CHIEF COMPLAINT: post anoxic brain injury

PRESENT ILLNESS: 56F with history of pneumococcal sepsis w/ multiple
complications in [**2181**], hypercholesterolemia, depression awoke
from sleeping at 1am this morning saying she could not breathe.
She became unresponsive and EMS arrived where she was found to
be bradycardic in the 20s and in PEA arrest. She was intubated
in the field and given epi and atropine. The rhythm changed to
VF and she converted to sinus tach. Estimated time of low
perfusion was ~40 minutes. She was transferred to [**Hospital1 18**]
intubated, sedated.

MEDICAL HISTORY: pneumococcl sepsis in [**2181**], c/b ARDS, ARF
depression
hypercholesterolemia
multinodular goiter

MEDICATION ON ADMISSION: lipitor 10mg qd
risperdal 1mg qhs for sleep

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 93, 79, 120/85, AC 500 x 20, 1.0/5
Gen: intubated woman, laying in bed, covered with warming
blanket, generalized myoclonus of face, arms, axial muscles
HEENT: NC/AT, anicteric sclera, MMM
Neck: supple, no carotid bruits, + multinodular goiter
Chest: course BS bilterally
CV: RRR without murmurs
Abd: soft, NT/ND, +BS, no HSM, obese
Ext: no edema, WWP, radial and DP pulses 2+
Neuro:
MS: does not open eyes to voice or stimulation
CN:
-pupils 4->2mm bilaterally and reactive
-fundi with crisp disc margins, no hemorrhages, discs with rim
of hyperpigmentation surrounding disc laterally
-EOM exam: no dolls, no spontaneous eye movements
-Corneal reflex: present b/l
-facial symmetry: appers symmetric but ETT limits exam
-gag reflex: not present
Motor: + myoclonus of eye lids/face/chest/arms, nonrhythmic. No
spontaneous movement of any limbs. Hypotonic extremities.
Sensory: withdraws arms to painful stimuli, triple flexion legs
bilaterally to painful stim.
Reflexes: 2+ [**Hospital1 **]/br/tri/pat/ach, toes upgoing b/l

FAMILY HISTORY: DM in parents, prostate CA in family, mother with ovarian
cancer, no CVA or seizures

SOCIAL HISTORY: lives at home with boyfriend and uncle, 2 children, divorced, 60
pack-year h/o smoking, social EtOH, no IVDA. Works in patient
information at [**Hospital1 18**].
Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Grand mal status,Anoxic brain damage,Unspecified essential hypertension,Goiter, unspecified,Obesity, unspecified,Pure hypercholesterolemia
Cardiac arrest,Food/vomit pneumonitis,Grand mal status,Anoxic brain damage,Hypertension NOS,Goiter NOS,Obesity NOS,Pure hypercholesterolem
Admission Date:  [**2186-7-12**]              Discharge Date:   [**2186-7-17**]

Date of Birth:  [**2130-2-7**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 297**]
Chief Complaint:
post anoxic brain injury

Major Surgical or Invasive Procedure:
none

History of Present Illness:
56F with history of pneumococcal sepsis w/ multiple
complications in [**2181**], hypercholesterolemia, depression awoke
from sleeping at 1am this morning saying she could not breathe.
She became unresponsive and EMS arrived where she was found to
be bradycardic in the 20s and in PEA arrest. She was intubated
in the field and given epi and atropine. The rhythm changed to
VF and she converted to sinus tach. Estimated time of low
perfusion was ~40 minutes. She was transferred to [**Hospital1 18**]
intubated, sedated.

Past Medical History:
pneumococcl sepsis in [**2181**], c/b ARDS, ARF
depression
hypercholesterolemia
multinodular goiter

Social History:
lives at home with boyfriend and uncle, 2 children, divorced, 60
pack-year h/o smoking, social EtOH, no IVDA. Works in patient
information at [**Hospital1 18**].

Family History:
DM in parents, prostate CA in family, mother with ovarian
cancer, no CVA or seizures

Physical Exam:
VS: 93, 79, 120/85, AC 500 x 20, 1.0/5
Gen: intubated woman, laying in bed, covered with warming
blanket, generalized myoclonus of face, arms, axial muscles
HEENT: NC/AT, anicteric sclera, MMM
Neck: supple, no carotid bruits, + multinodular goiter
Chest: course BS bilterally
CV: RRR without murmurs
Abd: soft, NT/ND, +BS, no HSM, obese
Ext: no edema, WWP, radial and DP pulses 2+
Neuro:
MS: does not open eyes to voice or stimulation
CN:
-pupils 4->2mm bilaterally and reactive
-fundi with crisp disc margins, no hemorrhages, discs with rim
of hyperpigmentation surrounding disc laterally
-EOM exam: no dolls, no spontaneous eye movements
-Corneal reflex: present b/l
-facial symmetry: appers symmetric but ETT limits exam
-gag reflex: not present
Motor: + myoclonus of eye lids/face/chest/arms, nonrhythmic. No
spontaneous movement of any limbs. Hypotonic extremities.
Sensory: withdraws arms to painful stimuli, triple flexion legs
bilaterally to painful stim.
Reflexes: 2+ [**Hospital1 **]/br/tri/pat/ach, toes upgoing b/l


Pertinent Results:
[**2186-7-12**] 02:27AM URINE  COLOR-Straw APPEAR-Hazy SP [**Last Name (un) 155**]-1.013
[**2186-7-12**] 02:27AM URINE  BLOOD-SM NITRITE-NEG PROTEIN-500
GLUCOSE-1000 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2186-7-12**] 02:27AM URINE  RBC-[**11-26**]* WBC-<1 BACTERIA-MOD
YEAST-RARE EPI-0-2
[**2186-7-12**] 02:27AM   FIBRINOGE-357
[**2186-7-12**] 02:27AM   PT-11.5 PTT-23.3 INR(PT)-0.9
[**2186-7-12**] 02:27AM   WBC-6.2 RBC-4.43 HGB-12.2 HCT-36.3 MCV-82
MCH-27.6 MCHC-33.7 RDW-13.7
[**2186-7-12**] 02:27AM   PLT COUNT-244
[**2186-7-12**] 02:27AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2186-7-12**] 02:27AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2186-7-12**] 02:27AM   CK-MB-2
[**2186-7-12**] 02:27AM   CK(CPK)-125 AMYLASE-91
[**2186-7-12**] 02:27AM   UREA N-26* CREAT-1.3*
[**2186-7-12**] 02:31AM   freeCa-1.10*
[**2186-7-12**] 02:31AM   HGB-12.3 calcHCT-37 O2 SAT-92 CARBOXYHB-7.6*
MET HGB-0.3
[**2186-7-12**] 02:31AM   GLUCOSE-242* LACTATE-6.0* NA+-142 K+-4.0
CL--107
[**2186-7-12**] 02:31AM   PH-7.32* COMMENTS-GREEN TOP
[**2186-7-12**] 02:34AM   cTropnT-<0.01

Brief Hospital Course:
The patient was transferred to the CCU because the cause of the
patient's cardiac arrest was unclear. A TTE showed normal EF and
a very small pericardial effusion with no signs of tamponade. A
CTA was negative for PE and only showed small bilateral
atelectasis and the known goiter. Tox screens were negative. A
head CT showed global loss of [**Doctor Last Name 352**]-white differentiation, which
was concerning for edema related to ischemia. The patient was
started on mannitol. EEG showed frequent discharges c/w either
non-convlusive status or periodic epileptiform discharges with
suppression pattern. A pentobarb coma was initiated because of
failure of dilantin and phenobarbitol to suppress this activity.
Her care was transferred to the MICU team given her normal CV
status.

In consultation with [**Doctor Last Name **], the patient's prognosis for any
meaningful recovery was deemed to be very poor. After several
family meetings with members of the ICU team, her PCP,
[**Name10 (NameIs) **], nurses, and social worker/case management, the
decision was made by the family to withdraw care. Given the
patient's wishes to be an organ donor, the patient received
30,000U of heparin IV at the time of extubation on [**2186-7-17**]. The
patient expired at 1356 on [**2186-7-17**].

Medications on Admission:
lipitor 10mg qd
risperdal 1mg qhs for sleep

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
PEA arrest of unclear etiology

Discharge Condition:
expired

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Grand mal status,Anoxic brain damage,Unspecified essential hypertension,Goiter, unspecified,Obesity, unspecified,Pure hypercholesterolemia'}


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: post anoxic brain injury

PRESENT ILLNESS: 56F with history of pneumococcal sepsis w/ multiple
complications in [**2181**], hypercholesterolemia, depression awoke
from sleeping at 1am this morning saying she could not breathe.
She became unresponsive and EMS arrived where she was found to
be bradycardic in the 20s and in PEA arrest. She was intubated
in the field and given epi and atropine. The rhythm changed to
VF and she converted to sinus tach. Estimated time of low
perfusion was ~40 minutes. She was transferred to [**Hospital1 18**]
intubated, sedated.

MEDICAL HISTORY: pneumococcl sepsis in [**2181**], c/b ARDS, ARF
depression
hypercholesterolemia
multinodular goiter

MEDICATION ON ADMISSION: lipitor 10mg qd
risperdal 1mg qhs for sleep

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 93, 79, 120/85, AC 500 x 20, 1.0/5
Gen: intubated woman, laying in bed, covered with warming
blanket, generalized myoclonus of face, arms, axial muscles
HEENT: NC/AT, anicteric sclera, MMM
Neck: supple, no carotid bruits, + multinodular goiter
Chest: course BS bilterally
CV: RRR without murmurs
Abd: soft, NT/ND, +BS, no HSM, obese
Ext: no edema, WWP, radial and DP pulses 2+
Neuro:
MS: does not open eyes to voice or stimulation
CN:
-pupils 4->2mm bilaterally and reactive
-fundi with crisp disc margins, no hemorrhages, discs with rim
of hyperpigmentation surrounding disc laterally
-EOM exam: no dolls, no spontaneous eye movements
-Corneal reflex: present b/l
-facial symmetry: appers symmetric but ETT limits exam
-gag reflex: not present
Motor: + myoclonus of eye lids/face/chest/arms, nonrhythmic. No
spontaneous movement of any limbs. Hypotonic extremities.
Sensory: withdraws arms to painful stimuli, triple flexion legs
bilaterally to painful stim.
Reflexes: 2+ [**Hospital1 **]/br/tri/pat/ach, toes upgoing b/l

FAMILY HISTORY: DM in parents, prostate CA in family, mother with ovarian
cancer, no CVA or seizures

SOCIAL HISTORY: lives at home with boyfriend and uncle, 2 children, divorced, 60
pack-year h/o smoking, social EtOH, no IVDA. Works in patient
information at [**Hospital1 18**]. 

### Response:
{'Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Grand mal status,Anoxic brain damage,Unspecified essential hypertension,Goiter, unspecified,Obesity, unspecified,Pure hypercholesterolemia'}
