CHIEF COMPLAINT: ED admit to [**Hospital Unit Name 153**] for status epilepticus

PRESENT ILLNESS: 26yo woman with polysubstance abuse who is transferred from
[**Hospital **] Hospital for status epilepticus, admitted to the [**Hospital Unit Name 153**]
intubated for further evaluation. As patient is unable to answer
questions on admission, history obtained by prior records and
discussion with family.  Per pt's sister's, pt was in USOH,
without complaining of fevers, chills, headaches, or other
symptoms.  Of note they report that she has been having cocaine
induced "seizures" over the past year but never sought medical
attention. Pt was with her father on day of admission to OSH,
when he reports that he heard a noise, and found her on the
floor of the bathroom shaking, with blood tinged "foam" in her
mouth.  Cocaine and heroin were found at the site, with the
needle still present. The shaking activity continued
intermittently.  EMS arrived after about 20 minutes at which
time she was intubated for airway protection. She was brought to
OSH and received ativan 6mg, was loaded on fosphenytoin 1gram
and PB 500mg. Her pupils were fixed and dilated. She was febrile
(103) and her tox screen was positive for benzo, cocaine,
methadone and cannabis. To obtain a head CT, she received
vecuronium as she was apparently still seizing. Head CT was read
as normal. She was on pressors for a short time for hypotension.

MEDICAL HISTORY: - one febrile childhood seizure (age 2; chickenpox)
- seizures after shooting cocaine (during the past year)
- hep C for few years
- s/p C-section 4wks ago; baby was addicted
- three pregnancies

MEDICATION ON ADMISSION: Methadone 120mg [**Name (NI) 244**] (unclear, don't know who prescribed this or
if getting it from a friend)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: T102.3 HR144 BP116/81 RR15 sO295
GEN: intubated, feels warm, sedated
HEENT: mmm; PERRL, mildly injected, unable to assess oropharynx
NECK: in hard collar, trachea midline, no LAD
LUNGS: Coarse breath sounds bilaterally, no wheezes
HEART: Regular rate and rhythm, normal S1 and physiologically
split S2, no murmur or rub
ABDOMEN: normal bowel sounds, soft, nontender, nondistended;
scar of C-section looks clean; some vaginal bleeding
EXTREMITIES: no clubbing, cyanosis, ecchymosis, or edema; no
petechial rash or vesicular rash
MENTAL STATUS:
intubated; currently not on any sedatives (but s/p ativan,
fosphenytoin, PB and vecuronium-this was given 1.5 hr prior to
this exam). Not responding to voice or noxious.
CRANIAL NERVES:
II: no blink to threat. PERL 2.5-->2 mm. . Disc margins sharp,
no pappilledema.
III, IV, VI: No dolls. No rooving eye movements. Eyes midline,
no skew.
V: No corneals or response to nasal tickle
VII: Face symmetrical
VIII: -
IX: no gag
XII: -
[**Doctor First Name 81**]: -
MOTOR SYSTEM: Normal bulk. Tone flaccid. No adventitious
movements, no tremor, no clonus. No spontaneous movements and no
response to noxious.
SENSORY SYSTEM:
No response to noxious
REFLEXES:
Absent DTS's
Toes: mute bilaterally.
COORDINATION: deferred
GAIT: deferred

FAMILY HISTORY: Family History:
- nephew with seizures
- no sudden death
- both parents with etoh abuse

SOCIAL HISTORY: + heroin, intravenous cocaine, smoking, oxycontin
Recent time spent in jail for one week, released [**2164-12-18**]
(unclear which charges--mostly drug related and shoplifitng)
Three children with three fathers
[**Name (NI) 32007**] 4 weeks ago
Currently without a home; stays at others' places or on the
street
Acute respiratory failure,Grand mal status,Anoxic brain damage,Cocaine abuse, unspecified,Pneumonitis due to inhalation of food or vomitus,Rhabdomyolysis,Epilepsy complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication,Mental disorders of mother, postpartum condition or complication,Lack of housing,Essential thrombocythemia,Candidiasis of vulva and vagina,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]
Acute respiratry failure,Grand mal status,Anoxic brain damage,Cocaine abuse-unspec,Food/vomit pneumonitis,Rhabdomyolysis,Epilepsy-postpartum,Mental disorder-postpart,Lack of housing,Essntial thrombocythemia,Candidal vulvovaginitis,Elev transaminase/ldh
Admission Date:  [**2164-12-22**]              Discharge Date:   [**2165-3-21**]

Date of Birth:  [**2138-4-14**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3705**]
Chief Complaint:
ED admit to [**Hospital Unit Name 153**] for status epilepticus

Major Surgical or Invasive Procedure:
A-line placement
Endotrachial tube placement
NG tube placement


History of Present Illness:
26yo woman with polysubstance abuse who is transferred from
[**Hospital **] Hospital for status epilepticus, admitted to the [**Hospital Unit Name 153**]
intubated for further evaluation. As patient is unable to answer
questions on admission, history obtained by prior records and
discussion with family.  Per pt's sister's, pt was in USOH,
without complaining of fevers, chills, headaches, or other
symptoms.  Of note they report that she has been having cocaine
induced "seizures" over the past year but never sought medical
attention. Pt was with her father on day of admission to OSH,
when he reports that he heard a noise, and found her on the
floor of the bathroom shaking, with blood tinged "foam" in her
mouth.  Cocaine and heroin were found at the site, with the
needle still present. The shaking activity continued
intermittently.  EMS arrived after about 20 minutes at which
time she was intubated for airway protection. She was brought to
OSH and received ativan 6mg, was loaded on fosphenytoin 1gram
and PB 500mg. Her pupils were fixed and dilated. She was febrile
(103) and her tox screen was positive for benzo, cocaine,
methadone and cannabis. To obtain a head CT, she received
vecuronium as she was apparently still seizing. Head CT was read
as normal. She was on pressors for a short time for hypotension.

.
[**Hospital1 18**] ED course: She was med-flighted; VS on arrival 102.3, HR
200s, 100/40, intubated. Tylenol, vanco, CTX given; started on
versed gtt. NS bolus 1.25 liters; acyclovir 600mg IV x 1.
.
[**Hospital Unit Name 153**] course: LP obtained without meningitis. Pt was followed by
the neurology team who initially felt that her seizures were due
to substance toxicity, however, after review of EEG, felt that
there may be an aspect of epileptiform changes.  She was
initially on broad spectrum antibiotics, but after CSF showed no
meningitis and all other cultures remained negative, these were
discontinued.  Of note, cxr on [**12-24**] was consistent with an
aspiration pneumonia vs. pneumonitis.  She was never febrile
after this, and wbc count remained normal, and so antibiotics
were not re-started.
.
Her hemodynamics stabilized and the patient was transferred to
the floor for further management.

Past Medical History:
- one febrile childhood seizure (age 2; chickenpox)
- seizures after shooting cocaine (during the past year)
- hep C for few years
- s/p C-section 4wks ago; baby was addicted
- three pregnancies


Social History:
+ heroin, intravenous cocaine, smoking, oxycontin
Recent time spent in jail for one week, released [**2164-12-18**]
(unclear which charges--mostly drug related and shoplifitng)
Three children with three fathers
[**Name (NI) 32007**] 4 weeks ago
Currently without a home; stays at others' places or on the
street

Family History:
Family History:
- nephew with seizures
- no sudden death
- both parents with etoh abuse

Physical Exam:
VITALS: T102.3 HR144 BP116/81 RR15 sO295
GEN: intubated, feels warm, sedated
HEENT: mmm; PERRL, mildly injected, unable to assess oropharynx
NECK: in hard collar, trachea midline, no LAD
LUNGS: Coarse breath sounds bilaterally, no wheezes
HEART: Regular rate and rhythm, normal S1 and physiologically
split S2, no murmur or rub
ABDOMEN: normal bowel sounds, soft, nontender, nondistended;
scar of C-section looks clean; some vaginal bleeding
EXTREMITIES: no clubbing, cyanosis, ecchymosis, or edema; no
petechial rash or vesicular rash
MENTAL STATUS:
intubated; currently not on any sedatives (but s/p ativan,
fosphenytoin, PB and vecuronium-this was given 1.5 hr prior to
this exam). Not responding to voice or noxious.
CRANIAL NERVES:
II: no blink to threat. PERL 2.5-->2 mm. . Disc margins sharp,
no pappilledema.
III, IV, VI: No dolls. No rooving eye movements. Eyes midline,
no skew.
V: No corneals or response to nasal tickle
VII: Face symmetrical
VIII: -
IX: no gag
XII: -
[**Doctor First Name 81**]: -
MOTOR SYSTEM: Normal bulk. Tone flaccid. No adventitious
movements, no tremor, no clonus. No spontaneous movements and no
response to noxious.
SENSORY SYSTEM:
No response to noxious
REFLEXES:
Absent DTS's
Toes: mute bilaterally.
COORDINATION: deferred
GAIT: deferred

Pertinent Results:
[**2164-12-22**] 04:11PM   GLUCOSE-87 UREA N-8 CREAT-0.7 SODIUM-141
POTASSIUM-3.2* CHLORIDE-118* TOTAL CO2-15* ANION GAP-11
[**2164-12-22**] 04:11PM   CK(CPK)-8901*
[**2164-12-22**] 04:11PM   CALCIUM-7.4* PHOSPHATE-3.1 MAGNESIUM-1.7
[**2164-12-22**] 04:11PM   WBC-9.4 RBC-4.09* HGB-12.1 HCT-34.0* MCV-83
MCH-29.6 MCHC-35.5* RDW-13.3
[**2164-12-22**] 04:11PM   PLT COUNT-223
[**2164-12-22**] 12:13PM   FDP-40-80
[**2164-12-22**] 11:25AM   WBC-11.8* RBC-4.36 HGB-12.9 HCT-37.0 MCV-85
MCH-29.5 MCHC-34.8 RDW-13.3
[**2164-12-22**] 11:25AM   PLT COUNT-265
[**2164-12-22**] 07:12AM   GLUCOSE-102 UREA N-12 CREAT-0.8 SODIUM-145
POTASSIUM-3.4 CHLORIDE-120* TOTAL CO2-15* ANION GAP-13
[**2164-12-22**] 07:12AM   ALT(SGPT)-47* AST(SGOT)-109* LD(LDH)-544*
CK(CPK)-5311* ALK PHOS-51 AMYLASE-403* TOT BILI-0.2
[**2164-12-22**] 07:12AM   LIPASE-74*
[**2164-12-22**] 07:12AM   CK-MB-75* MB INDX-1.4 cTropnT-<0.01
[**2164-12-22**] 07:12AM   ALBUMIN-3.4 CALCIUM-6.4* PHOSPHATE-2.0*#
MAGNESIUM-2.2
[**2164-12-22**] 07:12AM   PT-15.4* PTT-31.9 INR(PT)-1.4*
[**2164-12-22**] 07:12AM   FIBRINOGE-202 D-DIMER-4206*
[**2164-12-22**] 05:28AM   TYPE-ART TEMP-37.3 RATES-20/2 TIDAL VOL-500
PEEP-5 O2-60 PO2-138* PCO2-27* PH-7.31* TOTAL CO2-14* BASE
XS--11 -ASSIST/CON INTUBATED-INTUBATED
[**2164-12-22**] 02:45AM CEREBROSPINAL FLUID (CSF)  PROTEIN-43
GLUCOSE-112
[**2164-12-22**] 02:45AM CEREBROSPINAL FLUID (CSF)  WBC-4 RBC-0 POLYS-0
LYMPHS-82 MONOS-18
[**2164-12-21**] 11:40PM   PHENOBARB-8.9* PHENYTOIN-17.4
[**2164-12-21**] 11:40PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-POS barbitrt-POS tricyclic-NEG
[**2164-12-21**] 11:40PM URINE  bnzodzpn-POS barbitrt-POS opiates-NEG
cocaine-POS amphetmn-NEG mthdone-POS
[**2164-12-21**] 11:40PM   WBC-12.9* RBC-4.52 HGB-13.5 HCT-38.5 MCV-85
MCH-29.9 MCHC-35.0 RDW-13.3
[**2164-12-21**] 11:40PM   NEUTS-77.3* LYMPHS-17.7* MONOS-3.3 EOS-1.4
BASOS-0.4
[**2164-12-21**] 11:40PM   PLT COUNT-387
.
[**2164-12-22**] CXR: ET tube 4cm above carina.  No clear infiltrate or
effusion.
.
[**2164-12-22**] CT Head: No evidence for hemorrhage, mass effect, or
acute ischemic changes.  Please note that MRI is more sensitive
in the detection of acute ischemia.  Bilateral air fluid levels
in the maxillary sinuses may be secondary to intubation,
however, could also represent acute sinusitis
.
[**2164-12-22**] CT Cspine: No fracture or dislocation
.
[**2164-12-22**] CT Chest, Abd, Pelvis: (wet read) 1. Probable
aspiration left upper lung lobe vs consolidation; 2. mildly
dilated fluid filled loops of small and large bowel throughout
abd/pelvis; 3. peri-portal vein edema which can be a CT sign of
liver disease;  4. Enlarged uterus c/w post-partum hx;  5.
Cholelithiasis without evidence for cholecystitis.
.
[**12-22**] EEG
IMPRESSION: This is an abnormal EEG. The first abnormality of
bilateral central sharps is consistent with cortical
irritability in
these regions. Abnormality number two of a posterior low voltage

activity may suggest a subcortical reason in the posterior
regions
bilaterally. Further evaluation with imaging and clinical
correlation
would be suggested. The generally slowed background and
suppressed
background would be suggestive of medication effect. If clinical

suspicion for seizures remains, intermittent EEGs or bedside
telemetry
would be suggested.
.
[**12-24**] CXR
IMPRESSION: AP chest compared to [**12-21**] through 26:
Mild vascular congestion and small regions of peribronchial
opacification have developed at the lung bases since [**12-23**]
and may represent volume overload and early pneumonia,
respectively. Heart is normal size. Pleural effusion, if any, is
on the right and minimal. No pneumothorax. ET tube tip at the
thoracic inlet. Nasogastric tube looped in the stomach.
.
[**12-27**] EEG
IMPRESSION: Minimally abnormal EEG due to the occasional
generalized
slowing in wakefulness. This suggests a disturbance in midline
structures but is not specific with regard to etiologies. Some
might
even be due to drowsiness, possibly in turn the sign of a mild
encephalopathy. Nevertheless, the background rhythm reached
normal
frequencies at times, and there were no areas of focal slowing
or any
epileptiform features.
.
[**12-31**] CT head
FINDINGS: There is no intracranial hemorrhage, hydrocephalus, or
acute territorial infarction. There is no mass effect or shift
of the normally midline structures. The visualized orbits,
paranasal sinuses, and osseous structures are unremarkable.

IMPRESSION: Normal non-contrast head CT.
.
[**12-31**] CXR
The heart is normal in size. The mediastinal and hilar contours
are normal. The pulmonary vascularity is normal. The lungs
appear clear. There are no pleural effusions. The soft tissues
and osseous structures are unremarkable aside from mild thoracic
scoliosis.

IMPRESSION: No evidence of pulmonary infiltrates.
.
[**12-31**] Upper arm U/S
FINDINGS: In the left upper arm medially, there is a
subcutaneous collection measuring 1.3 x 0.7 x 1.2 cm with
well-defined margins, without vascularity, but with echogenic
debris within it. In the mid upper arm, there is a 1.1 x 1.5 x
0.7 cm thick-walled noncompressible collection without
vascularity.

IMPRESSION: Two subcutaneous nodules as described above, which
confirm the palpatory findings.

.
[**1-2**] Video Swallow
FINDINGS: Barium of varying consistencies was administered to
the patient under fluoroscopic guidance in conjunction with the
speech pathologist. There was no evidence of aspiration with any
consistency barium. The exam was otherwise unremarkable. Please
refer to the speech and swallow pathologist report for full
details and recommendations.

IMPRESSION: No evidence of aspiration.
.

Brief Hospital Course:
Ms. [**Known lastname 70746**] is a 26 female with history of polysubstance abuse
who has suffered anoxic brain injury on account of drug-induced
seizures.  Pateint required ICU stay and prolonged hospital stay
for management of social issues.
.
[**Hospital Unit Name 13533**]: Her Status Eiplipticus stopped after dilantin load.
She was continued on dilatin per neurology as she was thought to
be prone to seizures from childhood febrile seizure. Her mental
status remained depressed, with slurred speech, thought to be
from expected prolonged post-ictal state [**3-1**] status.  Social
work was also consulted for polysubstance abuse. Her
transaminitis was thought to be [**3-1**] massive drug use, and
trended down with IV fluids. Hepatits labs pending.  Patient was
extubated without event and her new baseline functional status
is likely secondary to anoxic brain injury sustained during
seizures.
.
# Thrombocytosis: Resolved.  Likely due to a systemic
inflammatory response from prolonged seizure.  Could also have
been due to inflammation from hypoxic encephalopathy.
.
# Hypoxic encephalopathy: Improvement from admission, although
patient has suffered anoxic brain injury thus limiting her ADLs.
 She has been seen by Speech Pathology and has had improvement
in ability to speak.  Patient also evaluated by Neuropsychology
and will require outpatient behavior neurology evaluation as per
her Discharge Plan.  Patient seen by OT in house and patient has
progressed.  She will require intensive OT as an outpatient.
She was also seen by Speech Therapy and also improved in her
ability to articulate simple words.
.
# Seizures: Now resolved.  Most likely secondary to cocaine use,
given pt's history of cocaine-induced seizures.  No further
seizures since admission.  EEG showed central irritable focus
(thus ? predisposed to seizure) and MRI/MRA head normal. Patient
to follow-up with behavioral neurology as an outpatient.
.
# Psychosocial: Difficult family dynamics, although father has
been made offical guardian.  She will be returning home with her
brother and sister-in-law.
.
# Transaminitis: Resolved.  Likely secondary to hypotension in
setting of status epilepticus superimposed on underlying HepB
sAb and cAb positive. [**Last Name (un) **] negative.  Hepatic function remained
normal throughout the remainder of the hospital course.
.
# Polysubstance abuse: Strong history of abuse involving
cocaine/heroin/cannibis.  Patient did not experience withdrawal
symptoms while on the floor.
.
# Possible suicide attempt prior to admission: Psychiatry
evaluated patient and believe that she is not at current risk
for suicidal gestures given her poor functional status and
greatly diminished executive function.
.
.
Her hospital course on the floor was a prolonged stay that was
propagated by the social and insurance situation surrounding her
discharge.  During the stay that was in excess of 80 days was
remarkable for improvement in both her speech and able to
interact with others.  She was medically stable and at one time
was treated with an anti-fungal for vaginal pruritus.  Labs were
not drawn towards the end of her hospital stay and there were no
concerns that was she not medically stable.
.
After discussion with the patient and the medical staff, all
were in agreement that [**Known firstname 27414**] [**Known lastname 70746**] was a suitable
candidate for discharge.

Medications on Admission:
Methadone 120mg [**Name (NI) 244**] (unclear, don't know who prescribed this or
if getting it from a friend)

Discharge Medications:
1. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
4. Outpatient Occupational Therapy
Patient with anoxic brain injury who will require intensive
Occupational Therapy.
5. Outpatient Speech/Swallowing Therapy
Patient with anoxic brain injury who will require intensive
Speech Therapy.


Discharge Disposition:
Home

Discharge Diagnosis:
Status epilepticus
Thrombocytosis
Hypoxic Encephalopathy
Aspiration pneumonitis
Rhabdomyolysis
Polysubstance Abuse
Transaminitis


Discharge Condition:
Hemodynamically stable. Ambulatory with assist.


Discharge Instructions:
Please take all medications as instructed.  There were several
changes made to your current medications regimen.
.
If you experience any fever, nausea, vomiting, lightheadedness,
chest pain, shortness of breath, or any other concerning
symptoms please seek medical attention immediately.

Followup Instructions:
Please make a follow-up appointment with a primary care doctor
within the next 2 weeks.
.
Please make appointment with behavior neurology 2 weeks after
you have been discharged.  Ask for Dr. [**Last Name (STitle) **] [**Name (STitle) **] who saw you when
you were at the hospital.  His number is [**Telephone/Fax (1) 1690**].  Tell
secretary that Dr. [**Last Name (STitle) **] saw you when you were at the hospital.
.
You will also need Occupational Therapy and Speech Therapy.



Completed by:[**2165-3-26**]
{'Acute respiratory failure,Grand mal status,Anoxic brain damage,Cocaine abuse, unspecified,Pneumonitis due to inhalation of food or vomitus,Rhabdomyolysis,Epilepsy complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication,Mental disorders of mother, postpartum condition or complication,Lack of housing,Essential thrombocythemia,Candidiasis of vulva and vagina,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}


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: ED admit to [**Hospital Unit Name 153**] for status epilepticus

PRESENT ILLNESS: 26yo woman with polysubstance abuse who is transferred from
[**Hospital **] Hospital for status epilepticus, admitted to the [**Hospital Unit Name 153**]
intubated for further evaluation. As patient is unable to answer
questions on admission, history obtained by prior records and
discussion with family.  Per pt's sister's, pt was in USOH,
without complaining of fevers, chills, headaches, or other
symptoms.  Of note they report that she has been having cocaine
induced "seizures" over the past year but never sought medical
attention. Pt was with her father on day of admission to OSH,
when he reports that he heard a noise, and found her on the
floor of the bathroom shaking, with blood tinged "foam" in her
mouth.  Cocaine and heroin were found at the site, with the
needle still present. The shaking activity continued
intermittently.  EMS arrived after about 20 minutes at which
time she was intubated for airway protection. She was brought to
OSH and received ativan 6mg, was loaded on fosphenytoin 1gram
and PB 500mg. Her pupils were fixed and dilated. She was febrile
(103) and her tox screen was positive for benzo, cocaine,
methadone and cannabis. To obtain a head CT, she received
vecuronium as she was apparently still seizing. Head CT was read
as normal. She was on pressors for a short time for hypotension.

MEDICAL HISTORY: - one febrile childhood seizure (age 2; chickenpox)
- seizures after shooting cocaine (during the past year)
- hep C for few years
- s/p C-section 4wks ago; baby was addicted
- three pregnancies

MEDICATION ON ADMISSION: Methadone 120mg [**Name (NI) 244**] (unclear, don't know who prescribed this or
if getting it from a friend)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: T102.3 HR144 BP116/81 RR15 sO295
GEN: intubated, feels warm, sedated
HEENT: mmm; PERRL, mildly injected, unable to assess oropharynx
NECK: in hard collar, trachea midline, no LAD
LUNGS: Coarse breath sounds bilaterally, no wheezes
HEART: Regular rate and rhythm, normal S1 and physiologically
split S2, no murmur or rub
ABDOMEN: normal bowel sounds, soft, nontender, nondistended;
scar of C-section looks clean; some vaginal bleeding
EXTREMITIES: no clubbing, cyanosis, ecchymosis, or edema; no
petechial rash or vesicular rash
MENTAL STATUS:
intubated; currently not on any sedatives (but s/p ativan,
fosphenytoin, PB and vecuronium-this was given 1.5 hr prior to
this exam). Not responding to voice or noxious.
CRANIAL NERVES:
II: no blink to threat. PERL 2.5-->2 mm. . Disc margins sharp,
no pappilledema.
III, IV, VI: No dolls. No rooving eye movements. Eyes midline,
no skew.
V: No corneals or response to nasal tickle
VII: Face symmetrical
VIII: -
IX: no gag
XII: -
[**Doctor First Name 81**]: -
MOTOR SYSTEM: Normal bulk. Tone flaccid. No adventitious
movements, no tremor, no clonus. No spontaneous movements and no
response to noxious.
SENSORY SYSTEM:
No response to noxious
REFLEXES:
Absent DTS's
Toes: mute bilaterally.
COORDINATION: deferred
GAIT: deferred

FAMILY HISTORY: Family History:
- nephew with seizures
- no sudden death
- both parents with etoh abuse

SOCIAL HISTORY: + heroin, intravenous cocaine, smoking, oxycontin
Recent time spent in jail for one week, released [**2164-12-18**]
(unclear which charges--mostly drug related and shoplifitng)
Three children with three fathers
[**Name (NI) 32007**] 4 weeks ago
Currently without a home; stays at others' places or on the
street 

### Response:
{'Acute respiratory failure,Grand mal status,Anoxic brain damage,Cocaine abuse, unspecified,Pneumonitis due to inhalation of food or vomitus,Rhabdomyolysis,Epilepsy complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication,Mental disorders of mother, postpartum condition or complication,Lack of housing,Essential thrombocythemia,Candidiasis of vulva and vagina,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}
