CHIEF COMPLAINT: Found down

PRESENT ILLNESS: 50-year-old male with history of bipolar disorder and asthma who
was found down by his roommate.  Per EMS, roommate raised
suspicion of overdose on sleeping pills.  He was brought to an
OSH where he was given 1mg narcan with minimal benefit.  He was
subsequently intubated as he was unresponsive and snoring
deeply. He had head CT that showed "diffuse loss of grey/white
matter consistent with global hypoxic ischemia."  Initial ABG
was 7.18/68/482/25.  WBC 19 at OSH.  Tox screen at OSH was
negative.

MEDICAL HISTORY: Bipolar disorder
Asthma
tobacco abuse
alcoholism in the past.
head injury (beaten int he head and hospitalized in [**State 40074**]in [**10/2094**])
cocaine/heroine abuse clean since [**2098**], hep B and C negative.

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from  PCP, [**Name10 (NameIs) **]
bottles.
1. traZODONE 300 mg PO HS
2. Divalproex (EXTended Release) 500 mg PO BID
3. Quetiapine extended-release 300 mg PO HS
4. BusPIRone 10 mg PO BID
5. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
6. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation
Inhalation q4h shortness of breath
7. Ibuprofen 800 mg PO Q8H:PRN pain
8. Pantoprazole 40 mg PO Q24H
9. Risperidone 2 mg PO DAILY

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: ADMISSION EXAM
General: Intubated, sedated, not following commands, not
withdrawing to painful stimuli
HEENT: Sclera anicteric, left pupil not reactive, right surgical
pupil
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: sedated, not withdrawing to painful stimuli, not
following commands

FAMILY HISTORY: non contributory

SOCIAL HISTORY: unable to obtain but per PCP, [**Name10 (NameIs) **] of alcohol/heroin/cocaine
abuse.
Poisoning by heroin,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acidosis,Other conditions of brain,Accidental poisoning by heroin,Asthma, unspecified type, unspecified,Tobacco use disorder,Bipolar disorder, unspecified,Opioid type dependence, unspecified,Personal history of traumatic brain injury
Poisoning-heroin,Food/vomit pneumonitis,Acute respiratry failure,Acidosis,Brain conditions NEC,Acc poison-heroin,Asthma NOS,Tobacco use disorder,Bipolar disorder NOS,Opioid dependence-unspec,Hx traumatc brain injury
Admission Date:  [**2100-10-21**]              Discharge Date:   [**2100-10-23**]

Date of Birth:  [**2049-12-4**]             Sex:   M

Service: MEDICINE

Allergies:
No Allergies/ADRs on File

Attending:[**First Name3 (LF) 594**]
Chief Complaint:
Found down

Major Surgical or Invasive Procedure:
Extubated [**2100-10-21**] (was intubated at outside hospital)

History of Present Illness:
50-year-old male with history of bipolar disorder and asthma who
was found down by his roommate.  Per EMS, roommate raised
suspicion of overdose on sleeping pills.  He was brought to an
OSH where he was given 1mg narcan with minimal benefit.  He was
subsequently intubated as he was unresponsive and snoring
deeply. He had head CT that showed "diffuse loss of grey/white
matter consistent with global hypoxic ischemia."  Initial ABG
was 7.18/68/482/25.  WBC 19 at OSH.  Tox screen at OSH was
negative.

He was transferred to [**Hospital1 18**] ED where initial VS were: 98.4  79
111/77 20 100%.  Per neurology notes, his sedation was lightened
at the ED and he was noted to have strong purposeful movements
and became very agitated.  OG tube drained maroon colored
substances.  He was trace guaiac positive on rectal exam.  She
was bolused with PPI and started on a drip. Repeat head CT w/o
contrast showed no acute intracranial process.  CTA neck showed
no dissection of the carotid/vertebral arteries.  CT chest
showed no acute injury and nodular ground glass opacities in
right upper and lower lobes.


Past Medical History:
Bipolar disorder
Asthma
tobacco abuse
alcoholism in the past.
head injury (beaten int he head and hospitalized in [**State 40074**]in [**10/2094**])
cocaine/heroine abuse clean since [**2098**], hep B and C negative.


Social History:
unable to obtain but per PCP, [**Name10 (NameIs) **] of alcohol/heroin/cocaine
abuse.

Family History:
non contributory

Physical Exam:
ADMISSION EXAM
General: Intubated, sedated, not following commands, not
withdrawing to painful stimuli
HEENT: Sclera anicteric, left pupil not reactive, right surgical
pupil
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: sedated, not withdrawing to painful stimuli, not
following commands

DISCHARGE EXAM
ambulatory, oriented x3, intermittently agitated but
redirectable. Otherwise, abdominal, cardiopulmonary and
neurologic exams are within normal limits.

Pertinent Results:
ADMISSION LABS

[**2100-10-21**] 02:25AM BLOOD WBC-17.5* RBC-4.96 Hgb-15.4 Hct-50.0
MCV-101* MCH-31.1 MCHC-30.8* RDW-12.7 Plt Ct-242
[**2100-10-21**] 02:25AM BLOOD Neuts-83.7* Lymphs-11.2* Monos-4.4
Eos-0.4 Baso-0.2
[**2100-10-21**] 02:25AM BLOOD Neuts-83.7* Lymphs-11.2* Monos-4.4
Eos-0.4 Baso-0.2
[**2100-10-21**] 02:25AM BLOOD PT-10.2 PTT-27.7 INR(PT)-0.9
[**2100-10-21**] 02:25AM BLOOD Glucose-115* UreaN-17 Creat-1.2 Na-140
K-4.8 Cl-107 HCO3-24 AnGap-14
[**2100-10-21**] 02:25AM BLOOD CK(CPK)-135
[**2100-10-21**] 10:12AM BLOOD ALT-17 AST-36 CK(CPK)-311 AlkPhos-58
TotBili-0.5
[**2100-10-21**] 02:25AM BLOOD cTropnT-<0.01
[**2100-10-21**] 10:12AM BLOOD CK-MB-4 cTropnT-<0.01
[**2100-10-23**] 04:05AM BLOOD CK-MB-3 cTropnT-<0.01
[**2100-10-21**] 10:12AM BLOOD Albumin-4.0 Calcium-8.5 Phos-3.7 Mg-1.8
[**2100-10-21**] 10:12AM BLOOD Ammonia-28
[**2100-10-21**] 10:12AM BLOOD Valproa-LESS THAN
[**2100-10-21**] 02:25AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2100-10-21**] 02:59AM BLOOD Type-ART pO2-78* pCO2-61* pH-7.23*
calTCO2-27 Base XS--3 Comment-GREEN TOP
[**2100-10-21**] 02:55AM BLOOD Lactate-1.9
[**2100-10-21**] 02:25AM URINE Blood-NEG Nitrite-NEG Protein-30
Glucose-300 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG

PERTINENT STUDIES
[**2100-10-21**] 05:20AM URINE bnzodzp-NEG barbitr-NEG opiates-POS
cocaine-NEG amphetm-NEG mthdone-NEG
[**2100-10-21**] BLOOD CULTURE PENDING

RADIOLOGY
[**2100-10-21**] EEG
This is an abnormal EEG due to intermittent, moderate amplitude
generalized bursts of delta waves with no associated
epileptiform discharges. The background activity is also slow in
theta frequency. These findings are suggestive of mild to
moderate encephalopathy. There are no focal abnormalities or
epileptiform discharges.

[**2100-10-21**] CXR
Endotracheal tube high in position, terminating approximately
8.5
cm above the level of the carina and should be repositioned.
The nasogastric tube is also high in position, terminating in
the expected location of the mid esophagus, as above.  The above
findings were discussed with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 426**] on [**2100-10-21**]
immediately after the study was read, at approximately 3:18 p.m.
 At that point, the patient had been extubated.

[**2100-10-21**] CT HEAD
1. No evidence of hemorrhage or infarction.
2. Old right medial orbital blow out fracture.

[**2100-10-21**] CT CHEST/ABD/PELVIS
1. No acute injury to the chest, abdomen or pelvis.
2. Nodular ground glass opacity in the right upper and lower
lobes are likely
inflammatory, possible due to aspiration, much less likely
contusions or
malignancy. Non-urgent (outpatient) followup CT after completion
of acute
treatment is recommedended to assure resolution.

[**2100-10-21**] CTA  HEAD AND NECK
No evidence of vascular dissection, stenosis, or occlusion.

DISCHARGE LABS

[**2100-10-23**] 04:05AM BLOOD WBC-9.1 RBC-4.66 Hgb-14.9 Hct-45.5 MCV-98
MCH-32.0 MCHC-32.8 RDW-12.7 Plt Ct-262
[**2100-10-23**] 04:05AM BLOOD Glucose-101* UreaN-9 Creat-0.8 Na-142
K-3.8 Cl-107 HCO3-26 AnGap-13

Brief Hospital Course:
50-year-old male with history of bipolar disorder and asthma who
was found down by his roommate.

# Heroin Overdose: the patient was found not responsive, he was
extubated the morning after his admission. He was very agtitated
for the day following his extubation, and his symptoms were
possibly consistent with withdrawal, either from opioids or from
alcohol. The patient's delirium cleared and he endorsed
overdosing on heroin. Psychiatry assessment cleared him from
Section 12, as he consistently denied SI and the patient was
oriented x3. The patient was going to be discharged but he left
before he received his paperwork, so he left AMA.

# Hypercarbic respiratory failure: Likely due to heroin overdose
causing decreased respiratory drive.  [**Month (only) 116**] also have aspiration
pneumonia vs pneumonitis contributing to respiratory failure.

# Cerebral edema: CT head at OSH reportedly showing diffuse loss
of grey/white matter consistent with global hypoxic ischemia.
Repeat CT head here did not show acute process.  The patient was
recommended to get MRI but was too agitated to obtain one and
then was ready for discharge but left AMA.

# Coffee ground emesis: Pt reportedly had coffee ground emesis
and had trace guaiac positive stools at OSH.  On exam at ICU, OG
tube output is gastro-occult negative and never had recurrence.


# Leukocytosis: WBC elevated to 17 on initiation, this resolved.
Likely due to hemoconcentration as Hct is elevated to 50.

# Bipolar disorder: per psychiatry, should resume home
medications at time of discharge. Patient denied SI or
intentional overdose.

# Communication: [**First Name8 (NamePattern2) 2048**] [**Known lastname **] [**Telephone/Fax (1) 112195**]; [**Name (NI) 18659**] (brother)
[**Telephone/Fax (1) 112196**]; [**Known firstname 56474**] home number-[**Numeric Identifier 112197**]-called but it was
disconnected. PCP's Office: [**Numeric Identifier 112198**]-overhead page Dr.[**Name (NI) 112199**]
nurse, [**Doctor First Name **].
# Code: Presumed full

Medications on Admission:
Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from  PCP, [**Name10 (NameIs) **]
bottles.
1. traZODONE 300 mg PO HS
2. Divalproex (EXTended Release) 500 mg PO BID
3. Quetiapine extended-release 300 mg PO HS
4. BusPIRone 10 mg PO BID
5. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
6. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation
Inhalation q4h shortness of breath
7. Ibuprofen 800 mg PO Q8H:PRN pain
8. Pantoprazole 40 mg PO Q24H
9. Risperidone 2 mg PO DAILY


Discharge Medications:
1. BusPIRone 10 mg PO BID
2. Divalproex (EXTended Release) 500 mg PO BID
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
4. Ibuprofen 800 mg PO Q8H:PRN pain
5. Pantoprazole 40 mg PO Q24H
6. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation
Inhalation q4h shortness of breath
7. Quetiapine extended-release 300 mg PO HS
8. traZODONE 300 mg PO HS
9. Risperidone 2 mg PO DAILY


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Heroin use
Hypercarbic respiratory failure

Secondary:
Bipolar disorder
Polysubstsance use


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
It was a pleasure taking care of you in the hospital.  You were
admitted after being found down in your home.  This was likely
due to using heroin.  A breathing tube was placed to protect
your airway.  It is very important that you stop using heroin
because it can cause breathing difficulties and even death.  We
were able to remove the breathing tube.  You were evaluated by
our psychiatry team who felt that you had capacity to make
decisions.  Although we strongly recommended that you stay in
the hospital for further evaluation, you requested that you be
discharged home.  You will be discharged against medical advice.


There were no changes made to your medications.

Followup Instructions:
Please follow up with your primary care provider and with your
psychiatrist within 1-2 weeks of discharge from the hospital.

of note, patient left AMA before receiving his paperwork
although he was ready for discharge.
{'Poisoning by heroin,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acidosis,Other conditions of brain,Accidental poisoning by heroin,Asthma, unspecified type, unspecified,Tobacco use disorder,Bipolar disorder, unspecified,Opioid type dependence, unspecified,Personal history of traumatic brain injury'}


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: Found down

PRESENT ILLNESS: 50-year-old male with history of bipolar disorder and asthma who
was found down by his roommate.  Per EMS, roommate raised
suspicion of overdose on sleeping pills.  He was brought to an
OSH where he was given 1mg narcan with minimal benefit.  He was
subsequently intubated as he was unresponsive and snoring
deeply. He had head CT that showed "diffuse loss of grey/white
matter consistent with global hypoxic ischemia."  Initial ABG
was 7.18/68/482/25.  WBC 19 at OSH.  Tox screen at OSH was
negative.

MEDICAL HISTORY: Bipolar disorder
Asthma
tobacco abuse
alcoholism in the past.
head injury (beaten int he head and hospitalized in [**State 40074**]in [**10/2094**])
cocaine/heroine abuse clean since [**2098**], hep B and C negative.

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from  PCP, [**Name10 (NameIs) **]
bottles.
1. traZODONE 300 mg PO HS
2. Divalproex (EXTended Release) 500 mg PO BID
3. Quetiapine extended-release 300 mg PO HS
4. BusPIRone 10 mg PO BID
5. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
6. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation
Inhalation q4h shortness of breath
7. Ibuprofen 800 mg PO Q8H:PRN pain
8. Pantoprazole 40 mg PO Q24H
9. Risperidone 2 mg PO DAILY

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: ADMISSION EXAM
General: Intubated, sedated, not following commands, not
withdrawing to painful stimuli
HEENT: Sclera anicteric, left pupil not reactive, right surgical
pupil
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: sedated, not withdrawing to painful stimuli, not
following commands

FAMILY HISTORY: non contributory

SOCIAL HISTORY: unable to obtain but per PCP, [**Name10 (NameIs) **] of alcohol/heroin/cocaine
abuse. 

### Response:
{'Poisoning by heroin,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acidosis,Other conditions of brain,Accidental poisoning by heroin,Asthma, unspecified type, unspecified,Tobacco use disorder,Bipolar disorder, unspecified,Opioid type dependence, unspecified,Personal history of traumatic brain injury'}
