CHIEF COMPLAINT: Transfer from OSH

PRESENT ILLNESS: This is a 87 y/o F with h/o CAD s/p CABG [**01**] who is transfered
from OSH after having PEA arrest s/p Right knee replacement.
.
Patient underwent Right knee replacement [**2115-3-28**] without aparent
complications. This morning at around noon patient went into
afib with RVR, diltiazem drip was started but after a bolus she
started droping her HR and BP, code blue was called, patient
received epinephrine, atropine x1 and was intubated.
There were no strips sent during the code. EKG were received and
it seems that patient had an inferior MI and also escape
junctional rhytm after the events. Echocardiogram was done that
showed dilated RV and given high suspicion for PE patient was
started heparin. Patient remained hypotensive levophed and
dopamine were started.
.
Patient transfered to [**Hospital1 18**] for further management.

MEDICAL HISTORY: 1. CAD - s/p CABG two vessels [**2101-11-21**] LIMA--LAD, SVG -- OM1
2. HTN
3. Paget's disease
4. Hyperthyroidism
5. History of seizures
6. Paroxysmal SVT
7. Osteoarthritis
8. s/p Total abdominal histerectomy
9. s/p Right Knee replacement [**2115-3-28**]

MEDICATION ON ADMISSION: Medications on transfer:
Heparin drip
Fentanyl
Midazolam
Dopamin drip
Norepinephrine

ALLERGIES: Demerol

PHYSICAL EXAM: VS: SBP 60's. HR 80 externally paced, Sats 93%
AC 450/18/100/10
General: Patient intubated, sedated, pale
HEENT: pupiles dilated non reactive to light. Fixed. doll's
eyes. No JVD appreciated, no lymphadenopathy.
Oropharinx: ETT tube in placed. echymosis upper lip.
Lungs: clear to ausculation bilaterally.
Cardiovascular: distant heart sounds, regular rate rhytm, no
murmurs appreciated.
Abdomen: BS decreased, mildly distended. obese. No hepatomegaly.
Extremities: cold, clamy, cyanotic.

FAMILY HISTORY: No family history of CAD.

SOCIAL HISTORY: Lives at home. Daughter lives upstairs. Per prior records no
tobacco use. No alcohol abuse.
Cardiac complications, not elsewhere classified,Acute myocardial infarction of other inferior wall, initial episode of care,Cardiac arrest,Other pulmonary embolism and infarction,Cardiogenic shock,Anoxic brain damage,Other iatrogenic hypotension,Unspecified essential hypertension,Aortocoronary bypass status,Knee joint replacement
Surg compl-heart,AMI inferior wall, init,Cardiac arrest,Pulm embol/infarct NEC,Cardiogenic shock,Anoxic brain damage,Iatrogenc hypotnsion NEC,Hypertension NOS,Aortocoronary bypass,Joint replaced knee
Admission Date:  [**2115-3-29**]              Discharge Date:   [**2115-3-29**]


Service: MEDICINE

Allergies:
Demerol

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
Transfer from OSH

Major Surgical or Invasive Procedure:
None

History of Present Illness:
This is a 87 y/o F with h/o CAD s/p CABG [**01**] who is transfered
from OSH after having PEA arrest s/p Right knee replacement.
.
Patient underwent Right knee replacement [**2115-3-28**] without aparent
complications. This morning at around noon patient went into
afib with RVR, diltiazem drip was started but after a bolus she
started droping her HR and BP, code blue was called, patient
received epinephrine, atropine x1 and was intubated.
There were no strips sent during the code. EKG were received and
it seems that patient had an inferior MI and also escape
junctional rhytm after the events. Echocardiogram was done that
showed dilated RV and given high suspicion for PE patient was
started heparin. Patient remained hypotensive levophed and
dopamine were started.
.
Patient transfered to [**Hospital1 18**] for further management.


Past Medical History:
1. CAD - s/p CABG two vessels [**2101-11-21**] LIMA--LAD, SVG -- OM1
2. HTN
3. Paget's disease
4. Hyperthyroidism
5. History of seizures
6. Paroxysmal SVT
7. Osteoarthritis
8. s/p Total abdominal histerectomy
9. s/p Right Knee replacement [**2115-3-28**]


Social History:
Lives at home. Daughter lives upstairs. Per prior records no
tobacco use. No alcohol abuse.


Family History:
No family history of CAD.

Physical Exam:
VS: SBP 60's. HR 80 externally paced, Sats 93%
AC 450/18/100/10
General: Patient intubated, sedated, pale
HEENT: pupiles dilated non reactive to light. Fixed. doll's
eyes. No JVD appreciated, no lymphadenopathy.
Oropharinx: ETT tube in placed. echymosis upper lip.
Lungs: clear to ausculation bilaterally.
Cardiovascular: distant heart sounds, regular rate rhytm, no
murmurs appreciated.
Abdomen: BS decreased, mildly distended. obese. No hepatomegaly.
Extremities: cold, clamy, cyanotic.


Pertinent Results:
[**2115-3-29**] 09:19PM   LACTATE-12.3*
[**2115-3-29**] 09:19PM   TYPE-ART O2-100 PO2-61* PCO2-30* PH-7.19*
TOTAL CO2-12* BASE XS--15 AADO2-641 REQ O2-100 -ASSIST/CON
INTUBATED-INTUBATED
[**2115-3-29**] 09:23PM   PT-22.7* PTT-150* INR(PT)-2.2*
[**2115-3-29**] 09:23PM   PLT COUNT-108*
[**2115-3-29**] 09:23PM   WBC-21.4* RBC-4.26 HGB-12.6 HCT-38.2 MCV-90
MCH-29.6 MCHC-33.0 RDW-14.5
[**2115-3-29**] 09:23PM   CALCIUM-7.0* PHOSPHATE-5.9* MAGNESIUM-2.7*
[**2115-3-29**] 09:23PM   ALT(SGPT)-11 AST(SGOT)-81* LD(LDH)-699*
CK(CPK)-402* ALK PHOS-75 TOT BILI-0.8
[**2115-3-29**] 09:23PM   estGFR-Using this
[**2115-3-29**] 09:23PM   GLUCOSE-425* UREA N-10 CREAT-1.1 SODIUM-134
POTASSIUM-5.6* CHLORIDE-100 TOTAL CO2-16* ANION GAP-24*
.
EKG: Hr 53, junctional scape rhytm. St elevation III.

2D-ECHOCARDIOGRAM bed side echo: largely dilated RV. EF ~ 10-15%


Brief Hospital Course:
This is a 87 y/o with h/o HTN, CAD s/p CABG, s/p recent R knee
replacement c/b PEA arrest likely secondary to PE transfered for
further management.

# Hypoxemic Respiratory Failure: Patient with an elevatede A-a
gradient, FIo2 100% and PaO2 60, x ray with no clear evidence of
infiltrates, this is more likely secondary to pulmonary embolism
- continue vent support
- heparin drip
- midazolam - fentanyl drip
- recheck x ray after transfer for ETT tube
.
# Hypotension: Patient with severe hypotension on dopamin and
levophed drip on arrival. Likely secondary to poor cardiac
output secondary acute PE.
- continue IV fluids
- continue dopamin, levophed, and add vasopresin
- Bedside Echo
- holding all BP meds
- Stat labs - lactate
.
# Cardiac:
CAD: EKG from OSH showed st elevations in the inferior leads.
Last troponin 3.36
More likely demand ischemia in the setting of acute hypotension.
.
Rhytm: after external pacer was discontinued, patient with a
junctional escape rhytm.
- continue to monitor
.
Pump: cardiogenic shock
- Bed side echo
- continue dopamin, levophed
.
# Neuro: patient with fix dilated pupiles and dull eyes which
represent severe brain injury. Very poor likelyhood of recovery.
.
# Communication: daughter [**Name (NI) **] HCP - [**Telephone/Fax (1) 6621**] cell
[**Telephone/Fax (1) 6622**] (H), [**Telephone/Fax (1) 6623**] (w)

Addendum:
After patient evaluation, patient clinical status was discussed
with daughter [**Name (NI) **] at length. Given the poor prognosis of
recovery,  worsening acidosis, poor neurological status
patient's code status is changed to DNR. No further scalation of
care.  The patient died within 4 hours of admission to the
hospital.


Medications on Admission:
Medications on transfer:
Heparin drip
Fentanyl
Midazolam
Dopamin drip
Norepinephrine

Home Meds:
Fosamax 10 mg daily
aspirin 81 mg p.o/ day
phenobarbital 6.2 mg t.i.d.
quinapril 20 mg p.o/ day
metoprolol 37.5 mg p.o. b.i.d.
methimazole 5 mg q.a.m. alternating with 2.5 mg
Dilantin 100 mg p.o. t.i.d.


Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
N/A

Discharge Condition:
N/A

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of other inferior wall, initial episode of care,Cardiac arrest,Other pulmonary embolism and infarction,Cardiogenic shock,Anoxic brain damage,Other iatrogenic hypotension,Unspecified essential hypertension,Aortocoronary bypass status,Knee joint replacement'}


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: Transfer from OSH

PRESENT ILLNESS: This is a 87 y/o F with h/o CAD s/p CABG [**01**] who is transfered
from OSH after having PEA arrest s/p Right knee replacement.
.
Patient underwent Right knee replacement [**2115-3-28**] without aparent
complications. This morning at around noon patient went into
afib with RVR, diltiazem drip was started but after a bolus she
started droping her HR and BP, code blue was called, patient
received epinephrine, atropine x1 and was intubated.
There were no strips sent during the code. EKG were received and
it seems that patient had an inferior MI and also escape
junctional rhytm after the events. Echocardiogram was done that
showed dilated RV and given high suspicion for PE patient was
started heparin. Patient remained hypotensive levophed and
dopamine were started.
.
Patient transfered to [**Hospital1 18**] for further management.

MEDICAL HISTORY: 1. CAD - s/p CABG two vessels [**2101-11-21**] LIMA--LAD, SVG -- OM1
2. HTN
3. Paget's disease
4. Hyperthyroidism
5. History of seizures
6. Paroxysmal SVT
7. Osteoarthritis
8. s/p Total abdominal histerectomy
9. s/p Right Knee replacement [**2115-3-28**]

MEDICATION ON ADMISSION: Medications on transfer:
Heparin drip
Fentanyl
Midazolam
Dopamin drip
Norepinephrine

ALLERGIES: Demerol

PHYSICAL EXAM: VS: SBP 60's. HR 80 externally paced, Sats 93%
AC 450/18/100/10
General: Patient intubated, sedated, pale
HEENT: pupiles dilated non reactive to light. Fixed. doll's
eyes. No JVD appreciated, no lymphadenopathy.
Oropharinx: ETT tube in placed. echymosis upper lip.
Lungs: clear to ausculation bilaterally.
Cardiovascular: distant heart sounds, regular rate rhytm, no
murmurs appreciated.
Abdomen: BS decreased, mildly distended. obese. No hepatomegaly.
Extremities: cold, clamy, cyanotic.

FAMILY HISTORY: No family history of CAD.

SOCIAL HISTORY: Lives at home. Daughter lives upstairs. Per prior records no
tobacco use. No alcohol abuse. 

### Response:
{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of other inferior wall, initial episode of care,Cardiac arrest,Other pulmonary embolism and infarction,Cardiogenic shock,Anoxic brain damage,Other iatrogenic hypotension,Unspecified essential hypertension,Aortocoronary bypass status,Knee joint replacement'}
