CHIEF COMPLAINT: s/p PEA arrest

PRESENT ILLNESS: [**Age over 90 **] yof with history of HTN, DM, hypothyriodism, BIBEMS to OSH ED
s/p witnessed PEA at home.  Per report, she was in her usual
state of health till 2pm on [**2141-12-2**], after returning from
shopping all day.  Her husband fell onto her and caused her to
fell.  She banged her head against the wall on her way down.
Her granddaughter was present during this time and called 911.
Fire department arrived in 2 minutes, found patient to be
non-responsive without a pulse and apnec.  She received CPR via
BLS for 2 mins.  When ACLS arrived noted patient to be
unresponsive, in sinus brady, no shock was delivered.
.
Once arrived to OSH ED, she was given 80 of succ and 80 of
propofol for RSI (7.5, 24cm at lip, position confirmed - 1 cm
from carina).  Repeat rhythm was in NSR rate of 60-40.  Head CT
was wnl, noted for C3-C6 fusion.  Abd US noted to have calcified
aorta without dissection.  Patient was noted to be unresponsive
per report of OSH, and not moving her limbs.  Cooling was
initiated at 1645 for a baseline of 35 with a goal of 33, this
was done with 2L of cold NS.  Patient was given veccuronium,
versed, propafol.  EKG showed sinus, first degree AV block,
normal ST-T waves, LAD.  Labs were significant for WBC of 5.7,
H&H of 8.8 and 26.7.  Chem7 was Na 137, K 4.4, Cl 107, HC03 21,
BUN 31, cr 1.2, glu 154.  Trop of 0.01.  ABG of 7.38, pCO2 of
38, pO2 483, HCO3 23.  At this point, she was transferred to
[**Hospital1 18**] for further managment.
.
In our ED, her inital vitals were: brady 30-40 SR, BP 130-140,
sats 100% FiO2 of 40%, PEEP of 5.  Temp was noted to be 32.8C
with ice packs, and HR showed persistent bradycardia, cooling
was temporarily stopped, then restarted.  Echo was performed in
the ED by cardiology fellow: The left ventricular cavity size is
normal. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is normal (LVEF>55%). The right ventricle
appears slightly enlarged but is contracting well; [**Last Name (un) 13367**]
sign is absent. The mitral valve leaflets are mildly thickened.
Trivial mitral regurgitation is seen. There is a very small
pericardial effusion. There are no echocardiographic signs of
tamponade.  Labs were similar to OSH.  pH of 7.45, PCO2 26, PO2
175, HCO3 of 17.  Lactate of 0.9.  Access 18x2, 20.  I/O
1.5L/1.25.
.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes (diet control), Hypertension
2. CARDIAC HISTORY:
- CABG:  none
- PERCUTANEOUS CORONARY INTERVENTIONS:  none
- PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
- hypothyroid
- s/p MVC and brain surgery for evacuation of blood (no seizure
activity since) 10 yrs ago.
- C3-C6 fusion
- L hip surgery on [**6-/2141**] [**Hospital1 336**].

MEDICATION ON ADMISSION: - lisinopril 30 mg qd
- famotidine 20 mg qd
- synthyroid 88 mg qd

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
VS: T=31 BP=130/60 HR= 50 RR=16 O2 sat=100
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - Brother had early MI (30s), no other family history of
arrhythmia, MI.

SOCIAL HISTORY: - Tobacco history:  distant, quit 30 yrs ago.
- ETOH: drinks 1 drink per day (wine.
- Illicit drugs:  none
Cardiac arrest,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Anoxic brain damage,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Anemia, unspecified,Arthrodesis status,Do not resuscitate status,Encounter for palliative care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Diseases of tricuspid valve,Emphysema (subcutaneous) (surgical) resulting from procedure,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Other fluid overload
Cardiac arrest,Acute respiratry failure,Food/vomit pneumonitis,Anoxic brain damage,Hypertension NOS,Hypothyroidism NOS,Anemia NOS,Arthrodesis status,Do not resusctate status,Encountr palliative care,DMII wo cmp nt st uncntr,Chr pulmon heart dis NEC,Tricuspid valve disease,Emphysema rsult frm proc,Abn react-procedure NEC,Accid in resident instit,Fluid overload NEC
Admission Date:  [**2141-12-2**]              Discharge Date:   [**2141-12-9**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
s/p PEA arrest

Major Surgical or Invasive Procedure:
none

History of Present Illness:
[**Age over 90 **] yof with history of HTN, DM, hypothyriodism, BIBEMS to OSH ED
s/p witnessed PEA at home.  Per report, she was in her usual
state of health till 2pm on [**2141-12-2**], after returning from
shopping all day.  Her husband fell onto her and caused her to
fell.  She banged her head against the wall on her way down.
Her granddaughter was present during this time and called 911.
Fire department arrived in 2 minutes, found patient to be
non-responsive without a pulse and apnec.  She received CPR via
BLS for 2 mins.  When ACLS arrived noted patient to be
unresponsive, in sinus brady, no shock was delivered.
.
Once arrived to OSH ED, she was given 80 of succ and 80 of
propofol for RSI (7.5, 24cm at lip, position confirmed - 1 cm
from carina).  Repeat rhythm was in NSR rate of 60-40.  Head CT
was wnl, noted for C3-C6 fusion.  Abd US noted to have calcified
aorta without dissection.  Patient was noted to be unresponsive
per report of OSH, and not moving her limbs.  Cooling was
initiated at 1645 for a baseline of 35 with a goal of 33, this
was done with 2L of cold NS.  Patient was given veccuronium,
versed, propafol.  EKG showed sinus, first degree AV block,
normal ST-T waves, LAD.  Labs were significant for WBC of 5.7,
H&H of 8.8 and 26.7.  Chem7 was Na 137, K 4.4, Cl 107, HC03 21,
BUN 31, cr 1.2, glu 154.  Trop of 0.01.  ABG of 7.38, pCO2 of
38, pO2 483, HCO3 23.  At this point, she was transferred to
[**Hospital1 18**] for further managment.
.
In our ED, her inital vitals were: brady 30-40 SR, BP 130-140,
sats 100% FiO2 of 40%, PEEP of 5.  Temp was noted to be 32.8C
with ice packs, and HR showed persistent bradycardia, cooling
was temporarily stopped, then restarted.  Echo was performed in
the ED by cardiology fellow: The left ventricular cavity size is
normal. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is normal (LVEF>55%). The right ventricle
appears slightly enlarged but is contracting well; [**Last Name (un) 13367**]
sign is absent. The mitral valve leaflets are mildly thickened.
Trivial mitral regurgitation is seen. There is a very small
pericardial effusion. There are no echocardiographic signs of
tamponade.  Labs were similar to OSH.  pH of 7.45, PCO2 26, PO2
175, HCO3 of 17.  Lactate of 0.9.  Access 18x2, 20.  I/O
1.5L/1.25.
.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes (diet control), Hypertension
2. CARDIAC HISTORY:
- CABG:  none
- PERCUTANEOUS CORONARY INTERVENTIONS:  none
- PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
- hypothyroid
- s/p MVC and brain surgery for evacuation of blood (no seizure
activity since) 10 yrs ago.
- C3-C6 fusion
- L hip surgery on [**6-/2141**] [**Hospital1 336**].

Social History:
- Tobacco history:  distant, quit 30 yrs ago.
- ETOH: drinks 1 drink per day (wine.
- Illicit drugs:  none

Family History:
- Brother had early MI (30s), no other family history of
arrhythmia, MI.

Physical Exam:
ADMISSION PHYSICAL EXAM
VS: T=31 BP=130/60 HR= 50 RR=16 O2 sat=100
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of *** cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

deceased

Pertinent Results:
ADMISSION LABS

[**2141-12-2**] 07:55PM BLOOD WBC-5.4 RBC-2.97* Hgb-8.9* Hct-27.2*
MCV-92 MCH-29.9 MCHC-32.6 RDW-14.6 Plt Ct-218
[**2141-12-2**] 07:55PM BLOOD Neuts-83.4* Lymphs-12.8* Monos-2.8
Eos-0.7 Baso-0.3
[**2141-12-2**] 07:55PM BLOOD PT-11.0 PTT-28.1 INR(PT)-1.0
[**2141-12-2**] 07:55PM BLOOD Glucose-125* UreaN-27* Creat-0.9 Na-142
K-3.5 Cl-114* HCO3-17* AnGap-15
[**2141-12-3**] 12:42AM BLOOD ALT-27 AST-40 LD(LDH)-243 CK(CPK)-577*
AlkPhos-110* TotBili-0.3
[**2141-12-2**] 07:55PM BLOOD cTropnT-0.03*
[**2141-12-2**] 07:55PM BLOOD Calcium-8.0* Phos-2.3* Mg-1.7
[**2141-12-2**] 08:11PM BLOOD Type-ART Rates-16/ Tidal V-420 PEEP-5
FiO2-40 pO2-175* pCO2-26* pH-7.45 calTCO2-19* Base XS--3
-ASSIST/CON Intubat-INTUBATED
[**2141-12-2**] 08:08PM BLOOD freeCa-1.00*

PERTINENT LABS AND STUDIES

[**2141-12-2**] 07:55PM BLOOD cTropnT-0.03*
[**2141-12-3**] 12:42AM BLOOD CK-MB-55* MB Indx-9.5* cTropnT-0.03*
[**2141-12-3**] 06:15AM BLOOD CK-MB-65* MB Indx-11.0* cTropnT-0.02*
[**2141-12-3**] 12:42AM BLOOD ALT-27 AST-40 LD(LDH)-243 CK(CPK)-577*
AlkPhos-110* TotBili-0.3
[**2141-12-3**] 06:15AM BLOOD CK(CPK)-591*
[**2141-12-2**] 07:55PM BLOOD TSH-3.5

ECHO [**12-2**] There is symmetric left ventricular hypertrophy. The
left ventricular cavity size is normal. Due to suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded. Overall left ventricular systolic function is
normal (LVEF 65%). There is no ventricular septal defect. The
right ventricular free wall is hypertrophied. The right
ventricular cavity is dilated with borderline normal free wall
function. The mitral valve leaflets are mildly thickened.
Trivial mitral regurgitation is seen. The tricuspid valve
leaflets are mildly thickened. Moderate [2+] tricuspid
regurgitation is seen. The pulmonary artery systolic pressure
could not be determined. There is a very small pericardial
effusion. There is an anterior space which most likely
represents a prominent fat pad.

CXR [**12-2**] Single supine AP portable view of the chest was
obtained.
Endotracheal tube is seen, terminating approximately the 3.3 cm
above the
level of the carina. Nasogastric tube is seen coursing below the
level of the diaphragm, distal aspect not included on the image.
Right perihilar opacity may relate to atelectasis or
consolidation from aspiration, less likely infection. The left
lung is clear. No large pleural effusion is seen, although a
trace effusion may be difficult to exclude. The cardiac
silhouette is mildly enlarged. The aorta is calcified and
tortuous.

deceased

Brief Hospital Course:
[**Age over 90 **]yo F with history of HTN, DM, hypothyroidism presents s/p
cardiac arrest on cooling protocol, now deceased.

#PEA arrest - Patient was found to be pulseless after her
husband fell on top of her prior to admission.  She received CPR
in the field but no medications or shocks.  She was brought to
an OSH where she was intubated and received 2L of chilled NS for
post-arrest cooling protocol, she was transferred to [**Hospital1 18**] for
further management.  The precise etiology of her arrest is not
known, however it is not thought to be ischemic.  Here, she was
started on dopamine for hypotension and cooling protocol was
continued for 24 hours via Arctic Sun.  She was rewarmed and
sedation was weaned, her mental status began to slowly improve.
TTE after cooling showed a preserved EF with no wall motion
abnornalities.  There was briefly concern for PE on her repeat
TTE, but CTA chest did not show a PE.

#Neurologic status - She was reported to be not moving her
extremities in the field prior to arrival at the OSH, which is
why the cooling protocol was initiated after her arrest.  After
rewarming was complete, versed and fentanyl were weaned and her
mental status slowly improved, although she had movement in all
4 extremities.  Head CT did not show any acute changes.
Continuous EEG during and after cooling did not show evidence of
seizure.  Neurology was consulted and they felt that she would
have low likelihood of having improvement in her mental status
given her prolonged state of altered mental status due to severe
anoxic brain injury. The patient's family expressed their wish
to transition the patient to comfort measures only. The patient
was extubated [**12-7**] and continued to spontaneously breath until
her death on [**12-9**] at 11:33am.

#Potential aspiration and leukocytosis - There was initial
concern for aspiration with subsequent respiratory arrest after
her fall.  She subsequently developed a worsening opacification
on her CXR but, in alignment with her family's subsequent wishes
for comfort measures only, the patient was not started on abx.

#Pneumomediastinum - There was a small amount of air in the
mediastinum noted on CXR and CT chest.  Etiology is not entirely
clear, this may have been introduced during right IJ line
placement.  Thoracic surgery was contact[**Name (NI) **] and felt that there
was no intervention required.

#Anemia - Her baseline hct is unknown, but she was found to be
anemic with a normal MCV and hct in the 26-29 range during this
admission.  Iron studies were normal.  B12 and folate were 1009
and 9.6.  There was no evidence of bleeding on exam.

#HTN - Home lisinopril was held because of her hypotension at
admission

#Hypothyroidism - Her home levothyroxine was initially converted
to the equivalent IV dose and was continued.

#Code status this admission: FULL CODE, transition to DNR/DNI,
transition to CMO.

#Transitional issues:
deceased.

Medications on Admission:
- lisinopril 30 mg qd
- famotidine 20 mg qd
- synthyroid 88 mg qd

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
primary: pneumonia, respiratory failure, anoxic brain injury,
cardiac arrest


Discharge Condition:
Pt expired.


Discharge Instructions:
Pt expired.

Followup Instructions:
Pt expired.
{'Cardiac arrest,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Anoxic brain damage,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Anemia, unspecified,Arthrodesis status,Do not resuscitate status,Encounter for palliative care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Diseases of tricuspid valve,Emphysema (subcutaneous) (surgical) resulting from procedure,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Other fluid overload'}


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: s/p PEA arrest

PRESENT ILLNESS: [**Age over 90 **] yof with history of HTN, DM, hypothyriodism, BIBEMS to OSH ED
s/p witnessed PEA at home.  Per report, she was in her usual
state of health till 2pm on [**2141-12-2**], after returning from
shopping all day.  Her husband fell onto her and caused her to
fell.  She banged her head against the wall on her way down.
Her granddaughter was present during this time and called 911.
Fire department arrived in 2 minutes, found patient to be
non-responsive without a pulse and apnec.  She received CPR via
BLS for 2 mins.  When ACLS arrived noted patient to be
unresponsive, in sinus brady, no shock was delivered.
.
Once arrived to OSH ED, she was given 80 of succ and 80 of
propofol for RSI (7.5, 24cm at lip, position confirmed - 1 cm
from carina).  Repeat rhythm was in NSR rate of 60-40.  Head CT
was wnl, noted for C3-C6 fusion.  Abd US noted to have calcified
aorta without dissection.  Patient was noted to be unresponsive
per report of OSH, and not moving her limbs.  Cooling was
initiated at 1645 for a baseline of 35 with a goal of 33, this
was done with 2L of cold NS.  Patient was given veccuronium,
versed, propafol.  EKG showed sinus, first degree AV block,
normal ST-T waves, LAD.  Labs were significant for WBC of 5.7,
H&H of 8.8 and 26.7.  Chem7 was Na 137, K 4.4, Cl 107, HC03 21,
BUN 31, cr 1.2, glu 154.  Trop of 0.01.  ABG of 7.38, pCO2 of
38, pO2 483, HCO3 23.  At this point, she was transferred to
[**Hospital1 18**] for further managment.
.
In our ED, her inital vitals were: brady 30-40 SR, BP 130-140,
sats 100% FiO2 of 40%, PEEP of 5.  Temp was noted to be 32.8C
with ice packs, and HR showed persistent bradycardia, cooling
was temporarily stopped, then restarted.  Echo was performed in
the ED by cardiology fellow: The left ventricular cavity size is
normal. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is normal (LVEF>55%). The right ventricle
appears slightly enlarged but is contracting well; [**Last Name (un) 13367**]
sign is absent. The mitral valve leaflets are mildly thickened.
Trivial mitral regurgitation is seen. There is a very small
pericardial effusion. There are no echocardiographic signs of
tamponade.  Labs were similar to OSH.  pH of 7.45, PCO2 26, PO2
175, HCO3 of 17.  Lactate of 0.9.  Access 18x2, 20.  I/O
1.5L/1.25.
.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes (diet control), Hypertension
2. CARDIAC HISTORY:
- CABG:  none
- PERCUTANEOUS CORONARY INTERVENTIONS:  none
- PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
- hypothyroid
- s/p MVC and brain surgery for evacuation of blood (no seizure
activity since) 10 yrs ago.
- C3-C6 fusion
- L hip surgery on [**6-/2141**] [**Hospital1 336**].

MEDICATION ON ADMISSION: - lisinopril 30 mg qd
- famotidine 20 mg qd
- synthyroid 88 mg qd

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
VS: T=31 BP=130/60 HR= 50 RR=16 O2 sat=100
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - Brother had early MI (30s), no other family history of
arrhythmia, MI.

SOCIAL HISTORY: - Tobacco history:  distant, quit 30 yrs ago.
- ETOH: drinks 1 drink per day (wine.
- Illicit drugs:  none 

### Response:
{'Cardiac arrest,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Anoxic brain damage,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Anemia, unspecified,Arthrodesis status,Do not resuscitate status,Encounter for palliative care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Diseases of tricuspid valve,Emphysema (subcutaneous) (surgical) resulting from procedure,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Other fluid overload'}
