CHIEF COMPLAINT: 1. Shortness of breath
2. Status post PEA arrest
3. Hypotension

PRESENT ILLNESS: 72-year-old female with a history of CAD who called EMS
yesterday for increasing SOB. [**Hospital **] transferred to [**Hospital1 1474**]
obtunded, acutely sob, was then noted to be bradycardic and
hypotensive after receiving albuterol, atrovent nebs, IV
solumedrol 125mg, and morphine 4mg. Patient intubated (SIMV
Vt500 R14 Peep 5 PS 5 gas 7.24/51/191) and PEA arrested, CPR
performed (2 minutes) and pt received epi, atropine, bicarb.
Arrested 2nd time. Pulse restarted and pt was started on
dopamine. EKG at OSH showed [**Street Address(2) 1766**] elevations V1 and V2. Noted
to have temp to 100.2. Started on heparin gtt. Transferred to
[**Hospital1 18**] for emergent cath. Patient unable to give history given
all of above, but pt's daughter reports that pt felt some
"indigestion" and mild epigastric pain two days ago w/ some mild
diarrhea-- both resolved yesterday. They had lunch together
yesterday, patient felt fine. patient then called her daughter
at 4 pm feeling SOB. Daughter lives next door, came right over
to find patient doing neb treatment, looking unwell. Nebs w/o
effect so patient's daughter called 911. Rest of history as
outlined above. Per patient's daughter, pt is very stoic and
rarely complains about her health, even when she does not feel
well. Patient did not complain about any other sx's over last
days.
.
At [**Hospital1 18**] [**Name (NI) **], pt weaned off dopa. Tachy to 130s -> started on
esmolol gtt. Given levo and vanc for ?sepsis, ASA for MI.
Bedside echo showed decreased wall motion in bilateral
ventricles and septum. L femoral central line placed in ED. Pt
became hypotensive again and restarted on dopamine as taken to
cath lab.

MEDICAL HISTORY: 1. Coronary artery disease: Acute MI, s/p OM2 stent [**1-12**];
[**2169-2-8**] cath [**Hospital 1474**] Hospital: Emergent cath for acute onset
SOB, + troponin. LAD: mild luminal irregularities. LCx: 90%
stenosis prox lg OM2, 30% prox circ. RCA: 30% mid. PTCI LCx
lesion, s/p Pixel stent.
2. Chronic obstructive pulmonary disease: intubated 1.5 yrs ago

MEDICATION ON ADMISSION: 1. Prevacid 30 QD
2. Toprol XL 50 QD
3. Lipitor 20 QD
4. HCTZ 12.5 QD
5. MVI 1 tab QD
6. Celexa 10 QD
7. FeSO4 300 QD
8. Atrovent MDI 2p QID
9. Darvocet 1 tablet prn
10. Tylenol prn
11. ASA 325 QD
12. Cozaar 50 QD
13. Advair

ALLERGIES: Keflex

PHYSICAL EXAM: VS: in ICU, HR: 106, BP: 124/74, R: 25  100%
Vent: Vt 400 x 25, Fio2 100% x Peep 5
ABG: 7.13/24/69
Gen: intubated, sedated
HEENT: pupils 3 mm b/l
Neck: laying flat
Chest: expiratory wheezes through out ant fields
CV: RRR Nl S1 S2, heart sounds obscured by BS
Abd: ND, + BS, no rebound/guarding
Ext: no edema, cool, 2+ DP and PT b/l. L fem line: CDI.
Neuro: sedated

FAMILY HISTORY: NC

SOCIAL HISTORY: Was at [**Hospital1 **] rehab but lives next door to her
daughter and son-in-law.  Heavy smoking and etoh use history.
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,Hypotension, unspecified,Cellulitis and abscess of hand, except fingers and thumb,Swelling of limb,Unspecified essential hypertension,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Tobacco use disorder,Family history of ischemic heart disease
Acute respiratry failure,Obs chr bronc w(ac) exac,CHF NOS,Hyperosmolality,Hypotension NOS,Cellulitis of hand,Swelling of limb,Hypertension NOS,Old myocardial infarct,Status-post ptca,Tobacco use disorder,Fam hx-ischem heart dis
Admission Date:  [**2170-7-19**]              Discharge Date:   [**2170-7-30**]

Date of Birth:  [**2098-2-18**]             Sex:   F

Service: MEDICINE

Allergies:
Keflex

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
1. Shortness of breath
2. Status post PEA arrest
3. Hypotension

Major Surgical or Invasive Procedure:
1. Orotracheal intubation
2. Central venous access

History of Present Illness:
72-year-old female with a history of CAD who called EMS
yesterday for increasing SOB. [**Hospital **] transferred to [**Hospital1 1474**]
obtunded, acutely sob, was then noted to be bradycardic and
hypotensive after receiving albuterol, atrovent nebs, IV
solumedrol 125mg, and morphine 4mg. Patient intubated (SIMV
Vt500 R14 Peep 5 PS 5 gas 7.24/51/191) and PEA arrested, CPR
performed (2 minutes) and pt received epi, atropine, bicarb.
Arrested 2nd time. Pulse restarted and pt was started on
dopamine. EKG at OSH showed [**Street Address(2) 1766**] elevations V1 and V2. Noted
to have temp to 100.2. Started on heparin gtt. Transferred to
[**Hospital1 18**] for emergent cath. Patient unable to give history given
all of above, but pt's daughter reports that pt felt some
"indigestion" and mild epigastric pain two days ago w/ some mild
diarrhea-- both resolved yesterday. They had lunch together
yesterday, patient felt fine. patient then called her daughter
at 4 pm feeling SOB. Daughter lives next door, came right over
to find patient doing neb treatment, looking unwell. Nebs w/o
effect so patient's daughter called 911. Rest of history as
outlined above. Per patient's daughter, pt is very stoic and
rarely complains about her health, even when she does not feel
well. Patient did not complain about any other sx's over last
days.
.
At [**Hospital1 18**] [**Name (NI) **], pt weaned off dopa. Tachy to 130s -> started on
esmolol gtt. Given levo and vanc for ?sepsis, ASA for MI.
Bedside echo showed decreased wall motion in bilateral
ventricles and septum. L femoral central line placed in ED. Pt
became hypotensive again and restarted on dopamine as taken to
cath lab.

Past Medical History:
1. Coronary artery disease: Acute MI, s/p OM2 stent [**1-12**];
[**2169-2-8**] cath [**Hospital 1474**] Hospital: Emergent cath for acute onset
SOB, + troponin. LAD: mild luminal irregularities. LCx: 90%
stenosis prox lg OM2, 30% prox circ. RCA: 30% mid. PTCI LCx
lesion, s/p Pixel stent.
2. Chronic obstructive pulmonary disease: intubated 1.5 yrs ago

3. Hypertension
4. History of recurrent pneumonias

Social History:
Was at [**Hospital1 **] rehab but lives next door to her
daughter and son-in-law.  Heavy smoking and etoh use history.

Family History:
NC

Physical Exam:
VS: in ICU, HR: 106, BP: 124/74, R: 25  100%
Vent: Vt 400 x 25, Fio2 100% x Peep 5
ABG: 7.13/24/69
Gen: intubated, sedated
HEENT: pupils 3 mm b/l
Neck: laying flat
Chest: expiratory wheezes through out ant fields
CV: RRR Nl S1 S2, heart sounds obscured by BS
Abd: ND, + BS, no rebound/guarding
Ext: no edema, cool, 2+ DP and PT b/l. L fem line: CDI.
Neuro: sedated

Pertinent Results:
[**2170-7-19**] 04:00AM   WBC-21.3* RBC-4.27 HGB-13.6 HCT-41.0 MCV-96
MCH-31.8 MCHC-33.1 RDW-13.0
[**2170-7-19**] 04:00AM   NEUTS-84* BANDS-9* LYMPHS-4* MONOS-3 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2170-7-19**] 04:00AM   PLT SMR-NORMAL PLT COUNT-212
[**2170-7-19**] 04:00AM   PT-24.2* PTT-150* INR(PT)-3.9
[**2170-7-19**] 04:00AM   GLUCOSE-330* UREA N-27* CREAT-1.4* SODIUM-140
POTASSIUM-4.5 CHLORIDE-106 TOTAL CO2-16* ANION GAP-23
[**2170-7-19**] 04:00AM   CK(CPK)-25*
[**2170-7-19**] 04:00AM   CK-MB-NotDone cTropnT-0.58*
[**2170-7-19**] 04:00AM   CALCIUM-9.6 PHOSPHATE-1.5* MAGNESIUM-1.8
[**2170-7-27**] 03:59AM BLOOD WBC-12.5* RBC-3.37* Hgb-10.5* Hct-32.4*
MCV-96 MCH-31.2 MCHC-32.5 RDW-13.4 Plt Ct-261
[**2170-7-25**] 02:19AM BLOOD PT-11.6 PTT-29.3 INR(PT)-0.9
[**2170-7-26**] 04:03AM BLOOD PT-11.5 PTT-24.6 INR(PT)-0.9
[**2170-7-24**] 04:36AM BLOOD Glucose-169* UreaN-33* Creat-0.8 Na-147*
K-3.9 Cl-111* HCO3-31* AnGap-9
[**2170-7-27**] 03:59AM BLOOD Glucose-114* UreaN-30* Creat-0.7 Na-147*
K-4.0 Cl-101 HCO3-38* AnGap-12
[**2170-7-19**] 09:42AM BLOOD ALT-113* AST-121* CK(CPK)-153* AlkPhos-87
Amylase-62 TotBili-0.7
[**2170-7-23**] 03:36AM BLOOD ALT-31 AST-16 AlkPhos-56 TotBili-0.2
[**2170-7-24**] 04:36AM BLOOD Calcium-7.8* Phos-1.8* Mg-1.8
[**2170-7-27**] 03:59AM BLOOD Calcium-8.5 Phos-2.5* Mg-2.0
[**2170-7-20**] 04:31AM BLOOD Type-ART Temp-37.4 Rates-25/1 Tidal V-400
PEEP-10 FiO2-30 pO2-75* pCO2-55* pH-7.24* calHCO3-25 Base XS--4
Intubat-INTUBATED Vent-CONTROLLED
[**2170-7-21**] 03:30AM BLOOD Type-ART Temp-37.8 Rates-20/ Tidal V-400
PEEP-10 FiO2-30 pO2-112* pCO2-55* pH-7.28* calHCO3-27 Base XS--1
-ASSIST/CON Intubat-INTUBATED
[**2170-7-25**] 09:23PM BLOOD Type-ART Tidal V-550 PEEP-5 FiO2-30
pO2-87 pCO2-68* pH-7.32* calHCO3-37* Base XS-5 Intubat-NOT
INTUBA
[**2170-7-27**] 04:48AM BLOOD Type-ART pO2-63* pCO2-62* pH-7.43
calHCO3-43* Base XS-13
##
Cath [**7-19**]:
1. Selective coronary arteriography revealed a right dominant
system
without evidence for acute coronary artery thrombosis. The LMCA
and LAD
had no angiographic evidence of coronary artery disease. The LCx
had a
patent stent in the OM with mild in-stent restenosis of 50%.
The RCA
had a 40% mid-vessel stenosis and a 50% mid PDA stenosis.
2. Hemodynamics revealed elevated left and right heart filling
pressures.  The patient was hypotensive off pressors and had a
high
cardiac output with low SVR.  However, given the hypokinesis
noted on
echo, the patient's stroke volume is lower than normal and while
she was
tachycardic, it is impossible that she could produce the cardiac
output
calculated.  It was felt that she had septic physiology with
inability
to extract oxygen at the tissue level.
3. Left ventriculography was not performed.
##
Echo [**7-19**]:
The left atrium is dilated. The right atrium is dilated. Overall
left
ventricular systolic function is severely depressed. No masses
or thrombi are seen in the left ventricle. The right ventricular
cavity is dilated. There is severe global right ventricular free
wall hypokinesis. The aortic valve leaflets are mildly
thickened. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Physiologic mitral regurgitation
is seen although significant regurgitation cannot be excluded by
this study. The left ventricular inflow pattern suggests a
restrictive filling abnormality, with elevated left atrial
pressure. There is no pericardial effusion.
##
CXR [**7-25**]:
Status post extubation. Allowing for differences in technique,
no other interval change. No evidence of congestive heart
failure or pneumonia.

Brief Hospital Course:
##
Respiratory failure -- Hypercarbic/hypoxic. Likely secondary to
a copd exacerbation. Improved with maximizing PEEP, regular MDI,
steroid therapy. Pt also started on tiotropium and salmeterol.
Patient required many adjustments to vent as she had significant
auto-peep by decreasing inspiration time. Initially extubated
after trial of pressure support but had to be reintubated for
shortness of breath, anxiety and hypertension. Patient
subsequently faired well with pressure support and reextubated.
She continued to do well, initially on bipap for long stretches
(2hours on, 30min off), but then switched to nocturnal and as
needed bipap; however, she rarely required bipap during the day
and generally did not require it at night either. She was put on
a steroid taper with scheduled MDIs. Patient should be slowly
tapered off the steroids over a period of 2 weeks.  Her goal O2
sat is 88-92%, not above, as she develops hypercarbia and
somnolence with higher O2 sats.
##
Hypotension -- Pt did not appear septic (no fever, tachycardia,
wbc declined quickly) and had cath without cad. She does have
chf with ef 15-20%. Hypotension was likely due to impeded venous
return related to significant auto-peep. Pt quickly became
normontensive with vent adjustments, had no pressor requirement
for the entire admission minus the few hours surrounding her
presentation.
##
CAD -- Pt has h/o cad s/p stent, and there was concern for
another event, though cath without flow-limiting lesions. Her
troponins were initially elevated but this was secondary to her
severe copd exacerbation, especially given that her ck's were
near flat.  They trended down rapidly.  She was started on
aspirin.
##
GI bleed -- Pt with coffee-ground in ng-aspirate that rapidly
cleared with flushing, however hct remained stable. She was
placed in PPI and hct was monitored, and was stable.  She had no
melena or hematochezia.
##
Abdominal distension -- Had KUB [**7-20**] with no obstruction. Has
bowel sounds and low residuals.
##
RLE pallor -- Occured after pulling sheath but improved within
48 hours without intervention. Has good pulses, and this was
followed closely in house. In addition, ther was a question of a
R hand cellulitis. Patient received 4 days of clindamycin with
marked improvement, and this was stopped.
##
Code -- dnr/dni

Medications on Admission:
1. Prevacid 30 QD
2. Toprol XL 50 QD
3. Lipitor 20 QD
4. HCTZ 12.5 QD
5. MVI 1 tab QD
6. Celexa 10 QD
7. FeSO4 300 QD
8. Atrovent MDI 2p QID
9. Darvocet 1 tablet prn
10. Tylenol prn
11. ASA 325 QD
12. Cozaar 50 QD
13. Advair

Discharge Medications:
1. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
2. Therapeutic Multivitamin     Liquid Sig: One (1) Cap PO DAILY
(Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
5. Citalopram Hydrobromide 20 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
6. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO BID (2 times a day) as needed.

7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
9. Albuterol 90 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation Q4H (every 4 hours) as needed.
10. Ipratropium Bromide 0.02 % Solution Sig: One (1) NEB IH
Inhalation Q6H (every 6 hours).
11. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for pain.
12. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24
hours).
14. Losartan Potassium 50 mg Tablet Sig: 1.5 Tablets PO DAILY
(Daily).
15. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
16. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) IH Inhalation [**Hospital1 **] (2 times a day).
17. Prednisone 20 mg Tablet Sig: One (1) Tablet PO QD () for 3
doses.
18. Prednisone 10 mg Tablet Sig: One (1) Tablet PO QD () for 3
doses.
19. Prednisone 5 mg Tablet Sig: One (1) Tablet PO QD () for 4
doses.
20. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One
(1) ML Intravenous  DAILY (Daily) as needed.
21. Lorazepam 2 mg/mL Syringe Sig: One (1) mg Injection Q4H
(every 4 hours) as needed.
22. Morphine 2 mg/mL Syringe Sig: 2-4 mg IV mg Injection Q4H
(every 4 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**]

Discharge Diagnosis:
1. COPD exacerbation

Discharge Condition:
Good

Discharge Instructions:
Please call your doctor or come to ED if you develop fevers,
chills, shortness of breath, chest pain, nausea/ vomiting.

Followup Instructions:
Please call Dr. [**Last Name (STitle) 17025**] at [**Telephone/Fax (1) 3183**] for a follow up
appointment within one week of discharge



Completed by:[**2170-7-30**]
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,Hypotension, unspecified,Cellulitis and abscess of hand, except fingers and thumb,Swelling of limb,Unspecified essential hypertension,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Tobacco use disorder,Family history of ischemic heart disease'}


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: 1. Shortness of breath
2. Status post PEA arrest
3. Hypotension

PRESENT ILLNESS: 72-year-old female with a history of CAD who called EMS
yesterday for increasing SOB. [**Hospital **] transferred to [**Hospital1 1474**]
obtunded, acutely sob, was then noted to be bradycardic and
hypotensive after receiving albuterol, atrovent nebs, IV
solumedrol 125mg, and morphine 4mg. Patient intubated (SIMV
Vt500 R14 Peep 5 PS 5 gas 7.24/51/191) and PEA arrested, CPR
performed (2 minutes) and pt received epi, atropine, bicarb.
Arrested 2nd time. Pulse restarted and pt was started on
dopamine. EKG at OSH showed [**Street Address(2) 1766**] elevations V1 and V2. Noted
to have temp to 100.2. Started on heparin gtt. Transferred to
[**Hospital1 18**] for emergent cath. Patient unable to give history given
all of above, but pt's daughter reports that pt felt some
"indigestion" and mild epigastric pain two days ago w/ some mild
diarrhea-- both resolved yesterday. They had lunch together
yesterday, patient felt fine. patient then called her daughter
at 4 pm feeling SOB. Daughter lives next door, came right over
to find patient doing neb treatment, looking unwell. Nebs w/o
effect so patient's daughter called 911. Rest of history as
outlined above. Per patient's daughter, pt is very stoic and
rarely complains about her health, even when she does not feel
well. Patient did not complain about any other sx's over last
days.
.
At [**Hospital1 18**] [**Name (NI) **], pt weaned off dopa. Tachy to 130s -> started on
esmolol gtt. Given levo and vanc for ?sepsis, ASA for MI.
Bedside echo showed decreased wall motion in bilateral
ventricles and septum. L femoral central line placed in ED. Pt
became hypotensive again and restarted on dopamine as taken to
cath lab.

MEDICAL HISTORY: 1. Coronary artery disease: Acute MI, s/p OM2 stent [**1-12**];
[**2169-2-8**] cath [**Hospital 1474**] Hospital: Emergent cath for acute onset
SOB, + troponin. LAD: mild luminal irregularities. LCx: 90%
stenosis prox lg OM2, 30% prox circ. RCA: 30% mid. PTCI LCx
lesion, s/p Pixel stent.
2. Chronic obstructive pulmonary disease: intubated 1.5 yrs ago

MEDICATION ON ADMISSION: 1. Prevacid 30 QD
2. Toprol XL 50 QD
3. Lipitor 20 QD
4. HCTZ 12.5 QD
5. MVI 1 tab QD
6. Celexa 10 QD
7. FeSO4 300 QD
8. Atrovent MDI 2p QID
9. Darvocet 1 tablet prn
10. Tylenol prn
11. ASA 325 QD
12. Cozaar 50 QD
13. Advair

ALLERGIES: Keflex

PHYSICAL EXAM: VS: in ICU, HR: 106, BP: 124/74, R: 25  100%
Vent: Vt 400 x 25, Fio2 100% x Peep 5
ABG: 7.13/24/69
Gen: intubated, sedated
HEENT: pupils 3 mm b/l
Neck: laying flat
Chest: expiratory wheezes through out ant fields
CV: RRR Nl S1 S2, heart sounds obscured by BS
Abd: ND, + BS, no rebound/guarding
Ext: no edema, cool, 2+ DP and PT b/l. L fem line: CDI.
Neuro: sedated

FAMILY HISTORY: NC

SOCIAL HISTORY: Was at [**Hospital1 **] rehab but lives next door to her
daughter and son-in-law.  Heavy smoking and etoh use history. 

### Response:
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,Hypotension, unspecified,Cellulitis and abscess of hand, except fingers and thumb,Swelling of limb,Unspecified essential hypertension,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Tobacco use disorder,Family history of ischemic heart disease'}
