86**].  Positive tobacco, three packs per day, and positive
ETOH, quit in [**2144**].

PHYSICAL EXAMINATION:  On physical examination, temperature
was 101.7, blood pressure 119/65, heart rate 116, oxygen
saturation 94% on BiPAP.  In general, an elderly male with
face mask on BiPAP.  Head, eyes, ears, nose and throat - no
lymphadenopathy, jugular venous distention flat, unable to be
properly assessed due to postsurgical changes.  Chest -
Coarse breath sounds bilaterally.  Cor tachycardic.  The
abdomen is soft, nontender.  Extremities positive edema.
Neurologically, alert and was able to answer questions.

LABORATORY DATA:  Significant for white blood cell count of
11.2, potassium 6.5, creatinine 7.1.  Urinalysis negative.
Arterial blood gases revealed pH 7.39, 42 and 112 on CPAP.

Chest x-ray - no infiltrate, possible cephalization.
Electrocardiogram revealed sinus tachycardia at 114.
Echocardiogram revealed ejection fraction greater than 55%.

HOSPITAL COURSE:  The patient was admitted to the SICU
service.  It was unclear what the patient's respiratory
distress was due to, had been short of breath times two
weeks, and there was no strong evidence of infection.  The
patient was diuresed empirically and covered with
Levofloxacin for infection.  The patient was continued on
CPAP.

On [**2168-5-13**], the patient was continuing to require mask
ventilation.  The patient's code status was DNR/DNI and,
after speaking with the patient's daughter at length, the
daughter felt that it would be in the patient's best interest
to change goals of care to comfort measures only.

The patient also had worsening renal failure of unclear
etiology although his creatinine had appeared to be rising in
the past.  The patient ruled out for myocardial infarction
during this hospitalization as well.

The patient was started on a Morphine drip for comfort.  His
medications, telemetry and intravenous fluids were
discontinued.  On [**2168-5-13**], at 1:47 p.m., the patient was
found to be unresponsive and not to be breathing
spontaneously.  He had no heart sounds and no pulse.  The
patient's pupils were dilated and fixed.   The patient was
pronounced at 1:47 p.m..  The patient's daughter was spoken
to and declined postmortem examination at the time of death.

DISCHARGE DIAGNOSES:
1.  Chronic obstructive pulmonary disease.
2.  Esophageal cancer.
3.  Respiratory failure.

CONDITION ON DISCHARGE:  The patient expired.




                          [**Name6 (MD) **] [**Last Name (NamePattern4) 5837**], M.D.  [**MD Number(1) 8285**]

Dictated By:[**Last Name (NamePattern1) 218**]

MEDQUIST36

D:  [**2168-6-26**]  15:10
T:  [**2168-6-27**]  19:48
JOB#:  [**Job Number 107207**]
{'Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Acute kidney failure, unspecified,Hyperpotassemia,Congestive heart failure, unspecified,Personal history of malignant neoplasm of esophagus,Personal history of tobacco use'}


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 distress.

PRESENT ILLNESS: The patient is a 78 year old
male with a history of chronic obstructive pulmonary disease,
esophageal cancer, status post resection, parotid mass,
status post resection and neck dissection, who presents with
acute shortness of breath.  The patient was found by daughter
earlier on the evening of admission sitting on front porch
with his head slumped over.  The patient was able to answer
questions but was lethargic.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease on home oxygen at
five liters nasal cannula.
2.  Meningitis.
3.  History of esophageal carcinoma, status post resection in
[**2150**].
4.  Status post right parotidectomy.
5.  Status post right radical neck dissection with cervical
advancement flap in [**10-25**].

MEDICATION ON ADMISSION: 1.  Colace.
2.  Remeron.
3.  Nicoderm.
4.  Prednisone 20 mg p.o. q.d.
5.  Lasix 20 mg p.o. q.d.
6.  Albuterol.
7.  Atrovent.
8.  Flovent.
9.  Tremerase 25 mg.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Brother who died of liver or pancreatic
cancer.  Father died of "old age".

SOCIAL HISTORY: The patient is widowed and lives alone in
[**Location (un) 86**].  Positive tobacco, three packs per day, and positive
ETOH, quit in [**2144**]. 

### Response:
{'Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Acute kidney failure, unspecified,Hyperpotassemia,Congestive heart failure, unspecified,Personal history of malignant neoplasm of esophagus,Personal history of tobacco use'}
