CHIEF COMPLAINT: Unresponsive

PRESENT ILLNESS: Ms. [**Known lastname **] is a 59 yo F w/PMHx sx for substance abuse, COPD, and
asthma who presented after being discharged today from a rehab
facility. Pt had c.diff colitis, requiring emergency ex-lap with
partial colectomy and ileostomy. Patient's post-operative course
was c/b pneumonia, COPD flare. Patient states that she was
admitted to [**Hospital1 756**] for a reversal of her ileostomy one month
ago, and was sent to rehab from there. She did well there, and
was discharged to home today on multiple medications, including
oxycodone and ativan. She states that she took 3 ativan and 2
oxycodone at home due to worsening pain. She states that she
usually takes 1-2 tablets at a time. Four hours after discharge,
patient was found by her sister to be minimally responsive at
home, responsive only to painful stimuli. Upon arrival by EMS,
patient was given Narcan, and woke up completely. Pt denies any
other substance use. She does note dizziness on standing and
diarrhea, which is chronic for her.
.
In the ED, patient had a CXR which showed a right infrahilar
aspiration. Her EKG was unremarkable. She received 1L NS.
.
ROS: She denies any chest pain, palpitations, SOB, headache,
dizziness, abdominal pain, fevers, chills, rash. She notes
constant diarrhea as well as associated nausea. She notes some
dizziness on standing.

MEDICAL HISTORY: 1) COPD:  intubated previously, she uses O2 only when not
feeling well.  FEV1 0.64L.  Her functional status is poor--she
is not able to do much besides ADLs due to dyspnea.
2) Asthma
3) Parotid CA, tonsillar CA s/p surgery and XRT c/b mandibular
osteonecrosis.
4) Intermittent RLE edema:  took lasix for a few days 2-3 weeks
ago.  Etiology is not known.
5) Mitral valve prolapse.
NO h/o of CAD.

MEDICATION ON ADMISSION: Remeron 45 mg qhs
Zyprexa 5 mg qam
Prilosec 20 mg qd
Advair 500/50 1 puff [**Hospital1 **]
FOlic acid 1 tab qd
Magnesium oxide 400 mg qd
SImethicone 80 mg tid
PRednisone 10 mg qd
Duoneb 1 treatment qid
Oxycodone 5 mg 1-2 tabs q4h prn
Ativan 0.5 mg q6h prn
.
Allergies: Theophylline, flagyl, clindamycin, antihistamines

ALLERGIES: Theophylline / Flagyl / Clindamycin / Antihistamines

PHYSICAL EXAM: VS: T98.2/99.4 BP 125/75 HR 115 O2sat 93% 2L NC.
Gen: cachectic appearing female in NAD. Speaking in a whisper.
HEENT: MM dry. No oral ulcers or lesions. Radiation changes on
right jaw.
Hrt: Distant heart sounds. No MRG.
Lungs: Poor air movement. Minimal expiratory wheezing. No rales
or rhonchi.
Abd: Soft, nontender. Normoactive BS. Ileostomy revision site
with full thickness wound, with no drainage. Good granulation
tissue.
Ext: Warm.
Neuro: PERRL. Pinpoint pupils. Able to move all extremities.

FAMILY HISTORY: Father with h/o laryngeal CA, PE

SOCIAL HISTORY: Lives at home, just discharged from rehab on day of
presentation. Single. On disability. Hx substance abuse,
including alcohol, tobacco, cocaine, opiates.
Poisoning by other specified analgesics and antipyretics,Pneumonitis due to inhalation of food or vomitus,Chronic obstructive asthma, unspecified,Unspecified viral hepatitis C without hepatic coma,Mitral valve disorders,Unspecified drug dependence, continuous,Cocaine abuse, unspecified,Other alteration of consciousness,Anemia, unspecified,Essential thrombocythemia,Esophageal reflux,Inflammatory conditions of jaw,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Personal history of malignant neoplasm of other sites,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidental poisoning by other specified analgesics and antipyretics
Pois-analges/antipyr NEC,Food/vomit pneumonitis,Chronic obst asthma NOS,Hpt C w/o hepat coma NOS,Mitral valve disorder,Drug depend NOS-contin,Cocaine abuse-unspec,Other alter consciousnes,Anemia NOS,Essntial thrombocythemia,Esophageal reflux,Inflammation of jaw,Anxiety state NOS,Depressive disorder NEC,Hx-oral/pharynx malg NEC,Hx of malignancy NEC,Abn react-radiotherapy,Acc poison-analgesic NEC
Admission Date:  [**2179-3-29**]              Discharge Date:   [**2179-4-2**]

Date of Birth:  [**2119-11-3**]             Sex:   F

Service: MEDICINE

Allergies:
Theophylline / Flagyl / Clindamycin / Antihistamines

Attending:[**First Name3 (LF) 9240**]
Chief Complaint:
Unresponsive


Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname **] is a 59 yo F w/PMHx sx for substance abuse, COPD, and
asthma who presented after being discharged today from a rehab
facility. Pt had c.diff colitis, requiring emergency ex-lap with
partial colectomy and ileostomy. Patient's post-operative course
was c/b pneumonia, COPD flare. Patient states that she was
admitted to [**Hospital1 756**] for a reversal of her ileostomy one month
ago, and was sent to rehab from there. She did well there, and
was discharged to home today on multiple medications, including
oxycodone and ativan. She states that she took 3 ativan and 2
oxycodone at home due to worsening pain. She states that she
usually takes 1-2 tablets at a time. Four hours after discharge,
patient was found by her sister to be minimally responsive at
home, responsive only to painful stimuli. Upon arrival by EMS,
patient was given Narcan, and woke up completely. Pt denies any
other substance use. She does note dizziness on standing and
diarrhea, which is chronic for her.
.
In the ED, patient had a CXR which showed a right infrahilar
aspiration. Her EKG was unremarkable. She received 1L NS.
.
ROS: She denies any chest pain, palpitations, SOB, headache,
dizziness, abdominal pain, fevers, chills, rash. She notes
constant diarrhea as well as associated nausea. She notes some
dizziness on standing.


Past Medical History:
1) COPD:  intubated previously, she uses O2 only when not
feeling well.  FEV1 0.64L.  Her functional status is poor--she
is not able to do much besides ADLs due to dyspnea.
2) Asthma
3) Parotid CA, tonsillar CA s/p surgery and XRT c/b mandibular
osteonecrosis.
4) Intermittent RLE edema:  took lasix for a few days 2-3 weeks
ago.  Etiology is not known.
5) Mitral valve prolapse.
NO h/o of CAD.

Social History:
Lives at home, just discharged from rehab on day of
presentation. Single. On disability. Hx substance abuse,
including alcohol, tobacco, cocaine, opiates.

Family History:
Father with h/o laryngeal CA, PE

Physical Exam:
VS: T98.2/99.4 BP 125/75 HR 115 O2sat 93% 2L NC.
Gen: cachectic appearing female in NAD. Speaking in a whisper.
HEENT: MM dry. No oral ulcers or lesions. Radiation changes on
right jaw.
Hrt: Distant heart sounds. No MRG.
Lungs: Poor air movement. Minimal expiratory wheezing. No rales
or rhonchi.
Abd: Soft, nontender. Normoactive BS. Ileostomy revision site
with full thickness wound, with no drainage. Good granulation
tissue.
Ext: Warm.
Neuro: PERRL. Pinpoint pupils. Able to move all extremities.


Pertinent Results:
Na:139 K:5.2
Cl:95 TCO2:30 Creat 1.0 Glu:170
.
9.8 \ 11.4 / 577 D
------
33.8
N:92.1 Band:0 L:5.2 M:1.8 E:0.5 Bas:0.4
UA: Neg leuks, neg nitrites, trace protein, occ bacteria, [**4-12**]
WBC.
CXR:
1. Upper zone redistribution, without other evidence of CHF.
Probable
underlying COPD with pulmonary hypertension.
2. Right infrahilar patchy air -- this could be due to
aspiration or
pneumonic infiltrate.
3. Probable scarring at the left lung base. Recommend comparison
with
previous films when they become available, to confirm this.
4. Asymmetry of breast shadows as described.
.
EKG: Sinus rhythm. PRWP. No acute ST-T changes. Intervals fine.
No significant change from prior.
.
Serum tox: negative
Urine tox: positive for cocaine, opiates


Brief Hospital Course:
Ms. [**Known lastname **] is a 59 yo F w/hx polysubstance abuse who presents
after being found unresponsive at home, likely [**3-12**] substance
abuse, now improved after Narcan administration.  Hospital
course by problem:
.
#. Unresponsiveness. Most likely etiology for episode of
unresponsiveness is narcotics overdose, with reversal with
Narcan. Pt has a significant substance abuse history, and tox
screen is positive for both cocaine and opiates on admission.
We monitored her in the ICU and she returned to her baseline.
We obtained a social work consult and screened her for
placement.  This event occurred within four hours of your
discharge from rehab so feel it is safest for you to return to a
rehab.
.
#. Aspiration pneumonitis. Patient with evidence of aspiration
pneumonitis on CXR, likely from episode of being down on at
home. Patient also on pureed diets at discharge from rehab,
possibly due to hx of esophageal dysmotility.  We monitored her
oxygen requirement.  She remained at her normal requirement of
2L NC so did not start antibiotics.
.
#. COPD/asthma. Patient with FEV1 0.64L, with history of
intubations in the past. She was breathing well on 2L NC.
-Albuterol/ipratropium nebulizers q6h
-Advair inhaler 500/50 1 puff [**Hospital1 **]
-Continue home prednisone dose of 10 mg qd with PPI and insulin
SC
.
#. S/P colostomy revision.
-we monitored site.  It did not appear to be superinfected
-Tylenol for pain relief
.
#. Substance abuse. Patient with evidence of cocaine/opiates on
tox screen, and has a significant substance abuse history. Pt
denies any current use of cocaine.
-We placed a social work consult
.
#. Hx alcohol abuse.
-MVI, folate, thiamine.
-No need for CIWA scale as serum alcohol negative, and just
discharged from rehab on day of admission
.
#. Hx depression. Patient denied SI, although has a hx of
depression and episode of overdose today.  She denied that it
was intentional and had no thoughts of hurting herself.
-Continued Zyprexa and Remeron
.
#. Anemia. Patient with microcytic anemia, of unclear duration.
-iron studies did not indicate chronic inflammation or iron
deficiency
-we guaiac'd stools
.
#. FEN. Pureed diet. Ensure 1 can three times a day. Aspiration
precautions. 1L LR overnight.
.
#. PPx. Heparin SC. Senna/colace. Simethicone. PPI.
Acetaminophen for pain relief.
.
#. Code. DNR/DNI.
.
#. Communcation. With patient.


Medications on Admission:
Remeron 45 mg qhs
Zyprexa 5 mg qam
Prilosec 20 mg qd
Advair 500/50 1 puff [**Hospital1 **]
FOlic acid 1 tab qd
Magnesium oxide 400 mg qd
SImethicone 80 mg tid
PRednisone 10 mg qd
Duoneb 1 treatment qid
Oxycodone 5 mg 1-2 tabs q4h prn
Ativan 0.5 mg q6h prn
.
Allergies: Theophylline, flagyl, clindamycin, antihistamines


Discharge Medications:
1. Mirtazapine 15 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
2. Olanzapine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1)  Inhalation twice a day.
5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO once a
day.
7. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO three times a day.
8. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. DuoNeb 2.5-0.5 mg/3 mL Solution Sig: One (1)  Inhalation four
times a day.
10. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every
4 to 6 hours) as needed.
11. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
13. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
14. Olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO twice a day
as needed for anxiety.
Disp:*60 Tablet(s)* Refills:*0*
15. Lorazepam 0.5 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6
hours) as needed: Please take according to taper:
half tab 4 times daily for one day, then 3 times daily for one
day, then two times daily for one day, then once daily for one
day, then stop.
Disp:*5 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
- cocaine abuse
- opiate intake
- altered mental status
- COPD
Secondary:
- asthma
- HCV
- colostomy reversal
- esophageal dysmotility
- hx of substance abuse: cocaine, tobacco, alcohol
- parotid cancer s/p surgery and xrt c/b mandibular
osteonecrosis
- MVP
- depression and anxiety


Discharge Condition:
fair


Discharge Instructions:
You were admitted with altered mental status.  This was thought
secondary to inappropriate use of your medications.  You had
cocaine and opiates in your system.  We treated you with Narcan
and you awoke.  Given your altered mental status, we monitored
you in the intensive care unit.  You improved back to your
baseline.
.
Please take your medications as instructed.  Please followup
with your PCP.  [**Name10 (NameIs) 357**] contact your physician or return to the
emergency department if you experience shortness of breath,
chest pain, abdominal pain, or worsening confusion. We have
decided to have your sister administer your medications. Please
follow up with your PCP as scheduled.

Followup Instructions:
1. Please followup with Dr. [**First Name (STitle) **] on [**4-7**] at 10:15am. You can
call [**Telephone/Fax (1) 101516**] if you have questions.

2. Please follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 101517**] of Addiction
Consultation and Evaluation Services. Call [**Telephone/Fax (1) 79298**] for an
appointment in the next week.
{'Poisoning by other specified analgesics and antipyretics,Pneumonitis due to inhalation of food or vomitus,Chronic obstructive asthma, unspecified,Unspecified viral hepatitis C without hepatic coma,Mitral valve disorders,Unspecified drug dependence, continuous,Cocaine abuse, unspecified,Other alteration of consciousness,Anemia, unspecified,Essential thrombocythemia,Esophageal reflux,Inflammatory conditions of jaw,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Personal history of malignant neoplasm of other sites,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidental poisoning by other specified analgesics and antipyretics'}


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: Unresponsive

PRESENT ILLNESS: Ms. [**Known lastname **] is a 59 yo F w/PMHx sx for substance abuse, COPD, and
asthma who presented after being discharged today from a rehab
facility. Pt had c.diff colitis, requiring emergency ex-lap with
partial colectomy and ileostomy. Patient's post-operative course
was c/b pneumonia, COPD flare. Patient states that she was
admitted to [**Hospital1 756**] for a reversal of her ileostomy one month
ago, and was sent to rehab from there. She did well there, and
was discharged to home today on multiple medications, including
oxycodone and ativan. She states that she took 3 ativan and 2
oxycodone at home due to worsening pain. She states that she
usually takes 1-2 tablets at a time. Four hours after discharge,
patient was found by her sister to be minimally responsive at
home, responsive only to painful stimuli. Upon arrival by EMS,
patient was given Narcan, and woke up completely. Pt denies any
other substance use. She does note dizziness on standing and
diarrhea, which is chronic for her.
.
In the ED, patient had a CXR which showed a right infrahilar
aspiration. Her EKG was unremarkable. She received 1L NS.
.
ROS: She denies any chest pain, palpitations, SOB, headache,
dizziness, abdominal pain, fevers, chills, rash. She notes
constant diarrhea as well as associated nausea. She notes some
dizziness on standing.

MEDICAL HISTORY: 1) COPD:  intubated previously, she uses O2 only when not
feeling well.  FEV1 0.64L.  Her functional status is poor--she
is not able to do much besides ADLs due to dyspnea.
2) Asthma
3) Parotid CA, tonsillar CA s/p surgery and XRT c/b mandibular
osteonecrosis.
4) Intermittent RLE edema:  took lasix for a few days 2-3 weeks
ago.  Etiology is not known.
5) Mitral valve prolapse.
NO h/o of CAD.

MEDICATION ON ADMISSION: Remeron 45 mg qhs
Zyprexa 5 mg qam
Prilosec 20 mg qd
Advair 500/50 1 puff [**Hospital1 **]
FOlic acid 1 tab qd
Magnesium oxide 400 mg qd
SImethicone 80 mg tid
PRednisone 10 mg qd
Duoneb 1 treatment qid
Oxycodone 5 mg 1-2 tabs q4h prn
Ativan 0.5 mg q6h prn
.
Allergies: Theophylline, flagyl, clindamycin, antihistamines

ALLERGIES: Theophylline / Flagyl / Clindamycin / Antihistamines

PHYSICAL EXAM: VS: T98.2/99.4 BP 125/75 HR 115 O2sat 93% 2L NC.
Gen: cachectic appearing female in NAD. Speaking in a whisper.
HEENT: MM dry. No oral ulcers or lesions. Radiation changes on
right jaw.
Hrt: Distant heart sounds. No MRG.
Lungs: Poor air movement. Minimal expiratory wheezing. No rales
or rhonchi.
Abd: Soft, nontender. Normoactive BS. Ileostomy revision site
with full thickness wound, with no drainage. Good granulation
tissue.
Ext: Warm.
Neuro: PERRL. Pinpoint pupils. Able to move all extremities.

FAMILY HISTORY: Father with h/o laryngeal CA, PE

SOCIAL HISTORY: Lives at home, just discharged from rehab on day of
presentation. Single. On disability. Hx substance abuse,
including alcohol, tobacco, cocaine, opiates. 

### Response:
{'Poisoning by other specified analgesics and antipyretics,Pneumonitis due to inhalation of food or vomitus,Chronic obstructive asthma, unspecified,Unspecified viral hepatitis C without hepatic coma,Mitral valve disorders,Unspecified drug dependence, continuous,Cocaine abuse, unspecified,Other alteration of consciousness,Anemia, unspecified,Essential thrombocythemia,Esophageal reflux,Inflammatory conditions of jaw,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Personal history of malignant neoplasm of other sites,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidental poisoning by other specified analgesics and antipyretics'}
