CHIEF COMPLAINT: Unresponsive, overdose

PRESENT ILLNESS: Patient is a 42year old female with history of depression,
anxiety, suicide attempts who was brought in by EMS
unresponsive, found to have toxocology screen positive for
benzodiazepines and amphetamines and intubated for airway
protection.

MEDICAL HISTORY: Suicide attepts
over 20 psych admissions
Depression
Axiety
Iron deficiency anemia
Cervical dysplasia
Anorexia
Dissociative disorder
Etoh abuse
Borderline Personality Disorder
ADHD
[**Doctor First Name 147**] HX:
chest tube
facial surgery at age 21 due to trauma from abuse

MEDICATION ON ADMISSION: Medications on Admission:
unclear, but per EMS on antabuse, valium and trazadone. no note
in chart.

ALLERGIES: Bactrim / Tegretol

PHYSICAL EXAM: Physical Exam:
Vitals: T: 97.5 BP: 126/88 P: 75 RR: 14 O2Sat: 100%
Gen: intunbated, sedated, follows commands
HEENT: Clear OP, MMM
NECK: Supple, No LAD, No JVD
CV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops
LUNGS: CTA, BS BL, No W/R/C
ABD: Soft, NT, ND. NL BS. No HSM
EXT: No edema. 2+ DP pulses BL
SKIN: No lesions, multiple healed scars on b/l wrists

FAMILY HISTORY: Family history: per PCP note from [**1-10**]
Not able to give much details of her family's hx as estranged
from most of them.
Mother: 65 yo
Father: d. in prison in his 60s
Siblings: 6 B 2 sisters - she talks to one of her sisters.

SOCIAL HISTORY: Social History: unable to obtain as is intubated
Per history: estranged from family as was abused growing up.
smoking history and hx of ETOH abuse. multiple psych admissions.
Poisoning by benzodiazepine-based tranquilizers,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Home accidents,Alcohol abuse, unspecified,Dysthymic disorder,Iron deficiency anemia, unspecified,Borderline personality disorder,Attention deficit disorder with hyperactivity,Posttraumatic stress disorder
Pois-benzodiazepine tran,Poison-psychotropic agt,Accident in home,Alcohol abuse-unspec,Dysthymic disorder,Iron defic anemia NOS,Borderline personality,Attn deficit w hyperact,Posttraumatic stress dis
Admission Date:  [**2124-6-19**]              Discharge Date:   [**2124-6-20**]

Date of Birth:  [**2081-10-20**]             Sex:   F

Service: MEDICINE

Allergies:
Bactrim / Tegretol

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Unresponsive, overdose

Major Surgical or Invasive Procedure:
intubation/extubation

History of Present Illness:
Patient is a 42year old female with history of depression,
anxiety, suicide attempts who was brought in by EMS
unresponsive, found to have toxocology screen positive for
benzodiazepines and amphetamines and intubated for airway
protection.

Per report, the patient's neighbor heard a crash, and to the
patients apartment to check up on her and found her flailing
around. EMS was called. She was brought to the [**Hospital1 18**] ED
unresponsive.

Her vitals on admission to the ED were T97.4, BP 104/64, RR 16,
O2 sat 98% NRB She was given narcan 0.4mg x2. She was not
responsive to pain, and had a minimal gag and was intubated. She
was initially given versed, did not tolerated CT scan, as she
was thrashing around, and then was given a dose of vecuronium.
After the CT scan she got ativan, and is now sent to the ICU on
a propofol drip.

On admission to the ICU, she was intubated and sedated, but
following commands


Past Medical History:
Suicide attepts
over 20 psych admissions
Depression
Axiety
Iron deficiency anemia
Cervical dysplasia
Anorexia
Dissociative disorder
Etoh abuse
Borderline Personality Disorder
ADHD
[**Doctor First Name 147**] HX:
chest tube
facial surgery at age 21 due to trauma from abuse


Social History:
Social History: unable to obtain as is intubated
Per history: estranged from family as was abused growing up.
smoking history and hx of ETOH abuse. multiple psych admissions.



Family History:
Family history: per PCP note from [**1-10**]
Not able to give much details of her family's hx as estranged
from most of them.
Mother: 65 yo
Father: d. in prison in his 60s
Siblings: 6 B 2 sisters - she talks to one of her sisters.


Physical Exam:
Physical Exam:
Vitals: T: 97.5 BP: 126/88 P: 75 RR: 14 O2Sat: 100%
Gen: intunbated, sedated, follows commands
HEENT: Clear OP, MMM
NECK: Supple, No LAD, No JVD
CV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops
LUNGS: CTA, BS BL, No W/R/C
ABD: Soft, NT, ND. NL BS. No HSM
EXT: No edema. 2+ DP pulses BL
SKIN: No lesions, multiple healed scars on b/l wrists


Pertinent Results:
[**2124-6-19**] 03:40PM   WBC-7.2 RBC-4.56 HGB-14.7 HCT-42.8 MCV-94
MCH-32.2* MCHC-34.3 RDW-13.8
[**2124-6-19**] 03:40PM   ASA-NEG ETHANOL-220* ACETMNPHN-NEG
bnzodzpn-POS barbitrt-NEG tricyclic-NEG
[**2124-6-19**] 03:52PM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-POS mthdone-NEG
.
[**2124-6-19**] CT C Spine: prelim: no acute fractures or dislocations
of the cervical spine
.
[**2124-6-19**] CT Head: prelim: no acute intracranial process.
.
[**2124-6-19**] CXR: no acute process
.
DISCHARGE LABS:
[**2124-6-20**] 06:09AM BLOOD WBC-10.8 RBC-4.82 Hgb-15.5 Hct-45.5
MCV-94 MCH-32.0 MCHC-34.0 RDW-13.7 Plt Ct-284
[**2124-6-20**] 06:09AM BLOOD Glucose-77 UreaN-3* Creat-0.6 Na-143
K-3.6 Cl-109* HCO3-26 AnGap-12
[**2124-6-19**] 03:40PM BLOOD ALT-23 AST-41* LD(LDH)-147 AlkPhos-42
Amylase-48 TotBili-0.2
[**2124-6-20**] 06:09AM BLOOD Calcium-8.5 Phos-3.3 Mg-2.3

Brief Hospital Course:
Patient is a 42 year old female with a history of anxiety,
posttraumatic stress disorder, abuse, anorexia, ETOH abuse
admitted unresponsive, intubated, with urine toxicology notable
for positive benzodiazepines, positive amphetamines, ETOH of
220. The patient was initially unresponsive and was intubated
for airway protection. Unresponsiveness was attributed to
multiple drugs on urine toxicology. As propofol sedation was
weaned and as medications cleared from her system, the patient
became more responsive. The patient was successfully extubated.
Trauma was ruled out as cause of the altered mental status as
per negative CT head, spine. There was concern that the drug
overdose was related to a suicide attempt and the patient was
Section 12'ed when she tried to leave AMA. Code purple was
called and security had to restrain the patient. Valium was
given as per CIWA scale and home dose medications given to
reduce withdrawals.  Patient refused most of her medications.
Psychiatry evaluated the patient who felt that she would benefit
from an inpatient psychiatric stay. With the resolution of the
patient's active medical issues, namely her altered mental
status, the patient was cleared for transfer to psychiatric
care.

The patient has been admitted to [**Hospital1 **] 4 at [**Hospital1 18**] for
further care.


Medications on Admission:
Medications on Admission:
unclear, but per EMS on antabuse, valium and trazadone. no note
in chart.


Discharge Medications:
1. Valium 10 mg Tablet Sig: 1-2 Tablets PO three times a day: 20
mg in am
10mg in afternoon
20mg qhs.
2. Haldol Decanoate 50 mg/mL Solution Sig: Five (5) mg
Intramuscular TID:PRN as needed for agitation.


Discharge Disposition:
Extended Care

Facility:
Deconesse 4

Discharge Diagnosis:
Drug overdose: benzodiazepines, amphetamines, EtOH

Discharge Condition:
stable

Discharge Instructions:
You were admitted due to a change in your mental status which
has resolved and was felt to be due to trouble taking your
medications. You have a need to be in an inpatient psychiatric
facility for further care at this time.

Please continue to see your psychiatist and go to the emergency
room if you have any suicidal or homicidal idealations.

You are strongly encouraged to speak with your psychiatrist
about additions and treatment counseling.

If you develop fevers, chills, nausea, vomiting, chest pain,
shortness of breath or any other concerning symptom please
notify your primary care provider or go to the emergency room.

Followup Instructions:
Please follow up with your PCP and outpatient psychiatrist
{'Poisoning by benzodiazepine-based tranquilizers,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Home accidents,Alcohol abuse, unspecified,Dysthymic disorder,Iron deficiency anemia, unspecified,Borderline personality disorder,Attention deficit disorder with hyperactivity,Posttraumatic stress 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: Unresponsive, overdose

PRESENT ILLNESS: Patient is a 42year old female with history of depression,
anxiety, suicide attempts who was brought in by EMS
unresponsive, found to have toxocology screen positive for
benzodiazepines and amphetamines and intubated for airway
protection.

MEDICAL HISTORY: Suicide attepts
over 20 psych admissions
Depression
Axiety
Iron deficiency anemia
Cervical dysplasia
Anorexia
Dissociative disorder
Etoh abuse
Borderline Personality Disorder
ADHD
[**Doctor First Name 147**] HX:
chest tube
facial surgery at age 21 due to trauma from abuse

MEDICATION ON ADMISSION: Medications on Admission:
unclear, but per EMS on antabuse, valium and trazadone. no note
in chart.

ALLERGIES: Bactrim / Tegretol

PHYSICAL EXAM: Physical Exam:
Vitals: T: 97.5 BP: 126/88 P: 75 RR: 14 O2Sat: 100%
Gen: intunbated, sedated, follows commands
HEENT: Clear OP, MMM
NECK: Supple, No LAD, No JVD
CV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops
LUNGS: CTA, BS BL, No W/R/C
ABD: Soft, NT, ND. NL BS. No HSM
EXT: No edema. 2+ DP pulses BL
SKIN: No lesions, multiple healed scars on b/l wrists

FAMILY HISTORY: Family history: per PCP note from [**1-10**]
Not able to give much details of her family's hx as estranged
from most of them.
Mother: 65 yo
Father: d. in prison in his 60s
Siblings: 6 B 2 sisters - she talks to one of her sisters.

SOCIAL HISTORY: Social History: unable to obtain as is intubated
Per history: estranged from family as was abused growing up.
smoking history and hx of ETOH abuse. multiple psych admissions. 

### Response:
{'Poisoning by benzodiazepine-based tranquilizers,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Home accidents,Alcohol abuse, unspecified,Dysthymic disorder,Iron deficiency anemia, unspecified,Borderline personality disorder,Attention deficit disorder with hyperactivity,Posttraumatic stress disorder'}
