CHIEF COMPLAINT: unresponsive, hypotension

PRESENT ILLNESS: EVENTS / HISTORY OF PRESENTING ILLNESS: 81 M with ESRD on HD,
IDDM, TIA, CAD s/p CABG presented to OSH as family had witnessed
him having "seizure activity." He had apparently had N/V
weakness for several hours prior to admission. Had HD on [**3-9**]
without complication. Vomited on arrival to the OSH ED. On OSH
ROS: no fever, chest pain, abdominal pain, headache, neck pain
or sore throat, shortness of breath or diaphoresis.
.
OSH Course: Found to be in afib (108), CT head without acute
bleed, BP down to 60/30, bolused fluid and Neo-synephrin
started. R femoral line placed. Began to have coffee-ground
emesis during ED course.
.

MEDICAL HISTORY: ESRD on HD
CAD s/p CABG ([**2131**]) and status post PCI stent left circumflex
HTN
ICD placement
Chronic diarrhea
AV graft clotting and revision about a week ago
Diabetes complicated by retinopathy and nephropathy
Hyperlipidemia
Coronary disease
Mitral insufficiency status post MVR
ICD placement for depressed left ventricular systolic function
Status post carotid stenting in [**10/2141**] on the right internal
carotid artery
Status post left carotid endarterectomy in [**2131**].
peripheral vascular disease.
Diverticulosis.
Cerebrovascular accident with ataxia, left arm numbness and
right sided lacunar infarction
Basal cell carcinoma.
Diabetic neuropathy.
Chronic back pain.
s/p cholecystectomy

MEDICATION ON ADMISSION: Home medications:
Lexapro 5 mg daily
Nephrocaps 1 tab daily
ASA 81 mg daily
NPH and Reg SSI
Cardura 2 mg daily
Tums 500 mg tid
Glucerna 1 can daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Blood pressure was 124/48, on 0.182 mcg/kg/min. Pulse was 84
beats/min and regular. He wa satting 100% on AC 500/12 on 100%
FiO2 and 5 of PEEP. Generally the patient was intubated and
sedated.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. Neck veins flat. The were
no chest wall deformities. Loud upper airway sounds without
crackles anteriorly.
.
Distant heart sounds. There were no thrills, lifts or palpable
S3 or S4. The heart sounds revealed a normal S1 and the S2 was
normal. There were no rubs, murmurs, clicks or gallops.
.
The abdominal aorta was not enlarged by palpation. There was no
hepatosplenomegaly or tenderness. The abdomen was soft nontender
and nondistended. The extremities were cool but without edema.
There were no abdominal, femoral or carotid bruits. Inspection
and/or palpation of skin and subcutaneous tissue showed no
stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Carotid 2+ bilaterally, Femoral with central lines bilaterally,
dopplerable DP pulses
.

FAMILY HISTORY: Could not obtain additional family history

SOCIAL HISTORY: He lives with his wife and does not smoke
cigarettes, does not drink alcohol. Walks with a walker.
Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified septicemia,Severe sepsis,Septic shock,Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled
React-oth vasc dev/graft,Septicemia NOS,Severe sepsis,Septic shock,Subendo infarct, initial,Hyp kid NOS w cr kid V,End stage renal disease,Cardiac arrest,Crnry athrscl natve vssl,DMII renl nt st uncntrld
Admission Date:  [**2145-3-10**]              Discharge Date:   [**2145-3-12**]

Date of Birth:  [**2063-9-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2698**]
Chief Complaint:
unresponsive, hypotension

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
EVENTS / HISTORY OF PRESENTING ILLNESS: 81 M with ESRD on HD,
IDDM, TIA, CAD s/p CABG presented to OSH as family had witnessed
him having "seizure activity." He had apparently had N/V
weakness for several hours prior to admission. Had HD on [**3-9**]
without complication. Vomited on arrival to the OSH ED. On OSH
ROS: no fever, chest pain, abdominal pain, headache, neck pain
or sore throat, shortness of breath or diaphoresis.
.
OSH Course: Found to be in afib (108), CT head without acute
bleed, BP down to 60/30, bolused fluid and Neo-synephrin
started. R femoral line placed. Began to have coffee-ground
emesis during ED course.
.


Past Medical History:
ESRD on HD
CAD s/p CABG ([**2131**]) and status post PCI stent left circumflex
HTN
ICD placement
Chronic diarrhea
AV graft clotting and revision about a week ago
Diabetes complicated by retinopathy and nephropathy
Hyperlipidemia
Coronary disease
Mitral insufficiency status post MVR
ICD placement for depressed left ventricular systolic function
Status post carotid stenting in [**10/2141**] on the right internal
carotid artery
Status post left carotid endarterectomy in [**2131**].
peripheral vascular disease.
Diverticulosis.
Cerebrovascular accident with ataxia, left arm numbness and
right sided lacunar infarction
Basal cell carcinoma.
Diabetic neuropathy.
Chronic back pain.
s/p cholecystectomy


Social History:
He lives with his wife and does not smoke
cigarettes, does not drink alcohol. Walks with a walker.


Family History:
Could not obtain additional family history

Physical Exam:
Blood pressure was 124/48, on 0.182 mcg/kg/min. Pulse was 84
beats/min and regular. He wa satting 100% on AC 500/12 on 100%
FiO2 and 5 of PEEP. Generally the patient was intubated and
sedated.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. Neck veins flat. The were
no chest wall deformities. Loud upper airway sounds without
crackles anteriorly.
.
Distant heart sounds. There were no thrills, lifts or palpable
S3 or S4. The heart sounds revealed a normal S1 and the S2 was
normal. There were no rubs, murmurs, clicks or gallops.
.
The abdominal aorta was not enlarged by palpation. There was no
hepatosplenomegaly or tenderness. The abdomen was soft nontender
and nondistended. The extremities were cool but without edema.
There were no abdominal, femoral or carotid bruits. Inspection
and/or palpation of skin and subcutaneous tissue showed no
stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Carotid 2+ bilaterally, Femoral with central lines bilaterally,
dopplerable DP pulses
.


Pertinent Results:
[**2145-3-10**] 08:15PM BLOOD WBC-16.2*# RBC-3.35* Hgb-11.7* Hct-34.8*
MCV-104*# MCH-35.0*# MCHC-33.7 RDW-21.2* Plt Ct-117*
[**2145-3-10**] 08:15PM BLOOD PT-14.7* PTT-135.4* INR(PT)-1.3*
[**2145-3-10**] 08:15PM BLOOD Plt Smr-LOW Plt Ct-117*
[**2145-3-10**] 08:15PM BLOOD Glucose-257* UreaN-51* Creat-4.9*# Na-134
K-5.2* Cl-97 HCO3-19* AnGap-23*
[**2145-3-10**] 08:15PM BLOOD CK(CPK)-743*
[**2145-3-11**] 05:23AM BLOOD ALT-108* AST-235* CK(CPK)-950* AlkPhos-74
TotBili-0.3
[**2145-3-10**] 08:15PM BLOOD cTropnT-6.44*
[**2145-3-11**] 02:10AM BLOOD CK-MB-218* MB Indx-21.5*
[**2145-3-11**] 05:44PM BLOOD CK-MB-85* MB Indx-19.5* cTropnT-10.74*
[**2145-3-12**] 04:35AM BLOOD CK-MB-48* MB Indx-17.9* cTropnT-10.42*
[**2145-3-11**] 05:23AM BLOOD Calcium-7.7* Phos-7.0*# Mg-1.9

TTE [**2144-3-12**]: The left atrium is mildly dilated. Overall left
ventricular systolic function
is severely depressed. The right ventricular cavity is dilated.
Right
ventricular systolic function appears depressed. The aortic root
is mildly
dilated at the sinus level. The aortic valve leaflets are
moderately
thickened. Severe [4+] tricuspid regurgitation is seen. The
pulmonary artery
systolic pressure could not be determined. There is no
pericardial effusion.

Compared with the prior study (images reviewed) of [**2141-11-28**],
biventriuclar
systolic funciton is worse. The degree of tricuspid
regurgitation has
increased.

CCAth: [**3-10**]: )
3VD
Successful PTCA and rotational atherectomy was performed of the
proximal and mid CX with 2.0 mm and 2.5 mm balloons.  Final
angiography
revealed 30% residual stenosis and improved flow into the OM1
and small
distal CX and collateral RCA territory.


Brief Hospital Course:
81 M with ESRD on HD, CAD s/p CABG, HTN, IDDM p/w hypotension
from outside hospital underwent CCAth which showed 3VD but
underwent PTCA to LCx. Unclear if hypotension secodnary to
cardiogenic shock vs sepsis. Was started on Broad Spectrum Abx.
Was able to be extubated on HD#2 and pressors weaned to off.
HD#3 with acute distress.  Symptomatic bradycardia requiring
pressors.  PPM interogated by EP with increasing of parameters
with little hemodynamic improvement. Underwent stat TTE which
showed much worse RV function and worsening TR. Underwent
Asytolic Cardiac Arrest and was intubated and resusicated.
Recovered a perfusing rythmn on Epi/Levophed gtt.  Family at
bedside and meeting had with Dr [**Last Name (STitle) 911**]. Decision made not to
pursue further aggressive management. Pt made CMO with
withdrawal of care. Pt pronounced dead at 9:04 PM.

Medications on Admission:
Home medications:
Lexapro 5 mg daily
Nephrocaps 1 tab daily
ASA 81 mg daily
NPH and Reg SSI
Cardura 2 mg daily
Tums 500 mg tid
Glucerna 1 can daily


Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
.

Discharge Condition:
.

Discharge Instructions:
.

Followup Instructions:
.
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified septicemia,Severe sepsis,Septic shock,Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled'}


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: unresponsive, hypotension

PRESENT ILLNESS: EVENTS / HISTORY OF PRESENTING ILLNESS: 81 M with ESRD on HD,
IDDM, TIA, CAD s/p CABG presented to OSH as family had witnessed
him having "seizure activity." He had apparently had N/V
weakness for several hours prior to admission. Had HD on [**3-9**]
without complication. Vomited on arrival to the OSH ED. On OSH
ROS: no fever, chest pain, abdominal pain, headache, neck pain
or sore throat, shortness of breath or diaphoresis.
.
OSH Course: Found to be in afib (108), CT head without acute
bleed, BP down to 60/30, bolused fluid and Neo-synephrin
started. R femoral line placed. Began to have coffee-ground
emesis during ED course.
.

MEDICAL HISTORY: ESRD on HD
CAD s/p CABG ([**2131**]) and status post PCI stent left circumflex
HTN
ICD placement
Chronic diarrhea
AV graft clotting and revision about a week ago
Diabetes complicated by retinopathy and nephropathy
Hyperlipidemia
Coronary disease
Mitral insufficiency status post MVR
ICD placement for depressed left ventricular systolic function
Status post carotid stenting in [**10/2141**] on the right internal
carotid artery
Status post left carotid endarterectomy in [**2131**].
peripheral vascular disease.
Diverticulosis.
Cerebrovascular accident with ataxia, left arm numbness and
right sided lacunar infarction
Basal cell carcinoma.
Diabetic neuropathy.
Chronic back pain.
s/p cholecystectomy

MEDICATION ON ADMISSION: Home medications:
Lexapro 5 mg daily
Nephrocaps 1 tab daily
ASA 81 mg daily
NPH and Reg SSI
Cardura 2 mg daily
Tums 500 mg tid
Glucerna 1 can daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Blood pressure was 124/48, on 0.182 mcg/kg/min. Pulse was 84
beats/min and regular. He wa satting 100% on AC 500/12 on 100%
FiO2 and 5 of PEEP. Generally the patient was intubated and
sedated.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. Neck veins flat. The were
no chest wall deformities. Loud upper airway sounds without
crackles anteriorly.
.
Distant heart sounds. There were no thrills, lifts or palpable
S3 or S4. The heart sounds revealed a normal S1 and the S2 was
normal. There were no rubs, murmurs, clicks or gallops.
.
The abdominal aorta was not enlarged by palpation. There was no
hepatosplenomegaly or tenderness. The abdomen was soft nontender
and nondistended. The extremities were cool but without edema.
There were no abdominal, femoral or carotid bruits. Inspection
and/or palpation of skin and subcutaneous tissue showed no
stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Carotid 2+ bilaterally, Femoral with central lines bilaterally,
dopplerable DP pulses
.

FAMILY HISTORY: Could not obtain additional family history

SOCIAL HISTORY: He lives with his wife and does not smoke
cigarettes, does not drink alcohol. Walks with a walker. 

### Response:
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Unspecified septicemia,Severe sepsis,Septic shock,Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled'}
