CHIEF COMPLAINT: respiratory distress
fevers

PRESENT ILLNESS: 74 yo female, transferred from [**Hospital1 1872**] rehab for recurrent
flash pulmonary edema.  Pt recently admitted/hospital stay at
[**Hospital1 **] on [**9-8**] for DKA and NSTEMI.  At this time, pt had a
long/complicated hospital course, determined not to be a
candidate for cardiac catheterization and MI managed medically.
She developed pulm edema, respiratory failure, was intubated,
developed vent-associated pna (MSSA), treated with levo until
[**10-7**].  She failed extubation and was eventually PEG/Trached,
sent to rehab on [**10-2**].  At rehab, pt had multiple episodes of
flash pulm edema that were managed with Morphine and lasix prn.
This morning, she had a similar episode with desat to 85%,
tachypnea to 30's, and SBP=78 with leukocytosis.  At family's
request and with these symptoms, she was transferred back here.
On presentation, she received MSO4 for dyspnea, was febrile to
102.2, BP=90/41, WBC=19 with left shift.  Pt with some new EKG
changes (t-wave inv v5-6, st elev v2-4), and elevated tnt.  Pt
admitted to MICU at this time for management of respiratory
failure vs. pneumonia.

MEDICAL HISTORY: DM2 on insulin
Hypercholesterolemia
Dementia/[**Doctor Last Name 122**] disease (an inherited spinocerebellar ataxia:
progressive neurological disorder of ataxia, peripheral
neuropathy)
(No known HTN)
Vent-associated PNA
NSTEMI
CHF
Anemia

MEDICATION ON ADMISSION: Meds: lantus, ssi, asa, captopril, colace, laxis, sq heparin,
HCTZ, levothyroxine, lopressor, nystatin, senna

ALLERGIES: Penicillins

PHYSICAL EXAM: 102.2       85         90/41      18   99%
Gen:  elderly appearing, lethargic, sedated
HEENT: PERRL, dry MM, tracheostomy c, d, i
CV: RRR, 2/6 SEM
Pulm: coarse BS, occasional rhonchi, no crackles
Abd: PEG-c,d,i; soft, NABS, nt
Extr: warm, no edema, good pulses, L PICC line-c, d, i
Neuro: non arousable

FAMILY HISTORY: [**Last Name (un) 32665**]-[**Doctor Last Name 11042**] disease.

SOCIAL HISTORY: Prior to admission the patient was living at home with her
daughter. The patient was bedridden and very dependent on family
members to care for her. She has a significant smoking history
of 50 pack years, though she quit smoking 10 years ago. Denies
EtOH or other drugs.
Acute and chronic respiratory failure,Congestive heart failure, unspecified,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure with lesion of tubular necrosis,Other degenerative diseases of the basal ganglia,Subendocardial infarction, subsequent episode of care,Coronary atherosclerosis of native coronary artery,Tracheostomy status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Long-term (current) use of insulin
Acute & chronc resp fail,CHF NOS,Meth sus pneum d/t Staph,Ac kidny fail, tubr necr,Degen basal ganglia NEC,Subendo infarct, subseq,Crnry athrscl natve vssl,Tracheostomy status,DMII wo cmp nt st uncntr,Hypothyroidism NOS,Long-term use of insulin
Admission Date:  [**2137-10-10**]              Discharge Date:   [**2137-11-1**]

Date of Birth:  [**2063-1-4**]             Sex:   F

Service: MED

Allergies:
Penicillins

Attending:[**First Name3 (LF) 281**]
Chief Complaint:
respiratory distress
fevers

Major Surgical or Invasive Procedure:
none

History of Present Illness:
74 yo female, transferred from [**Hospital1 1872**] rehab for recurrent
flash pulmonary edema.  Pt recently admitted/hospital stay at
[**Hospital1 **] on [**9-8**] for DKA and NSTEMI.  At this time, pt had a
long/complicated hospital course, determined not to be a
candidate for cardiac catheterization and MI managed medically.
She developed pulm edema, respiratory failure, was intubated,
developed vent-associated pna (MSSA), treated with levo until
[**10-7**].  She failed extubation and was eventually PEG/Trached,
sent to rehab on [**10-2**].  At rehab, pt had multiple episodes of
flash pulm edema that were managed with Morphine and lasix prn.
This morning, she had a similar episode with desat to 85%,
tachypnea to 30's, and SBP=78 with leukocytosis.  At family's
request and with these symptoms, she was transferred back here.
On presentation, she received MSO4 for dyspnea, was febrile to
102.2, BP=90/41, WBC=19 with left shift.  Pt with some new EKG
changes (t-wave inv v5-6, st elev v2-4), and elevated tnt.  Pt
admitted to MICU at this time for management of respiratory
failure vs. pneumonia.


Past Medical History:
DM2 on insulin
Hypercholesterolemia
Dementia/[**Doctor Last Name 122**] disease (an inherited spinocerebellar ataxia:
progressive neurological disorder of ataxia, peripheral
neuropathy)
(No known HTN)
Vent-associated PNA
NSTEMI
CHF
Anemia


Social History:
Prior to admission the patient was living at home with her
daughter. The patient was bedridden and very dependent on family
members to care for her. She has a significant smoking history
of 50 pack years, though she quit smoking 10 years ago. Denies
EtOH or other drugs.

Family History:
[**Last Name (un) 32665**]-[**Doctor Last Name 11042**] disease.

Physical Exam:
102.2       85         90/41      18   99%
Gen:  elderly appearing, lethargic, sedated
HEENT: PERRL, dry MM, tracheostomy c, d, i
CV: RRR, 2/6 SEM
Pulm: coarse BS, occasional rhonchi, no crackles
Abd: PEG-c,d,i; soft, NABS, nt
Extr: warm, no edema, good pulses, L PICC line-c, d, i
Neuro: non arousable

Pertinent Results:
[**2137-10-10**] 09:34PM   TYPE-ART PO2-126* PCO2-42 PH-7.50* TOTAL
CO2-34* BASE XS-8
[**2137-10-10**] 09:34PM   LACTATE-1.8
[**2137-10-10**] 04:44PM   TYPE-ART PO2-144* PCO2-45 PH-7.50* TOTAL
CO2-36* BASE XS-10
[**2137-10-10**] 04:44PM   LACTATE-2.2*
[**2137-10-10**] 03:21PM   GLUCOSE-276* UREA N-47* CREAT-0.6 SODIUM-138
POTASSIUM-5.1 CHLORIDE-94* TOTAL CO2-33* ANION GAP-16
[**2137-10-10**] 03:21PM   ALT(SGPT)-44* AST(SGOT)-38 LD(LDH)-278*
CK(CPK)-52 ALK PHOS-403* AMYLASE-65 TOT BILI-0.4
[**2137-10-10**] 03:21PM   LIPASE-53
[**2137-10-10**] 03:21PM   CK-MB-NotDone cTropnT-0.28*
[**2137-10-10**] 03:21PM   ALBUMIN-3.5 CALCIUM-8.9 PHOSPHATE-3.8
MAGNESIUM-2.3
[**2137-10-10**] 03:21PM   WBC-19.1*# RBC-3.65* HGB-11.5* HCT-35.5*
MCV-97 MCH-31.4 MCHC-32.4 RDW-13.9
[**2137-10-10**] 03:21PM   NEUTS-88.5* LYMPHS-6.8* MONOS-4.0 EOS-0.4
BASOS-0.3
[**2137-10-10**] 03:21PM   MACROCYT-1+
[**2137-10-10**] 03:21PM   PLT COUNT-446*
[**2137-10-10**] 03:21PM   PT-12.2 PTT-23.7 INR(PT)-0.9
[**2137-10-10**] 03:21PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.022
[**2137-10-10**] 03:21PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-NEG
GLUCOSE-100 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-TR
[**2137-10-10**] 03:21PM URINE  RBC-0-2 WBC-0-2 BACTERIA-OCC YEAST-NONE
EPI-0

Brief Hospital Course:
A/P: 74F s/p recent NSTEMI, VAP, with recurrent flash pulmonary
edema, presenting with respiratory distress, fever,
leukocytosis, in setting of likely more flash pulmonary edema.

1.  Fever/leukocytosis - The patient was pan cultured and grew
out MSSA from her sputum for which she was treated with
clindimycin.

2.  Respiratory Failure - likely multifactorial with
contributions from both PNA and CHF.  The MSSA PNA was treated
with clindimycin for a 2 week course.  The CHF team was
consulted regarding the patients CHF.  A cardiac cath was
performed which demonstrated three vessel coronary artery
disease, moderate systolic ventricular dysfuction, and moderate
diastolic ventricular function. It was decided at this time that
the patients CAD was not amenable to PCI and that medical
management was the best option.  Hence the patient was optimized
on a medical regimen which included hydralazine, clonidine,
captopril, metoprolol, amlodipine, isordil, plavix, and aspirin.
 On this regimen, the patients BP's were maintained with
systolics in the 140's.

3. DM - The patient's blood sugars were controlled on an insulin
drip.  At discharge the drip was converted to an equivalent dose
NPH/Regular.

4. Hypothyroidism - the patient was continued on her home dose
of synthroid.

5. Code Status - DNR.  Given the patient's severe CAD/CHF the
patient's functional status is severely impaired and she is now
vent dependent.  Her prognosis for any meningful recovery is
grim and this was discussed in detail with the family which ha
decided to make her DNR.


Medications on Admission:
Meds: lantus, ssi, asa, captopril, colace, laxis, sq heparin,
HCTZ, levothyroxine, lopressor, nystatin, senna


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
coronary artery disease
congestive heart failure / flash pulmonary edema
pneumonia


Discharge Condition:
stable

Discharge Instructions:
Please take medications as directed.

Followup Instructions:
none


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 286**]
{'Acute and chronic respiratory failure,Congestive heart failure, unspecified,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure with lesion of tubular necrosis,Other degenerative diseases of the basal ganglia,Subendocardial infarction, subsequent episode of care,Coronary atherosclerosis of native coronary artery,Tracheostomy status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Long-term (current) use of insulin'}


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
fevers

PRESENT ILLNESS: 74 yo female, transferred from [**Hospital1 1872**] rehab for recurrent
flash pulmonary edema.  Pt recently admitted/hospital stay at
[**Hospital1 **] on [**9-8**] for DKA and NSTEMI.  At this time, pt had a
long/complicated hospital course, determined not to be a
candidate for cardiac catheterization and MI managed medically.
She developed pulm edema, respiratory failure, was intubated,
developed vent-associated pna (MSSA), treated with levo until
[**10-7**].  She failed extubation and was eventually PEG/Trached,
sent to rehab on [**10-2**].  At rehab, pt had multiple episodes of
flash pulm edema that were managed with Morphine and lasix prn.
This morning, she had a similar episode with desat to 85%,
tachypnea to 30's, and SBP=78 with leukocytosis.  At family's
request and with these symptoms, she was transferred back here.
On presentation, she received MSO4 for dyspnea, was febrile to
102.2, BP=90/41, WBC=19 with left shift.  Pt with some new EKG
changes (t-wave inv v5-6, st elev v2-4), and elevated tnt.  Pt
admitted to MICU at this time for management of respiratory
failure vs. pneumonia.

MEDICAL HISTORY: DM2 on insulin
Hypercholesterolemia
Dementia/[**Doctor Last Name 122**] disease (an inherited spinocerebellar ataxia:
progressive neurological disorder of ataxia, peripheral
neuropathy)
(No known HTN)
Vent-associated PNA
NSTEMI
CHF
Anemia

MEDICATION ON ADMISSION: Meds: lantus, ssi, asa, captopril, colace, laxis, sq heparin,
HCTZ, levothyroxine, lopressor, nystatin, senna

ALLERGIES: Penicillins

PHYSICAL EXAM: 102.2       85         90/41      18   99%
Gen:  elderly appearing, lethargic, sedated
HEENT: PERRL, dry MM, tracheostomy c, d, i
CV: RRR, 2/6 SEM
Pulm: coarse BS, occasional rhonchi, no crackles
Abd: PEG-c,d,i; soft, NABS, nt
Extr: warm, no edema, good pulses, L PICC line-c, d, i
Neuro: non arousable

FAMILY HISTORY: [**Last Name (un) 32665**]-[**Doctor Last Name 11042**] disease.

SOCIAL HISTORY: Prior to admission the patient was living at home with her
daughter. The patient was bedridden and very dependent on family
members to care for her. She has a significant smoking history
of 50 pack years, though she quit smoking 10 years ago. Denies
EtOH or other drugs. 

### Response:
{'Acute and chronic respiratory failure,Congestive heart failure, unspecified,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure with lesion of tubular necrosis,Other degenerative diseases of the basal ganglia,Subendocardial infarction, subsequent episode of care,Coronary atherosclerosis of native coronary artery,Tracheostomy status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Long-term (current) use of insulin'}
