CHIEF COMPLAINT: s/p cardiac arrest

PRESENT ILLNESS: 85 year-old Mandarin-speaking woman with a history of recent hip
fracture (discharged to rehab [**8-30**]) and pulmonary mycobacterium
avium intracellulare infection (on Ethambutol and Azithromycin)
admitted post cardiac arrest.  The patient was eating breakfast
with her daughter this AM and became unresponsive.  No choking
episode observed, but patient presumed to have an aspiration
event.  The patient was found to be in asystole with
non-shockable rhythm on AED, and CPR was started by EMS.  She
received 4 rounds of epinephrine.  She was intubated and an I/O
was placed in the field.  Presumed time in asystole 10 minutes.

MEDICAL HISTORY: 1. Hypertension (ambulatory BP range 140-160 mmHg systolics)
2. Chronic renal insufficiency (stage III), creatinine clearance

MEDICATION ON ADMISSION: 1. Amlodipine 5 mg PO BID hold for SBP<100
2. Azithromycin 250 mg PO Q24H
3. Carvedilol 12.5 mg PO BID
4. CloniDINE 0.3 mg PO BID
5. Docusate Sodium 100 mg PO BID constipation
6. Ethambutol HCl 400 mg PO BID
7. Furosemide 20 mg PO DAILY
8. Polyethylene Glycol 17 g PO DAILY:PRN constipation
9. Ranitidine 150 mg PO BID
10. Valsartan 80 mg PO BID hold for SBP <100
11. Acetaminophen 1000 mg PO Q8H
12. Heparin 5000 UNIT SC BID last day [**2148-9-10**]
13. Alendronate Sodium 35 mg PO 1X/WEEK (MO)
14. Nateglinide 120 mg PO BID
15. Non-Aspirin Extra Strength *NF* (acetaminophen) 500 mg Oral
QID:PRN 1 tablet 4 times a day as needed
16. Proctosol HC *NF* (hydrocorTISone) 2.5 % Rectal [**Hospital1 **]
17. Sodium Polystyrene Sulfonate 15 gm PO 3X/WEEK (MO,WE,FR)
Mon/wed/fri. hold for K<3.4
18. Zolpidem Tartrate 5 mg PO DAILY
1.5 tablets once a day
19. TraMADOL (Ultram) 25 mg PO BID:PRN pain hold for sedation

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T: 32.2 BP: 110/61 P: 83 R: 16 O2: 100% on FIO2 50% Vt
400 RR 16 peep 5
General: Intubated, unarousable to painful stimuli; does exhibit
intermittent clonic movements of upper extremities preceeded by
eye opening
HEENT: Sclera anicteric, MMM, intubated
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Decreased breath sounds in bases bilaterally
Abdomen: cooling packs in place
GU: foley in place draining yellow urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Dolls eyes abnormal; corneal reflexes negative; does not
withdraw to painful stimuli in all 4 extremities
.
Physical Exam at time patient expired:
Neuro:  Pupils fully dilated and unresponsive; corneal reflexes
negative
CV:  No cardiac sounds; carotid and femoral pulses absent
Lungs:  No breath sounds

FAMILY HISTORY: Per daughter, no significant family history of early MI,
arrhythmia or sudden cardiac death.

SOCIAL HISTORY: Patient in rehab since recent admission for hip fracture.  She
normally lives at home with her husband and is [**Name (NI) 53881**]
only; she has 2 daughters and 1 son. She immigrated from [**Country 651**]
over 20 years ago. No history of tobacco use or alcohol use; no
recreational substance use. Patient is independent in ADLs and
ambulates unassisted at baseline.
Pneumonitis due to inhalation of food or vomitus,Coma,Anoxic brain damage,Paroxysmal ventricular tachycardia,Hyperosmolality and/or hypernatremia,Pulmonary diseases due to other mycobacteria,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Aftercare for healing traumatic fracture of hip,Do not resuscitate status,Myoclonus
Food/vomit pneumonitis,Coma,Anoxic brain damage,Parox ventric tachycard,Hyperosmolality,Pulmonary mycobacteria,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Nephritis NOS in oth dis,Hx TIA/stroke w/o resid,DMII renal uncntrld,Aftrcre traumatic fx hip,Do not resusctate status,Myoclonus
Admission Date:  [**2148-9-8**]              Discharge Date:   [**2148-9-11**]

Date of Birth:  [**2062-9-26**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
s/p cardiac arrest

Major Surgical or Invasive Procedure:
intubation and mechanical ventilation

History of Present Illness:
85 year-old Mandarin-speaking woman with a history of recent hip
fracture (discharged to rehab [**8-30**]) and pulmonary mycobacterium
avium intracellulare infection (on Ethambutol and Azithromycin)
admitted post cardiac arrest.  The patient was eating breakfast
with her daughter this AM and became unresponsive.  No choking
episode observed, but patient presumed to have an aspiration
event.  The patient was found to be in asystole with
non-shockable rhythm on AED, and CPR was started by EMS.  She
received 4 rounds of epinephrine.  She was intubated and an I/O
was placed in the field.  Presumed time in asystole 10 minutes.

.
On arrival to the ED, pulses were present.  The patient was
hypotensive, with BP 80s/40s and HR 80s.  She received 2L NS.
Right IJ was placed, but no pressors were initiated as blood
pressure increased to SBP 90s.  The patient underwent head CT
that did not show any acute event.  CT cervical spine negative.
CTA chest demonstrated left bronchiectasis, supporting
aspiration.  No PE observed.  The patient was started on the
post-arrest cooling protocol.  She did become bradycardic
following initiation of cooling.  VS at time of transfer to the
MICU BP 97/47 HR 41 Temp 32.2.  Current vent settings FIO2 50%
Vt 400 RR 16 peep 5.
.
On arrival to the MICU, the patient displayed 4-5 episodes of
activity that began with opening her eyes, followed by rhythmic
movements of upper extremities bilaterally.  Otherwise
non-responsive while not on sedation.

Past Medical History:
1. Hypertension (ambulatory BP range 140-160 mmHg systolics)
2. Chronic renal insufficiency (stage III), creatinine clearance

35 mL/min/1.73 m^2 most recently in [**7-/2148**]; GFR has fluctuated
between 35-60 per Nephrology notes; followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]

at [**Hospital1 3278**] - likely secondary to hypertensive nephrosclerosis and
diabetic nephropathy with proteinuria (no history of biopsy)
3. Chronic vision loss
4. Non-insulin dependent diabetes (last HbA1c 6.7% in [**6-/2148**],
home blood glucose well-controlled in 120-130 mg/dL range)
5. Pulmonary mycobacterium avium intracellulare infection
(diagnosed in [**11/2145**] with CXR showing prominent interstitial
markings and scarring; PFTs noted a restrictive pattern; PPD
negative, AFB positive - started triple therapy with
Azithromycin, Ethambutol and Rifabutin; followed by Pulmonology
and Infectious Disease. Rifambutin stopped in [**2147-8-7**] -
planning to maintain her on suppressive therapy indefinitely)
6. Iron deficiency anemia
7. Multiple liver masses (likely cysts per records)
8. Left occipital infarct ([**11/2133**])
9. Malnutrition
10. s/p excision of left breast mass ([**1-/2135**])
11. s/p left vitrectomy and endolaser ([**4-/2143**])
12. s/p excision of left forearm mass ([**12/2144**])
13. s/p right inguinal hernia repair ([**3-/2145**])
14. Recent left hip fracture - discharged to rehab [**2148-8-30**]

Social History:
Patient in rehab since recent admission for hip fracture.  She
normally lives at home with her husband and is [**Name (NI) 53881**]
only; she has 2 daughters and 1 son. She immigrated from [**Country 651**]
over 20 years ago. No history of tobacco use or alcohol use; no
recreational substance use. Patient is independent in ADLs and
ambulates unassisted at baseline.


Family History:
Per daughter, no significant family history of early MI,
arrhythmia or sudden cardiac death.


Physical Exam:
Admission Physical Exam:
Vitals: T: 32.2 BP: 110/61 P: 83 R: 16 O2: 100% on FIO2 50% Vt
400 RR 16 peep 5
General: Intubated, unarousable to painful stimuli; does exhibit
intermittent clonic movements of upper extremities preceeded by
eye opening
HEENT: Sclera anicteric, MMM, intubated
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Decreased breath sounds in bases bilaterally
Abdomen: cooling packs in place
GU: foley in place draining yellow urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Dolls eyes abnormal; corneal reflexes negative; does not
withdraw to painful stimuli in all 4 extremities
.
Physical Exam at time patient expired:
Neuro:  Pupils fully dilated and unresponsive; corneal reflexes
negative
CV:  No cardiac sounds; carotid and femoral pulses absent
Lungs:  No breath sounds


Pertinent Results:
Admission Labs:
[**2148-9-8**] 09:08AM BLOOD WBC-8.1 RBC-2.73* Hgb-8.7* Hct-29.7*
MCV-109* MCH-32.0 MCHC-29.4* RDW-15.8* Plt Ct-399
[**2148-9-8**] 01:45PM BLOOD Neuts-94.2* Lymphs-2.4* Monos-3.2 Eos-0.1
Baso-0.1
[**2148-9-8**] 01:45PM BLOOD PT-9.9 PTT-54.8* INR(PT)-0.9
[**2148-9-8**] 09:08AM BLOOD Glucose-738* UreaN-50* Creat-1.5* Na-138
K-8.0* Cl-112* HCO3-15* AnGap-19
[**2148-9-8**] 01:45PM BLOOD ALT-64* AST-104* CK(CPK)-274* AlkPhos-86
TotBili-0.3
[**2148-9-8**] 01:45PM BLOOD CK-MB-14* MB Indx-5.1 cTropnT-0.07*
[**2148-9-8**] 01:45PM BLOOD Calcium-6.7* Phos-4.9*# Mg-2.9*
.
Labs 1 day prior to when patient expired:
[**2148-9-10**] 03:14AM BLOOD WBC-17.8* RBC-2.76* Hgb-8.5* Hct-27.2*
MCV-99* MCH-30.9 MCHC-31.4 RDW-16.4* Plt Ct-382
[**2148-9-10**] 03:14AM BLOOD PT-10.9 PTT-31.2 INR(PT)-1.0
[**2148-9-10**] 03:14AM BLOOD Glucose-148* UreaN-54* Creat-2.0* Na-144
K-5.5* Cl-115* HCO3-17* AnGap-18
[**2148-9-10**] 03:14AM BLOOD CK-MB-7 cTropnT-0.06*
[**2148-9-10**] 03:14AM BLOOD Calcium-7.7* Phos-6.6* Mg-2.9*

Brief Hospital Course:
85 year-old Mandarin-speaking woman with a history of recent hip
fracture admitted s/p PEA cardiac arrest.  She underwent ACLS
for 10 minutes and received 4 rounds of epinephrine prior to
admission.  Unclear etiology of arrest, although likely due to
hypoxemia secondary to aspiration as patient was eating
breakfast at time of arrest, and had bronchiectasis on CTA
indicating likely chronic aspiration.  She was treated with
vancomycin and Zosyn to cover for aspiration pneumonia.  No
evidence of ischemia or new infarct on EKG. No PE on CTA.  On
admission, the patient was started on the Arctic Sun cooling
protocol, with goal temperature 33 degrees C.  She began to warm
prematurely against the machine to 35.8 degrees, and was started
on midazolam, cisatracurium, Keppra, and Tylenol to cover for
fevers, subclinical shivering, and potential seizures.
Temperature returned to goal.  During the re-warming phase, the
patient exhibited poor neurologic return, with absent corneal
reflexes and increasing burst-suppression on EEG.  She also
exhibited myoclonic jerks.  She was evaluated by neurology, who
discussed the patient's poor neurologic status with the family
in detail.  On the ventilator, the patient showed markedly poor
respiratory drive when placed on pressure support.  The
patient's neurologic and respiratory status was discussed with
the family, and per the family's request, goals of care were
transitioned towards comfort.  The patient was extubated per the
family's request, and expired within 10 minutes of extubation.

Medications on Admission:
1. Amlodipine 5 mg PO BID hold for SBP<100
2. Azithromycin 250 mg PO Q24H
3. Carvedilol 12.5 mg PO BID
4. CloniDINE 0.3 mg PO BID
5. Docusate Sodium 100 mg PO BID constipation
6. Ethambutol HCl 400 mg PO BID
7. Furosemide 20 mg PO DAILY
8. Polyethylene Glycol 17 g PO DAILY:PRN constipation
9. Ranitidine 150 mg PO BID
10. Valsartan 80 mg PO BID hold for SBP <100
11. Acetaminophen 1000 mg PO Q8H
12. Heparin 5000 UNIT SC BID last day [**2148-9-10**]
13. Alendronate Sodium 35 mg PO 1X/WEEK (MO)
14. Nateglinide 120 mg PO BID
15. Non-Aspirin Extra Strength *NF* (acetaminophen) 500 mg Oral
QID:PRN 1 tablet 4 times a day as needed
16. Proctosol HC *NF* (hydrocorTISone) 2.5 % Rectal [**Hospital1 **]
17. Sodium Polystyrene Sulfonate 15 gm PO 3X/WEEK (MO,WE,FR)
Mon/wed/fri. hold for K<3.4
18. Zolpidem Tartrate 5 mg PO DAILY
1.5 tablets once a day
19. TraMADOL (Ultram) 25 mg PO BID:PRN pain hold for sedation

Discharge Medications:
Patient expired.

Discharge Disposition:
Expired

Discharge Diagnosis:
Status Post Pulseless Electrical Activity Cardiac Arrest

Discharge Condition:
Expired
{'Pneumonitis due to inhalation of food or vomitus,Coma,Anoxic brain damage,Paroxysmal ventricular tachycardia,Hyperosmolality and/or hypernatremia,Pulmonary diseases due to other mycobacteria,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Aftercare for healing traumatic fracture of hip,Do not resuscitate status,Myoclonus'}


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: s/p cardiac arrest

PRESENT ILLNESS: 85 year-old Mandarin-speaking woman with a history of recent hip
fracture (discharged to rehab [**8-30**]) and pulmonary mycobacterium
avium intracellulare infection (on Ethambutol and Azithromycin)
admitted post cardiac arrest.  The patient was eating breakfast
with her daughter this AM and became unresponsive.  No choking
episode observed, but patient presumed to have an aspiration
event.  The patient was found to be in asystole with
non-shockable rhythm on AED, and CPR was started by EMS.  She
received 4 rounds of epinephrine.  She was intubated and an I/O
was placed in the field.  Presumed time in asystole 10 minutes.

MEDICAL HISTORY: 1. Hypertension (ambulatory BP range 140-160 mmHg systolics)
2. Chronic renal insufficiency (stage III), creatinine clearance

MEDICATION ON ADMISSION: 1. Amlodipine 5 mg PO BID hold for SBP<100
2. Azithromycin 250 mg PO Q24H
3. Carvedilol 12.5 mg PO BID
4. CloniDINE 0.3 mg PO BID
5. Docusate Sodium 100 mg PO BID constipation
6. Ethambutol HCl 400 mg PO BID
7. Furosemide 20 mg PO DAILY
8. Polyethylene Glycol 17 g PO DAILY:PRN constipation
9. Ranitidine 150 mg PO BID
10. Valsartan 80 mg PO BID hold for SBP <100
11. Acetaminophen 1000 mg PO Q8H
12. Heparin 5000 UNIT SC BID last day [**2148-9-10**]
13. Alendronate Sodium 35 mg PO 1X/WEEK (MO)
14. Nateglinide 120 mg PO BID
15. Non-Aspirin Extra Strength *NF* (acetaminophen) 500 mg Oral
QID:PRN 1 tablet 4 times a day as needed
16. Proctosol HC *NF* (hydrocorTISone) 2.5 % Rectal [**Hospital1 **]
17. Sodium Polystyrene Sulfonate 15 gm PO 3X/WEEK (MO,WE,FR)
Mon/wed/fri. hold for K<3.4
18. Zolpidem Tartrate 5 mg PO DAILY
1.5 tablets once a day
19. TraMADOL (Ultram) 25 mg PO BID:PRN pain hold for sedation

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T: 32.2 BP: 110/61 P: 83 R: 16 O2: 100% on FIO2 50% Vt
400 RR 16 peep 5
General: Intubated, unarousable to painful stimuli; does exhibit
intermittent clonic movements of upper extremities preceeded by
eye opening
HEENT: Sclera anicteric, MMM, intubated
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Decreased breath sounds in bases bilaterally
Abdomen: cooling packs in place
GU: foley in place draining yellow urine
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Dolls eyes abnormal; corneal reflexes negative; does not
withdraw to painful stimuli in all 4 extremities
.
Physical Exam at time patient expired:
Neuro:  Pupils fully dilated and unresponsive; corneal reflexes
negative
CV:  No cardiac sounds; carotid and femoral pulses absent
Lungs:  No breath sounds

FAMILY HISTORY: Per daughter, no significant family history of early MI,
arrhythmia or sudden cardiac death.

SOCIAL HISTORY: Patient in rehab since recent admission for hip fracture.  She
normally lives at home with her husband and is [**Name (NI) 53881**]
only; she has 2 daughters and 1 son. She immigrated from [**Country 651**]
over 20 years ago. No history of tobacco use or alcohol use; no
recreational substance use. Patient is independent in ADLs and
ambulates unassisted at baseline. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Coma,Anoxic brain damage,Paroxysmal ventricular tachycardia,Hyperosmolality and/or hypernatremia,Pulmonary diseases due to other mycobacteria,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Aftercare for healing traumatic fracture of hip,Do not resuscitate status,Myoclonus'}
