CHIEF COMPLAINT: Patient was found down.

PRESENT ILLNESS: 49 yo M with a history of EtOH abuse and DT's, significant
tobacco history and prescription drug abuse with odd behavior
and ?respiratory suppression found unresponsive at home with
cardiac arrest.
.
The patient's mother and sister report that the patient has a
long history of substance abuse. He has a history of significant
EtOH abuse with DT's and more recently prescription drug abuse
including benzodiazepines. The patient has been acting odd by
family report since [**2111-7-22**]. There is high concern for
substance abuse. The patient was not known to be suicidal. On
the morning of admission, the patient was seen by his mother at
his home and was noted to be "in a haze" acting as if "in a
stupor." Later in the day the patient's mother found him asleep
in bed and over many minutes was noted to have poor breathing.
EMS was called and the he was thought to be in asystole vs. VF
and received epinephrine and atropine x3 followed by
cardioversion with return to sinus rhythm. The patient was
intubated and sedated in the field and brought to [**Hospital **]
Hospital prior to transfer to [**Hospital1 18**] [**Location (un) 86**]. There was concern
for intentional overdose as a cause of his arrest however tox
screen was notable only for EtOH level in the 200's at the OSH.
In the ED the patient was initiated on a cooling protocol. CXR
revealed left-sided retrocardiac opacity concerning for
aspiration and in light of leukocytosis, the patient was started
on levofloxacin and metronidazole for antibiotic coverage.
.
Review of Systems: Negative in detail including no CP, SOB, DOE,
edema, orthopnea, N/V or diaphoresis.

MEDICAL HISTORY: Alcoholic with history of DT's
2ppd smoking history x decades
Prescription drug abuse
Paranoia with history of elopement from hospitals

MEDICATION ON ADMISSION: Xanax
Percocet
Lomotil

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAMINATION:
VS 98.4-99.9 65-89 125-138/88-107 AC Vt 550 RR 16 PEEP 5 100%
Gen: Intubated and sedated.
HEENT: PERRL.
CV: RRR. Normal S1 and S2. No M/R/G.
Pulm: Roncorous upper airway sounds.
Abd: Soft, nontender.
Ext: No edema.
Neuro: Sedated.
Integumentary: No rashes or lesions.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Engaged, lived alone. Unemployed orderly in hospitals.
Significant EtOH and tobacco use. No illicit drug use but
thought to abuse prescription drugs.
Methicillin susceptible pneumonia due to Staphylococcus aureus,Ventricular fibrillation,Other and unspecified alcohol dependence, continuous,Other, mixed, or unspecified drug abuse, unspecified,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other chronic sinusitis,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hypopotassemia,Alcohol withdrawal,Anoxic brain damage
Meth sus pneum d/t Staph,Ventricular fibrillation,Alcoh dep NEC/NOS-contin,Drug abuse NEC-unspec,Gstr/ddnts NOS w/o hmrhg,Chronic sinusitis NEC,Acute respiratry failure,Food/vomit pneumonitis,Hypopotassemia,Alcohol withdrawal,Anoxic brain damage
Admission Date:  [**2112-1-29**]              Discharge Date:   [**2112-2-10**]

Date of Birth:  [**2062-3-31**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 458**]
Chief Complaint:
Patient was found down.

Major Surgical or Invasive Procedure:
.

History of Present Illness:
49 yo M with a history of EtOH abuse and DT's, significant
tobacco history and prescription drug abuse with odd behavior
and ?respiratory suppression found unresponsive at home with
cardiac arrest.
.
The patient's mother and sister report that the patient has a
long history of substance abuse. He has a history of significant
EtOH abuse with DT's and more recently prescription drug abuse
including benzodiazepines. The patient has been acting odd by
family report since [**2111-7-22**]. There is high concern for
substance abuse. The patient was not known to be suicidal. On
the morning of admission, the patient was seen by his mother at
his home and was noted to be "in a haze" acting as if "in a
stupor." Later in the day the patient's mother found him asleep
in bed and over many minutes was noted to have poor breathing.
EMS was called and the he was thought to be in asystole vs. VF
and received epinephrine and atropine x3 followed by
cardioversion with return to sinus rhythm. The patient was
intubated and sedated in the field and brought to [**Hospital **]
Hospital prior to transfer to [**Hospital1 18**] [**Location (un) 86**]. There was concern
for intentional overdose as a cause of his arrest however tox
screen was notable only for EtOH level in the 200's at the OSH.
In the ED the patient was initiated on a cooling protocol. CXR
revealed left-sided retrocardiac opacity concerning for
aspiration and in light of leukocytosis, the patient was started
on levofloxacin and metronidazole for antibiotic coverage.
.
Review of Systems: Negative in detail including no CP, SOB, DOE,
edema, orthopnea, N/V or diaphoresis.


Past Medical History:
Alcoholic with history of DT's
2ppd smoking history x decades
Prescription drug abuse
Paranoia with history of elopement from hospitals


Social History:
Engaged, lived alone. Unemployed orderly in hospitals.
Significant EtOH and tobacco use. No illicit drug use but
thought to abuse prescription drugs.


Family History:
Non-contributory

Physical Exam:
ADMISSION PHYSICAL EXAMINATION:
VS 98.4-99.9 65-89 125-138/88-107 AC Vt 550 RR 16 PEEP 5 100%
Gen: Intubated and sedated.
HEENT: PERRL.
CV: RRR. Normal S1 and S2. No M/R/G.
Pulm: Roncorous upper airway sounds.
Abd: Soft, nontender.
Ext: No edema.
Neuro: Sedated.
Integumentary: No rashes or lesions.

Pertinent Results:
ADMISSION LABS:
[**2112-1-29**] 09:38PM BLOOD WBC-17.5* RBC-4.15* Hgb-13.6* Hct-38.3*
MCV-92 MCH-32.7* MCHC-35.5* RDW-13.8 Plt Ct-189
[**2112-1-29**] 09:38PM BLOOD Neuts-86.4* Lymphs-9.1* Monos-4.0 Eos-0.2
Baso-0.2
[**2112-1-29**] 09:38PM BLOOD Plt Ct-189
[**2112-1-29**] 09:38PM BLOOD Glucose-94 UreaN-10 Creat-0.8 Na-143
K-3.6 Cl-106 HCO3-25 AnGap-16
[**2112-1-29**] 09:38PM BLOOD CK(CPK)-449*
[**2112-1-29**] 09:38PM BLOOD Cholest-104
[**2112-1-30**] 04:06AM BLOOD TSH-0.31
[**2112-1-31**] 05:56PM BLOOD Ammonia-17
[**2112-1-29**] 09:38PM BLOOD HDL-22 CHOL/HD-4.7 LDLmeas-57
[**2112-1-29**] 09:52PM BLOOD Type-[**Last Name (un) **] pO2-54* pCO2-52* pH-7.29*
calTCO2-26 Base XS--1
[**2112-1-29**] 09:52PM BLOOD Glucose-90 Lactate-2.8* Na-144 K-3.7
Cl-103
[**2112-1-29**] 09:52PM BLOOD freeCa-1.05*
[**2112-1-30**] 06:39AM BLOOD O2 Sat-99

CARDIAC ENZYMES:
[**2112-1-29**] 09:38PM BLOOD CK-MB-21* MB Indx-4.7
[**2112-1-29**] 09:38PM BLOOD cTropnT-1.02*
[**2112-1-30**] 04:06AM BLOOD CK-MB-27* MB Indx-5.2 cTropnT-0.49*

EKG ([**2112-1-29**]): Sinus rhythm at a rate of 68. Normal axis.
Normal intervals. Downgoing T's in III and aVF. No acute ST or T
wave changes. No prior for comparison.

Rhythm strip from [**Hospital **] Hospital ([**2112-1-29**] 16:24): Atrial
tachycardia at 150.

CT head/C-spine ([**2112-1-29**]): No intracranial process, no C-spine
fracture. Fluid within the nasal cavity and some layering within
the sinuses.

CXR ([**2112-1-29**]): Retrocardiac opacities on the left representing
either aspiration, atelectasis, or pneumonia.

[**2112-11-30**] EEG:
Abnormal portable EEG due to the widespread monotonous
alpha background. This suggests medication effect as the most
common
cause of such records. There were no areas of prominent focal
slowing,
and there were no epileptiform features.

[**2112-12-5**] EEG
This is an abnormal portable EEG due to the low voltage,
disorganized and poorly modulated background, consisting mainly
of a
faster beta frequency rhythm, likely reflecting medication
effects from
benzodiazepine or barbiturate administration. Findings are
consistent
with a moderate encephalopathy, suggestive of dysfunction of
bilateral
subcortical or deep midline structures. Medications, metabolic
disturbances, infection, and anoxia are among the common causes
of
encephalopathy. There were no areas of prominent focal slowing.
Several episodes of lower extremity tremulousness were noted by
the EEG
technician; no associated epileptiform features were noted. No
electrographic seizure activity was noted.

[**2112-2-6**] MRI Brain:
1.  Low ADC is identified in the white matter of
parietooccipital lobes and temporal lobes, suspicious for a
hypoxic injury.
2.  The exact nature of the increased signal identified in the
basal ganglia on ADC map and FLAIR is unclear but could be also
due to hypoxic injury.
3.  Enhancement along the sulci and also in the basal ganglia
region could be secondary to meningitis or meningeal
inflammation from other causes.  Clinical correlation is
recommended.
4.  Extensive paranasal sinus changes as described above.

[**2112-2-6**] LUMBAR PUNCTURE:
[**2112-2-6**] 05:47PM CEREBROSPINAL FLUID (CSF) WBC-4 RBC-2* Polys-2
Lymphs-83 Monos-15
[**2112-2-6**] 05:47PM CEREBROSPINAL FLUID (CSF) TotProt-34 Glucose-71
LD(LDH)-271
Opening pressure 40
Cryptococcal antigen: negative
Culture:

[**2112-2-8**] CTA Chest:

[**2112-2-8**] CXR:
IMPRESSION: Persistent bilateral basal atelectasis with almost
complete collapse of the left lower lobe.

==============
MICROBIOLOGY:
==============
[**2112-2-5**] 9:09pm  SPUTUM     Site: ENDOTRACHEAL

   GRAM STAIN (Final [**2112-2-6**]):
      >25 PMNs and <10 epithelial cells/100X field.
      1+    (<1 per 1000X FIELD):   GRAM NEGATIVE ROD(S).
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE COCCI IN
PAIRS.
      1+    (<1 per 1000X FIELD):   BUDDING YEAST WITH
PSEUDOHYPHAE.

   RESPIRATORY CULTURE (Preliminary):
      RARE GROWTH OROPHARYNGEAL FLORA, YEAST. SPARSE GROWTH.
      STAPH AUREUS COAG +. SPARSE GROWTH.


Brief Hospital Course:
CARDIAC ARREST:
Mr. [**Known lastname 14887**] is a 49 yo M with a history of EtOH and prescription
drug abuse, who was found unresponsive at home by his mother.
EMS was called and thought Mr. [**Known lastname 14887**] was in VF asystole vs. VF
and received epinephrine and atropine x3 followed by
cardioversion with return to sinus rhythm. The patient was
intubated and sedated in the field and brought to [**Hospital **]
Hospital prior to transfer to [**Hospital1 18**]. There was concern for
intentional overdose as a cause of his arrest; however, tox
screen was notable only for EtOH level in the 200's at the OSH.
TSH was normal.  CXR revealed left-sided retrocardiac opacity
concerning for aspiration and in light of leukocytosis, the
patient was started on levofloxacin and metronidazole for
antibiotic coverage.  It is likely that hypoxia, possibly from
the aspiration, led to a cardiac arrest.  He was also found to
be hypokalemic on admission, which may have also contributed to
cardiac arrest.

ANOXIC BRAIN INJURY:
In the ED the patient was initiated on a cooling protocol.
Neurology was consulted to advise on prognosis, but his acute
febrile illness made it difficult to prognosticate long-term
function from the cardiac arrest. He remained intubated and
sedated on propofol from admission to [**2112-12-7**], at which point
his sedation was changed to fentanyl/versed.

EEG on [**2112-1-31**] revealed widespread monotomous slowing with no
areas of prominent focal slowing; there were also no
epileptiform features.  Repeat EEG was later performed on
[**2112-2-5**] because of concern that the patient may have been in
status epilepticus after he was noted to have rhythmic shaking
movements from his toes to his face.  It did not show epileptic
activity and was unchanged from the prior EEG. Ultimately, it
was felt that his movements were tremors, possibly the result of
his brain stem injury.

Mr. [**Known lastname 14887**] made no progress neurologically and remained
ventillator dependent.  In light of this, and his peristent
fevers and leikocytosis (see below) he was made CMO on [**2112-2-9**]
and extubated on [**2112-2-10**].  He expired on [**2112-2-11**].

PNEUMONIA and RESPIRATORY FAILURE
Sputum cultures from early in the admission grew out MSSA, and
he was treated with several rounds of broad spectrum
antibiotics.  Patient continued to require ventilator support,
so he was made CMO on [**2112-2-9**] and extubated on [**2112-2-10**]

PERSISTENT FEVERS AND LEUKOCYTOSIS:
Mr. [**Known lastname 14887**] had positive sputum cultures from his MSSA pneumonia.
He also had blood cultures showing GPCs in pairs and clusters.
His high fevers and elevated WBC persisted despite several
rounds of antibiotics. He had an LP on [**2112-2-6**], with an opening
pressure of 40 but otherwise normal. His abdomen was also noted
to be tense, and he developed diarrhea, but tested negative for
C.diff twice and had a C.diff toxin B pending. He likely had a
central component to his persistent fevers. He had no evidence
of a drug reaction, and never developed any rash or
eosinophilia.

ETOH WITHDRAWAL
The patient was monitored for EtOH withdrawal when intubated,
but he had no signs of withdrawal and required no
benzodiazepines for treatment.  He was given thiamine, folate
and a banana bag.


Medications on Admission:
Xanax
Percocet
Lomotil

Discharge Medications:
Expired.

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired.

Discharge Condition:
Expired.

Discharge Instructions:
Expired.

Followup Instructions:
Expired.
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Ventricular fibrillation,Other and unspecified alcohol dependence, continuous,Other, mixed, or unspecified drug abuse, unspecified,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other chronic sinusitis,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hypopotassemia,Alcohol withdrawal,Anoxic brain damage'}


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: Patient was found down.

PRESENT ILLNESS: 49 yo M with a history of EtOH abuse and DT's, significant
tobacco history and prescription drug abuse with odd behavior
and ?respiratory suppression found unresponsive at home with
cardiac arrest.
.
The patient's mother and sister report that the patient has a
long history of substance abuse. He has a history of significant
EtOH abuse with DT's and more recently prescription drug abuse
including benzodiazepines. The patient has been acting odd by
family report since [**2111-7-22**]. There is high concern for
substance abuse. The patient was not known to be suicidal. On
the morning of admission, the patient was seen by his mother at
his home and was noted to be "in a haze" acting as if "in a
stupor." Later in the day the patient's mother found him asleep
in bed and over many minutes was noted to have poor breathing.
EMS was called and the he was thought to be in asystole vs. VF
and received epinephrine and atropine x3 followed by
cardioversion with return to sinus rhythm. The patient was
intubated and sedated in the field and brought to [**Hospital **]
Hospital prior to transfer to [**Hospital1 18**] [**Location (un) 86**]. There was concern
for intentional overdose as a cause of his arrest however tox
screen was notable only for EtOH level in the 200's at the OSH.
In the ED the patient was initiated on a cooling protocol. CXR
revealed left-sided retrocardiac opacity concerning for
aspiration and in light of leukocytosis, the patient was started
on levofloxacin and metronidazole for antibiotic coverage.
.
Review of Systems: Negative in detail including no CP, SOB, DOE,
edema, orthopnea, N/V or diaphoresis.

MEDICAL HISTORY: Alcoholic with history of DT's
2ppd smoking history x decades
Prescription drug abuse
Paranoia with history of elopement from hospitals

MEDICATION ON ADMISSION: Xanax
Percocet
Lomotil

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAMINATION:
VS 98.4-99.9 65-89 125-138/88-107 AC Vt 550 RR 16 PEEP 5 100%
Gen: Intubated and sedated.
HEENT: PERRL.
CV: RRR. Normal S1 and S2. No M/R/G.
Pulm: Roncorous upper airway sounds.
Abd: Soft, nontender.
Ext: No edema.
Neuro: Sedated.
Integumentary: No rashes or lesions.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Engaged, lived alone. Unemployed orderly in hospitals.
Significant EtOH and tobacco use. No illicit drug use but
thought to abuse prescription drugs. 

### Response:
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Ventricular fibrillation,Other and unspecified alcohol dependence, continuous,Other, mixed, or unspecified drug abuse, unspecified,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other chronic sinusitis,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hypopotassemia,Alcohol withdrawal,Anoxic brain damage'}
