CHIEF COMPLAINT: Hypoxia

PRESENT ILLNESS: This is a 69M with CAD, CHF, PVD, aplastic anemia (last
transfusion [**1-25**]), and DM2, who presented to the ED after his
family called EMS for agonal breathing. He was intubated in the
field and brought to the ED. As he is intubated and sedated,
history is obtained from the online medical record and family.

MEDICAL HISTORY: # Diabetes Mellitus type 2
# Hypertension
# Chronic Kidney Disease, Cr 1.6-1.9
# Coronary Artery Disease s/p balloon angioplasty in [**2133**] &
NSTEMI in [**9-/2146**]
# scar-mediated VT, s/p failed ablation
# aplastic anemia/MDS, Hct 25-28 & transfusion dependent (most
recent was [**1-25**] for Hct of 22.1); platelets usually 70-130k;
WBC usually 3.0-4.0k.
# Peripheral Vascular Disease s/p R fem-[**Doctor Last Name **] bypass in [**Month (only) 216**],
[**2138**]
# s/p right Carotid Endarterectomy in [**2135-1-26**]; left carotid
artery completely occluded but asymptomatic
# s/p right 5th toe amputation in [**2137-6-25**]

MEDICATION ON ADMISSION: Folic Acid 2 mg daily
Clopidogrel 75 mg daily
Aspirin 325 mg daily
pravastatin 10 mg daily
Isosorbide Dinitrate 60mg tid
Hydralazine 25 mg tid
Metoprolol Tartrate 75mg [**Hospital1 **]
furosemide 20mg daily
Neoral 50mg QAM and 25 mg QPM -- HELD for elevated Cr since
[**1-25**]
Procrit everyother week, started [**1-25**]
novolin 70/30 insulin, unknown dose

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Presentation:

FAMILY HISTORY: His mother and sister have diabetes mellitus type two. Many
members of his family have hyptertension.

SOCIAL HISTORY: He is retired. He worked as a maintenance worker at [**Hospital1 2177**] for 25
yrs. He is widowed but has a son and daughter-in-law in town who
he stays in close touch with. He lives by himself in poor
financial circumstances. He has smoked one and a half packs of
cigarettes/day for at least 50 years. He denies alcohol or other
drugs.
Unspecified septicemia,Acute respiratory failure,Septic shock,Acute kidney failure, unspecified,Defibrination syndrome,Acute and subacute necrosis of liver,Aplastic anemia, unspecified,Cardiac arrest,Hyperpotassemia,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Congestive heart failure, unspecified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status
Septicemia NOS,Acute respiratry failure,Septic shock,Acute kidney failure NOS,Defibrination syndrome,Acute necrosis of liver,Aplastic anemia NOS,Cardiac arrest,Hyperpotassemia,Chronic kidney dis NOS,Thrombocytopenia NOS,CHF NOS,Severe sepsis,Hy kid NOS w cr kid I-IV,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Old myocardial infarct,Status-post ptca
Admission Date:  [**2147-1-27**]              Discharge Date:   [**2147-1-31**]

Date of Birth:  [**2077-12-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
Hypoxia

Major Surgical or Invasive Procedure:
Central Venous Line x2
Arterial Line

History of Present Illness:
This is a 69M with CAD, CHF, PVD, aplastic anemia (last
transfusion [**1-25**]), and DM2, who presented to the ED after his
family called EMS for agonal breathing. He was intubated in the
field and brought to the ED. As he is intubated and sedated,
history is obtained from the online medical record and family.

In the ED, he was fighting the vent; he had poor peripheral
access, so a groin line was placed. While placing the groin
line, no femoral pulse was present and the rhythm on the bedside
monitor was wide complex. Epinephrine was given via ETT and once
venous access was obtained, CaCl2, bicarb, and insulin were
administered. He never received chest compressions, as
spontaneous circulation returned quickly (<45 seconds, according
to ED resident). He received kayexalate via OG tube. He is
receiving 2 units of PRBCs for Hct of 21. Vital signs at the
time of transfer were afebrile, pulse 120s, SBP 130s-140s,
vented with good O2 saturation.

ROS: Unable to obtain


Past Medical History:
# Diabetes Mellitus type 2
# Hypertension
# Chronic Kidney Disease, Cr 1.6-1.9
# Coronary Artery Disease s/p balloon angioplasty in [**2133**] &
NSTEMI in [**9-/2146**]
# scar-mediated VT, s/p failed ablation
# aplastic anemia/MDS, Hct 25-28 & transfusion dependent (most
recent was [**1-25**] for Hct of 22.1); platelets usually 70-130k;
WBC usually 3.0-4.0k.
# Peripheral Vascular Disease s/p R fem-[**Doctor Last Name **] bypass in [**Month (only) 216**],
[**2138**]
# s/p right Carotid Endarterectomy in [**2135-1-26**]; left carotid
artery completely occluded but asymptomatic
# s/p right 5th toe amputation in [**2137-6-25**]


Social History:
He is retired. He worked as a maintenance worker at [**Hospital1 2177**] for 25
yrs. He is widowed but has a son and daughter-in-law in town who
he stays in close touch with. He lives by himself in poor
financial circumstances. He has smoked one and a half packs of
cigarettes/day for at least 50 years. He denies alcohol or other
drugs.


Family History:
His mother and sister have diabetes mellitus type two. Many
members of his family have hyptertension.


Physical Exam:
On Presentation:

Vitals: T:92.6 BP:133/83 HR:65 Vent: AC 600x14(24), 5 PEEP, 40%
FiO2 O2Sat: 99%
GEN: thin elderly male intubated, nonresponsive, after receiving
versed in the ED
HEENT: EOMI, PERRL 4-2mm and brisk, sclera anicteric, no
epistaxis or rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, no M/G/R, normal S1 S2, radial pulses doppler on R, 1+
on Left, where there is a large hematoma
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: + gag, + corneals, but no withdrawal to pain/noxious
stimuli
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.
No petechiae


Pertinent Results:
IMAGING:
CT A/P: Prelim read:
Limited noncontrast evaluation. Bilateral moderate pleural
effusions and
bibasilar consolidations likely representing aspiration in the
setting of
recent cardiac/respiratory arrest. Mild free abdominal fluid and
anasarca.
Large gallstone. No definite evidence for acute intra-abdominal
process.

HEAD CT:
No evidence of hemorrhage. Multifocal areas of cortical and
subcortical hypodensity represent chronic infarct, though
further evaluation with MRI may be pursued to evaluate for acute
or subacute components.

ECHo:
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. The estimated right atrial pressure
is 10-20mmHg. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity is moderately dilated.
No masses or thrombi are seen in the left ventricle. Overall
left ventricular systolic function is severely depressed (LVEF=
20 %) with akinesis of the inferior, infero-lateral, distal
LV/apical segments. Tissue Doppler imaging suggests an increased
left ventricular filling pressure (PCWP>18mmHg). The right
ventricular cavity is mildly dilated with moderate global free
wall hypokinesis. The aortic root is mildly dilated at the sinus
level. The ascending aorta is mildly dilated. The aortic arch is
mildly dilated. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Moderate to severe (3+) mitral regurgitation is seen.
The tricuspid valve leaflets are mildly thickened. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion.

ADMISSION LABS:
-[**2147-1-27**] BLOOD WBC-3.2* RBC-1.83* Hgb-6.8* Hct-21.0* MCV-116*
MCH-37.1* MCHC-32.1 RDW-20.9* Plt Ct-28*#
-[**2147-1-27**] BLOOD PT-28.8* PTT-90.5* INR(PT)-2.9*
-[**2147-1-28**] BLOOD FDP->1280*
-[**2147-1-28**] BLOOD Glucose-235* UreaN-120* Creat-4.7* Na-142 K-5.7*
Cl-107 HCO3-10* AnGap-31*
-[**2147-1-28**] BLOOD ALT-1592* AST-1808* LD(LDH)-2890* CK(CPK)-9394*
AlkPhos-147* TotBili-4.3* DirBili-2.6* IndBili-1.7
-[**2147-1-28**] BLOOD CK-MB-60* MB Indx-0.6 cTropnT-1.14*
-[**2147-1-28**] BLOOD Albumin-3.6 Calcium-10.2 Phos-10.6*# Mg-3.5*
-[**2147-1-28**] BLOOD Hapto-<20*
-[**2147-1-28**] BLOOD D-Dimer-8754*
-[**2147-1-28**] BLOOD Cortsol-158.6*
-[**2147-1-27**] BLOOD [**Year/Month/Day **]-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG
-[**2147-1-27**] BLOOD pO2-502* pCO2-23* pH-7.05* calTCO2-7* Base
XS--23
-[**2147-1-27**] BLOOD Glucose-GREATER TH Lactate-12.5* Na-134* K-6.3*
Cl-106 calHCO3-9*

Brief Hospital Course:
69M with multiple medical problems including DM2, CAD, CHF,
aplastic anemia, CKD, who presented to the ICU s/p respiratory
and cardiac arrests with hyperkalemia, acute on chronic renal
failure, and DIC. The exact nature of these events is unclear,
but he has had worsening renal function over the past week,
leading to electrolyte disturbances and possibly an
arrhythmogenic cardiac arrest with spontaneous return of
circulation prior to the arrival of EMS. On admission, patient
was intubated, unresponsive, in acute renal failure, liver
failure and had cardiac damage as evidenced by elevated cardiac
biomarkers. He was aggressively fluid recussitated, started on
broad spectrum antibiotics for presumed sepsis, transfused RBC's
and started on pressors for blood pressure support.  Heme/onc
was consulted and patient was determined to be in DIC.  Renal
was consulted and it was determined that renal replacement
therapy was not indicated.

Patient was maintained on vent, antibiotics and pressors but
continued to deteriorate with worsening renal function, no
improvement in respiratory status, and decreasing blood pressure
to systolics of 30 in spite of pressor support.  The decision
was made by his family to make patient comfort measures only.
He was started on a morphine drip for comfort, extubated and all
non-comfort medications were discontinued.  He expired on [**2147-1-31**]
at 12:10pm.


Medications on Admission:
Folic Acid 2 mg daily
Clopidogrel 75 mg daily
Aspirin 325 mg daily
pravastatin 10 mg daily
Isosorbide Dinitrate 60mg tid
Hydralazine 25 mg tid
Metoprolol Tartrate 75mg [**Hospital1 **]
furosemide 20mg daily
Neoral 50mg QAM and 25 mg QPM -- HELD for elevated Cr since
[**1-25**]
Procrit everyother week, started [**1-25**]
novolin 70/30 insulin, unknown dose


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
none


Discharge Condition:
Expired.

Discharge Instructions:
none

Followup Instructions:
none
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Acute kidney failure, unspecified,Defibrination syndrome,Acute and subacute necrosis of liver,Aplastic anemia, unspecified,Cardiac arrest,Hyperpotassemia,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Congestive heart failure, unspecified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}


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: Hypoxia

PRESENT ILLNESS: This is a 69M with CAD, CHF, PVD, aplastic anemia (last
transfusion [**1-25**]), and DM2, who presented to the ED after his
family called EMS for agonal breathing. He was intubated in the
field and brought to the ED. As he is intubated and sedated,
history is obtained from the online medical record and family.

MEDICAL HISTORY: # Diabetes Mellitus type 2
# Hypertension
# Chronic Kidney Disease, Cr 1.6-1.9
# Coronary Artery Disease s/p balloon angioplasty in [**2133**] &
NSTEMI in [**9-/2146**]
# scar-mediated VT, s/p failed ablation
# aplastic anemia/MDS, Hct 25-28 & transfusion dependent (most
recent was [**1-25**] for Hct of 22.1); platelets usually 70-130k;
WBC usually 3.0-4.0k.
# Peripheral Vascular Disease s/p R fem-[**Doctor Last Name **] bypass in [**Month (only) 216**],
[**2138**]
# s/p right Carotid Endarterectomy in [**2135-1-26**]; left carotid
artery completely occluded but asymptomatic
# s/p right 5th toe amputation in [**2137-6-25**]

MEDICATION ON ADMISSION: Folic Acid 2 mg daily
Clopidogrel 75 mg daily
Aspirin 325 mg daily
pravastatin 10 mg daily
Isosorbide Dinitrate 60mg tid
Hydralazine 25 mg tid
Metoprolol Tartrate 75mg [**Hospital1 **]
furosemide 20mg daily
Neoral 50mg QAM and 25 mg QPM -- HELD for elevated Cr since
[**1-25**]
Procrit everyother week, started [**1-25**]
novolin 70/30 insulin, unknown dose

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Presentation:

FAMILY HISTORY: His mother and sister have diabetes mellitus type two. Many
members of his family have hyptertension.

SOCIAL HISTORY: He is retired. He worked as a maintenance worker at [**Hospital1 2177**] for 25
yrs. He is widowed but has a son and daughter-in-law in town who
he stays in close touch with. He lives by himself in poor
financial circumstances. He has smoked one and a half packs of
cigarettes/day for at least 50 years. He denies alcohol or other
drugs. 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Septic shock,Acute kidney failure, unspecified,Defibrination syndrome,Acute and subacute necrosis of liver,Aplastic anemia, unspecified,Cardiac arrest,Hyperpotassemia,Chronic kidney disease, unspecified,Thrombocytopenia, unspecified,Congestive heart failure, unspecified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}
