CHIEF COMPLAINT: tx from [**Hospital3 **] in septic shock

PRESENT ILLNESS: 47M complaining of brown phlegm, fever, trouble sleeping for two
days. Pt was initially alert and oriented and stated that for
the past two days he had developed shortness of breath. Pt was
placed on 2 liters in route to the hospital and was satting at
90%. Initial vitals were signifcant for pulse of 131 and an o2
sat of 90% on 2 liters NC. Physical exam revealed large amount
of nasal flaring and pt reported orthopnea. Initial labs
demonstrated a wbc count of 1.5 and a creatinine of 1.4. Initial
PH on the morning of admission was 7.52, 28, PO2 of 45. Pt did
not receive influenza vaccination this year.
At 9:10 this morning, pt noted to have temp of 98.0 with a pulse
of 132 and a resp rate of 28. O2 saturation was noted to be 87%
and patient was receiving oxygen via nasal cannula. He was then
given nebs and was placed on a venti mask at 12LPM at 10:03 with
a sat of 89%. At 11:55, pt was noted to drop his pressure to
95/68 with a respiratory rate of 38. He was placed on bipap with
oxygen saturation coming up to 100%. At 1351, pt noted to
continue to be hypoxemic on his ABG. Per the OSH hospital
attending, the patient was then intubated. After intubation, the
pt was very tachycardic in the 170 range and then his blood
pressure dropped after about ten minutes from 80-->40 and his
color changed and he was in sinus tachycardia on monitor but had
no pulses. CPR was started and the patient received one round of
epi and atropine with return of his pulse. Shortly thereafter
the patient lost his pulse again, was given epi and got his
pulse back. In the ED, the pt got stress dose steroids. Received
600cc's in outside ED and then 2 liters in the air enroute to
[**Hospital1 18**]. Pt received 1gm ceftriaxone, 500mg Zithromax at OSH.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: expired

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: 1 ppd smoker
occasional etoh
no drugs
Unspecified septicemia,Acute respiratory failure,Septic shock,Severe sepsis,Cardiac arrest,Tobacco use disorder
Septicemia NOS,Acute respiratry failure,Septic shock,Severe sepsis,Cardiac arrest,Tobacco use disorder
Admission Date:  [**2187-2-16**]              Discharge Date:   [**2187-2-17**]

Date of Birth:  [**2140-5-17**]             Sex:   M

Service: MEDICINE

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
tx from [**Hospital3 **] in septic shock

Major Surgical or Invasive Procedure:
none

History of Present Illness:
47M complaining of brown phlegm, fever, trouble sleeping for two
days. Pt was initially alert and oriented and stated that for
the past two days he had developed shortness of breath. Pt was
placed on 2 liters in route to the hospital and was satting at
90%. Initial vitals were signifcant for pulse of 131 and an o2
sat of 90% on 2 liters NC. Physical exam revealed large amount
of nasal flaring and pt reported orthopnea. Initial labs
demonstrated a wbc count of 1.5 and a creatinine of 1.4. Initial
PH on the morning of admission was 7.52, 28, PO2 of 45. Pt did
not receive influenza vaccination this year.
At 9:10 this morning, pt noted to have temp of 98.0 with a pulse
of 132 and a resp rate of 28. O2 saturation was noted to be 87%
and patient was receiving oxygen via nasal cannula. He was then
given nebs and was placed on a venti mask at 12LPM at 10:03 with
a sat of 89%. At 11:55, pt was noted to drop his pressure to
95/68 with a respiratory rate of 38. He was placed on bipap with
oxygen saturation coming up to 100%. At 1351, pt noted to
continue to be hypoxemic on his ABG. Per the OSH hospital
attending, the patient was then intubated. After intubation, the
pt was very tachycardic in the 170 range and then his blood
pressure dropped after about ten minutes from 80-->40 and his
color changed and he was in sinus tachycardia on monitor but had
no pulses. CPR was started and the patient received one round of
epi and atropine with return of his pulse. Shortly thereafter
the patient lost his pulse again, was given epi and got his
pulse back. In the ED, the pt got stress dose steroids. Received
600cc's in outside ED and then 2 liters in the air enroute to
[**Hospital1 18**]. Pt received 1gm ceftriaxone, 500mg Zithromax at OSH.

Pt was medflighted to [**Hospital1 18**] for further evaluation and
management.


Past Medical History:
none

Social History:
1 ppd smoker
occasional etoh
no drugs

Family History:
noncontributory


Physical Exam:
expired

Pertinent Results:
[**2187-2-16**] 08:11PM   TYPE-ART PO2-42* PCO2-91* PH-6.89* TOTAL
CO2-19* BASE XS--20 INTUBATED-INTUBATED
[**2187-2-16**] 08:11PM   GLUCOSE-71 LACTATE-7.1* NA+-134* K+-5.3
CL--112
[**2187-2-16**] 08:11PM   freeCa-1.49*
[**2187-2-16**] 08:00PM   GLUCOSE-82 UREA N-35* CREAT-3.2*
POTASSIUM-5.6* CHLORIDE-112* TOTAL CO2-17*
[**2187-2-16**] 08:00PM   ALT(SGPT)-963* AST(SGOT)-1133* LD(LDH)-3050*
ALK PHOS-19* AMYLASE-32
[**2187-2-16**] 08:00PM   LIPASE-11
[**2187-2-16**] 08:00PM   CK-MB-11*
[**2187-2-16**] 08:00PM   ALBUMIN-1.6* CALCIUM-9.8 PHOSPHATE-6.3*#
MAGNESIUM-2.0
[**2187-2-16**] 08:00PM   ETHANOL-NEG ACETMNPHN-6.3 bnzodzpn-NEG
barbitrt-NEG
[**2187-2-16**] 08:00PM   WBC-2.8*# RBC-3.75* HGB-11.8* HCT-36.4*
MCV-97 MCH-31.5 MCHC-32.4 RDW-12.7
[**2187-2-16**] 08:00PM   NEUTS-2* BANDS-1 LYMPHS-82* MONOS-1* EOS-0
BASOS-0 ATYPS-5* METAS-5* MYELOS-4*
[**2187-2-16**] 08:00PM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-1+
MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL OVALOCYT-1+
TARGET-1+ SCHISTOCY-OCCASIONAL BURR-1+
[**2187-2-16**] 08:00PM   PLT COUNT-51*
[**2187-2-16**] 08:00PM   PT-30.6* PTT-150* INR(PT)-3.1*
[**2187-2-16**] 06:32PM   TYPE-ART PO2-50* PCO2-65* PH-7.03* TOTAL
CO2-18* BASE XS--14 INTUBATED-INTUBATED
[**2187-2-16**] 06:32PM   GLUCOSE-50* LACTATE-2.7* NA+-135 K+-3.3*
CL--117*
[**2187-2-16**] 06:32PM   freeCa-1.16
[**2187-2-16**] 05:48PM   TYPE-ART PO2-68* PCO2-76* PH-7.00* TOTAL
CO2-20* BASE XS--14 INTUBATED-INTUBATED
[**2187-2-16**] 05:48PM   GLUCOSE-82 LACTATE-3.0* NA+-136 K+-2.8*
CL--117*
[**2187-2-16**] 05:45PM URINE  COLOR-Straw APPEAR-Hazy SP [**Last Name (un) 155**]-1.018
[**2187-2-16**] 05:45PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-100
GLUCOSE-100 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2187-2-16**] 05:45PM URINE  RBC->50 WBC-[**11-22**]* BACTERIA-MANY
YEAST-NONE EPI-[**3-7**]
[**2187-2-16**] 05:45PM URINE  GRANULAR-0-2 HYALINE-[**3-7**]*
[**2187-2-16**] 05:40PM   GLUCOSE-95 UREA N-33* CREAT-2.7* SODIUM-141
POTASSIUM-3.3 CHLORIDE-116* TOTAL CO2-17* ANION GAP-11
[**2187-2-16**] 05:40PM   ALT(SGPT)-106* AST(SGOT)-148* LD(LDH)-667*
ALK PHOS-16* AMYLASE-26
[**2187-2-16**] 05:40PM   LIPASE-11
[**2187-2-16**] 05:40PM   CK-MB-6 cTropnT-0.02*
[**2187-2-16**] 05:40PM   ALBUMIN-1.4* CALCIUM-7.6* PHOSPHATE-2.9
MAGNESIUM-1.5*
[**2187-2-16**] 05:40PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2187-2-16**] 05:40PM   WBC-1.6* RBC-3.23* HGB-10.4* HCT-30.3* MCV-94
MCH-32.1* MCHC-34.3 RDW-13.1
[**2187-2-16**] 05:40PM   PLT COUNT-68*
[**2187-2-16**] 05:40PM   PT-27.8* PTT-150* INR(PT)-2.8*
[**2187-2-16**] 05:40PM   GRAN CT-390*
[**2187-2-16**] 05:11PM   GLUCOSE-57* LACTATE-4.3*
[**2187-2-16**] 05:11PM   freeCa-0.92*
[**2187-2-16**] 05:01PM   GLUCOSE-66* UREA N-35* CREAT-3.2* SODIUM-140
POTASSIUM-3.8 CHLORIDE-108 TOTAL CO2-22 ANION GAP-14
[**2187-2-16**] 05:01PM   ALT(SGPT)-92* AST(SGOT)-147* LD(LDH)-741*
CK(CPK)-485* ALK PHOS-21* AMYLASE-35 TOT BILI-0.3
[**2187-2-16**] 05:01PM   CK-MB-6 cTropnT-0.02*
[**2187-2-16**] 05:01PM   WBC-1.6* RBC-3.91* HGB-12.2* HCT-36.6* MCV-94
MCH-31.2 MCHC-33.3 RDW-12.9
[**2187-2-16**] 05:01PM   NEUTS-3* BANDS-6* LYMPHS-72* MONOS-5 EOS-1
BASOS-0 ATYPS-4* METAS-6* MYELOS-3* NUC RBCS-1*
[**2187-2-16**] 05:01PM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-1+
MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-OCCASIONAL OVALOCYT-1+
TARGET-1+ SCHISTOCY-OCCASIONAL BURR-1+
[**2187-2-16**] 05:01PM   PLT SMR-LOW PLT COUNT-83*
[**2187-2-16**] 05:01PM   PT-24.1* PTT-104.9* INR(PT)-2.3*
[**2187-2-16**] 05:01PM   FIBRINOGE-402*
[**2187-2-16**] 05:01PM   GRAN CT-500*

Brief Hospital Course:
Pt admitted directly to the sicu from [**Location (un) **] in septic shock.
 Pt was maxed on pressors, was treated with broad spectrum abx,
electrolyes were repleted, and patient was maximally fluid
resuscitated.
In the ICU patient, the patient developed a PEA arrest from
which he was resuscitated with atropine and epinephrine.
Despite maximal vent settings we only achieved oxygen
saturations in the low 70s.  Pt persisted at low PO2s for the
duration of his ICU stay.  After discussions with the patient's
mother and his supporting family, decision was made to make the
patient DNR.  Pt expired at 12:48 on [**2187-2-17**] after dropping his
blood pressure and becoming bradycardic.


Medications on Admission:
none

Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Septic shock
Acute Renal Failure

Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Severe sepsis,Cardiac arrest,Tobacco use disorder'}


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: tx from [**Hospital3 **] in septic shock

PRESENT ILLNESS: 47M complaining of brown phlegm, fever, trouble sleeping for two
days. Pt was initially alert and oriented and stated that for
the past two days he had developed shortness of breath. Pt was
placed on 2 liters in route to the hospital and was satting at
90%. Initial vitals were signifcant for pulse of 131 and an o2
sat of 90% on 2 liters NC. Physical exam revealed large amount
of nasal flaring and pt reported orthopnea. Initial labs
demonstrated a wbc count of 1.5 and a creatinine of 1.4. Initial
PH on the morning of admission was 7.52, 28, PO2 of 45. Pt did
not receive influenza vaccination this year.
At 9:10 this morning, pt noted to have temp of 98.0 with a pulse
of 132 and a resp rate of 28. O2 saturation was noted to be 87%
and patient was receiving oxygen via nasal cannula. He was then
given nebs and was placed on a venti mask at 12LPM at 10:03 with
a sat of 89%. At 11:55, pt was noted to drop his pressure to
95/68 with a respiratory rate of 38. He was placed on bipap with
oxygen saturation coming up to 100%. At 1351, pt noted to
continue to be hypoxemic on his ABG. Per the OSH hospital
attending, the patient was then intubated. After intubation, the
pt was very tachycardic in the 170 range and then his blood
pressure dropped after about ten minutes from 80-->40 and his
color changed and he was in sinus tachycardia on monitor but had
no pulses. CPR was started and the patient received one round of
epi and atropine with return of his pulse. Shortly thereafter
the patient lost his pulse again, was given epi and got his
pulse back. In the ED, the pt got stress dose steroids. Received
600cc's in outside ED and then 2 liters in the air enroute to
[**Hospital1 18**]. Pt received 1gm ceftriaxone, 500mg Zithromax at OSH.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: expired

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: 1 ppd smoker
occasional etoh
no drugs 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Severe sepsis,Cardiac arrest,Tobacco use disorder'}
