CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 66-year-old man who
presented with the worst headache of his life the morning of
[**2168-9-26**].  He was seen in the Emergency Room at approximately
1:30 p.m. by neurosurgery.  He was straining while trying to
have a bowel movement.  The patient has a history of bad
headaches; however, this time the symptoms were much worse.

MEDICAL HISTORY: 1. Hepatitis C related to transfusion.
2. Benign prostatic hypertrophy.
3. Thrombocytopenia.
4. Atrial fibrillation.

MEDICATION ON ADMISSION: 1. Proscar.
2. Tylenol.
3. Lisinopril 5 mg p.o. daily.
4. Nadolol 40 mg p.o. daily.
5. Interferon once a week for hepatitis C.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subarachnoid hemorrhage,Cardiac arrest,Chronic hepatitis C without mention of hepatic coma,Acquired coagulation factor deficiency,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Unspecified septicemia,Severe sepsis,Acute vascular insufficiency of intestine,Long-term (current) use of other medications,Unspecified essential hypertension,Chronic congestive splenomegaly
Subarachnoid hemorrhage,Cardiac arrest,Chrnc hpt C wo hpat coma,Acq coagul factor defic,Acute necrosis of liver,Ac kidny fail, tubr necr,Hyposmolality,Septicemia NOS,Severe sepsis,Ac vasc insuff intestine,Long-term use meds NEC,Hypertension NOS,Chr congest splenomegaly
Admission Date: [**2168-9-26**]        Discharge Date: [**2168-10-8**]

Date of Birth:                    Sex:  M

Service: NSURG


HISTORY OF PRESENT ILLNESS:  This is a 66-year-old man who
presented with the worst headache of his life the morning of
[**2168-9-26**].  He was seen in the Emergency Room at approximately
1:30 p.m. by neurosurgery.  He was straining while trying to
have a bowel movement.  The patient has a history of bad
headaches; however, this time the symptoms were much worse.

PAST MEDICAL HISTORY:
1. Hepatitis C related to transfusion.
2. Benign prostatic hypertrophy.
3. Thrombocytopenia.
4. Atrial fibrillation.


MEDICATIONS ON ADMISSION:
1. Proscar.
2. Tylenol.
3. Lisinopril 5 mg p.o. daily.
4. Nadolol 40 mg p.o. daily.
5. Interferon once a week for hepatitis C.


PAST SURGICAL HISTORY:  Gastrectomy 31 years ago.

PHYSICAL EXAMINATION:  The vital signs on admission revealed
a blood pressure of 173/70, heart rate 70, respirations 16.
On physical examination, he was awake, alert, oriented times
three.  Cranial nerves II through XII were intact.  Motor
strength was [**4-27**] in both his upper and lower extremities.  He
had no localized motor or sensory deficits.

LABORATORY DATA:  White count 3.1, hematocrit 39.8, platelets
63,000.  Sodium 141, potassium 4.6, 108 chloride, 25
bicarbonate, 17 BUN, 0.8 creatinine, 117 glucose.  His
platelets on admission were 63.

HOSPITAL COURSE:  Given that his platelets were 63, he was
transfused with platelets.  He was obtained an immediate CTA
which showed a wide neck ACOM aneurysm.  He was brought
emergently to cerebral angiogram where he was showed to have
a ruptured wide neck ACOM aneurysm 4-5 mm, a dominant left A1
and minimal filling from the right A1.  He was then admitted
to the ICU where his blood pressure was kept at less than 120
at all times.  Hematology was consulted and asked to see the
patient for a thrombocytopenia in anticipation of
neurointerventional procedure for the subarachnoid hemorrhage
which they felt that the thrombocytopenia was chronic
secondary to splenic sequestration with moderate splenomegaly
and they recommended transfusing platelets as needed.  The
attending from hematology felt that such patients do not
usually bleed spontaneously post surgery and it was okay to
complete the procedure with the use of heparin.

He was monitored in the ICU overnight for his first day of
admission where he was started on nimodipine and Nipride to
keep his blood pressure less than 120.  His systolic goal was
100-120.  He remained neurologically intact overnight in
anticipation of undergoing a clipping of his ACOM aneurysm.

On [**2168-9-27**], he underwent a clipping where he had without
problems or complaints a vent drain placed without any
difficulties.  He continued to be followed by hematology for
his hepatitis C.  He also had atrial fibrillation which had
been diagnosed three months prior to his hospitalization and
his rate was well controlled in the 90s.  On [**2168-9-29**], his
vital signs were 98.7, blood pressure 118-130s/60s-80s, heart
rate in the 70s, atrial fibrillation, CVP was [**3-8**], ICP 4-17.
He was receiving some Nipride to keep his blood pressure up
at times.  He was started with gentle fluids on that day to
keep his goal CVP of 8.  He had a chest x-ray to assess for
CHF, and his CVP level was [**8-2**], systolic blood pressure was
in the range of the goal of 160.  He was noted to have some
high urine output from possible cerebral salt wasting.  His
sodium was 138.  He had an echocardiogram which showed normal
ejection fraction, chest x-ray had no acute changes.

On [**2168-9-30**], he remained awake, alert, completely
neurologically intact.  His urine input for 24 hours was
5,128, output was 10,100.  He was started on one-to-one
repletion therapy with saline due to cerebral salt wasting
and a formal endocrine consult was obtained.  His blood
pressure goal of 150-160 was started.  Endocrine did not have
any further recommendations other than to continue with his
one-to-one repletion for urine and they followed the patient
with us.  His sodiums remained in the 138 range for [**2168-9-30**].

On [**2168-10-1**], an echocardiogram showed a normal ejection
fraction but mild pulmonary hypertension and mild left
ventricular hypertrophy.  On [**2168-10-1**], he was awake, alert,
and oriented times three.  He was subarachnoid day five.  His
EOMs were full.  Visual fields were intact.  His hematocrit
and platelets were stable.  His drain was at 10 cm, put out
36 cc overnight.  ICPs were in the 6 range.  His drain was
raised at 15 and his systolic blood pressure goals were
increased from 170-180.  He was also started on albumin to
increase his CVP greater than 8.

On [**2168-10-2**], he was found to be awake, alert.  The face was
symmetric.  He had a right drift, grips were [**4-27**].  He
continued to need one-to-one volume repletion for his urine
output.  His Decadron doses were decreased.  His blood
pressure parameters were kept in the 160-180 range.  His
drain was raised to 20.

On [**2168-10-3**], a blood gas showed his pH at 7.44, PC02 24, and
02 of 192.  He had crackles at the bases.  A chest x-ray
showed pulmonary edema.  He was electively intubated for a
low PAC02.  He required propofol in order to maintain an
adequate CA02.  On [**2168-10-3**], his C02 was 30 even with
propofol and our goal rate was 35-40.  He needed significant
sedation to control his respiratory rate in order to get an
adequate PC02 level.

On [**2168-10-4**], the patient required Levophed to keep his blood
pressure goals in the 160-180 range.  He was increased to
CPAP plus pressure support of 10 in order to maintain an
adequate C02 and his nimodipine was discontinued in order to
keep his blood pressure in the high range.  He eventually had
to be paralyzed on cisatracurium in order to increase his
C02; however, that made his neurologic examination difficult
to assess.

On [**2168-10-4**], he was still receiving a high amount of Levophed
and Neo to maintain his blood pressure but at the same time
he was noted to be cyanotic.  His extremities started to
become cyanotic on [**2168-10-3**].  On [**2168-10-4**], it continued with
cyanosis and the ICU noted abdominal distention, worsening
acidemia, rising lactate.  The surgery team was asked for
resuscitation for ischemic bowel.  He had an emergent CAT
scan of his head and abdomen and also for a four vessel
angiogram which showed minimal vasospasm which were in the
bilateral ICA and PCA territories.  His blood pressure
parameters were now weaned down to 110.  CT of the abdomen
showed some moderate free fluid, mild rectal thickening, no
pneumonitis or free air.  They recommended a colonoscopy to
exclude ischemia of the bowel but they felt more likely he
was having some liver failure, hyperperfusion, or due to the
existing hepatitis C.

On [**2168-10-5**], it appeared that the patient was developing
ARDS.  Also, surgery recommended starting him on Levo,
Flagyl, and vancomycin for prophylaxis.  His abdomen remained
enlarged and distended.  It was difficult to get a
neurological examination on him due to his sedation.  His
pupils were equal and reactive to light and accommodation and
his corneal reflexes were intact on [**2168-10-5**] and CVPs were 10-
17.  His ICPs were in the 11-15 range.  His ventriculostomy
drain continued to work well.  His sodium remained in the 147
range.  His potassium was noted to be 6.0 and his creatinine
had risen to 1.7.  Renal was asked to see the patient
emergently for renal shock and this was felt due to marked
increased phosphate, calcium, and lactate and that he had
dense acute tubular necrosis.  They recommended to start
CVVHD/VF and to also replace 150 mEq of bicarbonate per liter
of fluid so he was to receive 300 mEq of bicarbonate per
hour.  The liver service also saw the patient and felt that
he did have acute shock liver and acute renal failure.  They
felt that he should start on dobutamine and avoid sedation
and that his prognosis was poor, but he was now in multiorgan
failure.

A family meeting was done on [**2168-10-5**] to explain the grim
prognosis due to multiorgan failure to the [**Known lastname 30435**]
family.  He was on a bicarbonate drip.  His acidosis on
[**2168-10-6**] did seem to improve.  He started to receive insulin
and calcium drips and CVVHD.  On [**2168-10-6**], he remained
intubated and sedated.  On examination, his pupil on the
right was 6 mm, on the left 4 mm.  He did not withdrawal to
pain in his extremities.  His blood pressure was maintained
in the 100-110 range.  He continued on CVVHD.  On [**2168-10-6**],
cardiology also saw the patient due to myocardial depression.
They were recommending transitioning his Neo-Synephrine to
Levophed, checking a cortisol, to stop his digoxin, keep his
CVP 10-15 with a PA diastolic of 18-25 and a cardiac index
greater than 2.

On [**2168-10-7**], the patient remained acutely ill with shock
liver, increased acidosis, acute renal failure, multiorgan
failure.  He received blood products and factor VII for his
hematocrit of 27 and his platelets of 74, INR of 1.7.  He
received lactulose to help increase his bicarbonate.

On the afternoon of [**2168-10-7**], a family meeting was convened
and due to his poor prognosis and multiorgan system failure,
his family requested withdrawal of care.  He passed away at
1:05 on [**2168-10-8**].

DISCHARGE DIAGNOSIS:
1. Subarachnoid hemorrhage from ACOM aneurysm.
2. Multiorgan system failure.
3. Shock liver.
4. Hepatitis C.
5. Hypertension.
6. Benign prostatic hypertrophy.
7. Acute renal failure.




                        [**Name6 (MD) **] [**Last Name (NamePattern4) 1359**], [**MD Number(1) 1360**]

Dictated By:[**Last Name (NamePattern1) 12790**]
MEDQUIST36
D:  [**2169-1-5**] 15:13:49
T:  [**2169-1-7**] 11:36:13
Job#:  [**Job Number 30436**]
{'Subarachnoid hemorrhage,Cardiac arrest,Chronic hepatitis C without mention of hepatic coma,Acquired coagulation factor deficiency,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Unspecified septicemia,Severe sepsis,Acute vascular insufficiency of intestine,Long-term (current) use of other medications,Unspecified essential hypertension,Chronic congestive splenomegaly'}


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: This is a 66-year-old man who
presented with the worst headache of his life the morning of
[**2168-9-26**].  He was seen in the Emergency Room at approximately
1:30 p.m. by neurosurgery.  He was straining while trying to
have a bowel movement.  The patient has a history of bad
headaches; however, this time the symptoms were much worse.

MEDICAL HISTORY: 1. Hepatitis C related to transfusion.
2. Benign prostatic hypertrophy.
3. Thrombocytopenia.
4. Atrial fibrillation.

MEDICATION ON ADMISSION: 1. Proscar.
2. Tylenol.
3. Lisinopril 5 mg p.o. daily.
4. Nadolol 40 mg p.o. daily.
5. Interferon once a week for hepatitis C.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subarachnoid hemorrhage,Cardiac arrest,Chronic hepatitis C without mention of hepatic coma,Acquired coagulation factor deficiency,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Unspecified septicemia,Severe sepsis,Acute vascular insufficiency of intestine,Long-term (current) use of other medications,Unspecified essential hypertension,Chronic congestive splenomegaly'}
