CHIEF COMPLAINT: Cerebral Edema and Anoxic Brain Injury

PRESENT ILLNESS: HPI: 44M with a history of polysubstance abuse was using heroin
and "pills" and was found unresponsive. He was not responsive to
narcan and was initially pulseless but regained circulation
after ACLS and epi x 3. In the ED at the OSH he was moving all
extremities but not purposefully. He was admitted to the ICU and
initiated on hypothermia protocol with sedation and paralysis
until [**7-31**] at 4am. His pressures were labile--hypertensive and
hypotensive at times. He was taken off paralytics and sedation
and was still unresponsive. CTH was performed demonstrating a
SAH and cerebral edema. On transfer he is spontaneously
breathing but has no other brainstem reflexes (fixed pupils, no
oculocephalic
reflex, no corneal reflex, no gag reflex). He was transfered to
[**Hospital1 18**] for further management.

MEDICAL HISTORY: unknown

MEDICATION ON ADMISSION: unknown

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: PHYSICAL EXAM:
GCS E: 1V:1 Motor:1
O: T:100.3  BP: 127/89  HR: 100  R:  30  O2Sats 99%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: fixed at 3.5mm        EOMs no movement
Neck: Supple.
Lungs: scattered rhonchi bilaterally.
Cardiac: tachycardia Reg rhythm. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: unknown

SOCIAL HISTORY: unknown
Poisoning by heroin,Subarachnoid hemorrhage,Cerebral edema,Poisoning by unspecified drug or medicinal substance,Do not resuscitate status,Other, mixed, or unspecified drug abuse, unspecified,Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted,Home accidents
Poisoning-heroin,Subarachnoid hemorrhage,Cerebral edema,Poison-medicinal agt NOS,Do not resusctate status,Drug abuse NEC-unspec,Undeterm pois-analgesics,Accident in home
Admission Date:  [**2200-8-1**]              Discharge Date:   [**2200-8-2**]

Date of Birth:  [**2156-6-10**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Allergies/ADRs on File

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Cerebral Edema and Anoxic Brain Injury

Major Surgical or Invasive Procedure:
Expired


History of Present Illness:
HPI: 44M with a history of polysubstance abuse was using heroin
and "pills" and was found unresponsive. He was not responsive to
narcan and was initially pulseless but regained circulation
after ACLS and epi x 3. In the ED at the OSH he was moving all
extremities but not purposefully. He was admitted to the ICU and
initiated on hypothermia protocol with sedation and paralysis
until [**7-31**] at 4am. His pressures were labile--hypertensive and
hypotensive at times. He was taken off paralytics and sedation
and was still unresponsive. CTH was performed demonstrating a
SAH and cerebral edema. On transfer he is spontaneously
breathing but has no other brainstem reflexes (fixed pupils, no
oculocephalic
reflex, no corneal reflex, no gag reflex). He was transfered to
[**Hospital1 18**] for further management.

Past Medical History:
unknown

Social History:
unknown

Family History:
unknown

Physical Exam:
PHYSICAL EXAM:
GCS E: 1V:1 Motor:1
O: T:100.3  BP: 127/89  HR: 100  R:  30  O2Sats 99%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: fixed at 3.5mm        EOMs no movement
Neck: Supple.
Lungs: scattered rhonchi bilaterally.
Cardiac: tachycardia Reg rhythm. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

Neuro:
Mental status: intubated not responsive off sedation for 8 hours
Cranial Nerves:
I: Not tested
II: Pupils fixed and dilated.

Motor: No response to sternal rub or noxious stimuli.

Reflexes: absent

Handedness unknown

On Discharge:
Expired

Pertinent Results:
CTH:moderate subarachnoid hemorrhage and diffuse cerebral edema.
Hypodensity in heads of caudate nucleus and basal ganglia--[**1-9**]
anoxic infarcts.

[**2200-8-1**] 08:00AM   GLUCOSE-133* UREA N-8 CREAT-0.6 SODIUM-132*
POTASSIUM-3.9 CHLORIDE-100 TOTAL CO2-22 ANION GAP-14
[**2200-8-1**] 08:00AM   CALCIUM-8.6 PHOSPHATE-2.7 MAGNESIUM-1.8
[**2200-8-1**] 05:27AM   LACTATE-2.7*
[**2200-8-1**] 04:31AM   SODIUM-134 POTASSIUM-4.3 CHLORIDE-105
[**2200-8-1**] 04:31AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.025
[**2200-8-1**] 04:31AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0
LEUK-NEG
[**2200-8-1**] 01:26AM   GLUCOSE-118* UREA N-11 CREAT-0.6 SODIUM-133
POTASSIUM-4.1 CHLORIDE-103 TOTAL CO2-17* ANION GAP-17
[**2200-8-1**] 01:26AM   ALT(SGPT)-110* AST(SGOT)-97* ALK PHOS-95 TOT
BILI-0.3
[**2200-8-1**] 01:26AM   ALBUMIN-3.3* CALCIUM-8.2* PHOSPHATE-1.5*
MAGNESIUM-1.9
[**2200-8-1**] 01:26AM   WBC-24.9* RBC-4.51* HGB-14.6 HCT-42.1 MCV-93
MCH-32.3* MCHC-34.6 RDW-14.3
[**2200-8-1**] 01:26AM   PLT COUNT-243
[**2200-8-1**] 01:26AM   PT-12.3 PTT-29.6 INR(PT)-1.1

Brief Hospital Course:
Pt was admited to Neurosurgery ICU. Plan included Q1 Neurochecks
and Vital Signs, Nimodipine 60mg Q 4 hours,HOB>30
degrees,Mannitol,Seizure Prophylaxis with Phyenytoin,Strict SBP
less < 130 parameters. He was transferred from an OSH after
being resuscitated following a cardiac arrest. He did not
recieve any sedative emdications and was normothermic upon
arrival. He was evaluated and found to have a very poor
neurologic exam with no corneal reflexes, minimal cough and gag
and minimal response to noxious stimuli. Imaging showed diffse
cerebral edema. He underwent a CTA of the brain to
assessvasculature and perfusion on [**8-1**] which showed hat flow
was still occuring at that time. During the course of the day on
[**8-1**] he no longer had a cough or a gag and he was no longer
taking breaths over the vent. A family meeting was had during
which the decision was made to make him DNR/DNI and the organ
bank was notified of his status. The patient continued with his
very poor neurologic exam into [**8-2**]. The family made the
decision to withdraw care in the early afternoon and he passed
shortly thereafter with his family at his bedside. Organ
donation was deferred by the family.


Medications on Admission:
unknown

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Cerebral Edema
Anoxic Brain Injury


Discharge Condition:
Expired


Discharge Instructions:
Expired

Followup Instructions:
Expired



Completed by:[**2200-8-2**]
{'Poisoning by heroin,Subarachnoid hemorrhage,Cerebral edema,Poisoning by unspecified drug or medicinal substance,Do not resuscitate status,Other, mixed, or unspecified drug abuse, unspecified,Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted,Home accidents'}


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: Cerebral Edema and Anoxic Brain Injury

PRESENT ILLNESS: HPI: 44M with a history of polysubstance abuse was using heroin
and "pills" and was found unresponsive. He was not responsive to
narcan and was initially pulseless but regained circulation
after ACLS and epi x 3. In the ED at the OSH he was moving all
extremities but not purposefully. He was admitted to the ICU and
initiated on hypothermia protocol with sedation and paralysis
until [**7-31**] at 4am. His pressures were labile--hypertensive and
hypotensive at times. He was taken off paralytics and sedation
and was still unresponsive. CTH was performed demonstrating a
SAH and cerebral edema. On transfer he is spontaneously
breathing but has no other brainstem reflexes (fixed pupils, no
oculocephalic
reflex, no corneal reflex, no gag reflex). He was transfered to
[**Hospital1 18**] for further management.

MEDICAL HISTORY: unknown

MEDICATION ON ADMISSION: unknown

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: PHYSICAL EXAM:
GCS E: 1V:1 Motor:1
O: T:100.3  BP: 127/89  HR: 100  R:  30  O2Sats 99%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: fixed at 3.5mm        EOMs no movement
Neck: Supple.
Lungs: scattered rhonchi bilaterally.
Cardiac: tachycardia Reg rhythm. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: unknown

SOCIAL HISTORY: unknown 

### Response:
{'Poisoning by heroin,Subarachnoid hemorrhage,Cerebral edema,Poisoning by unspecified drug or medicinal substance,Do not resuscitate status,Other, mixed, or unspecified drug abuse, unspecified,Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted,Home accidents'}
