CHIEF COMPLAINT: hypoxic respiratory failure
hypotension

PRESENT ILLNESS: 77 yo M with dementia, schizophrenia, HTN, DM presents to ED
after removing his PEG tube.

MEDICAL HISTORY: Dementia
Paranoid Schizophrenia
DM2
Prostate Ca
Hypertension
GERD
Angina
Bipolar d/o
COPD
Hearing impaired

MEDICATION ON ADMISSION: 1. Aspirin 81 mg qday
2. Atenolol 12.5 mg qday
3. Rosiglitazone 2 mg qday
4. Ferrous Sulfate 220 mg/5mL Elixir Sig: 7.5 ml PO qday
5. Amlodipine 5 mg qday
6. Clopidogrel 75 mg qday
7. Haloperidol Decanoate 25mg IM Intramuscular Every other Wed.
8. Olanzapine 5 mg qday
9. Zantac 150 mg [**Hospital1 **]
10. Benztropine 1 mg TID
11. Haloperidol 1 mg [**Hospital1 **]:PRN
12. Ipratropium Bromide 0.02 % Q6hrs:prn
13. Albuterol Sulfate 0.083 % Q6hrs:prn
14. RISS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 94 BP 89/58 HR 92 RR 24 O2sats 93% NRB CVP 3
Gen: Agitated gentleman, who is tachypneic.  Responds to yes/no
questions but otherwise non-communitative
HEENT: PERRL, dry mm, anicteric
Neck: No obvious LAD
Lungs: Course rhonchi bilaterally
Heart: Tachy, difficult to appreciate any murmurs given lungs
sounds
Abd: Soft, NT, ND, hypoactive bowel sounds.  Site of PEG tube
with pink tissue no obvious infection
Ext: No edema, 1+ DP/PT's
Neuro: Only answers yes/no questions.  Moving all 4 extremities.
 Unable to otherwise assess due to lack of cooperation.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Patient lives in [**Location **] Manor nursing [**Last Name (un) **], wheelchair bound. He
has one son who lives in the area. He smokes 10 cigarettes/day.
Baseline ADL/IADLs unknown.
- Guardian has been appointed by family in past given
difficulties with relationship between son and patient re:
forced psychiatric hospitalizations
Unspecified septicemia,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Schizophrenic disorders, residual type, unspecified,Acute kidney failure with lesion of tubular necrosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypovolemia,Thrombocytopenia, unspecified,Cardiac arrest,Iatrogenic pneumothorax,Severe sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Delirium due to conditions classified elsewhere,Epistaxis
Septicemia NOS,Acute respiratry failure,Chr airway obstruct NEC,Food/vomit pneumonitis,Schizophr dis resid NOS,Ac kidny fail, tubr necr,Hyp kid NOS w cr kid V,Hypovolemia,Thrombocytopenia NOS,Cardiac arrest,Iatrogenic pneumothorax,Severe sepsis,DMII wo cmp nt st uncntr,Delirium d/t other cond,Epistaxis
Admission Date:  [**2174-3-12**]              Discharge Date:   [**2174-4-15**]

Date of Birth:  [**2096-8-7**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
hypoxic respiratory failure
hypotension

Major Surgical or Invasive Procedure:
Endotracheal intubation
Subclavian central line
Thoracostomy tube placement

History of Present Illness:
77 yo M with dementia, schizophrenia, HTN, DM presents to ED
after removing his PEG tube.

When he initially arrived from [**Location **] he was doing well.  Enroute
his vital signs were T 97.9 BP 128/70 HR 72 RR 20 O2sats 95% RA.
 He was sent to the ED for replacement of his PEG tube.  In the
ED he vomited and developed hypotension and hypoxia.  His sats
dropped into the 80's on room air and BP into the 80's.  CXR
then showed RLL/RML infiltrate.  He was found to have
significant bandemia and then was treated as code sepsis.  He
was given 3 L of NS with good response in his BP.  He was
continued on NRB with appropriate bump in oxygen level.  He was
also given Zosyn/Vanco for antibiotic coverage.

He is only able to respond with yes or no answers.  At this time
he denies ant chest pain or abd pain.  Otherwise unable to
obtain history from this gentleman.  I spoke to both his
guardian and son who were not aware he was brought to the
hospital.  They said at baseline he is only able to give yes/no
answers.

Past Medical History:
Dementia
Paranoid Schizophrenia
DM2
Prostate Ca
Hypertension
GERD
Angina
Bipolar d/o
COPD
Hearing impaired


Social History:
Patient lives in [**Location **] Manor nursing [**Last Name (un) **], wheelchair bound. He
has one son who lives in the area. He smokes 10 cigarettes/day.
Baseline ADL/IADLs unknown.
- Guardian has been appointed by family in past given
difficulties with relationship between son and patient re:
forced psychiatric hospitalizations


Family History:
Noncontributory

Physical Exam:
T 94 BP 89/58 HR 92 RR 24 O2sats 93% NRB CVP 3
Gen: Agitated gentleman, who is tachypneic.  Responds to yes/no
questions but otherwise non-communitative
HEENT: PERRL, dry mm, anicteric
Neck: No obvious LAD
Lungs: Course rhonchi bilaterally
Heart: Tachy, difficult to appreciate any murmurs given lungs
sounds
Abd: Soft, NT, ND, hypoactive bowel sounds.  Site of PEG tube
with pink tissue no obvious infection
Ext: No edema, 1+ DP/PT's
Neuro: Only answers yes/no questions.  Moving all 4 extremities.
 Unable to otherwise assess due to lack of cooperation.


Pertinent Results:
From [**Location (un) **] [**3-11**]
WBC 5.2 Hct 32 plts 212
Na 138 K 4.9 Cl 101 CO2 31 BUN/Cr 45/1.1 ALT 31 AST 27
.
CXR #1- Continued diffuse mild fluffy opacity in the right lung
with
interval development of a more focal area of consolidation in
the right mid lung and interval improvement in aeration in the
right lower lung.  There is overall improved appearance of the
left retrocardiac region with a residual streaky opacity.
.
CXR #2- Left subclavian in place in SVC.
.
ECG: NSR at 81, nl axis, nl intervals, Qwave in inferior leads,
no ther acute/ischemic ST/Twave changes

Brief Hospital Course:
77M schizophrenia, advanced dementia, initially presented for
PEG dislodgement, subsequently complicated by sepsis,
pneumothorax complicating central line placement, hypoxic
respiratory failure, ventilator associated pneumonia, ultimately
leading to withdrawal of care and expiration.

Briefly, the pt was initially brought to [**Hospital1 18**] for replacement
of feeding tube, however, his course was complicated by shock
thought to be [**1-21**] sepsis.  Pt underwent central line placement
which was complicated by pneumothorax requiring thoracostomy
tube placement.  In addition, pt's course was also complicated
by hypoxic respiratory failure requiring intubation, ultimately
further complicated by ventilator associated pneumonia.
Multiple attempts to wean towards extubation failed as a result
of 1) asystolic arrest, 2) tachypnea to 40s-50s, 3) agitation
and discomfort.

Given extended endotracheal intubation time, discussion was had
with guardian who felt that this was not according to pt's
wishes.  In addition, guardian refused further invasive
procedures as pt's clinical status continued to decline.
However, guardian felt uncomfortable initially with moving
towards comfort measures due to an isolated statement made by
the pt in the distant past.  Nevertheless, following a court
hearing, it was decided by all parties including pt's sons that
pt would not have wanted continued aggressive care given his
extremely poor quality of life and prognosis.

Pt was made comfort measures only and extubated.  He expired
[**2174-4-15**].

Medications on Admission:
1. Aspirin 81 mg qday
2. Atenolol 12.5 mg qday
3. Rosiglitazone 2 mg qday
4. Ferrous Sulfate 220 mg/5mL Elixir Sig: 7.5 ml PO qday
5. Amlodipine 5 mg qday
6. Clopidogrel 75 mg qday
7. Haloperidol Decanoate 25mg IM Intramuscular Every other Wed.
8. Olanzapine 5 mg qday
9. Zantac 150 mg [**Hospital1 **]
10. Benztropine 1 mg TID
11. Haloperidol 1 mg [**Hospital1 **]:PRN
12. Ipratropium Bromide 0.02 % Q6hrs:prn
13. Albuterol Sulfate 0.083 % Q6hrs:prn
14. RISS

Discharge Disposition:
Expired

Discharge Diagnosis:
Septic Shock
Pneumothorax
Severe dementia
Schizophrenia
Hypoxic respiratory failure
Probable Community acquired pneumonia
Ventilator associated pneumonia

Discharge Condition:
Expired
{'Unspecified septicemia,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Schizophrenic disorders, residual type, unspecified,Acute kidney failure with lesion of tubular necrosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypovolemia,Thrombocytopenia, unspecified,Cardiac arrest,Iatrogenic pneumothorax,Severe sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Delirium due to conditions classified elsewhere,Epistaxis'}


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: hypoxic respiratory failure
hypotension

PRESENT ILLNESS: 77 yo M with dementia, schizophrenia, HTN, DM presents to ED
after removing his PEG tube.

MEDICAL HISTORY: Dementia
Paranoid Schizophrenia
DM2
Prostate Ca
Hypertension
GERD
Angina
Bipolar d/o
COPD
Hearing impaired

MEDICATION ON ADMISSION: 1. Aspirin 81 mg qday
2. Atenolol 12.5 mg qday
3. Rosiglitazone 2 mg qday
4. Ferrous Sulfate 220 mg/5mL Elixir Sig: 7.5 ml PO qday
5. Amlodipine 5 mg qday
6. Clopidogrel 75 mg qday
7. Haloperidol Decanoate 25mg IM Intramuscular Every other Wed.
8. Olanzapine 5 mg qday
9. Zantac 150 mg [**Hospital1 **]
10. Benztropine 1 mg TID
11. Haloperidol 1 mg [**Hospital1 **]:PRN
12. Ipratropium Bromide 0.02 % Q6hrs:prn
13. Albuterol Sulfate 0.083 % Q6hrs:prn
14. RISS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 94 BP 89/58 HR 92 RR 24 O2sats 93% NRB CVP 3
Gen: Agitated gentleman, who is tachypneic.  Responds to yes/no
questions but otherwise non-communitative
HEENT: PERRL, dry mm, anicteric
Neck: No obvious LAD
Lungs: Course rhonchi bilaterally
Heart: Tachy, difficult to appreciate any murmurs given lungs
sounds
Abd: Soft, NT, ND, hypoactive bowel sounds.  Site of PEG tube
with pink tissue no obvious infection
Ext: No edema, 1+ DP/PT's
Neuro: Only answers yes/no questions.  Moving all 4 extremities.
 Unable to otherwise assess due to lack of cooperation.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Patient lives in [**Location **] Manor nursing [**Last Name (un) **], wheelchair bound. He
has one son who lives in the area. He smokes 10 cigarettes/day.
Baseline ADL/IADLs unknown.
- Guardian has been appointed by family in past given
difficulties with relationship between son and patient re:
forced psychiatric hospitalizations 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Schizophrenic disorders, residual type, unspecified,Acute kidney failure with lesion of tubular necrosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hypovolemia,Thrombocytopenia, unspecified,Cardiac arrest,Iatrogenic pneumothorax,Severe sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Delirium due to conditions classified elsewhere,Epistaxis'}
