CHIEF COMPLAINT: respiratory code

PRESENT ILLNESS: This is a 77 year old male with a PMHX CAD, HTN, CVA, AAA,
Aortic dissection, recent acute cholecystitis who was transfered
from [**Location (un) **] for ERCP and who developed respiratory distress in
the ERCP suite. The patient was originally transfered from
rehab/nursing home to [**Hospital **] Hospital for fever, chills and RUQ
pain. At [**Location (un) **], a CT chest and abdomen found a stable right
pleural effusion, stable aortic dissection as well as findings
consistent with acute cholecystitis. He was admitted and treated
with Unasyn then Zosyn. As he was felt to be high risk for
cholecystectomy, Surgery attempted to drain the gallbladder
percutaneously; however, the pigtail catheter fell out. He was
then transfered to [**Hospital1 18**] for ERCP. Per report, he had stable
vital signs during ambulance transport.
.
At [**Hospital1 18**], he was noted to have progressive hypoxia while in the
ERCP suite. He was saturating 94% on 4LNC, then 92% 5L on NRB.
Due to a question of altered mental status and decreased ability
to protect his airway, he was intubated and code was called.
Prior to intubation, he was tachycardic in 130's with SBP 120's
and he received Esmolol 20mg. He also received Demerol 25mg x2
and then Fentanyl 250mcg x2 with intubation.

MEDICAL HISTORY: Surgical History
percutaneous drainage of GB - unsucessfull as pigtail fell out
.
Medical History
HTN
CAD with positive Persantine thallium stress test
Chronic aortic dissection type B, managed medically
Hyperlipidemia
CVA with right sided weakness and expressive aphasia
GERD
AAA

MEDICATION ON ADMISSION: Miralax 17g daily
Toprol-XL 25mg daily
Dulcolax 5mg qhs
Remeron 30mg qhs
Tylenol 1g [**Hospital1 **]
Imdur 30mg daily
Colace 200mg daily
Prilosec 40mg daily
Senna 2tabs qhs
ASA EC 325mg qhs
Ativan 1mg q3hrs PRN

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: Admission
Vitals: T:98.1 P:94 BP:99/58 R:15-20 SaO2: 97%
General: semi-awake, NAD, intubated and lightly sedated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
OP
Neck: supple, no JVD
Pulmonary: intubated, lungs clear on left side, no lung sounds
on right side and dull to percussion
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, ND, normoactive bowel sounds, tender to palpation
in RUQ
Extremities: no edema.
Neurologic: intubated, lightly sedated able to shake his head in
answer to questions

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Residing at Charwell house for nursing home/ rehab.Former
smoker, quit 20 years ago. No alcohol, no illicit drugs.
Acute respiratory failure,Unspecified pleural effusion,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Coronary atherosclerosis of native coronary artery
Acute respiratry failure,Pleural effusion NOS,Cholelith w ac cholecyst,Abdom aortic aneurysm,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Crnry athrscl natve vssl
Admission Date:  [**2177-10-22**]              Discharge Date:   [**2177-10-22**]

Date of Birth:  [**2100-3-10**]             Sex:   M

Service: MEDICINE

Allergies:
No Drug Allergy Information on File

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

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
This is a 77 year old male with a PMHX CAD, HTN, CVA, AAA,
Aortic dissection, recent acute cholecystitis who was transfered
from [**Location (un) **] for ERCP and who developed respiratory distress in
the ERCP suite. The patient was originally transfered from
rehab/nursing home to [**Hospital **] Hospital for fever, chills and RUQ
pain. At [**Location (un) **], a CT chest and abdomen found a stable right
pleural effusion, stable aortic dissection as well as findings
consistent with acute cholecystitis. He was admitted and treated
with Unasyn then Zosyn. As he was felt to be high risk for
cholecystectomy, Surgery attempted to drain the gallbladder
percutaneously; however, the pigtail catheter fell out. He was
then transfered to [**Hospital1 18**] for ERCP. Per report, he had stable
vital signs during ambulance transport.
.
At [**Hospital1 18**], he was noted to have progressive hypoxia while in the
ERCP suite. He was saturating 94% on 4LNC, then 92% 5L on NRB.
Due to a question of altered mental status and decreased ability
to protect his airway, he was intubated and code was called.
Prior to intubation, he was tachycardic in 130's with SBP 120's
and he received Esmolol 20mg. He also received Demerol 25mg x2
and then Fentanyl 250mcg x2 with intubation.


Past Medical History:
Surgical History
percutaneous drainage of GB - unsucessfull as pigtail fell out
.
Medical History
HTN
CAD with positive Persantine thallium stress test
Chronic aortic dissection type B, managed medically
Hyperlipidemia
CVA with right sided weakness and expressive aphasia
GERD
AAA


Social History:
Residing at Charwell house for nursing home/ rehab.Former
smoker, quit 20 years ago. No alcohol, no illicit drugs.

Family History:
non-contributory


Physical Exam:
Admission
Vitals: T:98.1 P:94 BP:99/58 R:15-20 SaO2: 97%
General: semi-awake, NAD, intubated and lightly sedated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
OP
Neck: supple, no JVD
Pulmonary: intubated, lungs clear on left side, no lung sounds
on right side and dull to percussion
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, ND, normoactive bowel sounds, tender to palpation
in RUQ
Extremities: no edema.
Neurologic: intubated, lightly sedated able to shake his head in
answer to questions


Pertinent Results:
[**2177-10-22**] 04:41PM BLOOD WBC-8.6 RBC-4.51* Hgb-14.0 Hct-43.1
MCV-96 MCH-31.1 MCHC-32.5 RDW-14.4 Plt Ct-246
[**2177-10-22**] 04:41PM BLOOD Neuts-85.0* Lymphs-11.5* Monos-2.8
Eos-0.2 Baso-0.5
[**2177-10-22**] 04:41PM BLOOD Glucose-229* UreaN-20 Creat-0.8 Na-137
K-4.0 Cl-102 HCO3-28 AnGap-11
[**2177-10-22**] 04:41PM BLOOD CK-MB-51* MB Indx-34.0* cTropnT-0.31*
[**2177-10-22**] 04:41PM BLOOD Albumin-2.5* Calcium-8.6 Phos-2.4* Mg-2.5
.
RIGHT UPPER QUADRANT ULTRASOUND: This was a bedside portable
study and is somewhat limited by the patient's habitus and
inability to comply with positional maneuvers while intubated on
a ventilator.
There is no intra- or extra-hepatic biliary ductal dilatation.
The common bile duct measures 5 mm, normal maximal caliber.
There is a small amount of ascites layering around the liver. No
definite focal hepatic lesions are seen, although this study is
limited for this purpose. There is layering sludge within the
gallbladder. A few small more discrete intraluminal echogenic
foci mixed with sludge are probably non-shadowing stones. There
is no gallbladder wall thickening or pericholecystic fluid.
Assessment of the ultrasonic [**Doctor Last Name 515**] sign was not possible.
Doppler evaluation shows forward flow in the main portal vein.

IMPRESSION:
1. Dependent sludge and a few non-shadowing stones in the
gallbladder but no gallbladder wall thickening or adjacent fluid
to suggest acute cholecystitis. If this remains of clinical
concern, evaluation with nuclear medicine HIDA scan could be
performed.
2. No biliary ductal dilatation.
3. Small amount of ascites layering around the liver.

Brief Hospital Course:
The patient was admitted to the ICU after a respiratory code was
called in the ERCP suite. On admission to the ICU, he was
continued on antibiotics, given IVF and was hemodynamically
stable. A RUQ ultrasound was performed and general surgery was
consulted.  The RUQ showed dependent sludge and a few
non-shadowing stones in the gallbladder but no gallbladder wall
thickening or adjacent fluid to suggest acute cholecystitis. A
subsequent review of his [**Hospital **] medical records indicated that
the patient was DNR/DNI. The ICU team then met with his health
care proxy and close friends who confirmed the patient's desire
to be DNR/DNI. His health care proxy then made the decision to
extubated the patient and change his status to comfort measures
only as per the patient's previously stated wishes. The patient
was extubated and placed on a morphine drip. He died several
hours later.

Medications on Admission:
Miralax 17g daily
Toprol-XL 25mg daily
Dulcolax 5mg qhs
Remeron 30mg qhs
Tylenol 1g [**Hospital1 **]
Imdur 30mg daily
Colace 200mg daily
Prilosec 40mg daily
Senna 2tabs qhs
ASA EC 325mg qhs
Ativan 1mg q3hrs PRN


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Acute respiratory failure,Unspecified pleural effusion,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Coronary atherosclerosis of native coronary artery'}


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: respiratory code

PRESENT ILLNESS: This is a 77 year old male with a PMHX CAD, HTN, CVA, AAA,
Aortic dissection, recent acute cholecystitis who was transfered
from [**Location (un) **] for ERCP and who developed respiratory distress in
the ERCP suite. The patient was originally transfered from
rehab/nursing home to [**Hospital **] Hospital for fever, chills and RUQ
pain. At [**Location (un) **], a CT chest and abdomen found a stable right
pleural effusion, stable aortic dissection as well as findings
consistent with acute cholecystitis. He was admitted and treated
with Unasyn then Zosyn. As he was felt to be high risk for
cholecystectomy, Surgery attempted to drain the gallbladder
percutaneously; however, the pigtail catheter fell out. He was
then transfered to [**Hospital1 18**] for ERCP. Per report, he had stable
vital signs during ambulance transport.
.
At [**Hospital1 18**], he was noted to have progressive hypoxia while in the
ERCP suite. He was saturating 94% on 4LNC, then 92% 5L on NRB.
Due to a question of altered mental status and decreased ability
to protect his airway, he was intubated and code was called.
Prior to intubation, he was tachycardic in 130's with SBP 120's
and he received Esmolol 20mg. He also received Demerol 25mg x2
and then Fentanyl 250mcg x2 with intubation.

MEDICAL HISTORY: Surgical History
percutaneous drainage of GB - unsucessfull as pigtail fell out
.
Medical History
HTN
CAD with positive Persantine thallium stress test
Chronic aortic dissection type B, managed medically
Hyperlipidemia
CVA with right sided weakness and expressive aphasia
GERD
AAA

MEDICATION ON ADMISSION: Miralax 17g daily
Toprol-XL 25mg daily
Dulcolax 5mg qhs
Remeron 30mg qhs
Tylenol 1g [**Hospital1 **]
Imdur 30mg daily
Colace 200mg daily
Prilosec 40mg daily
Senna 2tabs qhs
ASA EC 325mg qhs
Ativan 1mg q3hrs PRN

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: Admission
Vitals: T:98.1 P:94 BP:99/58 R:15-20 SaO2: 97%
General: semi-awake, NAD, intubated and lightly sedated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
OP
Neck: supple, no JVD
Pulmonary: intubated, lungs clear on left side, no lung sounds
on right side and dull to percussion
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, ND, normoactive bowel sounds, tender to palpation
in RUQ
Extremities: no edema.
Neurologic: intubated, lightly sedated able to shake his head in
answer to questions

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Residing at Charwell house for nursing home/ rehab.Former
smoker, quit 20 years ago. No alcohol, no illicit drugs. 

### Response:
{'Acute respiratory failure,Unspecified pleural effusion,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Coronary atherosclerosis of native coronary artery'}
