CHIEF COMPLAINT: found unresponsive

PRESENT ILLNESS: Mr. [**Known firstname 108323**] is a [**Age over 90 **] year old man with hx of CAD s/p CABG, s/p
pacer insertion, AAA who presented to the ED after his wife
heard him fall in the bathroom.  EMS was activated by his wife
and on arrival he was found in to be in VT.  He was shocked
twice to PEA.  He was given 4mg Epi, 3mg Atropine total.  On
arrival to the ED, he was found to have a spontaneous pulse and
CPR was stopped.  He was intubated in the field.  Total out of
hospital CPR time was 30 minutes.
.
In the ED, initial BP was 130/62, HR 112.  The post-arrest team
and cardiology consult were called.  He was given Amiodarone
150mg bolus with a drip at 1mg/min.  His blood pressures dropped
to 77/54 and he was started on peripheral dopamine, maxed out at
20mcg/kg/min.  His blood pressure increased to 92/35, HR 59.  A
CXR was done showing the tube to be too deep and it was pulled
back 2cm.  After discussion with the family, they did not want
further heroic measures.  A central line was not placed and he
did not have a head CT.

MEDICAL HISTORY: PMH:
# CAD s/p CABG times two with sternal osteo as a complication.
# PPM
# Parkinson's with [**Last Name (un) 309**] Body Dementia c/b Visual Hallucinations.
 (details unknown)
# iron deficiency anemia
# spinal stenosis
# macular degenration
#GI bleed: AVMs
.
PSurgHx:
# Femur fracture s/p fall [**2127**]
# R TKR in [**2117**]
# L TKR in [**2127-4-27**] (c/b post-op confusion and AF-RVR)
# L hip repair [**11-30**]
# Right inguinal hernia repair
# Pilonidal cyst I&D.

MEDICATION ON ADMISSION: unknown at the time of admission

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Morphine /
Aspirin

PHYSICAL EXAM: VS: BP=85/69 HR=72 RR=15 O2 sat=  100% on vent 100% FIO2, 10
PEEP
GENERAL: Non-responsive to verbal or painful stimulus,
intubated.
HEENT: C-collar in place.  Pupils fixed and dilated,
non-responsive.  Doll's eyes not able to be tested due to collar
in place.  Corneal reflexes absent.   Multiple facial
lacerations.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: Mottled in appearance with IO access in left leg.

FAMILY HISTORY: unknown.

SOCIAL HISTORY: Per OMR records, unable to confirm:  The patient lives with his
wife in a 1 story apartment. He has difficulty walking [**1-29**] leg
stiffness due to Parkinsons. His wife takes care of him. He is
able to eat and dress by himself. His daughter lives down the
street. He quit smoking in [**2094**]. He has occassional sips of
wine.
Paroxysmal ventricular tachycardia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Abdominal aneurysm without mention of rupture,Aortocoronary bypass status,Cardiac pacemaker in situ,Encounter for palliative care
Parox ventric tachycard,Cor ath unsp vsl ntv/gft,Abdom aortic aneurysm,Aortocoronary bypass,Status cardiac pacemaker,Encountr palliative care
Admission Date:  [**2132-1-12**]              Discharge Date:   [**2132-1-12**]


Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamide Antibiotics) / Morphine /
Aspirin

Attending:[**First Name3 (LF) 4765**]
Chief Complaint:
found unresponsive

Major Surgical or Invasive Procedure:
intubation prior to arrival

History of Present Illness:
Mr. [**Known firstname 108323**] is a [**Age over 90 **] year old man with hx of CAD s/p CABG, s/p
pacer insertion, AAA who presented to the ED after his wife
heard him fall in the bathroom.  EMS was activated by his wife
and on arrival he was found in to be in VT.  He was shocked
twice to PEA.  He was given 4mg Epi, 3mg Atropine total.  On
arrival to the ED, he was found to have a spontaneous pulse and
CPR was stopped.  He was intubated in the field.  Total out of
hospital CPR time was 30 minutes.
.
In the ED, initial BP was 130/62, HR 112.  The post-arrest team
and cardiology consult were called.  He was given Amiodarone
150mg bolus with a drip at 1mg/min.  His blood pressures dropped
to 77/54 and he was started on peripheral dopamine, maxed out at
20mcg/kg/min.  His blood pressure increased to 92/35, HR 59.  A
CXR was done showing the tube to be too deep and it was pulled
back 2cm.  After discussion with the family, they did not want
further heroic measures.  A central line was not placed and he
did not have a head CT.


Past Medical History:
PMH:
# CAD s/p CABG times two with sternal osteo as a complication.
# PPM
# Parkinson's with [**Last Name (un) 309**] Body Dementia c/b Visual Hallucinations.
 (details unknown)
# iron deficiency anemia
# spinal stenosis
# macular degenration
#GI bleed: AVMs
.
PSurgHx:
# Femur fracture s/p fall [**2127**]
# R TKR in [**2117**]
# L TKR in [**2127-4-27**] (c/b post-op confusion and AF-RVR)
# L hip repair [**11-30**]
# Right inguinal hernia repair
# Pilonidal cyst I&D.

Social History:
Per OMR records, unable to confirm:  The patient lives with his
wife in a 1 story apartment. He has difficulty walking [**1-29**] leg
stiffness due to Parkinsons. His wife takes care of him. He is
able to eat and dress by himself. His daughter lives down the
street. He quit smoking in [**2094**]. He has occassional sips of
wine.


Family History:
unknown.

Physical Exam:
VS: BP=85/69 HR=72 RR=15 O2 sat=  100% on vent 100% FIO2, 10
PEEP
GENERAL: Non-responsive to verbal or painful stimulus,
intubated.
HEENT: C-collar in place.  Pupils fixed and dilated,
non-responsive.  Doll's eyes not able to be tested due to collar
in place.  Corneal reflexes absent.   Multiple facial
lacerations.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: Mottled in appearance with IO access in left leg.

Pertinent Results:
[**2132-1-12**] 01:42AM BLOOD WBC-16.5* RBC-3.62* Hgb-8.6* Hct-34.0*
MCV-90 MCH-25.4* MCHC-26.4* RDW-17.8* Plt Ct-168
[**2132-1-12**] 01:42AM BLOOD PT-41.9* PTT-57.6* INR(PT)-4.4*
[**2132-1-12**] 01:42AM BLOOD Glucose-215* UreaN-28* Creat-1.2 Na-142
K-4.9 Cl-104 HCO3-16* AnGap-27*
[**2132-1-12**] 01:42AM BLOOD Lipase-90*
[**2132-1-12**] 02:08AM BLOOD Glucose-205* Lactate-10.1* Na-138 K-6.2*
Cl-105 calHCO3-12*
.
ECG:
An atrial paced rhythm with one native junctional beat. Diffuse
non-specific ST-T wave abnormalities. Poor R wave progression.
Cannot rule out old anteroseptal myocardial infarction. Low QRS
voltage in the limb leads. No previous tracing available for
comparison.
.
CXR IMPRESSION:
1. Endotracheal tube tip 1.5 cm from the carina, and should be
slightly
withdrawn.
2. Confluent opacities throughout both lungs, likely reflect
pulmonary edema.


Brief Hospital Course:
Mr. [**Known firstname 108323**] is a [**Age over 90 **] year old man with CAD who had an
out-of-hospital arrest and prolonged period with no perfusion.
He was resuscitated and admitted.  After discussion with the
family, they wished to withdraw care due to his poor prognosis.
The patient was extubated and died within 5 minutes.  The family
declined an autopsy.  Time of death was 5:00am on [**2132-1-12**].

Medications on Admission:
unknown at the time of admission

Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired
{'Paroxysmal ventricular tachycardia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Abdominal aneurysm without mention of rupture,Aortocoronary bypass status,Cardiac pacemaker in situ,Encounter for palliative care'}


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 unresponsive

PRESENT ILLNESS: Mr. [**Known firstname 108323**] is a [**Age over 90 **] year old man with hx of CAD s/p CABG, s/p
pacer insertion, AAA who presented to the ED after his wife
heard him fall in the bathroom.  EMS was activated by his wife
and on arrival he was found in to be in VT.  He was shocked
twice to PEA.  He was given 4mg Epi, 3mg Atropine total.  On
arrival to the ED, he was found to have a spontaneous pulse and
CPR was stopped.  He was intubated in the field.  Total out of
hospital CPR time was 30 minutes.
.
In the ED, initial BP was 130/62, HR 112.  The post-arrest team
and cardiology consult were called.  He was given Amiodarone
150mg bolus with a drip at 1mg/min.  His blood pressures dropped
to 77/54 and he was started on peripheral dopamine, maxed out at
20mcg/kg/min.  His blood pressure increased to 92/35, HR 59.  A
CXR was done showing the tube to be too deep and it was pulled
back 2cm.  After discussion with the family, they did not want
further heroic measures.  A central line was not placed and he
did not have a head CT.

MEDICAL HISTORY: PMH:
# CAD s/p CABG times two with sternal osteo as a complication.
# PPM
# Parkinson's with [**Last Name (un) 309**] Body Dementia c/b Visual Hallucinations.
 (details unknown)
# iron deficiency anemia
# spinal stenosis
# macular degenration
#GI bleed: AVMs
.
PSurgHx:
# Femur fracture s/p fall [**2127**]
# R TKR in [**2117**]
# L TKR in [**2127-4-27**] (c/b post-op confusion and AF-RVR)
# L hip repair [**11-30**]
# Right inguinal hernia repair
# Pilonidal cyst I&D.

MEDICATION ON ADMISSION: unknown at the time of admission

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Morphine /
Aspirin

PHYSICAL EXAM: VS: BP=85/69 HR=72 RR=15 O2 sat=  100% on vent 100% FIO2, 10
PEEP
GENERAL: Non-responsive to verbal or painful stimulus,
intubated.
HEENT: C-collar in place.  Pupils fixed and dilated,
non-responsive.  Doll's eyes not able to be tested due to collar
in place.  Corneal reflexes absent.   Multiple facial
lacerations.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: Mottled in appearance with IO access in left leg.

FAMILY HISTORY: unknown.

SOCIAL HISTORY: Per OMR records, unable to confirm:  The patient lives with his
wife in a 1 story apartment. He has difficulty walking [**1-29**] leg
stiffness due to Parkinsons. His wife takes care of him. He is
able to eat and dress by himself. His daughter lives down the
street. He quit smoking in [**2094**]. He has occassional sips of
wine. 

### Response:
{'Paroxysmal ventricular tachycardia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Abdominal aneurysm without mention of rupture,Aortocoronary bypass status,Cardiac pacemaker in situ,Encounter for palliative care'}
