CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 17157**] is a 85 y/o man living at [**Hospital **] rehab admitted on
[**1-3**] to the medical service after presenting to the emergency
department with shortness of breath. He was foudn to be in
moderate respiratory distress, with evidence of fluid overload
on a chest xray. He was hypertensive and had chest pain. He was
breifly on bipap and diuresed wiht IV lasix. He was weaned from
Bipap and was admitted to the floor.
On the morning of [**2176-1-5**] he remarked on shortness of breath to
the nursing staff. He was in the process of receiving a
nebulizer when his eyes rolled back in his head and he became
pulseless. A code blue was called. His code status was in
question, as an admission note documented "reportedly DNR/DNI"
but this was not confrimed with the attending and not ordered in
POE. The attending was contact[**Name (NI) **] and did know the patient's code
status. Family members were [**Name2 (NI) 16535**] at the time of the code.
He was initially in Asystole and CPR was begun. He was given
atropine/epi x 2 of both, and enered a wide complex, bradycardic
PEA. He was given bicarb/calcium chloride, and regained a pulse
and a blood pressure of 140/90. He was intubated during the code
and brought to the ICU.
Subsequently, documentation of a signed DNR/DNR from [**Month (only) 462**]
[**2174**] was found in his chart, signed by his brother and HCP,
[**Name (NI) **].

MEDICAL HISTORY: Past Medical History:
1. Constipation and overflow fecal incontinence (2 yrs)
2. sacral decubitus ([**4-10**], sees derm for f/u)
3. presbylarynx (bilat vocal fold atrophy) - hoarseness since
[**2171**]
4. Atrial fibrillation - not on coumadin b/c fall history
5. GERD
6. Tremor
7. Scoliosis
8. Hypertension
9. Benign prostatic hypertrophy
10. Venous insufficiency: h/o venous stripping.
11. Depression
12. History of hyponatremia (siadh with ssri's, placed on
remeron)
13. Parkinson's disease: dx [**2172**].
14. Cognitive impairment
15: Anemia
16. Bilateral inguinal hernia repair with left re-repair [**11/2171**]

MEDICATION ON ADMISSION: sinemet 25/100 tid
asa ec 325 qday
cholecalciferol 1g qday
calcium carbonate 650 [**Hospital1 **]
lisinopril 10 qday
tamsulosin 0.4 qhs
acetaminophen 650 q4hr prn
arificial tears 1 drop bilaterally qhs
guaifenesin/dextr 5mls qhs
guaifenesin/dextro 5 mls q4hr prn
psyllium seed 1 ts [**Hospital1 **]

ALLERGIES: Protonix

PHYSICAL EXAM: vitals: 99.0 140/78 84 36 94%4L
gen: intubated, sedated
heent: pupils are reactive bialterally
pulm: diffuse bronchial breath sounds and expiratory wheezes, no
crackles. Poor air movement.
cv: irregularly irregular, some question of paradoxical chest
wall motion.
abd: slightly distended, nabs, nt/nd
extr: 1+ LE edema bilaterally
neuro: aox4, cn 2-12 intact grossly

FAMILY HISTORY: Notable for hypertension and coronary artery disease.

SOCIAL HISTORY: Lives alone in an apartment, with vna/pt visits.  looking to
move into [**Hospital6 **].
Drugs: ??????
Tob: remote hx of 2 pack-years
Alc: drink before dinner
Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Acute respiratory failure,Anoxic brain damage,Cardiac arrest,Unspecified essential hypertension,Paralysis agitans
Food/vomit pneumonitis,Ac systolic hrt failure,Acute respiratry failure,Anoxic brain damage,Cardiac arrest,Hypertension NOS,Paralysis agitans
Admission Date:  [**2176-1-3**]              Discharge Date:   [**2176-1-9**]


Service: MEDICINE

Allergies:
Protonix

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
Endotracheal intubation

History of Present Illness:
Mr. [**Known lastname 17157**] is a 85 y/o man living at [**Hospital **] rehab admitted on
[**1-3**] to the medical service after presenting to the emergency
department with shortness of breath. He was foudn to be in
moderate respiratory distress, with evidence of fluid overload
on a chest xray. He was hypertensive and had chest pain. He was
breifly on bipap and diuresed wiht IV lasix. He was weaned from
Bipap and was admitted to the floor.
On the morning of [**2176-1-5**] he remarked on shortness of breath to
the nursing staff. He was in the process of receiving a
nebulizer when his eyes rolled back in his head and he became
pulseless. A code blue was called. His code status was in
question, as an admission note documented "reportedly DNR/DNI"
but this was not confrimed with the attending and not ordered in
POE. The attending was contact[**Name (NI) **] and did know the patient's code
status. Family members were [**Name2 (NI) 16535**] at the time of the code.
He was initially in Asystole and CPR was begun. He was given
atropine/epi x 2 of both, and enered a wide complex, bradycardic
PEA. He was given bicarb/calcium chloride, and regained a pulse
and a blood pressure of 140/90. He was intubated during the code
and brought to the ICU.
Subsequently, documentation of a signed DNR/DNR from [**Month (only) 462**]
[**2174**] was found in his chart, signed by his brother and HCP,
[**Name (NI) **].

Past Medical History:
Past Medical History:
1. Constipation and overflow fecal incontinence (2 yrs)
2. sacral decubitus ([**4-10**], sees derm for f/u)
3. presbylarynx (bilat vocal fold atrophy) - hoarseness since
[**2171**]
4. Atrial fibrillation - not on coumadin b/c fall history
5. GERD
6. Tremor
7. Scoliosis
8. Hypertension
9. Benign prostatic hypertrophy
10. Venous insufficiency: h/o venous stripping.
11. Depression
12. History of hyponatremia (siadh with ssri's, placed on
remeron)
13. Parkinson's disease: dx [**2172**].
14. Cognitive impairment
15: Anemia
16. Bilateral inguinal hernia repair with left re-repair [**11/2171**]

17. Left femoral hernia repair [**11/2171**]

Social History:
Lives alone in an apartment, with vna/pt visits.  looking to
move into [**Hospital6 **].
Drugs: ??????
Tob: remote hx of 2 pack-years
Alc: drink before dinner


Family History:
Notable for hypertension and coronary artery disease.

Physical Exam:
vitals: 99.0 140/78 84 36 94%4L
gen: intubated, sedated
heent: pupils are reactive bialterally
pulm: diffuse bronchial breath sounds and expiratory wheezes, no
crackles. Poor air movement.
cv: irregularly irregular, some question of paradoxical chest
wall motion.
abd: slightly distended, nabs, nt/nd
extr: 1+ LE edema bilaterally
neuro: aox4, cn 2-12 intact grossly

Pertinent Results:
[**2176-1-3**] 11:35AM BLOOD WBC-8.1 RBC-4.06* Hgb-13.2* Hct-39.3*
MCV-97 MCH-32.4* MCHC-33.4 RDW-15.4 Plt Ct-190
[**2176-1-9**] 04:00AM BLOOD WBC-7.7 RBC-3.34* Hgb-11.1* Hct-33.0*
MCV-99* MCH-33.3* MCHC-33.7 RDW-15.6* Plt Ct-149*
[**2176-1-3**] 11:35AM BLOOD Neuts-86.3* Lymphs-9.8* Monos-3.6 Eos-0.2
Baso-0.1
[**2176-1-5**] 07:46AM BLOOD PT-13.9* PTT-29.1 INR(PT)-1.2*
[**2176-1-3**] 11:35AM BLOOD Plt Ct-190
[**2176-1-5**] 07:46AM BLOOD Fibrino-660*
[**2176-1-3**] 11:35AM BLOOD Glucose-191* UreaN-19 Creat-0.8 Na-138
K-3.6 Cl-98 HCO3-27 AnGap-17
[**2176-1-9**] 04:00AM BLOOD Glucose-134* UreaN-30* Creat-0.7 Na-147*
K-4.3 Cl-111* HCO3-30 AnGap-10
[**2176-1-3**] 09:00PM BLOOD CK(CPK)-135
[**2176-1-5**] 07:46AM BLOOD ALT-14 AST-37 LD(LDH)-242 AlkPhos-50
Amylase-83 TotBili-1.0
[**2176-1-3**] 11:35AM BLOOD CK-MB-8 cTropnT-<0.01 proBNP-1009*
[**2176-1-4**] 05:15AM BLOOD Calcium-10.1 Phos-4.1 Mg-2.0

Relevant Imaging:
ECHO ([**1-4**]): The left atrium is moderately dilated. The right
atrium is markedly dilated. The estimated right atrial pressure
is 10-20mmHg. Left ventricular wall thickness, cavity size and
regional/global systolic function are normal (LVEF 70%) Right
ventricular chamber size and free wall motion are normal. The
aortic root is mildly dilated at the sinus level. The ascending
aorta is mildly dilated. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. The aortic
valve is not well seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Trivial mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. There is no pericardial effusion.

CTA ([**1-5**]): 1. No pulmonary embolus. 2. Large left pneumothorax
and subcutaneous emphysema in the left chest wall. 3. Bilateral
lower lobe consolidation and additional patchy areas of
consolidation throughout the remainder of the lungs, findings
that could represent aspiration, pulmonary hemorrhage,
superimposed pneumonia, or a combination of the above. 4.
Dilated esophagus containing fluid and gas could relate to
possible aspiration. 5. Multiple left sided rib fractures.

CT Head ([**1-5**]): 1. No acute intracranial hemorrhage. 2.
Age-related brain atrophy. 3. No significant interval change
since the prior study.

CTA Head ([**1-6**]): Mild brain atrophy on head CT without acute
hemorrhage or mass effect. Normal CT angiography of the head.

EEG ([**1-7**]): This is an abnormal portable EEG due to persisent
moderate
amplitude generalized spike and slow wave epileptiform
discharges, with
a bifrontocentral predominance, at times in prolonged runs at a
frequency of [**1-6**].5 Hz. Clinically, the patient was unresponsive
to
voice or tactile stimuli and was noted to have intermittent
jerking
movements of his legs. Findings are consistent with
non-convulsive
status epilepticus.


Brief Hospital Course:
A/P: 85 yo male with history of afib, HTN, parkinson's disease
presents with new onset fluid overload, CP, and elevated BP, now
s/p asystolic cardiac arrest with unclear precipitant.

1) Cardiac arrest: The patient was admitted to the MICU
following his resusitation from cardiac arrest. At the time of
his code, his code status was uncertain. Ddx included
aspiration, acute arterial occlusion, hypoxia, acidemia,
electrolyte abnormalities, and pulmonary embolism. He was
intubated and then transferred to the MICU. He was placed on
broad spectrum antibiotics and also underwent several imaging
studies including echo, CTA chest, and CT head. Decision was
then made by health care proxy to change code status to [**Name (NI) 3225**].
Patient then passed away.

2) Respiratory failure: Given unclear code status, the patient
was intubated for airway protection during the cardiac arrest.


Medications on Admission:
sinemet 25/100 tid
asa ec 325 qday
cholecalciferol 1g qday
calcium carbonate 650 [**Hospital1 **]
lisinopril 10 qday
tamsulosin 0.4 qhs
acetaminophen 650 q4hr prn
arificial tears 1 drop bilaterally qhs
guaifenesin/dextr 5mls qhs
guaifenesin/dextro 5 mls q4hr prn
psyllium seed 1 ts [**Hospital1 **]

Discharge Medications:
Patient expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient expired

Discharge Condition:
Patient expired

Discharge Instructions:
Patient expired

Followup Instructions:
Patient expired
{'Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Acute respiratory failure,Anoxic brain damage,Cardiac arrest,Unspecified essential hypertension,Paralysis agitans'}


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: Shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 17157**] is a 85 y/o man living at [**Hospital **] rehab admitted on
[**1-3**] to the medical service after presenting to the emergency
department with shortness of breath. He was foudn to be in
moderate respiratory distress, with evidence of fluid overload
on a chest xray. He was hypertensive and had chest pain. He was
breifly on bipap and diuresed wiht IV lasix. He was weaned from
Bipap and was admitted to the floor.
On the morning of [**2176-1-5**] he remarked on shortness of breath to
the nursing staff. He was in the process of receiving a
nebulizer when his eyes rolled back in his head and he became
pulseless. A code blue was called. His code status was in
question, as an admission note documented "reportedly DNR/DNI"
but this was not confrimed with the attending and not ordered in
POE. The attending was contact[**Name (NI) **] and did know the patient's code
status. Family members were [**Name2 (NI) 16535**] at the time of the code.
He was initially in Asystole and CPR was begun. He was given
atropine/epi x 2 of both, and enered a wide complex, bradycardic
PEA. He was given bicarb/calcium chloride, and regained a pulse
and a blood pressure of 140/90. He was intubated during the code
and brought to the ICU.
Subsequently, documentation of a signed DNR/DNR from [**Month (only) 462**]
[**2174**] was found in his chart, signed by his brother and HCP,
[**Name (NI) **].

MEDICAL HISTORY: Past Medical History:
1. Constipation and overflow fecal incontinence (2 yrs)
2. sacral decubitus ([**4-10**], sees derm for f/u)
3. presbylarynx (bilat vocal fold atrophy) - hoarseness since
[**2171**]
4. Atrial fibrillation - not on coumadin b/c fall history
5. GERD
6. Tremor
7. Scoliosis
8. Hypertension
9. Benign prostatic hypertrophy
10. Venous insufficiency: h/o venous stripping.
11. Depression
12. History of hyponatremia (siadh with ssri's, placed on
remeron)
13. Parkinson's disease: dx [**2172**].
14. Cognitive impairment
15: Anemia
16. Bilateral inguinal hernia repair with left re-repair [**11/2171**]

MEDICATION ON ADMISSION: sinemet 25/100 tid
asa ec 325 qday
cholecalciferol 1g qday
calcium carbonate 650 [**Hospital1 **]
lisinopril 10 qday
tamsulosin 0.4 qhs
acetaminophen 650 q4hr prn
arificial tears 1 drop bilaterally qhs
guaifenesin/dextr 5mls qhs
guaifenesin/dextro 5 mls q4hr prn
psyllium seed 1 ts [**Hospital1 **]

ALLERGIES: Protonix

PHYSICAL EXAM: vitals: 99.0 140/78 84 36 94%4L
gen: intubated, sedated
heent: pupils are reactive bialterally
pulm: diffuse bronchial breath sounds and expiratory wheezes, no
crackles. Poor air movement.
cv: irregularly irregular, some question of paradoxical chest
wall motion.
abd: slightly distended, nabs, nt/nd
extr: 1+ LE edema bilaterally
neuro: aox4, cn 2-12 intact grossly

FAMILY HISTORY: Notable for hypertension and coronary artery disease.

SOCIAL HISTORY: Lives alone in an apartment, with vna/pt visits.  looking to
move into [**Hospital6 **].
Drugs: ??????
Tob: remote hx of 2 pack-years
Alc: drink before dinner 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Acute respiratory failure,Anoxic brain damage,Cardiac arrest,Unspecified essential hypertension,Paralysis agitans'}
