CHIEF COMPLAINT: Nausea and vomiting.

PRESENT ILLNESS: This is a 77-year-old female
status post a laparoscopic-assisted colectomy for a suspected
colon cancer on [**2184-10-4**].  Patient was discharged home,
tolerating full liquids, and having bowel movements and
passing flatus on [**2184-10-4**] states that she became nauseous
and was no longer able to tolerate liquids or solids.
Throughout the evening the patient continued to have nausea
and had two episodes of nonbloody, nonbilious vomiting.  The
patient  states she is still passing flatus and bowel
movement.  The patient is complaining of a slight increase in
periumbilical pain.  Patient denies any lightheadedness,
fever, headache, chest pain, shortness of breath.

MEDICAL HISTORY: 1.  Laparoscopic hand-assisted colectomy.
2.  Breast cancer.
3.  Left mastectomy.
4.  Aortic sclerosis.
5.  DDI pacemaker.
6.  Hypertension.
7.  Nonsustained ventricular tachycardia.
8.  Sick sinus syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Unspecified septicemia,Septic shock,Pneumonia, organism unspecified,Cardiac arrest,Atresia and stenosis of aorta
Septicemia NOS,Septic shock,Pneumonia, organism NOS,Cardiac arrest,Aortic atresia/stenosis
Admission Date:  [**2184-10-13**]     Discharge Date:  [**2184-10-14**]

Date of Birth:   [**2107-10-29**]     Sex:  F

Service:  GOLD [**Doctor First Name 147**]

CHIEF COMPLAINT:  Nausea and vomiting.

HISTORY OF PRESENT ILLNESS:  This is a 77-year-old female
status post a laparoscopic-assisted colectomy for a suspected
colon cancer on [**2184-10-4**].  Patient was discharged home,
tolerating full liquids, and having bowel movements and
passing flatus on [**2184-10-4**] states that she became nauseous
and was no longer able to tolerate liquids or solids.
Throughout the evening the patient continued to have nausea
and had two episodes of nonbloody, nonbilious vomiting.  The
patient  states she is still passing flatus and bowel
movement.  The patient is complaining of a slight increase in
periumbilical pain.  Patient denies any lightheadedness,
fever, headache, chest pain, shortness of breath.

PAST MEDICAL HISTORY:
1.  Laparoscopic hand-assisted colectomy.
2.  Breast cancer.
3.  Left mastectomy.
4.  Aortic sclerosis.
5.  DDI pacemaker.
6.  Hypertension.
7.  Nonsustained ventricular tachycardia.
8.  Sick sinus syndrome.

MEDICATIONS AT HOME:
1.  Atenolol 75 mg, one tablet per day.
2.  Metoclopramide 10 mg p.o. four times per day.
3.  Famotidine 20 mg p.o. b.i.d.
4.  Atorvastatin 10 mg p.o. q.d.
5.  Dyazide one capsule Monday, Wednesday, Friday.
6.  Percocet one to two tablets p.o. q. 4 to 6 hours p.r.n.
pain.

PHYSICAL EXAMINATION:  The patient was afebrile when seen in
the Emergency Department.  Blood pressure:  142/63, heart
rate 84, respiratory rate 25, 94% on room air.  Generally,
she appeared lethargic yet arousable in slight amount of
distress.  Cardiovascular showed regular rate and rhythm.  On
exam, positive bibasilar crackles.  Abdominal exam:  Mildly
distended.  No drainage was noted at the incision site;
slightly erythematous at the incision; tenderness to
palpation.  Rectal exam:  Positive loose stool, guaiac
negative.

LABORATORY DATA ON ADMISSION:  White count 17.2, hematocrit
47.6, platelets 254, bands 20.  Chemistry:  Sodium 135,
potassium 3.6, chloride 95, bicarbonate 19, BUN 18,
creatinine 0.6, calcium 9.7, magnesium  1.8, phosphorous 4.9,
PT 13.9, PTT 23.2, INR 1.3.

Chest x-ray in the Emergency Department, full:  Demonstrated
a patchy consolidation obscuring the right hemidiaphragm as
well as the right heart border.  This was determined to be
consistent with pneumonia involving the right lower lobe and
possibly the right middle lobe.

CT exam in the Emergency Department, full:  Impressions:
1.  Small bowel obstruction with transition point at the mid
ileum.  Focus of free air is also seen.
2.  Dilated esophagus.
3.  No evidence of pulmonary embolism.
4.  Aspiration of oral contrast.

HOSPITAL COURSE:  The patient was admitted to the Surgical
Intensive Care Unit. She appeared to be dehydrated and
hypoxic.  The patient was placed on central monitors,
hydrated.  Patient was also placed on NPO, intravenous
fluids, and nasogastric tube to suction.  The patient had a
PA catheter introduced.  After this point the patient
developed pulseless rhythm at 02:00 in the morning.  Advanced
cardiac life support protocol was initiated and a code was
called.  Patient was given 3 mg of epinephrine, two units of
bicarbonate, and 1 mg of Atropine.  Pulse was regained with a
pressure at 02:30.  After the pulse was established a left
femoral A-line was placed and the labs were sent.

Dr. [**Last Name (STitle) **] was informed about the status of his patient
at this time.  The Intensive Care Unit attending was present
during the entire procedure.

Laboratory data upon return:  The patient was intubated with
a tidal volume of 500, 14 breaths per minute and with a PEEP
of 12, assist control at 100%.  Her white count was 8.7,
hematocrit 48, platelets 252.  Chemistry 138, potassium 4.3,
chloride 107, bicarbonate 12, BUN 24, creatinine 1.1, glucose
138.  Post code ABG was sent.  pH 7.37, CO2 38, O2 173, HC03
23, base deficit of -2, lactate 16.3.

A chest x-ray was done post code which demonstrated no
pneumothorax and a right side infiltrate.

The patient was continually aggressively resuscitated and
supported with pressors.  Patient was placed on a
phenylephrine drip titrated to a mean arterial pressure of
greater than 60.

The patient was seen emergently by Cardiology.  The patient's
EKG demonstrated the patient had narrow complex tachycardia
with normal axis of rate of 180.  Patient was cardioverted,
was still in sinus tachycardia, rate of approximately 135,
still with a normal axis.  It was deemed that the patient was
septic, questionable multi-lobar pneumonia status post a
cardiac arrest.  The etiology of the arrest is most likely
sepsis and unlikely a pacemaker malfunction.

The patient was evaluated by Electrophysiology Department.  A
pacemaker interrogation was done.  This demonstrated the
patient was in supraventricular tachycardia in the setting of
septic shock, and there were no issues with the pacemaker.
The patient continued to do poorly cardiovascularly despite
the increasing of her Levophed.  Her O2 saturations steadily
decreased.  Her pupils were fixed and dilated.

After speaking with the family members and her health care
proxy, the patient was placed on comfort measures only.  The
patient expired on [**2184-10-14**] at 18:30.  Probable cause of
death was sepsis due to pneumonia.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 11126**]

Dictated By:[**Name8 (MD) 846**]

MEDQUIST36

D:  [**2184-10-29**]  12:12
T:  [**2184-10-30**]  11:25
JOB#:  [**Job Number 108137**]
{'Unspecified septicemia,Septic shock,Pneumonia, organism unspecified,Cardiac arrest,Atresia and stenosis of aorta'}


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: Nausea and vomiting.

PRESENT ILLNESS: This is a 77-year-old female
status post a laparoscopic-assisted colectomy for a suspected
colon cancer on [**2184-10-4**].  Patient was discharged home,
tolerating full liquids, and having bowel movements and
passing flatus on [**2184-10-4**] states that she became nauseous
and was no longer able to tolerate liquids or solids.
Throughout the evening the patient continued to have nausea
and had two episodes of nonbloody, nonbilious vomiting.  The
patient  states she is still passing flatus and bowel
movement.  The patient is complaining of a slight increase in
periumbilical pain.  Patient denies any lightheadedness,
fever, headache, chest pain, shortness of breath.

MEDICAL HISTORY: 1.  Laparoscopic hand-assisted colectomy.
2.  Breast cancer.
3.  Left mastectomy.
4.  Aortic sclerosis.
5.  DDI pacemaker.
6.  Hypertension.
7.  Nonsustained ventricular tachycardia.
8.  Sick sinus syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Unspecified septicemia,Septic shock,Pneumonia, organism unspecified,Cardiac arrest,Atresia and stenosis of aorta'}
