CHIEF COMPLAINT: Unresponsive with neck mass, difficult airway.

PRESENT ILLNESS: 89 year old male with no records at [**Hospital1 18**] per girlfriend had a
recent discharge 4 days ago from [**Last Name (un) 883**] for neck mass worked up
as unknown cancer. Patient found unresponsive by girlfriend.
[**Name (NI) **] (girlfriend) states patient had eaten breakfast and was
sitting on the bed getting dressed. When she returned [**3-31**]
minutes later patient was laying on bed unresponsive, but he did
appear to be breathing. She states she heard a "funny noise in
his throat". He continued to be non-responsive until EMS arrived
10 minutes later. He does not appear hit his head [**First Name8 (NamePattern2) **] [**Doctor First Name **].
Patient respirations not adequate for oxygenation, O2 sat 70% in
field, and he was bagged in the ambulance. BG 206, afib on
monitor per nursing note. Patient in ED found with blown right
pupil at 6mm, left pupil 3mm minimally responsive. Patient
posturing, with minimal response to pain. Patient difficult
airway intubation requiring cricoidotomy. Initial read head CT
with no acute event. Initial read CTA with small subsegmental PE
and extensive clot in almost all great veins. Patient neck with
evidence of multiple masses. Patient in ED dropped systolic
pressures to the 80s and was started on dopamine. Then
transitioned to levophed because patient became tachycardic.
Patient noted to be bleeding from mouth, gums, airway, and
urinary tract. All blood tests sent to the laboratory have not
clotted. Patient given vancomycin/levofloxacin/flagyl. Patient
felt to have DIC, in setting of ? urinary tract infection and
metastatic unknown cancer; he is being transferred to the MICU
for further management with 2 peripheral IVs. Patient received a
total of 11 mg of midazolam for sedation, but does not require a
drip to keep sedated. Per patient's son, [**Name (NI) **] [**Name (NI) 78556**], patient
is FULL CODE.

MEDICAL HISTORY: HTN
Cancer of the Tongue dx 3 yrs ago, tumor free for 2 yrs

MEDICATION ON ADMISSION: Amlodipine 5mg [**Hospital1 **] (last filled [**2151-6-2**])
Keflex 500mg TID (last filled [**2151-7-22**]) -- unclear if still
taking
Furosemide 20mg QD (last filled [**2151-7-22**])
Ramipril (altace) 10mg [**Hospital1 **] (last filled [**2151-6-2**])
Metoprolol Succinate ER 50mg QD (last filled [**2151-6-2**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: BP: 114/67 P: 77 RR: 16-18 O2Sat: 100% on PS
Gen: opens eyes on command. squeezes left hand, not right
HEENT: right pupil 5mm fixed, left pupil 2 mm min reactive
NECK: large mass noted in right anterior neck, bleeding from
trach site
CV: RRR, no m/r/g
LUNGS: CTA b/l
ABD: distended, soft, patient does not grimace on exam, +BS
EXT: no c/c/e, guaiac negative
SKIN: no rashes
NEURO: downgoing babinski's, withdraws to pain except for right
arm

FAMILY HISTORY: NC, no other head/neck cancers, no leukemia/lymphoma

SOCIAL HISTORY: former cigar smoker, [**1-27**] glasses of wine per week currently.
Unspecified septicemia,Defibrination syndrome,Acute respiratory failure,Septic shock,Unspecified intestinal obstruction,Other pulmonary embolism and infarction,Pneumonitis due to inhalation of food or vomitus,Unspecified protein-calorie malnutrition,Severe sepsis,Other malignant neoplasm without specification of site,Unspecified essential hypertension,Apnea,Atrial fibrillation
Septicemia NOS,Defibrination syndrome,Acute respiratry failure,Septic shock,Intestinal obstruct NOS,Pulm embol/infarct NEC,Food/vomit pneumonitis,Protein-cal malnutr NOS,Severe sepsis,Malignant neoplasm NOS,Hypertension NOS,Apnea,Atrial fibrillation
Admission Date:  [**2151-8-1**]              Discharge Date:   [**2151-8-8**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3556**]
Chief Complaint:
Unresponsive with neck mass, difficult airway.

Major Surgical or Invasive Procedure:
cricoidotomy

History of Present Illness:
89 year old male with no records at [**Hospital1 18**] per girlfriend had a
recent discharge 4 days ago from [**Last Name (un) 883**] for neck mass worked up
as unknown cancer. Patient found unresponsive by girlfriend.
[**Name (NI) **] (girlfriend) states patient had eaten breakfast and was
sitting on the bed getting dressed. When she returned [**3-31**]
minutes later patient was laying on bed unresponsive, but he did
appear to be breathing. She states she heard a "funny noise in
his throat". He continued to be non-responsive until EMS arrived
10 minutes later. He does not appear hit his head [**First Name8 (NamePattern2) **] [**Doctor First Name **].
Patient respirations not adequate for oxygenation, O2 sat 70% in
field, and he was bagged in the ambulance. BG 206, afib on
monitor per nursing note. Patient in ED found with blown right
pupil at 6mm, left pupil 3mm minimally responsive. Patient
posturing, with minimal response to pain. Patient difficult
airway intubation requiring cricoidotomy. Initial read head CT
with no acute event. Initial read CTA with small subsegmental PE
and extensive clot in almost all great veins. Patient neck with
evidence of multiple masses. Patient in ED dropped systolic
pressures to the 80s and was started on dopamine. Then
transitioned to levophed because patient became tachycardic.
Patient noted to be bleeding from mouth, gums, airway, and
urinary tract. All blood tests sent to the laboratory have not
clotted. Patient given vancomycin/levofloxacin/flagyl. Patient
felt to have DIC, in setting of ? urinary tract infection and
metastatic unknown cancer; he is being transferred to the MICU
for further management with 2 peripheral IVs. Patient received a
total of 11 mg of midazolam for sedation, but does not require a
drip to keep sedated. Per patient's son, [**Name (NI) **] [**Name (NI) 78556**], patient
is FULL CODE.

Past Medical History:
HTN
Cancer of the Tongue dx 3 yrs ago, tumor free for 2 yrs


Social History:
former cigar smoker, [**1-27**] glasses of wine per week currently.

Family History:
NC, no other head/neck cancers, no leukemia/lymphoma

Physical Exam:
Vitals: T: BP: 114/67 P: 77 RR: 16-18 O2Sat: 100% on PS
Gen: opens eyes on command. squeezes left hand, not right
HEENT: right pupil 5mm fixed, left pupil 2 mm min reactive
NECK: large mass noted in right anterior neck, bleeding from
trach site
CV: RRR, no m/r/g
LUNGS: CTA b/l
ABD: distended, soft, patient does not grimace on exam, +BS
EXT: no c/c/e, guaiac negative
SKIN: no rashes
NEURO: downgoing babinski's, withdraws to pain except for right
arm


Pertinent Results:
[**2151-8-1**] 05:00PM   PT->150 PTT->150 INR(PT)->22.8
[**2151-8-1**] 05:00PM URINE  COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.013
[**2151-8-1**] 05:00PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2151-8-1**] 05:00PM URINE  RBC->50 WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-[**3-31**] TRANS EPI-0-2
[**2151-8-1**] 03:00PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2151-8-1**] 02:56PM   GLUCOSE-199* LACTATE-4.9* NA+-138 K+-4.3
CL--98* TCO2-24
[**2151-8-1**] 02:50PM   WBC-15.3* RBC-5.12 HGB-14.1 HCT-42.8 MCV-84
MCH-27.6 MCHC-33.0 RDW-12.7
[**2151-8-1**] 02:50PM   PLT COUNT-208

Brief Hospital Course:
89 year old male with a adenocarcinamatous mass in his right
neck s/p DIC.
.
On admission the patient was found to be in DIC and was bleeding
from the gums and month, he was transfused two units of FFP.
Source of the DIC was unclear and [**Name2 (NI) **]/onc was consulted, it
resolved on its own and as per [**Name2 (NI) **]/onc recs, pt was on a heparin
drip. source suspected to be sepsis or Ca.
.
In the ED, since the patient had a neck mass with tracheal
deviation, an emergent cricoidotomy was done. ENT was consulted
re conversion to trach, but this was cancelled after the patient
wanted CMO. The neck mass continued to grow clinically, however,
repeat imaging did not show enlargement of the mass. There was a
positive blood culture with Coag neg staph which was treated
with vanc and zosyn. The cancer was thought to be a reemergence
of the tounge cancer that the patient was previously txed for in
FL, the evidence of mediastinal adenopathy suggested metatasis.
A PET/CT was contemplated but the patient decided to have CMO
before the procedure could be done. [**Name2 (NI) **]/onc was onboard. Goals
of care and prognosis was disucssed with the patient and his
family before the decision to become CMO was made.
. Id was consulted in the care of the pt as well.
The patient was in afib which was resistant to rate control with
metoprolol and diltiazem.
.
The patient's blown pupil was found to be long-standing as there
was previous eye surgery done. the patient's neurologic status
was intact and he was competent.
.
PE- there was evidence of a small PE on CTA scan, patient was
stating well and this was addressed with a heparin drip and
pneumoboots.
.
Partial SBO- patient was able to pass flatus and has small BM,
this was not an active issue during the admission. the patient
was kept NPO. Maintaince was done with D5W.
.
After multiple family meetings with the HCP, his son, [**Name (NI) **],
and the girlfriend, the course of care was determined. The
patient was initially DNR/DNI. On saturday evening, the
patient's sedation was completed weaning so that he could be
competent and made a medical decision re his care. He determined
that he wanted CMO, all medications were DC'ed, including the
vent, and the patient was placed on a morphine drip titrated to
comfort.
.
The patient expired of apena and resp failure at 1812 hrs on
[**2151-8-8**]. He was pronounced by [**Name6 (MD) 78557**] [**Name8 (MD) 40583**] MD.


Medications on Admission:
Amlodipine 5mg [**Hospital1 **] (last filled [**2151-6-2**])
Keflex 500mg TID (last filled [**2151-7-22**]) -- unclear if still
taking
Furosemide 20mg QD (last filled [**2151-7-22**])
Ramipril (altace) 10mg [**Hospital1 **] (last filled [**2151-6-2**])
Metoprolol Succinate ER 50mg QD (last filled [**2151-6-2**])

Discharge Medications:
none, discharge to death

Discharge Disposition:
Expired

Discharge Diagnosis:
metastatic adenocarcinoma of unknown primary
apnea, respiratory failure
atrial fibrillation
disseminated intravascular coagulation


Discharge Condition:
death

Discharge Instructions:
none, discharge to death

Followup Instructions:
none, discharge to death

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3559**] MD, [**MD Number(3) 3560**]

Completed by:[**2151-8-10**]
{'Unspecified septicemia,Defibrination syndrome,Acute respiratory failure,Septic shock,Unspecified intestinal obstruction,Other pulmonary embolism and infarction,Pneumonitis due to inhalation of food or vomitus,Unspecified protein-calorie malnutrition,Severe sepsis,Other malignant neoplasm without specification of site,Unspecified essential hypertension,Apnea,Atrial fibrillation'}


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: Unresponsive with neck mass, difficult airway.

PRESENT ILLNESS: 89 year old male with no records at [**Hospital1 18**] per girlfriend had a
recent discharge 4 days ago from [**Last Name (un) 883**] for neck mass worked up
as unknown cancer. Patient found unresponsive by girlfriend.
[**Name (NI) **] (girlfriend) states patient had eaten breakfast and was
sitting on the bed getting dressed. When she returned [**3-31**]
minutes later patient was laying on bed unresponsive, but he did
appear to be breathing. She states she heard a "funny noise in
his throat". He continued to be non-responsive until EMS arrived
10 minutes later. He does not appear hit his head [**First Name8 (NamePattern2) **] [**Doctor First Name **].
Patient respirations not adequate for oxygenation, O2 sat 70% in
field, and he was bagged in the ambulance. BG 206, afib on
monitor per nursing note. Patient in ED found with blown right
pupil at 6mm, left pupil 3mm minimally responsive. Patient
posturing, with minimal response to pain. Patient difficult
airway intubation requiring cricoidotomy. Initial read head CT
with no acute event. Initial read CTA with small subsegmental PE
and extensive clot in almost all great veins. Patient neck with
evidence of multiple masses. Patient in ED dropped systolic
pressures to the 80s and was started on dopamine. Then
transitioned to levophed because patient became tachycardic.
Patient noted to be bleeding from mouth, gums, airway, and
urinary tract. All blood tests sent to the laboratory have not
clotted. Patient given vancomycin/levofloxacin/flagyl. Patient
felt to have DIC, in setting of ? urinary tract infection and
metastatic unknown cancer; he is being transferred to the MICU
for further management with 2 peripheral IVs. Patient received a
total of 11 mg of midazolam for sedation, but does not require a
drip to keep sedated. Per patient's son, [**Name (NI) **] [**Name (NI) 78556**], patient
is FULL CODE.

MEDICAL HISTORY: HTN
Cancer of the Tongue dx 3 yrs ago, tumor free for 2 yrs

MEDICATION ON ADMISSION: Amlodipine 5mg [**Hospital1 **] (last filled [**2151-6-2**])
Keflex 500mg TID (last filled [**2151-7-22**]) -- unclear if still
taking
Furosemide 20mg QD (last filled [**2151-7-22**])
Ramipril (altace) 10mg [**Hospital1 **] (last filled [**2151-6-2**])
Metoprolol Succinate ER 50mg QD (last filled [**2151-6-2**])

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: BP: 114/67 P: 77 RR: 16-18 O2Sat: 100% on PS
Gen: opens eyes on command. squeezes left hand, not right
HEENT: right pupil 5mm fixed, left pupil 2 mm min reactive
NECK: large mass noted in right anterior neck, bleeding from
trach site
CV: RRR, no m/r/g
LUNGS: CTA b/l
ABD: distended, soft, patient does not grimace on exam, +BS
EXT: no c/c/e, guaiac negative
SKIN: no rashes
NEURO: downgoing babinski's, withdraws to pain except for right
arm

FAMILY HISTORY: NC, no other head/neck cancers, no leukemia/lymphoma

SOCIAL HISTORY: former cigar smoker, [**1-27**] glasses of wine per week currently. 

### Response:
{'Unspecified septicemia,Defibrination syndrome,Acute respiratory failure,Septic shock,Unspecified intestinal obstruction,Other pulmonary embolism and infarction,Pneumonitis due to inhalation of food or vomitus,Unspecified protein-calorie malnutrition,Severe sepsis,Other malignant neoplasm without specification of site,Unspecified essential hypertension,Apnea,Atrial fibrillation'}
