CHIEF COMPLAINT: COPD exacerbation

PRESENT ILLNESS: The patient is a 63 year old male transferred from [**Hospital 7137**] after having increased wheezing, shortness of breath, and
continued smoking.  He has severe COPD, is on home O2, and has
had numerous admissions for COPD flare with 2 previous
intubations, and was recently tapered down to Prednisone 20mg
daily.  On admission, he noted several days of runny nose, sore
throat, decreased PO intake, and feeling like he "had a cold."
No N/V/D, no abd pain, no CP.  He stated that his symptoms
became worse on the day of admission, and was noted to be
hypoxic to 85-90% on 2L.  He was brought to the ED and started
on BIPAP.  He was also given Solumedrol 125mg and Levofloxacin
500mg.

MEDICAL HISTORY: * COPD/Emphysema - on home O2; numerous flares + 2 intubations;
on slow steroid taper.  No documented PFT's.
* Asthma
* Hyperlipidemia
* Depression
* Atopic dermatitis
* hx of tobacco, EtOH use
* Hx of CAD - MI [**2-21**], EF 55%
* HTN
* Anemia of chronic disease
* Hx of seizures, tx with Primidone
* ? Hx of CVA
* Hx of lung nodule on CXR, not seen on CT

MEDICATION ON ADMISSION: * Prednisone 20mg QD
* Primidone 50mg QD
* Protonix 40mg QD
* Singulair 10mg QD
* [**Doctor First Name **] 60mg [**Hospital1 **]
* ASA 81mg QD
* Lipitor 10mg QD
* MVI 1 tab QD
* Vit D 400U QD
* Prozac 20mg QD
* Klonopin 0.25mg [**Hospital1 **]
* Duoneb QD

ALLERGIES: Bactrim

PHYSICAL EXAM: On admission to ICU:
T 95.4, HR 116, BP 151/99, RR 25-35, O2 sat 100% on BIPAP
Gen: Pt in mild resp distress, using accessory muscles.
HEENT: PERRL bilaterally, OP clear, nonicteric sclera, MMM, no
JVD
Chest: Poor air movement bilat; mild crackles at RLB, prolonged
exp phase, end exp wheezes bilaterally
Cor: Distant heart sounds, regular, tachy, no m/r/g
Abd: S/NT/ND
Ext: No LE edema
Neuro: II-XII intact

FAMILY HISTORY: Notable for DM and CAD.

SOCIAL HISTORY: Patient lives at [**Hospital3 2558**].  40-pack-yr smoking hx,
continues to smoke.  No EtOH.
Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Other convulsions,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia of other chronic disease,Other chronic pulmonary heart diseases
Obs chr bronc w(ac) exac,Acute respiratry failure,Convulsions NEC,Crnry athrscl natve vssl,Old myocardial infarct,Hypertension NOS,Hyperlipidemia NEC/NOS,Anemia-other chronic dis,Chr pulmon heart dis NEC
Admission Date:  [**2181-8-25**]              Discharge Date:   [**2181-8-29**]

Date of Birth:  [**2118-2-15**]             Sex:   M

Service: MED

Allergies:
Bactrim

Attending:[**First Name3 (LF) 287**]
Chief Complaint:
COPD exacerbation

Major Surgical or Invasive Procedure:
none

History of Present Illness:
The patient is a 63 year old male transferred from [**Hospital 7137**] after having increased wheezing, shortness of breath, and
continued smoking.  He has severe COPD, is on home O2, and has
had numerous admissions for COPD flare with 2 previous
intubations, and was recently tapered down to Prednisone 20mg
daily.  On admission, he noted several days of runny nose, sore
throat, decreased PO intake, and feeling like he "had a cold."
No N/V/D, no abd pain, no CP.  He stated that his symptoms
became worse on the day of admission, and was noted to be
hypoxic to 85-90% on 2L.  He was brought to the ED and started
on BIPAP.  He was also given Solumedrol 125mg and Levofloxacin
500mg.

Past Medical History:
* COPD/Emphysema - on home O2; numerous flares + 2 intubations;
on slow steroid taper.  No documented PFT's.
* Asthma
* Hyperlipidemia
* Depression
* Atopic dermatitis
* hx of tobacco, EtOH use
* Hx of CAD - MI [**2-21**], EF 55%
* HTN
* Anemia of chronic disease
* Hx of seizures, tx with Primidone
* ? Hx of CVA
* Hx of lung nodule on CXR, not seen on CT

Social History:
Patient lives at [**Hospital3 2558**].  40-pack-yr smoking hx,
continues to smoke.  No EtOH.

Family History:
Notable for DM and CAD.

Physical Exam:
On admission to ICU:
T 95.4, HR 116, BP 151/99, RR 25-35, O2 sat 100% on BIPAP
Gen: Pt in mild resp distress, using accessory muscles.
HEENT: PERRL bilaterally, OP clear, nonicteric sclera, MMM, no
JVD
Chest: Poor air movement bilat; mild crackles at RLB, prolonged
exp phase, end exp wheezes bilaterally
Cor: Distant heart sounds, regular, tachy, no m/r/g
Abd: S/NT/ND
Ext: No LE edema
Neuro: II-XII intact

Pertinent Results:
[**2181-8-25**] 04:35PM BLOOD WBC-7.4 RBC-6.11 Hgb-14.6 Hct-44.6
MCV-73* MCH-23.9* MCHC-32.8 RDW-13.1 Plt Ct-222
[**2181-8-25**] 04:35PM BLOOD Neuts-77.6* Lymphs-12.5* Monos-6.3
Eos-3.0 Baso-0.6
[**2181-8-25**] 04:35PM BLOOD Hypochr-1+ Microcy-2+
[**2181-8-25**] 04:35PM BLOOD PT-12.8 PTT-23.6 INR(PT)-1.0
[**2181-8-25**] 04:35PM BLOOD Glucose-107* UreaN-16 Creat-0.9 Na-137
K-5.7* Cl-97 HCO3-31* AnGap-15
[**2181-8-25**] 04:58PM BLOOD Type-ART PEEP-5 O2-40 pO2-61* pCO2-65*
pH-7.31* calHCO3-34* Base XS-3 Intubat-NOT INTUBA

[**2181-8-29**] 05:54AM BLOOD WBC-9.6 RBC-4.67 Hgb-11.4* Hct-33.6*
MCV-72* MCH-24.5* MCHC-34.0 RDW-13.8 Plt Ct-164
[**2181-8-29**] 05:54AM BLOOD Glucose-140* UreaN-15 Creat-0.8 Na-139
K-4.5 Cl-96 HCO3-38* AnGap-10
[**2181-8-29**] 05:54AM BLOOD Calcium-9.0 Phos-3.1 Mg-2.0

[**2181-8-25**] 04:35PM BLOOD CK(CPK)-399*
[**2181-8-26**] 04:47AM BLOOD CK-MB-12* MB Indx-3.6 cTropnT-<0.01
[**2181-8-26**] 02:01PM BLOOD CK-MB-10 MB Indx-3.7 cTropnT-<0.01

Chest xray [**2181-8-25**]: Cardiomediastinal silhouette is within normal
limits. The left upper lobe is particularly lucent, more so than
the right upper lung zone, consistent with history of COPD. No
evidence of pneumonia or pneumothorax. Blunting of the left
costophrenic angle is stable.


Brief Hospital Course:
1) COPD exacerbation: The patient responded well to a COPD
regimen of frequent every 3 hour nebulizer treatment with
flovent, serevent, albuterol, and singular as well as solumedrol
plus levofloxacin.  By the evening of hospital day two, the
patient's respiratory improved to where he did not require
persistent BiPap.  There were, however, 1-2 episodes where the
patient required a few hours of BiPap both of which occurred
during minimal exertion from bed to chair after eating.  This
was attributed to the patient's poor respiratory reserve.  By
the day of discharge, however, the patient had improved beyond
baseline with oxygen saturations 99-100% on his outpatient
oxygen requirement of 2 liters nasal cannula.  He was tapered
from 80 mg methylprednisolone every 8 hours to 60 mg every 8
hours to 50 mg prednisone every day with the thought that the
patient will need a very slow steroid taper given his prolonged
outpatient dependence.  The patient was urged to quit smoking
daily and given a nicotine patch to help with cravings.

2) CAD: The patient was ruled out times 3.  He was continued on
aspirin for coronary syndrome prophylaxis in light of the
patient's previous myocardial infarction.

3) Remote seizure history: The patient was continued on his
outpatient dose of primidone.  No seizures were noted during his
hospital admission.

4) Depression: The patient was continued on his outpatient dose
of prozac.  He did not admit to typical symptoms of depression
during his hospital course and reported a stable and good mood.

5) Physical Therapy: The patient was evaluated by physical
therapy who recommended short term rehabilitation during his
stay at the [**Hospital3 2558**].

Medications on Admission:
* Prednisone 20mg QD
* Primidone 50mg QD
* Protonix 40mg QD
* Singulair 10mg QD
* [**Doctor First Name **] 60mg [**Hospital1 **]
* ASA 81mg QD
* Lipitor 10mg QD
* MVI 1 tab QD
* Vit D 400U QD
* Prozac 20mg QD
* Klonopin 0.25mg [**Hospital1 **]
* Duoneb QD

Discharge Medications:
1. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
3. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

5. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD (once a day).
6. Multivitamin     Capsule Sig: One (1) Cap PO QD (once a day).

7. Fexofenadine HCl 60 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Fluoxetine HCl 20 mg Capsule Sig: One (1) Capsule PO QD (once
a day).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
11. Montelukast Sodium 10 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
12. Salmeterol Xinafoate 50 mcg/Dose Disk with Device Sig: One
(1) Disk with Device Inhalation Q12H (every 12 hours).
13. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Four
(4) Puff Inhalation [**Hospital1 **] (2 times a day).
14. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 3 days: End date: [**2181-9-1**].
Disp:*3 Tablet(s)* Refills:*0*
15. Primidone 50 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
16. Ipratropium Bromide 0.02 % Solution Sig: [**12-22**]  Inhalation
Q3HRS ().
17. Albuterol Sulfate 0.083 % Solution Sig: [**12-22**]  Inhalation Q3H
(every 3 hours).
18. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q2PRN ().
19. Zolpidem Tartrate 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.
20. Prednisone 20 mg Tablet Sig: See below for instructions
Tablet PO As below: Please give 50mg (2.5 tabs) QD x 1 week.
Then 40mg (2 tabs) QD x 1 week.  Then 30mg (1.5 tabs) QD x 1
week.
Then 20mg (1 tab) QD x 1 week.  Then 10mg (0.5 tabs) ongoing.
Disp:*50 Tablet(s)* Refills:*1*
21. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal QD (once a day).
Disp:*30 Patch 24HR(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
* COPD exacerbation
* severe reactive airway disease
* severe emphysema
* depression.

Discharge Condition:
Stable.

Discharge Instructions:
1. Please take all your medications, including regular nebulizer
treatments, as instructed.
2. Please use nicotine patches and stop smoking cigarettes.
3. Please seek medical attention if you experience any of the
following symptoms: lightheadedness, chest pain, persistent and
worsening shortness of breath, severe abdominal pain, upper
respiratory congestion, or any other new symptoms.


Followup Instructions:
Please follow up with your primary care doctor within 1-2 weeks
regarding this hospital admission.

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 288**] MD, [**MD Number(3) 289**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Other convulsions,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia of other chronic disease,Other chronic pulmonary heart diseases'}


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: COPD exacerbation

PRESENT ILLNESS: The patient is a 63 year old male transferred from [**Hospital 7137**] after having increased wheezing, shortness of breath, and
continued smoking.  He has severe COPD, is on home O2, and has
had numerous admissions for COPD flare with 2 previous
intubations, and was recently tapered down to Prednisone 20mg
daily.  On admission, he noted several days of runny nose, sore
throat, decreased PO intake, and feeling like he "had a cold."
No N/V/D, no abd pain, no CP.  He stated that his symptoms
became worse on the day of admission, and was noted to be
hypoxic to 85-90% on 2L.  He was brought to the ED and started
on BIPAP.  He was also given Solumedrol 125mg and Levofloxacin
500mg.

MEDICAL HISTORY: * COPD/Emphysema - on home O2; numerous flares + 2 intubations;
on slow steroid taper.  No documented PFT's.
* Asthma
* Hyperlipidemia
* Depression
* Atopic dermatitis
* hx of tobacco, EtOH use
* Hx of CAD - MI [**2-21**], EF 55%
* HTN
* Anemia of chronic disease
* Hx of seizures, tx with Primidone
* ? Hx of CVA
* Hx of lung nodule on CXR, not seen on CT

MEDICATION ON ADMISSION: * Prednisone 20mg QD
* Primidone 50mg QD
* Protonix 40mg QD
* Singulair 10mg QD
* [**Doctor First Name **] 60mg [**Hospital1 **]
* ASA 81mg QD
* Lipitor 10mg QD
* MVI 1 tab QD
* Vit D 400U QD
* Prozac 20mg QD
* Klonopin 0.25mg [**Hospital1 **]
* Duoneb QD

ALLERGIES: Bactrim

PHYSICAL EXAM: On admission to ICU:
T 95.4, HR 116, BP 151/99, RR 25-35, O2 sat 100% on BIPAP
Gen: Pt in mild resp distress, using accessory muscles.
HEENT: PERRL bilaterally, OP clear, nonicteric sclera, MMM, no
JVD
Chest: Poor air movement bilat; mild crackles at RLB, prolonged
exp phase, end exp wheezes bilaterally
Cor: Distant heart sounds, regular, tachy, no m/r/g
Abd: S/NT/ND
Ext: No LE edema
Neuro: II-XII intact

FAMILY HISTORY: Notable for DM and CAD.

SOCIAL HISTORY: Patient lives at [**Hospital3 2558**].  40-pack-yr smoking hx,
continues to smoke.  No EtOH. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Other convulsions,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia of other chronic disease,Other chronic pulmonary heart diseases'}
