CHIEF COMPLAINT: transfer from [**Hospital 5871**] hospital

PRESENT ILLNESS: 55M with hx Hep C, cirrhosis (on [**Hospital1 **] transplant list), HIV
admitted to OSH with hemetemasis and Hct of 11 on [**2115-2-17**].
Received 15 units pRBCs, 16 units FFP, 1 unit platelets. Pt had
EGD that showed bleeding varices, 1 was banded. Upon subsequent
bleed, pt was re-scoped and sclerosis was attempted. Intubated
for airway protection. At OSH, pt was hyperkalemia, also had G
negative bacteremia, started on Zosyn and Levofloxacin. Pt was
hemodynamically unstable and transferred on Levophed and
Vasopressin.
.
Upon arrival to MICU, pt was assystolic. Code Blue called. Pt
received 2 of atropine and 2 mg epi. Received chest compression.
Pulse and rhythm regained. Pt also received 2 amps bicarb during
code blue. Continued on levophed and vasopressin. Bolused with
IVF. Lactate initally 24, K 6.3. A line and dialysis catheter
placed.

MEDICAL HISTORY: HIV CD4 200 VL low
Hep C
cirrhosis
EtOH abuse in past
Eval for transplant at [**Hospital1 **]

MEDICATION ON ADMISSION: Meds on transfer:
Nexium 40 mg IV BID
Octreotide gtt at 50 mcg
Zosyn 3.375g Iv q 6
Levaquin 500 mg IV qD
VP 0.4
Hydrocort 100 IV q 8
Propofol gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 98.5, BP 80/56 HR 101 R 18 95% on Vent 450 X 16 P5 FiO2 50%
Gen: intubated, sedated
HEENT: pupils reactive
Chest: CTAB
CV: RRR tachy, unable to appreciate murmur
Abd: soft, distended +BS
Ext: tr edema ankles

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Remote Iv drug use, no EtOH or drugs lateley. Lives with
partner, [**Name (NI) **] [**Name (NI) **].
Septicemia due to escherichia coli [E. coli],Asymptomatic human immunodeficiency virus [HIV] infection status,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Awaiting organ transplant status,Septic shock,Acute kidney failure, unspecified,Esophageal varices in diseases classified elsewhere, with bleeding,Hyperpotassemia,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction
E coli septicemia,Asymp hiv infectn status,Cirrhosis of liver NOS,Chrnc hpt C wo hpat coma,Await organ transplnt st,Septic shock,Acute kidney failure NOS,Bleed esoph var oth dis,Hyperpotassemia,SIRS-noninf w ac org dys
Admission Date:  [**2115-2-18**]              Discharge Date:   [**2115-2-20**]

Date of Birth:  [**2059-4-8**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
transfer from [**Hospital 5871**] hospital

Major Surgical or Invasive Procedure:
central line placement

History of Present Illness:
55M with hx Hep C, cirrhosis (on [**Hospital1 **] transplant list), HIV
admitted to OSH with hemetemasis and Hct of 11 on [**2115-2-17**].
Received 15 units pRBCs, 16 units FFP, 1 unit platelets. Pt had
EGD that showed bleeding varices, 1 was banded. Upon subsequent
bleed, pt was re-scoped and sclerosis was attempted. Intubated
for airway protection. At OSH, pt was hyperkalemia, also had G
negative bacteremia, started on Zosyn and Levofloxacin. Pt was
hemodynamically unstable and transferred on Levophed and
Vasopressin.
.
Upon arrival to MICU, pt was assystolic. Code Blue called. Pt
received 2 of atropine and 2 mg epi. Received chest compression.
Pulse and rhythm regained. Pt also received 2 amps bicarb during
code blue. Continued on levophed and vasopressin. Bolused with
IVF. Lactate initally 24, K 6.3. A line and dialysis catheter
placed.


Past Medical History:
HIV CD4 200 VL low
Hep C
cirrhosis
EtOH abuse in past
Eval for transplant at [**Hospital1 **]


Social History:
Remote Iv drug use, no EtOH or drugs lateley. Lives with
partner, [**Name (NI) **] [**Name (NI) **].

Family History:
non-contributory


Physical Exam:
VS 98.5, BP 80/56 HR 101 R 18 95% on Vent 450 X 16 P5 FiO2 50%
Gen: intubated, sedated
HEENT: pupils reactive
Chest: CTAB
CV: RRR tachy, unable to appreciate murmur
Abd: soft, distended +BS
Ext: tr edema ankles


Pertinent Results:
[**2115-2-18**]
10:52p
pH6.82 pCO257 pO220 HCO311 BaseXS-30
Comments: Verified
Provider Notified [**Name9 (PRE) **] [**Name9 (PRE) **] Lab Policy
Type:Art
Na:139 K:6.2 Cl:101 Hgb:9.3 CalcHCT:28 Glu:120 freeCa:1.05
Lactate:24.7
Comments: Verified'

[**2115-2-18**]
10:48p
Source: Line-femoral line
143  102  48     AGap=39
-------------< 129
5.8  8  3.7 D
Comments: Notified K.Rose @ 0035 [**2115-2-19**]
Anion Gap Verified

Ca: 9.5 Mg: 2.2 P: 11.7
ALT: 1357 AP: 227 Tbili: 12.4 Alb:
AST: 6055 LDH: 5700 Dbili:  TProt:
[**Doctor First Name **]: 486 Lip: 186
Comments: Verified By Dilution

Source: Line-femoral line
 91
9.7 \ 9.0 / 46
    /26.2 \

 N:61 Band:18 L:12 M:1 E:1 Bas:0 Metas: 6 Myelos: 1 Nrbc: 23
Comments: Adjusted For Nrbc
23nrbc'S/100wbc'S
Verified By Smear
BILOBED AND DYSPLASTIC POLYS SEEN
Hypochr: 2+ Anisocy: 1+ Poiklo: 1+ Macrocy: 1+ Polychr: 1+
Schisto: 1+ Burr: 2+ Stipple: 1+ Tear-Dr: 1+
Comments: MANUALLY COUNTED
TOXIC GRANULATIONS
DOHLE BODIES
Plt-Est: Very Low

Source: Line-femoral line
PT: 25.6  PTT: 78.7  INR: 2.6
.
CXR:  Enlarged cardiac silhouette and slight widened mediastinum
which could represent pericardial effusion and/or mediastinal
hematoma, however AP projection makes for difficult comparison
and enlargement could be attributed to projectional differences.
2. Bilateral hazy opacifications within the parenchyma which
could represent pulmonary edema. Again projectional differences
could account for these findings.
3. Bilateral small-to-moderate pleural effusions.
4. Distended stomach with NG tube tip overlying the proximal
stomach.
5. Endotracheal tube in likely appropriate position 4 cm from
the carina. Lateral radiographs which are unavailable would
ensure location.
.
ECHO:
The left atrium is normal in size. Left ventricular wall
thickness, cavity size, and systolic function are normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. There is no pericardial effusion. Compared with the
prior study (images reviewed) of [**2115-1-7**], the heart rate is
faster.




Brief Hospital Course:
The patient was admitted to the ICU with asystole on transfer.
After the code described in the HPI, he was kept intubated but
required no sedation and was minimally responsive.  He required
multiple transfusions of both PRBCs and FFP, and was given IVF
resuscitation as well.  He was covered with broad spectrum
antibiotics and given Hydrocort for possible adrenal
insufficiency as well.  He was started on 3 different pressors,
all of which were eventually maxed out at the highest dose in
order to maintain a MAP >60.  Culture results from the outside
hospital were obtained, c/w high grade bacteremia.
.
Both surgery and liver services were consulted regarding his
esophageal bleed, and an octreotide drip was continued.  He had
an abdominal US which showed cirrhosis, splenomegaly, and a
small amount of ascites.  Given that he had an enlarged heart on
CXR a bedside echo was initially done to rule out effusion,
tamponade.  Given his elevated creatinine and severe volume
overload in addition to hyperkalemia, renal service was
consulted, and CVVH was initiated.  As the patient continued to
be unresponsive >24 hours after coding, it was thought that he
likely had a very poor neurological prognosis.  An EEG was
obtained, and the neuro service was consulted.  Goals of care
and prognosis were extensively discussed with the family by both
the primary medicine team and the liver attending.  The family
decided to make the patient CMO.  All pressors and medications
were discontinued, and the patient was started on a morphine
drip to titrate to comfort.  The patient expired shortly after,
with his family present at bedside.  An autopsy was offered, but
declined.

Medications on Admission:
Meds on transfer:
Nexium 40 mg IV BID
Octreotide gtt at 50 mcg
Zosyn 3.375g Iv q 6
Levaquin 500 mg IV qD
VP 0.4
Hydrocort 100 IV q 8
Propofol gtt


Discharge Disposition:
Expired

Discharge Diagnosis:
septic shock
bacteremia
end stage liver disease
cirrhosis

Discharge Condition:
expired
{'Septicemia due to escherichia coli [E. coli],Asymptomatic human immunodeficiency virus [HIV] infection status,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Awaiting organ transplant status,Septic shock,Acute kidney failure, unspecified,Esophageal varices in diseases classified elsewhere, with bleeding,Hyperpotassemia,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction'}


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: transfer from [**Hospital 5871**] hospital

PRESENT ILLNESS: 55M with hx Hep C, cirrhosis (on [**Hospital1 **] transplant list), HIV
admitted to OSH with hemetemasis and Hct of 11 on [**2115-2-17**].
Received 15 units pRBCs, 16 units FFP, 1 unit platelets. Pt had
EGD that showed bleeding varices, 1 was banded. Upon subsequent
bleed, pt was re-scoped and sclerosis was attempted. Intubated
for airway protection. At OSH, pt was hyperkalemia, also had G
negative bacteremia, started on Zosyn and Levofloxacin. Pt was
hemodynamically unstable and transferred on Levophed and
Vasopressin.
.
Upon arrival to MICU, pt was assystolic. Code Blue called. Pt
received 2 of atropine and 2 mg epi. Received chest compression.
Pulse and rhythm regained. Pt also received 2 amps bicarb during
code blue. Continued on levophed and vasopressin. Bolused with
IVF. Lactate initally 24, K 6.3. A line and dialysis catheter
placed.

MEDICAL HISTORY: HIV CD4 200 VL low
Hep C
cirrhosis
EtOH abuse in past
Eval for transplant at [**Hospital1 **]

MEDICATION ON ADMISSION: Meds on transfer:
Nexium 40 mg IV BID
Octreotide gtt at 50 mcg
Zosyn 3.375g Iv q 6
Levaquin 500 mg IV qD
VP 0.4
Hydrocort 100 IV q 8
Propofol gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 98.5, BP 80/56 HR 101 R 18 95% on Vent 450 X 16 P5 FiO2 50%
Gen: intubated, sedated
HEENT: pupils reactive
Chest: CTAB
CV: RRR tachy, unable to appreciate murmur
Abd: soft, distended +BS
Ext: tr edema ankles

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Remote Iv drug use, no EtOH or drugs lateley. Lives with
partner, [**Name (NI) **] [**Name (NI) **]. 

### Response:
{'Septicemia due to escherichia coli [E. coli],Asymptomatic human immunodeficiency virus [HIV] infection status,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Awaiting organ transplant status,Septic shock,Acute kidney failure, unspecified,Esophageal varices in diseases classified elsewhere, with bleeding,Hyperpotassemia,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction'}
