CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 61807**] was readmitted to
our hospital - well known to our service - on [**7-9**]. He had
been discharged to rehab on [**7-7**] after being readmitted
post surgery for respiratory arrest. At rehab he was found to
be asystolic on [**7-8**], the day prior to admission here, and
was given epinephrine which resulted in ventricular
tachycardia and required many cardioversion shocks.

MEDICAL HISTORY: 1. Chronic atrial fibrillation.
2. Status post ascending aortic replacement.
3. Status post multiple dental extractions.
4. Chronic renal insufficiency.
5. History of bilateral lower extremity cellulitis.
6. Chronic anemia.
7. Dwarfism.
8. Paget disease.
9. History of myocardial infarction.

MEDICATION ON ADMISSION: A dopamine drip, a Neo-Synephrine
drip, a Levophed drip, a bicarbonate drip, and amiodarone.

ALLERGIES: He was allergic to BACTRIM.

PHYSICAL EXAM: 

FAMILY HISTORY: Unremarkable.

SOCIAL HISTORY: Mr. [**Known lastname 61807**] is retired and lives alone. He
denies any tobacco. Admits to very rare alcohol.
Unspecified septicemia,Acute kidney failure with lesion of tubular necrosis,Non-healing surgical wound,Atrial fibrillation,Pressure ulcer, buttock,Acidosis,Severe sepsis,Blood vessel replaced by other means,Attention to tracheostomy,Long-term (current) use of anticoagulants,Anemia of other chronic disease,Dwarfism, not elsewhere classified,Old myocardial infarction
Septicemia NOS,Ac kidny fail, tubr necr,Non-healing surgcl wound,Atrial fibrillation,Pressure ulcer, buttock,Acidosis,Severe sepsis,Blood vessel replac NEC,Atten to tracheostomy,Long-term use anticoagul,Anemia-other chronic dis,Dwarfism NEC,Old myocardial infarct
Admission Date: [**2195-7-9**]        Discharge Date: [**2195-7-14**]

Date of Birth:  [**2121-2-27**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 61807**] was readmitted to
our hospital - well known to our service - on [**7-9**]. He had
been discharged to rehab on [**7-7**] after being readmitted
post surgery for respiratory arrest. At rehab he was found to
be asystolic on [**7-8**], the day prior to admission here, and
was given epinephrine which resulted in ventricular
tachycardia and required many cardioversion shocks.

[**Last Name (STitle) 61808**]ransferred to [**Hospital3 **] Medical Center for
further care. On admission, he developed another episode of
asystole which became V-tach after administration of
epinephrine. He was found to be profoundly acidotic and
started on a bicarbonate drip. TEE at that time at [**Hospital3 **] showed a large partially organized posterior
pericardial thrombus. The patient was transferred to [**Hospital1 18**]
for evaluation and care by Dr. [**Last Name (Prefixes) **].

PAST MEDICAL HISTORY:
1. Chronic atrial fibrillation.
2. Status post ascending aortic replacement.
3. Status post multiple dental extractions.
4. Chronic renal insufficiency.
5. History of bilateral lower extremity cellulitis.
6. Chronic anemia.
7. Dwarfism.
8. Paget disease.
9. History of myocardial infarction.


ALLERGIES:  He was allergic to BACTRIM.

MEDICATIONS ON ADMISSION:  A dopamine drip, a Neo-Synephrine
drip, a Levophed drip, a bicarbonate drip, and amiodarone.

SOCIAL HISTORY:  Mr. [**Known lastname 61807**] is retired and lives alone. He
denies any tobacco. Admits to very rare alcohol.

FAMILY HISTORY:  Unremarkable.

HOSPITAL COURSE:  He was admitted to our cardiothoracic ICU.
He was awake but occasionally confused. His heart was regular
in rate and rhythm with a question of a sinus rhythm or
block. His pulse was in the 70s. Blood pressure of 70s to
80s/30s to 40s at the time of transfer. His chest had
bilateral breath sounds that were very coarse. His abdomen
had hypoactive bowel sounds and was softly distended. There
was a question of whether or not his abdomen was tender, and
he had gross anasarca on exam. His extremities were cool and
mottled. His sternal incision had an open area at mid
sternum, draining bloody fluid, without any erythema. Sternal
stability was not assessed at that time given the illness of
the patient.

Th[**Last Name (STitle) 1050**] was admitted to the cardiothoracic ICU for PA
Swan placement. An echocardiogram and a renal consult to Dr.
[**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] service. Review of systems was deferred at that
time.

On admission, he was seen that afternoon at 5:00 p.m. by the
renal service to evaluate him for acute tubular necrosis,
which is what they ultimately determined; that this was
probably due to a hyperperfusion injury given his multiple
arrests at rehab. At the time he was seen he was on an
amiodarone drip, a dopamine drip, a Levophed drip, and a Neo-
Synephrine drip. He was seen again also early the next
morning. They recommended beginning CVVHD to help combat his
developing hyperkalemia and acidosis that was continuing. The
renal service continued to see him daily. A Quinton catheter
was placed in his femoral vein given his poor upper extremity
access for his CVVHD.

On the 21st, after he arrived on the unit, he was following
commands and was attempting to mouth words but was moving
very weakly. He continued to be hypotensive on dopamine and
Levophed - on high doses - when he arrived. Neo-Synephrine
was added in and the amiodarone continued. He was stabilized,
and on house day 2 he was on an amiodarone drip at 0.5, a
dopamine drip at 10, a Levophed drip at 0.08, and a Neo-
Synephrine drip at 0.5. Labs were a white count of 10.2,
hematocrit of 35.2, platelet count of 40,000. PT of 19.9, PTT
of 38, with an INR of 2.5. Sodium of 125, K of 4.9, chloride
of 92, bicarbonate of 22, BUN of 43, creatinine of 2.2, with
a blood sugar of 103. His AST had been [**2189**] and dropped to
940 in the course of that first 24 hours. His blood pressure
on house day 2 was 103/56 on triple pressor support. His exam
remained relatively unchanged with 3+ pedal edema, and wet
coarse lung sounds. His heart was regular in rate and rhythm.
His sternal incision was relatively intact. Ventilatory
adjustments were made. A HIT screen was sent, but he remained
acutely ill with unknown etiology at that time. A PICC line
was discontinued by the venous access team, and the PICC
catheter tip was sent for culture. He continued to receive
CVVHD every day for volume management and stability of his
acid base balance to help with his potassium while his anemia
continued. Infectious disease was also consulted to see the
patient for possible sepsis given his requirement for
significant pressor support.

On house day 3 his dopamine drip was at 10 mcg/kg/min, a
Levophed drip at 0.03 mcg/kg/min, and a Neo-Synephrine drip
at 1.75 mcg/kg/min. His K was stable on house day 3 at 4.3
with a BUN of 33 and a creatinine of 1.8. Platelet count rose
to 76,000. His HIT screen was negative. A CT scan of his
chest was performed to look for a pulmonary embolism, and the
CT scan was negative. His INR rose slightly to 2.6. He had
inspiratory and expiratory wheezes with some serosanguineous
drainage from his sternum. His abdomen was soft, nontender,
and nondistended. The extremities were warm and pink but with
continuing 2+ bilateral edema. Right femoral Swan remained in
place. The left femoral Quinton catheter also in place. He
remained stable on his triple pressor support but with an
unknown septic source. The patient was pan-cultured and CVVHD
continued that day.

On house day 4 the patient remained in a sinus rhythm with a
blood pressure of 101/65 on dopamine at 6, Levophed at 0.07,
and Neo-Synephrine at 2.0. He continued to have coarse breath
sounds through his tracheostomy tube. He was given additional
platelets for a platelet count of 28,000; and he continued
with CVVHD. His creatinine dropped to 1.3.

On house day [**6-23**] - the patient remained on a
significant dopamine drip at 6.0 mcg/kg/min and a Neo-
Synephrine drip at 2.5 mcg/kg/min. His platelet count rose
slightly to 61,000 after transfusion of platelets the day
prior. His INR was 2.0. Creatinine remained stable at 1.1.
His K was managed by the CVVHD and was 4.1 in the morning. He
was comfortable on his tracheostomy tube. He did have a
systolic click on exam. His lungs were clear, and he
continued to have 2+ pitting edema in his extremities. NG
tube was in place, and he continued to CVVHD at 100 cc an
hour. Additional labs were a total bilirubin of 9.3, lactate
of 3.3, amylase of 16, AST of 36, ALT of 161, alkaline
phosphatase of 157.

He was seen again the following morning by the infectious
disease fellow. He was continued on vancomycin and Zosyn,
which had been started for coverage of suspected sepsis. He
was also seen by his attending cardiologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **],
on the 25th for examination. It was still unclear at that
time what the etiology of his arrest at the outside
institution was. Dr. [**Last Name (STitle) **] suspected some secretions. The
patient did have asystole at the time of his exam. Also, his
cardiac index was 2.2 on significant doses of dopamine and
Neo-Synephrine drip. At the time of his exam there did not
seem to be any clear evidence of infection, but he continued
to have decreased SVR probably secondary to his
hyperperfusion. The decision was made to hold on a cath on
him or a pacemaker for now. Please refer to Dr.[**Name (NI) 5452**] note on
the 25th.

On house day [**6-24**] - the patient remained on a dopamine
drip at 10 mcg/kg/min, a heparin drip at 200 units an hour, a
Neo-Synephrine drip at 0.4. They were unable to wean his
dopamine which resulted in significant hypotension. His blood
pressure at the time was 83/47 in the morning, with a
respiratory rate of 41, a cardiac index of 2.4, SPO2 of 100.
Platelet count was pending in the morning. White count was
normal at 6.9, K of 4.3, INR of 2.1. Lactate continued to
rise slightly to 3.7. He had mild bilateral rhonchi. He was
alert and oriented. He had hypoactive bowel sounds with 2+
bilateral pitting edema. His Foley remained in place with
CVVHD catheter. Levophed was restarted for hemodynamic
lability, and tube feeds were to be started trophically. He
was also seen by the renal fellow at 9:30 in the morning for
continued evaluation of his CVVHD and was seen again by Dr.
[**Last Name (STitle) **] on the 26th who noted his triple pressor support and
continuing instability with PA pressures of 55/23. His pH was
7.30 at the time, and at 1:00 o'clock vasopressin drip was
started at 0.04. The patient remained on a dopamine drip at
10 mcg/kg/min, a Levophed drip at 0.18 mcg/kg/min, a Neo-
Synephrine drip at 4.0 mcg/kg/min.

The patient went asystolic at 2:20 p.m. on the 26th. He
brady'd down first and then went asystolic. Full ACLS code
was instituted. The Swan-Ganz catheter in his groin was
replaced with a pacing Swan. The patient went periodically
into electromechanical dissociation. Several rounds of ACLS
protocol drugs were administered. The patient received
multiple shocks when he moved from asystole into ventricular
fibrillation, and the patient underwent approximately 45
minutes of CPR to his chest with ventilation and ACLS
protocol and was pronounced by Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **]. At 2:43
p.m. the patient expired.

DISCHARGE SUMMARY:
1. Status post ascending aortic replacement.
2. Status post multiple dental extractions.
3. Status post multiple cardiac arrests with respiratory
   failure.
4. Chronic renal insufficiency.
5. History of bilateral lower extremity cellulitis.
6. Chronic anemia.
7. Dwarfism.
8. Paget disease.
9. History of myocardial infarction.
10.      Acute tubular necrosis.


TI[**Last Name (STitle) **]DEATH:  The patient was pronounced by Dr. [**Last Name (Prefixes) **]
at 2:43 p.m. and expired in the CSRU.



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2195-7-14**] 15:51:40
T:  [**2195-7-14**] 17:05:20
Job#:  [**Job Number 61809**]
{'Unspecified septicemia,Acute kidney failure with lesion of tubular necrosis,Non-healing surgical wound,Atrial fibrillation,Pressure ulcer, buttock,Acidosis,Severe sepsis,Blood vessel replaced by other means,Attention to tracheostomy,Long-term (current) use of anticoagulants,Anemia of other chronic disease,Dwarfism, not elsewhere classified,Old myocardial infarction'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname 61807**] was readmitted to
our hospital - well known to our service - on [**7-9**]. He had
been discharged to rehab on [**7-7**] after being readmitted
post surgery for respiratory arrest. At rehab he was found to
be asystolic on [**7-8**], the day prior to admission here, and
was given epinephrine which resulted in ventricular
tachycardia and required many cardioversion shocks.

MEDICAL HISTORY: 1. Chronic atrial fibrillation.
2. Status post ascending aortic replacement.
3. Status post multiple dental extractions.
4. Chronic renal insufficiency.
5. History of bilateral lower extremity cellulitis.
6. Chronic anemia.
7. Dwarfism.
8. Paget disease.
9. History of myocardial infarction.

MEDICATION ON ADMISSION: A dopamine drip, a Neo-Synephrine
drip, a Levophed drip, a bicarbonate drip, and amiodarone.

ALLERGIES: He was allergic to BACTRIM.

PHYSICAL EXAM: 

FAMILY HISTORY: Unremarkable.

SOCIAL HISTORY: Mr. [**Known lastname 61807**] is retired and lives alone. He
denies any tobacco. Admits to very rare alcohol. 

### Response:
{'Unspecified septicemia,Acute kidney failure with lesion of tubular necrosis,Non-healing surgical wound,Atrial fibrillation,Pressure ulcer, buttock,Acidosis,Severe sepsis,Blood vessel replaced by other means,Attention to tracheostomy,Long-term (current) use of anticoagulants,Anemia of other chronic disease,Dwarfism, not elsewhere classified,Old myocardial infarction'}
