CHIEF COMPLAINT: 

PRESENT ILLNESS: Ms. [**Known lastname **] is a 79-year-old
female with a history of gastrointestinal bleed who presents
to the Emergency Department with nausea and hematemesis the
morning of admission.  She reported melena and
lightheadedness.  She had no recent nonsteroidal
anti-inflammatory drug use.  Her review of systems is only
positive for a 30 pound weight loss over the past four years.
She is denying any abdominal pain.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Pneumonia due to Klebsiella pneumoniae,Acute respiratory failure,Urinary tract infection, site not specified,Other and unspecified coagulation defects,Hyperosmolality and/or hypernatremia,Unspecified pleural effusion,Congestive heart failure, unspecified
Gastrointest hemorr NOS,Ac posthemorrhag anemia,K. pneumoniae pneumonia,Acute respiratry failure,Urin tract infection NOS,Coagulat defect NEC/NOS,Hyperosmolality,Pleural effusion NOS,CHF NOS
Admission Date:  [**2108-12-14**]     Discharge Date:  [**2108-12-24**]

Date of Birth:                  Sex:  F

Service:  MICU

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname **] is a 79-year-old
female with a history of gastrointestinal bleed who presents
to the Emergency Department with nausea and hematemesis the
morning of admission.  She reported melena and
lightheadedness.  She had no recent nonsteroidal
anti-inflammatory drug use.  Her review of systems is only
positive for a 30 pound weight loss over the past four years.
She is denying any abdominal pain.

In the Emergency Room she was given intravenous Protonix, two
units of packed red blood cells.  She had melena times
several episodes in the Emergency Department.  She was
nasogastric lavaged with normal saline which cleared after
two liters.

She was seen by Gastroenterology in the Emergency Room.  They
recommended transfer to the Medical Intensive Care Unit for
emergent EGD.  She had four peripheral IVs for access.  In
the Emergency Room she became progressively hypotensive with
systolic blood pressure to 100 and heart rate to 90 to 100.

BRIEF HOSPITAL COURSE:  As mentioned above, Ms. [**Known lastname **] was
admitted to the Medical Intensive Care Unit for emergent EGD.
Immediately after admission to the MICU, at the beginning of
the EGD procedure, she began to bleed profusely with massive
volumes of hematemesis.  She was taken emergently to
Interventional Radiology for possible gastric artery
embolization after central line placement and intubation
within the MICU.  She had three of her short gastric arteries
embolized with Interventional Radiology and was stabilized
with the hope for repeat endoscopy once she was more stable.

Over the next several days she was stable in the MICU without
any further episodes of bleeding; however, she had multiple
contributors to respiratory failure, including fluid
overload, pneumonia, and decreased mental status with a poor
prognosis.  Multiple attempts were made to wean sedation and
wean ventilatory support with failed attempts.  She was also
continually spiking fevers despite antibiotics for
ventilator-assisted pneumonia.

On [**2108-12-24**] decision was made by the Primary team and the
family to withdraw care.  The patient was extubated with all
drips turned off and quickly expired due to cardiac and
respiratory failure.  Time of death was 13:08 on [**2108-12-24**].
The family was not at the bedside but was notified and
immediately came in.  Dr. [**Last Name (STitle) **] [**Name (STitle) **] was also notified.  The
medical examiner was not notified.  No autopsy was requested.




                   DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-994

Dictated By:[**Last Name (NamePattern1) 9820**]

MEDQUIST36

D:  [**2109-3-21**]  11:40
T:  [**2109-3-21**]  14:42
JOB#:  [**Job Number 97296**]
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Pneumonia due to Klebsiella pneumoniae,Acute respiratory failure,Urinary tract infection, site not specified,Other and unspecified coagulation defects,Hyperosmolality and/or hypernatremia,Unspecified pleural effusion,Congestive heart failure, unspecified'}


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: 

PRESENT ILLNESS: Ms. [**Known lastname **] is a 79-year-old
female with a history of gastrointestinal bleed who presents
to the Emergency Department with nausea and hematemesis the
morning of admission.  She reported melena and
lightheadedness.  She had no recent nonsteroidal
anti-inflammatory drug use.  Her review of systems is only
positive for a 30 pound weight loss over the past four years.
She is denying any abdominal pain.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Pneumonia due to Klebsiella pneumoniae,Acute respiratory failure,Urinary tract infection, site not specified,Other and unspecified coagulation defects,Hyperosmolality and/or hypernatremia,Unspecified pleural effusion,Congestive heart failure, unspecified'}
