CHIEF COMPLAINT: hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 38685**] is an 88 yo Man w/ HTN, sick sinus s/p PPM,
multiple GIB, Afib, prostate ca, MGUS, 2+ AI, CRF (Cr [**2-13**]), high
ammonia (w/o liver disease), who was discharged from [**Hospital1 18**] on
[**5-2**] with VRE bacteremia and fungemia (likely due to infected
midline) on linezolid and fluconazole for 14 day course, who
presents obtunded from his NH with hypoxia to 60%. He was placed
on NRB, given lasix 60mg iv and 1 inch of nitropaste with
resultant O2 sat 70-80% on transfer by EMS. Per EMS to ER
resident, his NH reported him full code. On arrival to the ER he
was making respiratory effort but had very minimal air movement.
He was intubated on AC 500*20, peep 5, fio2 1.0, L EJ was placed
for access and the patient has a PICC in place. He was given
levofloxacin and aspirin.  He was placed on a bair hugger for
hypothermia. His vitals were otherwise unremarkable. KUB showed
a large amount of bowel gas. CXR was fairly unremarkable. He was
on a minimal amount of versed for sedation and was minimally
responsive. He was guaiac positive.
.
The patient's family was informed of his transfer and came to
the ER to find him intubated, stating that he was DNR/DNI.
After discussion with the resident they decided to keep him
intubated for the night and to revisit this in the MA, but to
maintain his DNR status.  He was subsequently found to be
hypotensive with SBPs in the 70s. Per telephone discussion
between the ER resident and the patient's daughter, the family
declines central line and declines pressors. He was admitted to
the MICU for furhter care and management.
.
Note that on prior admission the pt also had ARF with urinary
retention of 400cc, which resolved with placement of foley
catheter. Baseline MS is to be sleepy most of day and respond to
questions appropriately, moments of clarity where recognizes
family.
.
ROS: unable to perform given intubated/sedated

MEDICAL HISTORY: 1. Prostate cancer dx'd [**2179**]- maintained on lupron (no
surgery/xrt).
2. Hypertension
3. Aortic insufficiency (2+).
3. Paroxysmal atrial fibrillation (not on anticoagulation due to
many GIBs)
4. Sick sinus syndrome s/p PPM for symptomatic bradycardia, [**5-18**]

MEDICATION ON ADMISSION: 1. Lactulose 30 mL PO Q 6 hours
2. Calcitriol 0.25 mcg PO QD
3. Atorvastatin 10 mg PO QD
4. Pantoprazole 40 mg PO QD
5. Donepezil 5 mg PO QHS
6. Fluticasone (intranasal)
7. Metoprolol Tartrate 50 mg PO TID
8. Amlodipine 5 mg PO QD
9. Tylenol PRN
10. Ipratropium Bromide Q6 PRN
11. Fluconazole 200 mg PO Q24H  (until [**5-10**])
12. Albuterol Q6 PRN
13. Linezolid 600 mg PO Q12H (until [**5-10**])
14. nephrocaps 1 po qday

ALLERGIES: Percocet / Simvastatin

PHYSICAL EXAM: Vitals:  cannot read temp,  60,  96/44, 100% on AC 500*20, peep
5, fio2 1.0.
General:  appears uncomfortable, opens eyes to stimulation
HEENT:  pupils sluggish but reactive
Neck:  R EJ in place
Chest/CV:  RRR, s1s2, decreased heart sounds
Lungs:  CTAB
Abd:  soft, nt, nd, +bs
Rectal:  per ER guaiac positive
Ext:  2+ pitting edema BLE

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: living at rehab. HCP is wife.
Acute respiratory failure,Secondary hyperparathyroidism (of renal origin),Congestive heart failure, unspecified,Unspecified disorder of kidney and ureter,Sinoatrial node dysfunction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Malignant neoplasm of prostate,Gout, unspecified,Chronic kidney disease, unspecified,Aortic valve disorders,Cardiac pacemaker in situ
Acute respiratry failure,Sec hyperparathyrd-renal,CHF NOS,Renal & ureteral dis NOS,Sinoatrial node dysfunct,Hy kid NOS w cr kid I-IV,Malign neopl prostate,Gout NOS,Chronic kidney dis NOS,Aortic valve disorder,Status cardiac pacemaker
Admission Date:  [**2185-5-8**]              Discharge Date:   [**2185-5-8**]


Service: MEDICINE

Allergies:
Percocet / Simvastatin

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
hypoxia

Major Surgical or Invasive Procedure:
endotracheal intubation

History of Present Illness:
Mr. [**Known lastname 38685**] is an 88 yo Man w/ HTN, sick sinus s/p PPM,
multiple GIB, Afib, prostate ca, MGUS, 2+ AI, CRF (Cr [**2-13**]), high
ammonia (w/o liver disease), who was discharged from [**Hospital1 18**] on
[**5-2**] with VRE bacteremia and fungemia (likely due to infected
midline) on linezolid and fluconazole for 14 day course, who
presents obtunded from his NH with hypoxia to 60%. He was placed
on NRB, given lasix 60mg iv and 1 inch of nitropaste with
resultant O2 sat 70-80% on transfer by EMS. Per EMS to ER
resident, his NH reported him full code. On arrival to the ER he
was making respiratory effort but had very minimal air movement.
He was intubated on AC 500*20, peep 5, fio2 1.0, L EJ was placed
for access and the patient has a PICC in place. He was given
levofloxacin and aspirin.  He was placed on a bair hugger for
hypothermia. His vitals were otherwise unremarkable. KUB showed
a large amount of bowel gas. CXR was fairly unremarkable. He was
on a minimal amount of versed for sedation and was minimally
responsive. He was guaiac positive.
.
The patient's family was informed of his transfer and came to
the ER to find him intubated, stating that he was DNR/DNI.
After discussion with the resident they decided to keep him
intubated for the night and to revisit this in the MA, but to
maintain his DNR status.  He was subsequently found to be
hypotensive with SBPs in the 70s. Per telephone discussion
between the ER resident and the patient's daughter, the family
declines central line and declines pressors. He was admitted to
the MICU for furhter care and management.
.
Note that on prior admission the pt also had ARF with urinary
retention of 400cc, which resolved with placement of foley
catheter. Baseline MS is to be sleepy most of day and respond to
questions appropriately, moments of clarity where recognizes
family.
.
ROS: unable to perform given intubated/sedated


Past Medical History:
1. Prostate cancer dx'd [**2179**]- maintained on lupron (no
surgery/xrt).
2. Hypertension
3. Aortic insufficiency (2+).
3. Paroxysmal atrial fibrillation (not on anticoagulation due to
many GIBs)
4. Sick sinus syndrome s/p PPM for symptomatic bradycardia, [**5-18**]

5. Iron deficiency anemia/ anemia of chronic disease
6. Chronic Renal Failure
7. Pulmonary Hypertension (TTE [**10-17**] PASP 38mmhg)
8. Secondary hyperparathyroidism (low 25-hydroxyvitamin D, s/p
tx)
9. MGUS, IgG monoclonal gammopathy
10. s/p GSW with retained pleural fragment
11. s/p pacemaker placement.
12. Severe bilateral DJD of the knees
13. Gout
14. Refractory UGIB from jejunal AVMs, diagnosed in [**7-/2180**], and

duodenal ulcers, diagnosed in [**4-/2183**]
15. Encephalopathy and hyperammonemia without evidence of
hepatic dysfunction.


Social History:
living at rehab. HCP is wife.

Family History:
noncontributory

Physical Exam:
Vitals:  cannot read temp,  60,  96/44, 100% on AC 500*20, peep
5, fio2 1.0.
General:  appears uncomfortable, opens eyes to stimulation
HEENT:  pupils sluggish but reactive
Neck:  R EJ in place
Chest/CV:  RRR, s1s2, decreased heart sounds
Lungs:  CTAB
Abd:  soft, nt, nd, +bs
Rectal:  per ER guaiac positive
Ext:  2+ pitting edema BLE


Pertinent Results:
- WBC-8.1 RBC-2.89* HGB-9.3* HCT-28.0* MCV-97 MCH-32.1*
MCHC-33.1 RDW-19.0* PLT COUNT-133*
     - NEUTS-87* BANDS-2 LYMPHS-8* MONOS-3 EOS-0 BASOS-0 ATYPS-0
METAS-0 MYELOS-0
- GLUCOSE-198* UREA N-52* CREAT-3.6*# SODIUM-132* POTASSIUM-3.8
CHLORIDE-104 TOTAL CO2-16* CALCIUM-8.5 PHOSPHATE-6.5*#
MAGNESIUM-2.1
- LACTATE-2.3*
- CK-MB-NotDone proBNP-[**Numeric Identifier 104520**]* CK(CPK)-26* cTropnT-0.05*

Brief Hospital Course:
Patient was admitted with hypoxic respiratory failure secondary
to CHF and renal failure.  He was intubated for this.  However,
it was then clarified with the family that he was DNR/DNI.
Patient was anuric while on floor.  It was decided to withdraw
mechanical ventilation due to goals of care.  Patient expired on
[**2185-5-8**].  Mr [**Known lastname 104521**] family was in attendance at the time
of withdrawl of care and patient expired without event.

Medications on Admission:
1. Lactulose 30 mL PO Q 6 hours
2. Calcitriol 0.25 mcg PO QD
3. Atorvastatin 10 mg PO QD
4. Pantoprazole 40 mg PO QD
5. Donepezil 5 mg PO QHS
6. Fluticasone (intranasal)
7. Metoprolol Tartrate 50 mg PO TID
8. Amlodipine 5 mg PO QD
9. Tylenol PRN
10. Ipratropium Bromide Q6 PRN
11. Fluconazole 200 mg PO Q24H  (until [**5-10**])
12. Albuterol Q6 PRN
13. Linezolid 600 mg PO Q12H (until [**5-10**])
14. nephrocaps 1 po qday

Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
Expired

Discharge Instructions:
NA

Followup Instructions:
NA


Completed by:[**2185-5-8**]
{'Acute respiratory failure,Secondary hyperparathyroidism (of renal origin),Congestive heart failure, unspecified,Unspecified disorder of kidney and ureter,Sinoatrial node dysfunction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Malignant neoplasm of prostate,Gout, unspecified,Chronic kidney disease, unspecified,Aortic valve disorders,Cardiac pacemaker in situ'}


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: hypoxia

PRESENT ILLNESS: Mr. [**Known lastname 38685**] is an 88 yo Man w/ HTN, sick sinus s/p PPM,
multiple GIB, Afib, prostate ca, MGUS, 2+ AI, CRF (Cr [**2-13**]), high
ammonia (w/o liver disease), who was discharged from [**Hospital1 18**] on
[**5-2**] with VRE bacteremia and fungemia (likely due to infected
midline) on linezolid and fluconazole for 14 day course, who
presents obtunded from his NH with hypoxia to 60%. He was placed
on NRB, given lasix 60mg iv and 1 inch of nitropaste with
resultant O2 sat 70-80% on transfer by EMS. Per EMS to ER
resident, his NH reported him full code. On arrival to the ER he
was making respiratory effort but had very minimal air movement.
He was intubated on AC 500*20, peep 5, fio2 1.0, L EJ was placed
for access and the patient has a PICC in place. He was given
levofloxacin and aspirin.  He was placed on a bair hugger for
hypothermia. His vitals were otherwise unremarkable. KUB showed
a large amount of bowel gas. CXR was fairly unremarkable. He was
on a minimal amount of versed for sedation and was minimally
responsive. He was guaiac positive.
.
The patient's family was informed of his transfer and came to
the ER to find him intubated, stating that he was DNR/DNI.
After discussion with the resident they decided to keep him
intubated for the night and to revisit this in the MA, but to
maintain his DNR status.  He was subsequently found to be
hypotensive with SBPs in the 70s. Per telephone discussion
between the ER resident and the patient's daughter, the family
declines central line and declines pressors. He was admitted to
the MICU for furhter care and management.
.
Note that on prior admission the pt also had ARF with urinary
retention of 400cc, which resolved with placement of foley
catheter. Baseline MS is to be sleepy most of day and respond to
questions appropriately, moments of clarity where recognizes
family.
.
ROS: unable to perform given intubated/sedated

MEDICAL HISTORY: 1. Prostate cancer dx'd [**2179**]- maintained on lupron (no
surgery/xrt).
2. Hypertension
3. Aortic insufficiency (2+).
3. Paroxysmal atrial fibrillation (not on anticoagulation due to
many GIBs)
4. Sick sinus syndrome s/p PPM for symptomatic bradycardia, [**5-18**]

MEDICATION ON ADMISSION: 1. Lactulose 30 mL PO Q 6 hours
2. Calcitriol 0.25 mcg PO QD
3. Atorvastatin 10 mg PO QD
4. Pantoprazole 40 mg PO QD
5. Donepezil 5 mg PO QHS
6. Fluticasone (intranasal)
7. Metoprolol Tartrate 50 mg PO TID
8. Amlodipine 5 mg PO QD
9. Tylenol PRN
10. Ipratropium Bromide Q6 PRN
11. Fluconazole 200 mg PO Q24H  (until [**5-10**])
12. Albuterol Q6 PRN
13. Linezolid 600 mg PO Q12H (until [**5-10**])
14. nephrocaps 1 po qday

ALLERGIES: Percocet / Simvastatin

PHYSICAL EXAM: Vitals:  cannot read temp,  60,  96/44, 100% on AC 500*20, peep
5, fio2 1.0.
General:  appears uncomfortable, opens eyes to stimulation
HEENT:  pupils sluggish but reactive
Neck:  R EJ in place
Chest/CV:  RRR, s1s2, decreased heart sounds
Lungs:  CTAB
Abd:  soft, nt, nd, +bs
Rectal:  per ER guaiac positive
Ext:  2+ pitting edema BLE

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: living at rehab. HCP is wife. 

### Response:
{'Acute respiratory failure,Secondary hyperparathyroidism (of renal origin),Congestive heart failure, unspecified,Unspecified disorder of kidney and ureter,Sinoatrial node dysfunction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Malignant neoplasm of prostate,Gout, unspecified,Chronic kidney disease, unspecified,Aortic valve disorders,Cardiac pacemaker in situ'}
