CHIEF COMPLAINT: hematemesis

PRESENT ILLNESS: This patient is a 43 year old female pmh EOTH cirrhosis with
known varices, who was transferred from an outside facility for
hematemesis. Pt has a history of
esophageal varices, followed at [**Hospital1 18**], who underwent a
paracentesis at [**Hospital1 18**] this AM, who presented to the OSH ER with
active hematemesis. EMS reported to that ER that there was 1 L
blood loss in the field. She had an additional 500 cc
hematemesis at that ER. She was hypotensive on arrival to their
ER with BP of 60 systolic, but reportedly had been stabilized
with sytolic BP 90 after 1 U PRBCs, FFP; and a 2nd unit was
being hung. Their GI physician was consulted, who advised
transfer to [**Hospital1 18**].
On [**Location (un) 7622**] arrival to our ER they report her SBP was 60 - 70
on arrival at OSH ER. She had the 5th U PRBCs hung. They started
pressors en route due to persistent hypotension. She has
continued to have hematemesis since transfer and passed large
clot per rectum as well.

MEDICAL HISTORY: -Alcohol cirrhosis - diagnosed 6 years ago, complicated by
esophageal varices (Grade 3 on EGD [**2129**] at [**Hospital6 28728**]
Center), ascites, SBP (treated at [**Hospital3 7362**] [**2129**]), recent
encephalopathy. Also with portal gastropathy and recent
hepatorenal syndrome
-GERD
-E. coli bacteremia/sepsis

MEDICATION ON ADMISSION: 1. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: HR: 140s BP: 40 systolic O(2)Sat: 94% Normal

FAMILY HISTORY: Prostate cancer, myocardial infarction, diabetes. Sister has
depression, hypothyroidism. Aunt with scleroderma.

SOCIAL HISTORY: -Tobacco history: At least 25 years
-ETOH: Started drinking at 11 years old, by 18 years old was
taking [**1-18**] drinks daily X 15 years. Recently 1-2 drinks/week.
-Illicit drugs: Cocaine use from 18 years old until [**2130-6-17**].
No history of IVDU, tattoos or transfusions.
-Home: Married for 1.5 years, now divorced. Living with a
partner for 5 years.
Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute respiratory failure,Portal hypertension,Acute posthemorrhagic anemia,Other and unspecified coagulation defects,Other ascites,Acidosis,Other and unspecified alcohol dependence, unspecified,Other shock without mention of trauma,Cardiac arrest
Alcohol cirrhosis liver,Bleed esoph var oth dis,Acute respiratry failure,Portal hypertension,Ac posthemorrhag anemia,Coagulat defect NEC/NOS,Ascites NEC,Acidosis,Alcoh dep NEC/NOS-unspec,Shock w/o trauma NEC,Cardiac arrest
Admission Date:  [**2133-1-27**]              Discharge Date:   [**2133-1-28**]

Date of Birth:  [**2089-10-27**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
hematemesis


Major Surgical or Invasive Procedure:
right femoral central line placement, left femoral central line


placement, TIPS procedure




History of Present Illness:
This patient is a 43 year old female pmh EOTH cirrhosis with
known varices, who was transferred from an outside facility for
hematemesis. Pt has a history of
esophageal varices, followed at [**Hospital1 18**], who underwent a
paracentesis at [**Hospital1 18**] this AM, who presented to the OSH ER with
active hematemesis. EMS reported to that ER that there was 1 L
blood loss in the field. She had an additional 500 cc
hematemesis at that ER. She was hypotensive on arrival to their
ER with BP of 60 systolic, but reportedly had been stabilized
with sytolic BP 90 after 1 U PRBCs, FFP; and a 2nd unit was
being hung. Their GI physician was consulted, who advised
transfer to [**Hospital1 18**].
On [**Location (un) 7622**] arrival to our ER they report her SBP was 60 - 70
on arrival at OSH ER. She had the 5th U PRBCs hung. They started
pressors en route due to persistent hypotension. She has
continued to have hematemesis since transfer and passed large
clot per rectum as well.




Past Medical History:
-Alcohol cirrhosis - diagnosed 6 years ago, complicated by
esophageal varices (Grade 3 on EGD [**2129**] at [**Hospital6 28728**]
Center), ascites, SBP (treated at [**Hospital3 7362**] [**2129**]), recent
encephalopathy. Also with portal gastropathy and recent
hepatorenal syndrome
-GERD
-E. coli bacteremia/sepsis

Social History:
-Tobacco history: At least 25 years
-ETOH: Started drinking at 11 years old, by 18 years old was
taking [**1-18**] drinks daily X 15 years. Recently 1-2 drinks/week.
-Illicit drugs: Cocaine use from 18 years old until [**2130-6-17**].
No history of IVDU, tattoos or transfusions.
-Home: Married for 1.5 years, now divorced. Living with a
partner for 5 years.


Family History:
Prostate cancer, myocardial infarction, diabetes. Sister has
depression, hypothyroidism. Aunt with scleroderma.

Physical Exam:
HR: 140s BP: 40 systolic O(2)Sat: 94% Normal

Constitutional: toxic appearing, awake, answering questions
but lethargic
HEENT: Normocephalic, atraumatic, Extraocular muscles
intact, icteric
blood in OP
Chest: grossly clear to limited anterior examination
Cardiovascular: tachycardic, regular
Abdominal: distended
Rectal: large clot of red blood per rectum
Extr/Back: non palpable DP. No sign LE dema
Skin: mottled extremities
Neuro: speech fluent, but lethargic, MAEE
Psych: lethargic


Pertinent Results:
[**2133-1-27**] 11:35PM   PT-30.3* PTT-101.1* INR(PT)-2.9*
[**2133-1-27**] 11:35PM   PLT COUNT-15*#
[**2133-1-27**] 11:35PM   FIBRINOGE-47*#
[**2133-1-27**] 11:32PM   TYPE-ART PO2-64* PCO2-53* PH-7.10* TOTAL
CO2-17* BASE XS--13 INTUBATED-INTUBATED
[**2133-1-27**] 11:32PM   GLUCOSE-207* LACTATE-6.3* NA+-137 K+-5.0
CL--111*
[**2133-1-27**] 11:32PM   HGB-6.7* calcHCT-20 O2 SAT-90 CARBOXYHB-1
[**2133-1-27**] 11:32PM   freeCa-0.41*
[**2133-1-27**] 09:58PM   TYPE-[**Last Name (un) **] PO2-106* PCO2-53* PH-7.03* TOTAL
CO2-15* BASE XS--17 COMMENTS-GREEN TOP
[**2133-1-27**] 09:58PM   GLUCOSE-261* LACTATE-5.4* NA+-136 K+-5.5*
CL--115*
[**2133-1-27**] 09:58PM   HGB-8.2* calcHCT-25
[**2133-1-27**] 09:55PM   GLUCOSE-278* UREA N-23* CREAT-0.8 SODIUM-142
POTASSIUM-5.7* CHLORIDE-113* TOTAL CO2-14* ANION GAP-21*
[**2133-1-27**] 09:55PM   CALCIUM-6.9* PHOSPHATE-7.6* MAGNESIUM-1.1*
[**2133-1-27**] 09:55PM   WBC-4.5 RBC-2.67* HGB-8.2* HCT-24.1* MCV-90
MCH-30.7 MCHC-34.0 RDW-14.2
[**2133-1-27**] 09:55PM   NEUTS-73* BANDS-2 LYMPHS-16* MONOS-1* EOS-0
BASOS-0 ATYPS-0 METAS-3* MYELOS-5*
[**2133-1-27**] 09:55PM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL BURR-3+ ACANTHOCY-OCCASIONAL
[**2133-1-27**] 09:55PM   PT-23.7* PTT-115.3* INR(PT)-2.3*
[**2133-1-27**] 09:55PM   PLT SMR-LOW PLT COUNT-87*
[**2133-1-27**] 09:03PM   PO2-95 PCO2-59* PH-6.97* TOTAL CO2-15* BASE
XS--19 INTUBATED-INTUBATED COMMENTS-GREEN TOP
[**2133-1-27**] 09:03PM   GLUCOSE-223* LACTATE-6.2* NA+-132* K+-7.2*
CL--110*
[**2133-1-27**] 09:03PM   HGB-9.1* calcHCT-27 O2 SAT-93 CARBOXYHB-2 MET
HGB-0
[**2133-1-27**] 09:03PM   freeCa-0.44*
[**2133-1-27**] 08:50PM   UREA N-27* CREAT-0.9
[**2133-1-27**] 08:50PM   estGFR-Using this
[**2133-1-27**] 08:50PM   LIPASE-82*
[**2133-1-27**] 08:50PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2133-1-27**] 08:50PM   WBC-5.8 RBC-2.95* HGB-9.1* HCT-26.4* MCV-89
MCH-30.8 MCHC-34.4 RDW-15.0
[**2133-1-27**] 08:50PM   PT-23.2* PTT-34.7 INR(PT)-2.2*
[**2133-1-27**] 08:50PM   PLT COUNT-71*
[**2133-1-27**] 08:50PM   FIBRINOGE-284
[**2133-1-27**] 08:50PM   PLT COUNT-71*
[**2133-1-27**] 08:50PM   FIBRINOGE-284
[**2133-1-27**] 07:30AM   WBC-12.3*# RBC-3.33* HGB-11.7* HCT-33.6*
MCV-101* MCH-35.2* MCHC-34.9 RDW-19.2*
[**2133-1-27**] 07:30AM   PLT COUNT-53*
[**2133-1-27**] 07:30AM   PT-22.0* INR(PT)-2.1*

Brief Hospital Course:
Patient arrived in the ER in critical condition. We activated
the massive transfusion protocol. Hepatology fellow was notified
of her transfer and approximate ETA. They were paged on her
arrival to ER and reported they would come in but requested IR
consultation as well, which was initiated within minutes of ER
arrival. She had active hematemsis with declining MS with severe
lethargy and needed intubation, but was severely hypotensive
with BP in 40s. Levophed added to regimen,
additional blood transfused, central lines placed. There was a R
femoral line (cordis) placed by ER resident, and attempt at a R
IJ placed that did not thread placed by another ER reisdent and
a L femoral resusication line placed by the ED attending for
access. With continued blood, maxxed pressors and boluses of
phenylephrine she continued to be hypotensive. Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] provided assistance during resuscitation and gave
additional boluses of epinephrine, with which we acheived BP
in70s and initiated RSI. Intubation successful on 1st attempt.
succinylcholine used as [**Location (un) **] reports normal K at referring
facility. OGT placed with >2 L bright red blood out- with
rapidly increasing output. Patient was persistently hypotensive
in ER despite >15 units PRBCs, FFP, cryoprecipitation, and
therefore [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 10045**] tube obtained. Surgery attending Dr. [**Last Name (STitle) 853**]
at bedside for assistance in placement. GI at beside after
placement. + decrease in OG output and
improvment in hemodynamics --> pressors weaneed. She did develop
a wide complex bradycardia, and was treated presumptively for
hyperK with improvement. Given improved stability after
[**Last Name (un) 10045**] placed with surgery, GI feels, Surgery, Emergency
medicine, and ICU attendings agreed that, it would be unsafe to
deflate the tube
for endoscopy. PT was taken directly to IR emergenctly for plan
for TIPS. Of note, during course of ED care, her abd became
increasingly distended. It is also notable that there was
persistent bleeding from the R IJ attempt: a suture was placed
and vascular surgery consulted.

In interventional radiology, pt was continued on the massive
transfusion protocol. Pt was prepped for TIPS, and surgery was
called to re-position the [**Last Name (un) 10045**] due to continued bleeding.
Re-positioning helped stem the flow of blood, but pt continued
to bleed profusely. The patient became more abdominally
distended, and more difficult to ventilate, with persistently
dropping O2 saturations during the procedure. Serial ABGs
revealed low oxygen content, acidosis, and persistent low hgb
despite massive transfusions. During the TIPS procedure, pt went
into PEA arrest. She had received 53 U of PRBC, 9 units of
cryoprecipitate, 14 units of FFP, 12 units of platelets, and a
total of 24 liters of fluids. It was decided that CPR was not
indicated in this circumstance, and the patient was pronounced
dead at 0238 on [**2133-1-28**].


Medications on Admission:
1. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).


2. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).


3. ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO once a
day.
4. ferrous sulfate 325 mg (65 mg iron) Tablet Sig: One (1)
Tablet PO once a day.
5. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day): Take at least once daily and titrate to [**1-19**] bowel
movements daily.
7. nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation every 4-6 hours as needed for shortness of
breath or wheezing.
9. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
10. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
11. spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
12. sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times

a day) for 7 days.
Disp:*28 Tablet(s)* Refills:*0*


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
cirrhosis, variceal bleed, hypotension, PEA arrest

Discharge Condition:
expired


Completed by:[**2133-1-28**]
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute respiratory failure,Portal hypertension,Acute posthemorrhagic anemia,Other and unspecified coagulation defects,Other ascites,Acidosis,Other and unspecified alcohol dependence, unspecified,Other shock without mention of trauma,Cardiac arrest'}


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: hematemesis

PRESENT ILLNESS: This patient is a 43 year old female pmh EOTH cirrhosis with
known varices, who was transferred from an outside facility for
hematemesis. Pt has a history of
esophageal varices, followed at [**Hospital1 18**], who underwent a
paracentesis at [**Hospital1 18**] this AM, who presented to the OSH ER with
active hematemesis. EMS reported to that ER that there was 1 L
blood loss in the field. She had an additional 500 cc
hematemesis at that ER. She was hypotensive on arrival to their
ER with BP of 60 systolic, but reportedly had been stabilized
with sytolic BP 90 after 1 U PRBCs, FFP; and a 2nd unit was
being hung. Their GI physician was consulted, who advised
transfer to [**Hospital1 18**].
On [**Location (un) 7622**] arrival to our ER they report her SBP was 60 - 70
on arrival at OSH ER. She had the 5th U PRBCs hung. They started
pressors en route due to persistent hypotension. She has
continued to have hematemesis since transfer and passed large
clot per rectum as well.

MEDICAL HISTORY: -Alcohol cirrhosis - diagnosed 6 years ago, complicated by
esophageal varices (Grade 3 on EGD [**2129**] at [**Hospital6 28728**]
Center), ascites, SBP (treated at [**Hospital3 7362**] [**2129**]), recent
encephalopathy. Also with portal gastropathy and recent
hepatorenal syndrome
-GERD
-E. coli bacteremia/sepsis

MEDICATION ON ADMISSION: 1. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: HR: 140s BP: 40 systolic O(2)Sat: 94% Normal

FAMILY HISTORY: Prostate cancer, myocardial infarction, diabetes. Sister has
depression, hypothyroidism. Aunt with scleroderma.

SOCIAL HISTORY: -Tobacco history: At least 25 years
-ETOH: Started drinking at 11 years old, by 18 years old was
taking [**1-18**] drinks daily X 15 years. Recently 1-2 drinks/week.
-Illicit drugs: Cocaine use from 18 years old until [**2130-6-17**].
No history of IVDU, tattoos or transfusions.
-Home: Married for 1.5 years, now divorced. Living with a
partner for 5 years. 

### Response:
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute respiratory failure,Portal hypertension,Acute posthemorrhagic anemia,Other and unspecified coagulation defects,Other ascites,Acidosis,Other and unspecified alcohol dependence, unspecified,Other shock without mention of trauma,Cardiac arrest'}
