CHIEF COMPLAINT: found down

PRESENT ILLNESS: Ms. [**Known lastname 40800**] is an 86 yo F with PMH HTN, arthritis brought in
by EMS after being found down in her apartment. Her downstairs
neighbors reportedly heard a thump at 2pm and went up and
knocked on her door at 11pm. When there was no answer they
called EMS who found her lying face down with eccymosis on left
side of her face. FSBG was in the 100's, VSS in the field HR 70
BP 122/82 100% on RA. Her daughter in law reports speaking to
her on the day preceding the event and reports that she was in
her usual state of health. She had not started any new
medications and was not complaining of any new problems.
.
Of note several months ago she had a fall and broke 8 ribs on
her left side as well as her clavical and shoulder. She
reportedly did not remember the cause of the fall. During her
admission, she was diagnosed with paroxysmal atrial
fibrillation.
.
In the ED VS on arrival T98.8 BP 156/84 HR 79 RR 20 100% FSBG
183. She did not have a gag reflex so was intubated in the ED
for airway protection. She was started on propofol for sedation.
Pupils were pinpoint and minimally reactive, she was withdrawing
to noxious stimulus but was otherwise unresponsive. She was
given 1 L NS. Head Ct did not show any acute process, CXR
without infiltrate, CT cspine without fracture, CT
chest/abdomen/pelvis without acute process.

MEDICAL HISTORY: HTN
Arthritis
Paroxysmal atrial fibrillation
s/p [**2166**] with clavicle and multiple left sided rib
fractures, left lung contusion
s/p right eye cataract surgery
Depression

MEDICATION ON ADMISSION: Toprol 200mg daily
lisinopril 40mg daily
actinel 35mg once weekly
hydrochlorothiazide 25mg daily
vitamin D 1000 units daily
tums 2 tabs daily
advil 200mg prn
B12 shot monthly

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T95.9 oral BP 138/63 HR 66 RR 14 100% 50%/500/14/5
Gen: intubated, unresponsive, extensor posturing to painful
stimulus
HEENT: pupils 2mm equal and reactive bilaterally, conjunctival
edema, bruising and edema around right eye, ET tube in
oropharynx
Neck: cervical collar in place
CV: RRR s1 s2 no appreciable murmur
Lungs: ctab anteriorly
Abd: soft, non distended, bowel sounds positive, no guarding
Ext: no pedal edema
Neuro: GCS 4, extremities rigid, extensor posturing in all four
extremities to noxious stimulus, hyperactive reflexes diffusely,
toes upgoing bilaterally

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: lives alone, ambulates independently, performs own ADL's
Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Hyperosmolality and/or hypernatremia,Atrial fibrillation
Crbl art ocl NOS w infrc,Acute respiratry failure,Hyperosmolality,Atrial fibrillation
Admission Date:  [**2166-3-30**]              Discharge Date:   [**2166-3-31**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
found down

Major Surgical or Invasive Procedure:
Intubation in the Emergency Department for airway protection

History of Present Illness:
Ms. [**Known lastname 40800**] is an 86 yo F with PMH HTN, arthritis brought in
by EMS after being found down in her apartment. Her downstairs
neighbors reportedly heard a thump at 2pm and went up and
knocked on her door at 11pm. When there was no answer they
called EMS who found her lying face down with eccymosis on left
side of her face. FSBG was in the 100's, VSS in the field HR 70
BP 122/82 100% on RA. Her daughter in law reports speaking to
her on the day preceding the event and reports that she was in
her usual state of health. She had not started any new
medications and was not complaining of any new problems.
.
Of note several months ago she had a fall and broke 8 ribs on
her left side as well as her clavical and shoulder. She
reportedly did not remember the cause of the fall. During her
admission, she was diagnosed with paroxysmal atrial
fibrillation.
.
In the ED VS on arrival T98.8 BP 156/84 HR 79 RR 20 100% FSBG
183. She did not have a gag reflex so was intubated in the ED
for airway protection. She was started on propofol for sedation.
Pupils were pinpoint and minimally reactive, she was withdrawing
to noxious stimulus but was otherwise unresponsive. She was
given 1 L NS. Head Ct did not show any acute process, CXR
without infiltrate, CT cspine without fracture, CT
chest/abdomen/pelvis without acute process.


Past Medical History:
HTN
Arthritis
Paroxysmal atrial fibrillation
s/p [**2166**] with clavicle and multiple left sided rib
fractures, left lung contusion
s/p right eye cataract surgery
Depression


Social History:
lives alone, ambulates independently, performs own ADL's

Family History:
Non contributory

Physical Exam:
VS: T95.9 oral BP 138/63 HR 66 RR 14 100% 50%/500/14/5
Gen: intubated, unresponsive, extensor posturing to painful
stimulus
HEENT: pupils 2mm equal and reactive bilaterally, conjunctival
edema, bruising and edema around right eye, ET tube in
oropharynx
Neck: cervical collar in place
CV: RRR s1 s2 no appreciable murmur
Lungs: ctab anteriorly
Abd: soft, non distended, bowel sounds positive, no guarding
Ext: no pedal edema
Neuro: GCS 4, extremities rigid, extensor posturing in all four
extremities to noxious stimulus, hyperactive reflexes diffusely,
toes upgoing bilaterally


Pertinent Results:
Na 140 K 3.6 Cl 105 HCO 21 BUN 25 Creat 1.1 Gluc 146
Mg 1.9 P3.3
CK: 728
MB 12
MBI 1.6
Trop 0.07
AST 32 ALT AP 53 Tbili 0.6 Alb 3.5 [**Doctor First Name **] 38 Lip 31
WBC 18.5 (N:88 L:7.2) HCT 37.9 PLT 284
PTT 24.5 INR 1.2
lactate 3.5

ABG: 7.38/39/318/24 100%/500/14/5

UA: lg blood, tr protein, tra gluc, tr ket

[**2166-3-30**] EKG: NSR at 76 bpm, normal axis, normal intervals, no st
segment or t wave changes, no prior for comparison

Micro:
4/5 Blood cx: pending

Studies:
[**2166-3-30**] CT Cspine:
1. No evidence of traumatic injury to the cervical spine.
2. Moderate degenerative changes, with marked facet arthropathy
predominantly on the left side as described above.
3. Malpositioned nasogastric tube, which is terminating in the
trachea.

[**2166-3-30**] CT Head:
I believe there is loss of grey-white matter
differentiation in both cerebral hemispheres, left greater than
right, with effacement of the cortical sulci. The finding could
represent developing infarction, as well as effects of hypoxia.
A follow-up MR study is recommended.

[**2166-3-30**] CT Chest/Abdomen/Pelvis:
1. No evidence of acute traumatic injury to chest, abdomen, and
pelvis.
2. Distortion of the left bony thorax with left lung patchy
atelectasis, and old healing rib fractures.
3. Multiple bilateral renal hypoattenuating lesions, the largest
in the left kidney represents a simple cyst. Others are
subcentimeter and too small to characterize.
4. Malpositioned nasogastric tube, which is terminating in the
airway.

[**2166-3-30**] MRI Head:
Findings appear consistent with massive evolving infarction of
the cerebral hemispheres, likely due to an anoxic episode. The
reduced flow within the anterior circulation likely represents
an effect of elevated intracranial pressure from the massive
brain edema. As of this time, however, there is no evidence for
transtentorial or cerebellar tonsillar herniation.


Brief Hospital Course:
Ms. [**Known lastname 40800**] is an 86 yo F with hisotry of hypertension found
down in her apartment by EMS.  On arrival to the emergency
department she remained unresponsive and was intubated for
airway protection.  On speaking with her neighbors it is likely
that she was down for many hours before EMS was called by a
neighbor.  She was admitted to the medical ICU and was noted to
be extensor posturing in all four extremities on arrival to the
ICU.  The neurology service was consulted and her exam was felt
to be very concerning for large cerebral infarction.  She had a
Head CT in the emergency department that showed loss of [**Doctor Last Name 352**]
white differentiation in both cerebral hemisphers.  On
recommendation by the neurology service a MRI was obtained which
showed massive evolving infarction of both cerebral hemispheres
likely due to an anoxic episode.  A family meeting was held and
they were informed that due to the very large territory
involved, her prognosis was extremely poor.  The family decided
at that time to make her comfort measures only.  She was
extubated and died several hours later.


Medications on Admission:
Toprol 200mg daily
lisinopril 40mg daily
actinel 35mg once weekly
hydrochlorothiazide 25mg daily
vitamin D 1000 units daily
tums 2 tabs daily
advil 200mg prn
B12 shot monthly


Discharge Medications:
Not applicable.  Patient died during this admission.

Discharge Disposition:
Expired

Discharge Diagnosis:
Deceased

Discharge Condition:
Deceased

Discharge Instructions:
Deceased

Followup Instructions:
Deceased
{'Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Hyperosmolality and/or hypernatremia,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: found down

PRESENT ILLNESS: Ms. [**Known lastname 40800**] is an 86 yo F with PMH HTN, arthritis brought in
by EMS after being found down in her apartment. Her downstairs
neighbors reportedly heard a thump at 2pm and went up and
knocked on her door at 11pm. When there was no answer they
called EMS who found her lying face down with eccymosis on left
side of her face. FSBG was in the 100's, VSS in the field HR 70
BP 122/82 100% on RA. Her daughter in law reports speaking to
her on the day preceding the event and reports that she was in
her usual state of health. She had not started any new
medications and was not complaining of any new problems.
.
Of note several months ago she had a fall and broke 8 ribs on
her left side as well as her clavical and shoulder. She
reportedly did not remember the cause of the fall. During her
admission, she was diagnosed with paroxysmal atrial
fibrillation.
.
In the ED VS on arrival T98.8 BP 156/84 HR 79 RR 20 100% FSBG
183. She did not have a gag reflex so was intubated in the ED
for airway protection. She was started on propofol for sedation.
Pupils were pinpoint and minimally reactive, she was withdrawing
to noxious stimulus but was otherwise unresponsive. She was
given 1 L NS. Head Ct did not show any acute process, CXR
without infiltrate, CT cspine without fracture, CT
chest/abdomen/pelvis without acute process.

MEDICAL HISTORY: HTN
Arthritis
Paroxysmal atrial fibrillation
s/p [**2166**] with clavicle and multiple left sided rib
fractures, left lung contusion
s/p right eye cataract surgery
Depression

MEDICATION ON ADMISSION: Toprol 200mg daily
lisinopril 40mg daily
actinel 35mg once weekly
hydrochlorothiazide 25mg daily
vitamin D 1000 units daily
tums 2 tabs daily
advil 200mg prn
B12 shot monthly

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T95.9 oral BP 138/63 HR 66 RR 14 100% 50%/500/14/5
Gen: intubated, unresponsive, extensor posturing to painful
stimulus
HEENT: pupils 2mm equal and reactive bilaterally, conjunctival
edema, bruising and edema around right eye, ET tube in
oropharynx
Neck: cervical collar in place
CV: RRR s1 s2 no appreciable murmur
Lungs: ctab anteriorly
Abd: soft, non distended, bowel sounds positive, no guarding
Ext: no pedal edema
Neuro: GCS 4, extremities rigid, extensor posturing in all four
extremities to noxious stimulus, hyperactive reflexes diffusely,
toes upgoing bilaterally

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: lives alone, ambulates independently, performs own ADL's 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Hyperosmolality and/or hypernatremia,Atrial fibrillation'}
