CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 62-year-old male with
longstanding severe emphysema/COPD requiring home oxygen with
a history of multiple hospitalizations for exacerbation
requiring intubation and antibiotics (last one in [**2180-3-21**]), presents with worsening shortness of breath for one
week.  The patient was last seen in the Emergency Room on
[**2180-10-26**] for "COPD exacerbation" after he ran out of
nebulizers and being exposed to smoke in a kitchen.  He was
treated at the time with IV Solu-Medrol one dose and
nebulizers twice, and discharged home and O2 saturation was
approximately 95% on 4 liters of oxygen (baseline).

MEDICAL HISTORY: 1. COPD/emphysema:  Diagnosed in [**2163**].  On home oxygen 2
liters of nasal cannula x24 hours.  He is on chronic
prednisone dose of 20 mg q.d.  He sleeps on three pillows and
has no orthopnea.  No pulmonary function tests on record
here.
2. Reactive airway disease/asthma.
3. Coronary artery disease:  Non-Q-wave myocardial infarction
on [**2180-2-19**].  Echocardiogram showed an ejection fraction
of 55% at that time with right ventricular hypertrophy and
dilatation of the right ventricle with global hypokinesis of
the right ventricle and moderate pulmonary artery systolic
hypertension.  He was scheduled to undergo a stress test at
the time, but has not gone.
4. Hypertension.
5. Dyslipidemia.
6. Cerebrovascular accident.
7. Seizure disorder:  On primidone stable.
8. Atopic dermatitis.
9. Chronic anemia.

MEDICATION ON ADMISSION: 

ALLERGIES: He is allergic to sulfa, causes facial edema.

PHYSICAL EXAM: 

FAMILY HISTORY: Noticeable for diabetes mellitus and
hypertension.  Denies history of cancer or heart disease.

SOCIAL HISTORY: Lives by himself at the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] House
in [**Location (un) **] with VNAs and home makers helping with food and
house keeping.  His daughter is in the area and sees her "on
and off."  He last smoked in [**2173**].  Up to that time he was
smoking about 1-2 packs per day for 20 years.  He denies any
recent alcohol.  Although to prior to '[**63**], he had a history
of alcohol abuse drinking a [**12-23**] pint of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**] daily.
He denies any IV drug use.
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Other convulsions,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Old myocardial infarction,Anemia, unspecified
Acute respiratry failure,Obs chr bronc w(ac) exac,Convulsions NEC,Crnry athrscl natve vssl,Hypertension NOS,Old myocardial infarct,Anemia NOS
Admission Date:  [**2180-11-7**]     Discharge Date:  [**2180-11-13**]

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

Service:  [**Doctor Last Name **] Medicine Firm

HISTORY OF PRESENT ILLNESS:  This is a 62-year-old male with
longstanding severe emphysema/COPD requiring home oxygen with
a history of multiple hospitalizations for exacerbation
requiring intubation and antibiotics (last one in [**2180-3-21**]), presents with worsening shortness of breath for one
week.  The patient was last seen in the Emergency Room on
[**2180-10-26**] for "COPD exacerbation" after he ran out of
nebulizers and being exposed to smoke in a kitchen.  He was
treated at the time with IV Solu-Medrol one dose and
nebulizers twice, and discharged home and O2 saturation was
approximately 95% on 4 liters of oxygen (baseline).

In the past week, he had finished a steroid taper back to 20
mg p.o. q.d. which is his baseline.  At this time, he started
noticing increased worsening of his dyspnea and a productive
cough of white yellow sputum.  At this time he was using
nebulizers every hour.  At 6:30 a.m., on the day of
admission, he ran out of nebulizers and called EMTs.  In the
Emergency Room, he was found to be in acute distress, and
tripod position and breathless.  Vitals showed a pulse of 96,
blood pressure of 156/96, respiratory rate of 28-32, and an
O2 saturation of 100% after nebulizer treatment.  He again
was treated with Solu-Medrol 125 mg IV and albuterol
nebulizers.  He desaturated from 90% to 60%, but refused
intubation, so he was placed on heliox without any
improvement.  He was started on 100% nonrebreather mask with
sats increasing to 97%.  At this time, he was transferred to
the MICU.  ABGs drawn at that time showed a pH of 7.23 and a
pCO2 of 85.

While in the MICU, he was started on BiPAP with O2
saturations ranging from 88 to 92%, however, he had another
episode of desaturation and he was put back on 100%
nonrebreather mask restoring his saturations.  He was
continued on Solu-Medrol drip 125 mg q.6h., nebulizer
treatments q15 minutes and started on empiric antibiotic
therapy with levofloxacin.  He had improved air movement on
ICU day #2.  His steroids were changed from IV to prednisone
p.o. 60 mg.  His nebulizers were weaned down to q2-3h and he
was weaned down to nasal cannula on 2 liters and maintaining
his sats around 90-93%.

Upon transfer to the floor, he felt much improved, but tired.
He had decreased appetite.  He denied any fevers, chills,
chest pain, abdominal pain, nausea, vomiting, or diarrhea.

PAST MEDICAL HISTORY:
1. COPD/emphysema:  Diagnosed in [**2163**].  On home oxygen 2
liters of nasal cannula x24 hours.  He is on chronic
prednisone dose of 20 mg q.d.  He sleeps on three pillows and
has no orthopnea.  No pulmonary function tests on record
here.
2. Reactive airway disease/asthma.
3. Coronary artery disease:  Non-Q-wave myocardial infarction
on [**2180-2-19**].  Echocardiogram showed an ejection fraction
of 55% at that time with right ventricular hypertrophy and
dilatation of the right ventricle with global hypokinesis of
the right ventricle and moderate pulmonary artery systolic
hypertension.  He was scheduled to undergo a stress test at
the time, but has not gone.
4. Hypertension.
5. Dyslipidemia.
6. Cerebrovascular accident.
7. Seizure disorder:  On primidone stable.
8. Atopic dermatitis.
9. Chronic anemia.

SOCIAL HISTORY:  Lives by himself at the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] House
in [**Location (un) **] with VNAs and home makers helping with food and
house keeping.  His daughter is in the area and sees her "on
and off."  He last smoked in [**2173**].  Up to that time he was
smoking about 1-2 packs per day for 20 years.  He denies any
recent alcohol.  Although to prior to '[**63**], he had a history
of alcohol abuse drinking a [**12-23**] pint of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**] daily.
He denies any IV drug use.

FAMILY HISTORY:  Noticeable for diabetes mellitus and
hypertension.  Denies history of cancer or heart disease.

ALLERGIES:  He is allergic to sulfa, causes facial edema.

MEDICATIONS:
1. Albuterol/ipratropium 1-2 puffs q.d.
2. Ipratropium one nebulizer treatment q.4-6h. prn.
3. Albuterol one nebulizer treatment q.4-6h. prn.
4. Prednisone 60 mg q.d.
5. Zolpidem 5 mg q.h.s. prn.
6. Tums 500 mg b.i.d.
7. Atorvastatin 10 mg p.o. q.d.
8. Verapamil 120 mg q.d.
9. Primidone 50 mg q.h.s.
10. Aspirin 325 mg q.d.
11. Vitamin D 800 mg q.d.
12. Isosorbide mononitrate 30 mg q.d.
13. Pantoprazole 40 mg q.d.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Blood
pressure 170/113, pulse is 103 beats per minute, respiratory
rate of 22, and 100% oxygen on 100% nonrebreather mask.  In
general, he was in mild distress using sternocleidomastoid,
pursed breathing in between words and sentences.  His sclerae
were anicteric.  His pupils are equal, round, and reactive to
light and accommodation.  His neck showed no jugular venous
distention.  His chest showed moderate air movement with
expiratory wheezes and hyperresonant to percussion.  His
heart was tachycardic, but regular, normal S1 and S2 with a
positive S4, no murmurs or gallops.  His abdomen had
paradoxical movement on inspiration, was soft, nontender,
nondistended with normal bowel sounds.  He had no
costovertebral angle tenderness.  He had no clubbing,
cyanosis, or edema on his extremities, but they were cool.
Neurologically, he was alert and oriented to person, place,
and time.  Sensory and motor were grossly intact.

LABORATORIES ON ADMISSION:  White count of 6, hematocrit of
44.6, platelets of 256.  He had a sodium of 135, potassium of
4.8, chloride of 94, bicarbonate of 40, BUN of 9, creatinine
of 0.7, and a sugar of 141.  Calcium was 9.0, magnesium was
1.9 and phosphate was 2.4.  His urinalysis was negative.
Urine cultures were sent.

Chest x-ray done showed no CHF or focal consolidation, but
evidence of hyperinflation consistent with emphysema.

EKG shows sinus rhythm at 97 beats per minute with atrial
premature beats, which were new since the last tracing of
[**2180-3-27**], normal axis, normal intervals, and no ST
segment changes.

HOSPITAL COURSE BY PROBLEMS:
1. COPD exacerbation with acute respiratory failure:  Upon
transfer to the floor, the patient was started on 2 liters
nasal cannula of oxygen and prednisone of 60 mg p.o. q.d. and
nebulizer treatments spaced out every two hours prn.  During
the next couple days, series attempts were made at weaning
off the nebulizer treatments and spacing them out, however,
the O2 saturations dropped and the patient continued to
complain of shortness of breath.

On hospital day #6, the patient was able to tolerate q.4h.
nebulizer treatments and was noticeably feeling much better
with O2 saturations ranging between 95 and 98% on 2 liter
nasal cannula.  He was continued on levofloxacin throughout
the hospitalization.

2. Lung nodule ?:  On chest x-ray, the patient was found to
have a lung nodule on the right middle lobe measuring 3 mm.
It was consistent with one observed back in [**2180-2-19**].
Per PCP's recommendations, a chest CT was ordered which
showed severe bullous emphysema with large bullae at the left
apex and no pulmonary nodule or mass corresponding to the
abnormality described by the chest x-ray.  However, several
small opacities in both lungs were noticed and recommended
that it should be re-evaluated in three months.

2. Hypertension:  Blood pressure well controlled on verapamil
and isosorbide mononitrate.  Stable.

3. Coronary artery disease:  EKG showed new onset of atrial
premature beats.  Unclear clinical significance.  Patient is
asymptomatic.  No events during hospitalization.

4. Seizure disorder:  Patient continued on primidone.  No
seizure activity noted.

5. FEN:  Patient was on a cardiac diabetic diet.  The
electrolytes were replenished prn.

6. Prophylaxis:  Patient was placed on pantoprazole and subQ
Heparin given his lack of ambulation.

DISCHARGE MEDICATIONS:
1. Levofloxacin 500 mg p.o. q.d. for a total of 14 days,
seven days left on treatment.
2. Tylenol 325 mg p.o. q.4-6h. as needed.
3. Docusate.
4. Senna.
5. Pantoprazole 40 mg q.d.
6. Isosorbide mononitrate 30 mg p.o. q.d.
7. Vitamin D 400 units two tablets p.o. q.d.
8. Aspirin 325 mg p.o. q.d.
9. Primidone 50 mg p.o. q.h.s.
10. Verapamil 120 mg p.o. q.d.
11. Atorvastatin 10 mg p.o. q.d.
12. Guaifenesin 600 mg two tablets p.o. q.12h.
13. Fexofenadine 60 mg p.o. b.i.d.
14. Tums 500 mg p.o. b.i.d.
15. Albuterol/ipratropium aerosol 1-2 puffs q.4h.
16. Albuterol 0.083% solution one nebulizer treatment every
four hours as needed.
17. Ipratropium bromide 0.02% solution one nebulizer
treatment q.4-6h. as needed.
18. Zolpidem 5 mg p.o. q.h.s.
19. Prednisone taper from 60 mg to 20 mg in 5 mg decrement
every four days.

DISPOSITION:  He was discharged to home with VNA services in
stable condition.

DISCHARGE DIAGNOSES:
1. Acute respiratory failure secondary to acute exacerbation
of chronic obstructive pulmonary disease.
2. Acute bronchitis.
3. Critical care.
4. Emphysema.
5. Hypertension.

CODE STATUS:  Full.

DISCHARGE FOLLOWUP:
1. Patient is to followup with Dr. [**Last Name (STitle) 5762**] within one week of
discharge.
2. Patient has a scheduled appointment with the Pulmonary
Clinic at the [**Hospital1 69**].  Phone
number is [**Telephone/Fax (1) 5091**] on [**2180-12-6**] at 10:45 a.m.
with Dr. [**Last Name (STitle) 34623**].  He is required to report to the Pulmonary
Breathing Test Center at the [**Hospital Ward Name 23**] Building at 10:45.



                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 9755**]

Dictated By:[**Last Name (NamePattern1) 34624**]

MEDQUIST36

D:  [**2180-11-13**]  14:07
T:  [**2180-11-14**]  07:57
JOB#:  [**Job Number 34625**]
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Other convulsions,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Old myocardial infarction,Anemia, 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: 

PRESENT ILLNESS: This is a 62-year-old male with
longstanding severe emphysema/COPD requiring home oxygen with
a history of multiple hospitalizations for exacerbation
requiring intubation and antibiotics (last one in [**2180-3-21**]), presents with worsening shortness of breath for one
week.  The patient was last seen in the Emergency Room on
[**2180-10-26**] for "COPD exacerbation" after he ran out of
nebulizers and being exposed to smoke in a kitchen.  He was
treated at the time with IV Solu-Medrol one dose and
nebulizers twice, and discharged home and O2 saturation was
approximately 95% on 4 liters of oxygen (baseline).

MEDICAL HISTORY: 1. COPD/emphysema:  Diagnosed in [**2163**].  On home oxygen 2
liters of nasal cannula x24 hours.  He is on chronic
prednisone dose of 20 mg q.d.  He sleeps on three pillows and
has no orthopnea.  No pulmonary function tests on record
here.
2. Reactive airway disease/asthma.
3. Coronary artery disease:  Non-Q-wave myocardial infarction
on [**2180-2-19**].  Echocardiogram showed an ejection fraction
of 55% at that time with right ventricular hypertrophy and
dilatation of the right ventricle with global hypokinesis of
the right ventricle and moderate pulmonary artery systolic
hypertension.  He was scheduled to undergo a stress test at
the time, but has not gone.
4. Hypertension.
5. Dyslipidemia.
6. Cerebrovascular accident.
7. Seizure disorder:  On primidone stable.
8. Atopic dermatitis.
9. Chronic anemia.

MEDICATION ON ADMISSION: 

ALLERGIES: He is allergic to sulfa, causes facial edema.

PHYSICAL EXAM: 

FAMILY HISTORY: Noticeable for diabetes mellitus and
hypertension.  Denies history of cancer or heart disease.

SOCIAL HISTORY: Lives by himself at the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] House
in [**Location (un) **] with VNAs and home makers helping with food and
house keeping.  His daughter is in the area and sees her "on
and off."  He last smoked in [**2173**].  Up to that time he was
smoking about 1-2 packs per day for 20 years.  He denies any
recent alcohol.  Although to prior to '[**63**], he had a history
of alcohol abuse drinking a [**12-23**] pint of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**] daily.
He denies any IV drug use. 

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