CHIEF COMPLAINT: PEA arrest

PRESENT ILLNESS: Patient is a 76 yo male with history of HTN who was undergoing a
urethral structure dilation and cystosopy on day of admission.
For anesthesia, patient recieved fentanyl 75 mcg, propofol
50mcg, sevoflurane, vercuronium. Approximately 20 minutes into
the procedure patient began to become hypotensive, bradycardic
and a pulse could not be palpated. The rhythm appeared to be
sinus brady with PACs. CPR was started as anesthesia could not
get a BP. Patient recieved 3 mg neo and 4-5 mg epi, 50 mg
ephedrine and was started on neo drip at 5 and epi at 0.03 with
BPs in 120s/80s and HR 60s-70 in wandering atrial rhythm. He was
agitated during end of procedure so was given scopolamine prior
to presumed PEA arrest.

MEDICAL HISTORY: Hypertension
Knee arthritis

MEDICATION ON ADMISSION: atenolol 25 mg QD, Norvasc 10 mg QD, Naprosen PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical exam on admission
PE: T 34.1, BP 120's/70's, HR 70's, RR 18, O2sat 100%
Vent: AC 600x15, Fio2 100%, PEEP 5
ABG: 7.31/40/500
GENL: sedated
HEENT: pupils 4mm and minimally reactive
CV: RRR no MRG
Lungs: CTAB, no wheezes
Abd: soft, NT, ND, +BS, guiaic pos brown stool, nl rectal tone
Ext: no edema
GU: blood at tip of penis

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: ex-smoker, quit many years ago, alcohol rarely, no iv drugs
Cardiac complications, not elsewhere classified,Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Acidosis,Other specified causes of urethral stricture,Unspecified essential hypertension,Anemia, unspecified,Pain in joint, ankle and foot
Surg compl-heart,Cardiac arrest,Food/vomit pneumonitis,Acidosis,Urethral stricture NEC,Hypertension NOS,Anemia NOS,Joint pain-ankle
Admission Date:  [**2136-1-3**]              Discharge Date:   [**2136-1-7**]

Date of Birth:  [**2059-5-8**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2932**]
Chief Complaint:
PEA arrest

Major Surgical or Invasive Procedure:
intubation, cystoscopy with urethral dilation


History of Present Illness:
Patient is a 76 yo male with history of HTN who was undergoing a
urethral structure dilation and cystosopy on day of admission.
For anesthesia, patient recieved fentanyl 75 mcg, propofol
50mcg, sevoflurane, vercuronium. Approximately 20 minutes into
the procedure patient began to become hypotensive, bradycardic
and a pulse could not be palpated. The rhythm appeared to be
sinus brady with PACs. CPR was started as anesthesia could not
get a BP. Patient recieved 3 mg neo and 4-5 mg epi, 50 mg
ephedrine and was started on neo drip at 5 and epi at 0.03 with
BPs in 120s/80s and HR 60s-70 in wandering atrial rhythm. He was
agitated during end of procedure so was given scopolamine prior
to presumed PEA arrest.

Past Medical History:
Hypertension
Knee arthritis


Social History:
ex-smoker, quit many years ago, alcohol rarely, no iv drugs

Family History:
noncontributory

Physical Exam:
Physical exam on admission
PE: T 34.1, BP 120's/70's, HR 70's, RR 18, O2sat 100%
Vent: AC 600x15, Fio2 100%, PEEP 5
ABG: 7.31/40/500
GENL: sedated
HEENT: pupils 4mm and minimally reactive
CV: RRR no MRG
Lungs: CTAB, no wheezes
Abd: soft, NT, ND, +BS, guiaic pos brown stool, nl rectal tone
Ext: no edema
GU: blood at tip of penis


Pertinent Results:
Laboratory studies on admission:
[**2136-1-3**]
WBC-16.9 HGB-15.6 HCT-45.6 MCV-90 RDW-12.7 PLT COUNT-444
NEUTS-82.8 BANDS-0 LYMPHS-13.5 MONOS-1.9 EOS-1.8 BASOS-0.1
PT-14.6 PTT-28.0 INR(PT)-1.3
FIBRINOGE-362
CK-MB-4 cTropnT-0.08
TSH-4.9
ALT(SGPT)-12 AST(SGOT)-17 LD(LDH)-180 CK(CPK)-72 ALK PHOS-64
AMYLASE-73 TOT BILI-0.8

Radiology:
[**1-3**] CXR: No pneumothorax, major pleural effusion, or
enlargement of the cardiomediastinal silhouette. Endotracheal
tube and Swan-Ganz catheter in place.

[**1-3**] right lower extremity ultrasound: No evidence for DVT in
the right lower extremity

[**1-3**] TTE: The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Left ventricular systolic function is
hyperdynamic (EF>75%). There is a mild resting left ventricular
outflow tract/cavity obstruction. Right ventricular chamber size
is normal. Right ventricular systolic function is normal. The
aortic valve leaflets are mildly thickened. There is no aortic
valve stenosis. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. There is no pericardial effusion

[**1-5**] right ankle plain film: The tibio talar joint is markedly
abnormal with bone destruction and fragmentation, sclerosis, and
remodellin around the distal tibia, fibula and talus. Soft
tissue calcification is present in the distal tibiofibular
syndesmosis. Findings are stable compared with 5/06. Given the
stability of the findings over time, they most likely reflect
the presence of advanced neuroarthropathy. Osteomyelitis is
considered less likely given the absence of interval change. The
right foot is in valgus alignment. Mid foot and forefoot
articulations are without signicant abnormality. There is
osteopenia.

[**1-6**] CXR PA/lateral: Heart size is borderline for technique.
There is tortuosity of the thoracic aorta. No pneumothorax.
There is persistent ill-defined opacity in the right lower lobe
consistent with apiration/pneumonia, not significantly changed
since the prior film of [**1-5**]. There is probable minimal
atelectasis in the left lower lobe. The lungs are otherwise
clear.

[**1-3**] EKG: Consider wandering atrial pacemaker Low QRS voltages
in limb leads Nonspecific inferolateral T wave changes Since
previous tracing, wandering atrial pacemaker and T wave changes
are present

Laboratory studies on discharge:
[**2136-1-7**]
WBC-10.0 Hgb-12.1 Hct-34.5 MCV-86 RDW-13.5 Plt Ct-251
Glucose-91 UreaN-17 Creat-0.7 Na-136 K-3.5 Cl-100 HCO3-28
Mg-2.1
CK(CPK)-69 CK-MB-3 cTropnT-<0.01

calTIBC-192* VitB12-715 Folate-7.4 Ferritn-347 TRF-148*
TSH-4.9 Free T4-1.7

Brief Hospital Course:
76 year old male with history of hypertension presents with PEA
arrest following cystoscopy and urethral stricture dilation.

1. PEA arrest: This was most likely due to a  reaction to
anaethesia, although anaphlaxis to Kefzol (received prior to
procedure) is possible (tryptase and histamine were high). The
patient was admitted to the intensive care unit, where work-up
included CXR (no evidence of pneumothorax), electrolyte panel
(only notable for mild hypokalemia), echocardiogram (no evidence
of tamponade, mild resting outflow obstruction noted), and
pulmonary artery pressure (not consistent with pulmonary
embolism). Cardiology, who was consulted, felt that the etiology
was unlikely to be myocardial ischemia; he will follow-up with
cardiology as an outpatient. He was treated with 24 hours of
hypothermia (goal temperature 34) for neuroprotection and high
dose steroids for possible anaphylaxis. He was subsequently
warmed and extubated without difficulty. He was transferred to
the general medical floor on [**2136-1-6**].  neuroprotection with
temp control goal 34 initially. Hydrocortisone was given to
treat possible anaphylaxis. He was subsequently extubated
without complication and transferred to the floor. At present
pt's well without complaint.

2. Wandering atrial pacemaker: This was noted on EKG following
his PEA arrest; this subsequently resolved. He will follow-up
with cardiology as an outpatient.

3. Aspiration pneumonia: The patient will complete a 7 day
course of levofloxacin/metronidazole for aspiration pneumonia.

4. Urethral stricture s/p dilation: The patient will continue
with a Foley until he follows up in urology clinic. He will
likely need repeated dilations given teh length of the
stricture.

5. Right foot pain: The patient's foot pain is a chronic issue,
since his motor vehicle accident several years ago. Plain films
were without significant change from prior. He was evaluated by
physical therapy prior to discharge

Medications on Admission:
atenolol 25 mg QD, Norvasc 10 mg QD, Naprosen PRN

Discharge Medications:
1. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
3. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 5 days: Do not drink alcohol while taking this
medication.
Disp:*15 Tablet(s)* Refills:*0*
5. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**1-17**]
Puffs Inhalation Q4H (every 4 hours).
Disp:*1 MDI* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: PEA arrest
Secondary: hypertension, right ankle pain, aspiration pneumonia,
urethral stricture, anemia


Discharge Condition:
Good, 95% O2 sat with ambulation.


Discharge Instructions:
1) Please follow-up as indicated below
2) Please take all medications as prescribed. You will complete
a 7 day course of antibiotics (levofloxacin/metronidazole) - 5
more days. Do not restart Norvasc until directed to do so by
your PCP.
3) Please see your primary care physician or come to the
emergency room if you develop chest pain, lightheadedness,
cough, or shortness of breath

Followup Instructions:
1) Primary Care: Please call to schedule an appointment with Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 7976**]) to be seen within 1-2 weeks following
discharge
2) Urology: Call to schedule an appointment in the resident
clinic ([**Telephone/Fax (1) 164**]) next week for Foley removal
3) Cardiology: Call [**Telephone/Fax (1) 10464**] to schedule an appointment with
Dr. [**Last Name (STitle) 696**] within 2 weeks following discharge.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2937**]

Completed by:[**2136-1-11**]
{'Cardiac complications, not elsewhere classified,Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Acidosis,Other specified causes of urethral stricture,Unspecified essential hypertension,Anemia, unspecified,Pain in joint, ankle and foot'}


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: PEA arrest

PRESENT ILLNESS: Patient is a 76 yo male with history of HTN who was undergoing a
urethral structure dilation and cystosopy on day of admission.
For anesthesia, patient recieved fentanyl 75 mcg, propofol
50mcg, sevoflurane, vercuronium. Approximately 20 minutes into
the procedure patient began to become hypotensive, bradycardic
and a pulse could not be palpated. The rhythm appeared to be
sinus brady with PACs. CPR was started as anesthesia could not
get a BP. Patient recieved 3 mg neo and 4-5 mg epi, 50 mg
ephedrine and was started on neo drip at 5 and epi at 0.03 with
BPs in 120s/80s and HR 60s-70 in wandering atrial rhythm. He was
agitated during end of procedure so was given scopolamine prior
to presumed PEA arrest.

MEDICAL HISTORY: Hypertension
Knee arthritis

MEDICATION ON ADMISSION: atenolol 25 mg QD, Norvasc 10 mg QD, Naprosen PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical exam on admission
PE: T 34.1, BP 120's/70's, HR 70's, RR 18, O2sat 100%
Vent: AC 600x15, Fio2 100%, PEEP 5
ABG: 7.31/40/500
GENL: sedated
HEENT: pupils 4mm and minimally reactive
CV: RRR no MRG
Lungs: CTAB, no wheezes
Abd: soft, NT, ND, +BS, guiaic pos brown stool, nl rectal tone
Ext: no edema
GU: blood at tip of penis

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: ex-smoker, quit many years ago, alcohol rarely, no iv drugs 

### Response:
{'Cardiac complications, not elsewhere classified,Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Acidosis,Other specified causes of urethral stricture,Unspecified essential hypertension,Anemia, unspecified,Pain in joint, ankle and foot'}
