CHIEF COMPLAINT: mental status changes, PE/DVT, RP bleed

PRESENT ILLNESS: 75yoW with h/o COPD, Alzheimer's dementia, diagnosed with DVT/PE
at Caritas [**Hospital6 5016**] and transferred to [**Hospital1 18**] ED with
RP bleed and hypotension.
.
The patient was initially transferred from her nursing home to
[**Hospital6 5016**] on [**2195-11-30**] with low grade fever, failure to
thrive, and altered mental status after staff found her
unresponsive for 40sec at breakfast.  She had been discharged
from that hospitalization the week prior after admission for
urosepsis with hypotension, UTI, and dehydration.  On admission
she was diagnosed with RLE DVT by U/S and bilateral PE by CT
angiogram.  Heparin gtt was started, and she was sent for IVC
filter placement.  Post-procedure she became hypotensive.  She
was intubated and transfused 5units PRBC and 4units FFP after
Hct noted to be 20.  Heparin gtt was discontinued.  Abdominal CT
revealed a large left retroperitoneal hematoma.  Prior to
transfer blood was also noted in the G-tube.  She was
transferred to [**Hospital1 18**] on peripheral dopamine for continued BP
support.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease
2.  Right tonsillar laryngeal carcinoma, status post XRT and
status
    post resection in [**2186**].
3.  Depression.
4.  Arthritis
5.  S/p cholecystectomy
6.  Hypothyroidism
7.  Hyperglycemia
8.  Right upper lobe lung mass with negative biopsy in
    [**2188-10-15**]
9.  Alzheimer's dementia
10. osteoporosis
11. Peripheral vascular disease
12. Hypertension
13. prior stroke

MEDICATION ON ADMISSION: Meds on Admission to OSH:
Depakote sprinkles 125mg 3caps [**Hospital1 **]
Folate 1mg daily
Plavix 75mg daily
Lasix 20mg daily
Cetrocal +D 1tab [**Hospital1 **]
Aclonel 35mg QThurs
Lipitor 10mg daily
Atenolol 50mg daily
ASA 325mg daily
KCl 30mEq daily
.
Meds on Transfer:
Folate 1mg daily
Depakote 125mg 3tabs [**Hospital1 **]
Zocor 20mg daily
Nexium 40mg iv daily

ALLERGIES: Clonidine

PHYSICAL EXAM: T 100.4  HR 84  BP 139/89  RR 21
AC  FiO2 50%  PEEP 5.0  Tv 500 RR 20
GEN:  somnolent, withdraws to pain
HEENT:  PERRL, anicteric, MMM, ETT
Neck:  supple, no LAD, JVP nondistended
CV:  distant heart sounds, regular, no mrg
Resp:  coarse B anteriorly R>L, no crackles
Abd:  +BS, ttp, no guarding, ND, no masses
Ext:  left groin echymoses, BLE edema R>L
Neuro:  withdraws to pain, at baseline oriented x1

FAMILY HISTORY: not elicited

SOCIAL HISTORY: lives in nursing home.  has 3 sons
[**Name (NI) **]:  h/o 70pack yrs, quit [**2186**]
EtOH: none
Other pulmonary embolism and infarction,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Chronic airway obstruction, not elsewhere classified,Dehydration,Acute kidney failure, unspecified,Acute respiratory failure,Subendocardial infarction, initial episode of care,Acute and subacute necrosis of liver,Hemorrhage complicating a procedure,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Osteoporosis, unspecified
Pulm embol/infarct NEC,Ac DVT/emb distl low ext,Chr airway obstruct NEC,Dehydration,Acute kidney failure NOS,Acute respiratry failure,Subendo infarct, initial,Acute necrosis of liver,Hemorrhage complic proc,Alzheimer's disease,Dementia w/o behav dist,Depressive disorder NEC,Hypothyroidism NOS,Hypertension NOS,Osteoporosis NOS
Admission Date:  [**2195-12-2**]              Discharge Date:   [**2195-12-5**]

Date of Birth:  [**2121-4-27**]             Sex:   F

Service: MEDICINE

Allergies:
Clonidine

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
mental status changes, PE/DVT, RP bleed

Major Surgical or Invasive Procedure:
placement of left subclavian

History of Present Illness:
75yoW with h/o COPD, Alzheimer's dementia, diagnosed with DVT/PE
at Caritas [**Hospital6 5016**] and transferred to [**Hospital1 18**] ED with
RP bleed and hypotension.
.
The patient was initially transferred from her nursing home to
[**Hospital6 5016**] on [**2195-11-30**] with low grade fever, failure to
thrive, and altered mental status after staff found her
unresponsive for 40sec at breakfast.  She had been discharged
from that hospitalization the week prior after admission for
urosepsis with hypotension, UTI, and dehydration.  On admission
she was diagnosed with RLE DVT by U/S and bilateral PE by CT
angiogram.  Heparin gtt was started, and she was sent for IVC
filter placement.  Post-procedure she became hypotensive.  She
was intubated and transfused 5units PRBC and 4units FFP after
Hct noted to be 20.  Heparin gtt was discontinued.  Abdominal CT
revealed a large left retroperitoneal hematoma.  Prior to
transfer blood was also noted in the G-tube.  She was
transferred to [**Hospital1 18**] on peripheral dopamine for continued BP
support.


Past Medical History:
1.  Chronic obstructive pulmonary disease
2.  Right tonsillar laryngeal carcinoma, status post XRT and
status
    post resection in [**2186**].
3.  Depression.
4.  Arthritis
5.  S/p cholecystectomy
6.  Hypothyroidism
7.  Hyperglycemia
8.  Right upper lobe lung mass with negative biopsy in
    [**2188-10-15**]
9.  Alzheimer's dementia
10. osteoporosis
11. Peripheral vascular disease
12. Hypertension
13. prior stroke


Social History:
lives in nursing home.  has 3 sons
[**Name (NI) **]:  h/o 70pack yrs, quit [**2186**]
EtOH: none

Family History:
not elicited

Physical Exam:
T 100.4  HR 84  BP 139/89  RR 21
AC  FiO2 50%  PEEP 5.0  Tv 500 RR 20
GEN:  somnolent, withdraws to pain
HEENT:  PERRL, anicteric, MMM, ETT
Neck:  supple, no LAD, JVP nondistended
CV:  distant heart sounds, regular, no mrg
Resp:  coarse B anteriorly R>L, no crackles
Abd:  +BS, ttp, no guarding, ND, no masses
Ext:  left groin echymoses, BLE edema R>L
Neuro:  withdraws to pain, at baseline oriented x1


Pertinent Results:
[**2195-12-3**] 12:34AM BLOOD WBC-14.1* RBC-3.28* Hgb-10.3* Hct-28.2*
MCV-86 MCH-31.4 MCHC-36.5* RDW-16.1* Plt Ct-120*
[**2195-12-4**] 03:18AM BLOOD WBC-11.9* RBC-3.51*# Hgb-10.7* Hct-28.3*
MCV-81* MCH-30.4 MCHC-37.7* RDW-20.3* Plt Ct-76*
[**2195-12-3**] 12:34AM BLOOD Neuts-80* Bands-14* Lymphs-2* Monos-4
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 NRBC-4*
[**2195-12-3**] 12:34AM BLOOD PT-20.9* PTT-34.0 INR(PT)-2.0*
[**2195-12-3**] 12:34AM BLOOD Plt Smr-LOW Plt Ct-120*
[**2195-12-4**] 11:18AM BLOOD Fibrino-420* D-Dimer-9033*
[**2195-12-4**] 11:18AM BLOOD FDP-80-160*
[**2195-12-3**] 12:34AM BLOOD Glucose-126* UreaN-36* Creat-1.9* Na-144
K-3.8 Cl-109* HCO3-20* AnGap-19
[**2195-12-3**] 12:34AM BLOOD ALT-2737* AST-6183* LD(LDH)-[**Numeric Identifier 7156**]*
CK(CPK)-548* AlkPhos-108 TotBili-0.6
[**2195-12-3**] 04:39AM BLOOD ALT-2511* AST-5932* AlkPhos-97
Amylase-587* TotBili-0.7
[**2195-12-4**] 03:18AM BLOOD ALT-1812* AST-3156* LD(LDH)-5992*
CK(CPK)-501* AlkPhos-119* TotBili-1.5
[**2195-12-3**] 12:34AM BLOOD CK-MB-21* MB Indx-3.8 cTropnT-0.34*
[**2195-12-3**] 12:34AM BLOOD Albumin-2.4* Calcium-6.7* Phos-6.5*
Mg-2.2
[**2195-12-3**] 04:00AM BLOOD Ammonia-39
[**2195-12-3**] 12:34AM BLOOD TSH-3.0
[**2195-12-3**] 12:34AM BLOOD Free T4-1.5
[**2195-12-3**] 12:42AM BLOOD Type-ART pO2-158* pCO2-24* pH-7.51*
calTCO2-20* Base XS--1
[**2195-12-4**] 03:32AM BLOOD Type-ART Temp-36.1 pO2-116* pCO2-29*
pH-7.42 calTCO2-19* Base XS--3 Intubat-INTUBATED
[**2195-12-3**] 10:51AM BLOOD Lactate-2.9*
[**2195-12-4**] 11:45AM BLOOD Lactate-2.0
[**2195-12-3**] 12:42AM BLOOD freeCa-0.93*
[**2195-12-4**] 11:45AM BLOOD freeCa-1.03*
.
Echo The left atrium is normal in size. Left ventricular wall
thicknesses are  normal. The left ventricular cavity size is
normal. Left ventricular systolic  function is hyperdynamic (EF
70-80%). There is no ventricular septal defect.  The right
ventricular cavity is dilated. Right ventricular systolic
function  is normal. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Trace aortic
regurgitation is seen. The mitral valve  leaflets are mildly
thickened. There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is seen. There is moderate pulmonary artery
systolic hypertension. There is no pericardial effusion.
.
CXR:  Portable AP chest radiograph was reviewed.  The ET tube
tip is 3.2 cm above the carina.  The NG tube passes below the
diaphragm and terminates most likely in the stomach.  The left
subclavian line tip terminates at the level of mid low SVC.
Minimal left apical pneumothorax cannot be excluded.  There is
no apical hematoma.  A small left pleural effusion as well as
right tiny effusion is identified.  There is no congestive heart
failure or focal lung consolidation.  The hila are bilaterally
enlarged, which may be related due to pulmonary emboli mentioned
in the patient's history.


Brief Hospital Course:
74yo woman with h/o COPD, Alzheimer's dementia, transferred from
OSH with RLE DVT, bilateral PE, RP bleed, and NSTEMI.  During
her hospitalization the following issues were addressed.  On
[**2195-12-4**], she was extubated and did not tolerate it with
persistant secretions and desaturation.  Extensive discussion
was held with her son and health care proxy, [**Name (NI) **] [**Name (NI) 37080**],
and the decision was made to focus on comfort measures.  She
expired [**2195-12-5**].
.
#  RP bleed:  This occurred following IVC filter placement while
on heparin.  Serial hematocrits were followed. She did not
require further PRBC transfusion.  Vitamin was given for INR
2.0.
#  Hypotension:  She was initially hypotensive requiring
dopamine for BP support.  CVL was placed and CVP found to be
[**5-22**].  She was hypovolemic from bleeding and dehydration.  She
was administered NS iv fluids.  BP normalized and the dopamine
was stopped.  She subsequently became hypertensive with BP
200s/100s, which was treated with propofol gtt sedation, iv
labetolol and hydralazine boluses.
.
#  DVT/PE:  filter in place for DVT.  She was not anticoagulated
for the PE given her retroperitoneal bleed.  Echo was performed.
.
#  ARF:  her renal function declined with rising BUN/Cr despite
fluid rehydration, and she became oliguric-anuric.  This was
thought to be due to ATN although no casts were seen in urine
specimen.
.
#  Resp failure: She presented with a respiratory alkalosis
which persisted with compensatory and concommittent metabolic
acidosis.  She was weaned to pressure support ventilation and
extubated on the day prior to death.
.
#  NSTEMI:  She sufferred a leak of cardiac enzymes without ECG
changes during the episodes of hypovolemia/hypotension and
anemia.  She received statin.
.
#  Shock liver:  she developed shock liver in setting of
hypotension and hypovolemia
.
#  Dispo:  She continued to decline with development of oliguric
renal failure, shock liver.  Sedation was lifted but mental
status did not return.  In discussion with her son and health
care proxy, decision was made to focus of comfort.  She expired
[**2195-12-5**].  Communication is with her son [**Name (NI) **] [**Name (NI) 37080**]
[**Telephone/Fax (1) 71462**](h), [**Telephone/Fax (1) 71463**](c)

Medications on Admission:
Meds on Admission to OSH:
Depakote sprinkles 125mg 3caps [**Hospital1 **]
Folate 1mg daily
Plavix 75mg daily
Lasix 20mg daily
Cetrocal +D 1tab [**Hospital1 **]
Aclonel 35mg QThurs
Lipitor 10mg daily
Atenolol 50mg daily
ASA 325mg daily
KCl 30mEq daily
.
Meds on Transfer:
Folate 1mg daily
Depakote 125mg 3tabs [**Hospital1 **]
Zocor 20mg daily
Nexium 40mg iv daily

Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired
{"Other pulmonary embolism and infarction,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Chronic airway obstruction, not elsewhere classified,Dehydration,Acute kidney failure, unspecified,Acute respiratory failure,Subendocardial infarction, initial episode of care,Acute and subacute necrosis of liver,Hemorrhage complicating a procedure,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Osteoporosis, unspecified"}


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: mental status changes, PE/DVT, RP bleed

PRESENT ILLNESS: 75yoW with h/o COPD, Alzheimer's dementia, diagnosed with DVT/PE
at Caritas [**Hospital6 5016**] and transferred to [**Hospital1 18**] ED with
RP bleed and hypotension.
.
The patient was initially transferred from her nursing home to
[**Hospital6 5016**] on [**2195-11-30**] with low grade fever, failure to
thrive, and altered mental status after staff found her
unresponsive for 40sec at breakfast.  She had been discharged
from that hospitalization the week prior after admission for
urosepsis with hypotension, UTI, and dehydration.  On admission
she was diagnosed with RLE DVT by U/S and bilateral PE by CT
angiogram.  Heparin gtt was started, and she was sent for IVC
filter placement.  Post-procedure she became hypotensive.  She
was intubated and transfused 5units PRBC and 4units FFP after
Hct noted to be 20.  Heparin gtt was discontinued.  Abdominal CT
revealed a large left retroperitoneal hematoma.  Prior to
transfer blood was also noted in the G-tube.  She was
transferred to [**Hospital1 18**] on peripheral dopamine for continued BP
support.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease
2.  Right tonsillar laryngeal carcinoma, status post XRT and
status
    post resection in [**2186**].
3.  Depression.
4.  Arthritis
5.  S/p cholecystectomy
6.  Hypothyroidism
7.  Hyperglycemia
8.  Right upper lobe lung mass with negative biopsy in
    [**2188-10-15**]
9.  Alzheimer's dementia
10. osteoporosis
11. Peripheral vascular disease
12. Hypertension
13. prior stroke

MEDICATION ON ADMISSION: Meds on Admission to OSH:
Depakote sprinkles 125mg 3caps [**Hospital1 **]
Folate 1mg daily
Plavix 75mg daily
Lasix 20mg daily
Cetrocal +D 1tab [**Hospital1 **]
Aclonel 35mg QThurs
Lipitor 10mg daily
Atenolol 50mg daily
ASA 325mg daily
KCl 30mEq daily
.
Meds on Transfer:
Folate 1mg daily
Depakote 125mg 3tabs [**Hospital1 **]
Zocor 20mg daily
Nexium 40mg iv daily

ALLERGIES: Clonidine

PHYSICAL EXAM: T 100.4  HR 84  BP 139/89  RR 21
AC  FiO2 50%  PEEP 5.0  Tv 500 RR 20
GEN:  somnolent, withdraws to pain
HEENT:  PERRL, anicteric, MMM, ETT
Neck:  supple, no LAD, JVP nondistended
CV:  distant heart sounds, regular, no mrg
Resp:  coarse B anteriorly R>L, no crackles
Abd:  +BS, ttp, no guarding, ND, no masses
Ext:  left groin echymoses, BLE edema R>L
Neuro:  withdraws to pain, at baseline oriented x1

FAMILY HISTORY: not elicited

SOCIAL HISTORY: lives in nursing home.  has 3 sons
[**Name (NI) **]:  h/o 70pack yrs, quit [**2186**]
EtOH: none 

### Response:
{"Other pulmonary embolism and infarction,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Chronic airway obstruction, not elsewhere classified,Dehydration,Acute kidney failure, unspecified,Acute respiratory failure,Subendocardial infarction, initial episode of care,Acute and subacute necrosis of liver,Hemorrhage complicating a procedure,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Osteoporosis, unspecified"}
