CHIEF COMPLAINT: s/p Cardiac arrest

PRESENT ILLNESS: 60 yo M with CAD, CHF EF 20% s/p ICD, IDDM, recent admission for
VT storm, who is transferred from OSH s/p cardiac arrest.

MEDICAL HISTORY: Systolic heart failure with EF 20%
s/p DES to RCA
s/p ICD implanted on [**2180-4-26**]

MEDICATION ON ADMISSION: bisacodyl 10 mg daily PRN constipation
senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID PRN Constipation
docusate sodium 100 mg [**Hospital1 **]
gemfibrozil 600 mg [**Hospital1 **]
atorvastatin 40 mg QHS
metoprolol succinate 25 mg daily
clopidogrel 75 mg daily
cholecalciferol (vitamin D3) [**2172**] units daily
multivitamin 1 Tablet PO DAILY
spironolactone 25 mg daily
mexiletine 150 mg PO Q12H
amiodarone 200 mg PO BID
Lantus 15 units at bedtime.
Humalog sliding scale
furosemide 80 mg PO BID
famotidine 20 mg PO Q12H
Niaspan Extended-Release 500 mg PO at bedtime
aspirin 81 mg daily

ALLERGIES: Penicillins / Actos / Percocet / Cephalosporins

PHYSICAL EXAM: VS: BP=99/74 HR=79 RR=17 O2 sat=96%
GENERAL: Intubated. Sedated. Rhythmically elevates shoulders.
HEENT: Sclera anicteric. Pupils 2-3 mm and fixed.
NECK: In cervical collar. Difficult to assess JVP secondary to
cervical collar.
CARDIAC: Very difficult to auscultate secondary to loud, coarse
breath sounds. RRR. No murmur, gallops, or rubs appreciated.
LUNGS: Diffusely course breath sounds.
ABDOMEN: Soft, NT/ND.
EXTREMITIES: There is edema in all 4 extremities. Radial and DP
pulses are 1+.
NEURO: Intubated. Sedated. Pupils fixed at 2-3 mm. Not
responsive to pain in any extremity.

FAMILY HISTORY: Father died with rectal cancer
Mother has [**Name2 (NI) **] of colon ca, rheumatic valvular dz
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: Former smoker
-ETOH: no etoh
Is not married.
Paroxysmal ventricular tachycardia,Acute respiratory failure,Other primary cardiomyopathies,Chronic systolic heart failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Automatic implantable cardiac defibrillator in situ,Long-term (current) use of anticoagulants,Nontoxic multinodular goiter
Parox ventric tachycard,Acute respiratry failure,Prim cardiomyopathy NEC,Chr systolic hrt failure,DMII wo cmp nt st uncntr,Status autm crd dfbrltr,Long-term use anticoagul,Nontox multinodul goiter
Admission Date:  [**2183-2-1**]              Discharge Date:   [**2183-2-1**]

Date of Birth:  [**2122-3-3**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Actos / Percocet / Cephalosporins

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
s/p Cardiac arrest

Major Surgical or Invasive Procedure:
None

History of Present Illness:
60 yo M with CAD, CHF EF 20% s/p ICD, IDDM, recent admission for
VT storm, who is transferred from OSH s/p cardiac arrest.

The history is passed down via multiple transitions of care, so
it is somewhat limited. Reportedly, the patient was found down
at rehab. It is thought that he was down for 15-20 minutes. He
was found pulseless, in asystole. He got 20-30 minutes of CPR en
route to [**Hospital6 5016**]. Intubation was attempted but was
unsuccessful pre-hospital, so put the patient on CPAP and
transferred to [**Hospital3 **]. At [**Hospital3 **], pulse was thready.
GCS was 3. Left tib I/O placed. Intubated.

On interrogation of the patient's ICD, it appears that the
patient had 3 episodes Vtach and 4 episodes of NSVT between 9:23
p.m. and 9:28 p.m. today. The sequence of events after that is
unclear, but after discussion with the EP fellow, it appears
that the patient received ATP and one shock before going into
PEA and then asystole.

The patient was med flighted to [**Hospital1 18**], where initial vital signs
were HR 80 BP 132/76 RR 23 Sat 100% on pressure support with
FiO2 100%. ABG was 7.38/45/270. CXR showed ET tube 2.7 cm above
the carina, Severe cardiomegaly, pulmonary vascular congestion,
and pulmonary edema, large right pleural effusion. CT head and
neck showed no acute process (wet read).

Of note, the patient was recently admitted to the CCU from [**1-24**]
to [**1-30**] for VT storm. He was treated with amiodarone and
mexilitine and discharged to rehab.

Review of systems is unobtainable.


Past Medical History:
Systolic heart failure with EF 20%
s/p DES to RCA
s/p ICD implanted on [**2180-4-26**]

OTHER PAST MEDICAL HISTORY:
Diabetes type II on insulin
Hypercholesterolemia
Peripheral neuropathy
Hypertriglyceridemia
Chronic systolic CHF
Afib on coumadin
Dilated non-ischemic cardiomyopathy
Multinodule goitor likely due to amiodarone



Social History:
-Tobacco history: Former smoker
-ETOH: no etoh
Is not married.


Family History:
Father died with rectal cancer
Mother has [**Name2 (NI) **] of colon ca, rheumatic valvular dz
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.


Physical Exam:
VS: BP=99/74 HR=79 RR=17 O2 sat=96%
GENERAL: Intubated. Sedated. Rhythmically elevates shoulders.
HEENT: Sclera anicteric. Pupils 2-3 mm and fixed.
NECK: In cervical collar. Difficult to assess JVP secondary to
cervical collar.
CARDIAC: Very difficult to auscultate secondary to loud, coarse
breath sounds. RRR. No murmur, gallops, or rubs appreciated.
LUNGS: Diffusely course breath sounds.
ABDOMEN: Soft, NT/ND.
EXTREMITIES: There is edema in all 4 extremities. Radial and DP
pulses are 1+.
NEURO: Intubated. Sedated. Pupils fixed at 2-3 mm. Not
responsive to pain in any extremity.


Pertinent Results:
Admission labs:
[**2183-2-1**] 02:10AM BLOOD WBC-16.0* RBC-3.70* Hgb-11.1* Hct-32.6*
MCV-88 MCH-29.9 MCHC-34.0 RDW-16.1* Plt Ct-161
[**2183-2-1**] 02:10AM BLOOD WBC-16.0* RBC-3.70* Hgb-11.1* Hct-32.6*
MCV-88 MCH-29.9 MCHC-34.0 RDW-16.1* Plt Ct-161
[**2183-2-1**] 02:10AM BLOOD Neuts-89* Bands-1 Lymphs-2* Monos-7 Eos-0
Baso-0 Atyps-0 Metas-1* Myelos-0
[**2183-2-1**] 02:10AM BLOOD PT-23.9* PTT-34.3 INR(PT)-2.3*
[**2183-2-1**] 02:10AM BLOOD Glucose-212* UreaN-92* Creat-2.2* Na-121*
K-4.0 Cl-82*
[**2183-2-1**] 02:10AM BLOOD ALT-648* AST-558* AlkPhos-189*
TotBili-1.4
[**2183-2-1**] 02:10AM BLOOD Lipase-69*
[**2183-2-1**] 02:10AM BLOOD cTropnT-0.09*
[**2183-2-1**] 02:10AM BLOOD Calcium-8.2* Phos-4.9* Mg-2.6
[**2183-2-1**] 02:10AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2183-2-1**] 02:17AM BLOOD Type-ART Rates-/20 Tidal V-512 PEEP-5
FiO2-100 pO2-270* pCO2-45 pH-7.38 calTCO2-28 Base XS-1 AADO2-418
REQ O2-71 Intubat-INTUBATED Vent-SPONTANEOU
[**2183-2-1**] 02:17AM BLOOD Glucose-202* Lactate-2.1* Na-121* K-4.1
Cl-82*

Studies:
CT HEAD W/O CONTRAST Study Date of [**2183-2-1**] 1:23 AM
IMPRESSION:
1. No acute intracranial hemorrhage or mass effect. In
particular, there is no intracranial hemorrhage. If there is
continued clinical concern for
parenchymal changes/acute infarction, MR can be considered if
not CI; however, pt. has a pacemaker and hence, if there is
continued clinical concern,a follwo up CT Head can be considered
to assess for short term stability. See details above.
2. Minimal maxillary sinus disease.

CT C-SPINE W/O CONTRAST Study Date of [**2183-2-1**] 1:24 AM
IMPRESSION:
1. No acute fracture or traumatic malalignment of the cervical
spine.
2. Multilevel severe degenerative changes throughout the
cervical spine,
resulting in mild-to-moderate spinal canal stenosis.

NOTE ON ATTENDING REVIEW:
A few linear lucencies are noted in proximity to the anterior
osteophyte at the antero-inferior aspect of C5 and C6. While
these may relate to orientation, subtle fractures associated
with the osteophytes cannot be excluded. ( Se 701b, im 37, 40)
Assessment of prevertebral soft tissue swelling is limited at
C5/6 and C6/7 levels due to intubation. As the aptient cannot
have MRI due to apcemaker in-situ, consider follow up with PXR
after spine consult to clear the spine and exclude fractures.

CHEST (PORTABLE AP) Study Date of [**2183-2-1**] 1:29 AM
IMPRESSION:
1. Endotracheal tube terminating 2.7 cm above the carina.
2. Severe cardiomegaly with severe pulmonary vascular congestion
and
pulmonary edema.
3. Large right pleural effusion.
4. Orogastric tube within the stomach.


Brief Hospital Course:
60yo M w/ CAD, CHF with an EF of 20%, s/p BiV ICD, DM, AF on
coumadin, recent admission for VT storm, now readmitted to CCU
s/p cardiac arrest.
.
# Neuroprotection s/p cardiac arrest: Arrived with GCS of 3 and
Arctic Sun protocol initiated.  Poor prognosis was discussed
with aunt, [**Name (NI) **]. She was understanding of patient's clinical
status and did not want escalation of care. Code status was
changed to DNR/DNI. Patient was rewarmed to better assess
neurologic function. Neurologic status continued to be poor and
the patient was terminally extubated.
.
# RHYTHM: Precipitant for event was VT -> PEA -> asystole. A-V
paced rhythm on admission.  For anti-arrythmics, he was started
on amiodarone drip + mexiletine.
Warfarin was continued for atrial fibrillation.
.
# Blood pressures: Metoprolol, lisinopril, spironolactone, and
lasix all held in setting of hypotension/cardiogenic shock.

Medications on Admission:
bisacodyl 10 mg daily PRN constipation
senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID PRN Constipation
docusate sodium 100 mg [**Hospital1 **]
gemfibrozil 600 mg [**Hospital1 **]
atorvastatin 40 mg QHS
metoprolol succinate 25 mg daily
clopidogrel 75 mg daily
cholecalciferol (vitamin D3) [**2172**] units daily
multivitamin 1 Tablet PO DAILY
spironolactone 25 mg daily
mexiletine 150 mg PO Q12H
amiodarone 200 mg PO BID
Lantus 15 units at bedtime.
Humalog sliding scale
furosemide 80 mg PO BID
famotidine 20 mg PO Q12H
Niaspan Extended-Release 500 mg PO at bedtime
aspirin 81 mg daily


Discharge Medications:
Not applicable

Discharge Disposition:
Expired

Discharge Diagnosis:
Cardiac arrest

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired
{'Paroxysmal ventricular tachycardia,Acute respiratory failure,Other primary cardiomyopathies,Chronic systolic heart failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Automatic implantable cardiac defibrillator in situ,Long-term (current) use of anticoagulants,Nontoxic multinodular goiter'}


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 Cardiac arrest

PRESENT ILLNESS: 60 yo M with CAD, CHF EF 20% s/p ICD, IDDM, recent admission for
VT storm, who is transferred from OSH s/p cardiac arrest.

MEDICAL HISTORY: Systolic heart failure with EF 20%
s/p DES to RCA
s/p ICD implanted on [**2180-4-26**]

MEDICATION ON ADMISSION: bisacodyl 10 mg daily PRN constipation
senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID PRN Constipation
docusate sodium 100 mg [**Hospital1 **]
gemfibrozil 600 mg [**Hospital1 **]
atorvastatin 40 mg QHS
metoprolol succinate 25 mg daily
clopidogrel 75 mg daily
cholecalciferol (vitamin D3) [**2172**] units daily
multivitamin 1 Tablet PO DAILY
spironolactone 25 mg daily
mexiletine 150 mg PO Q12H
amiodarone 200 mg PO BID
Lantus 15 units at bedtime.
Humalog sliding scale
furosemide 80 mg PO BID
famotidine 20 mg PO Q12H
Niaspan Extended-Release 500 mg PO at bedtime
aspirin 81 mg daily

ALLERGIES: Penicillins / Actos / Percocet / Cephalosporins

PHYSICAL EXAM: VS: BP=99/74 HR=79 RR=17 O2 sat=96%
GENERAL: Intubated. Sedated. Rhythmically elevates shoulders.
HEENT: Sclera anicteric. Pupils 2-3 mm and fixed.
NECK: In cervical collar. Difficult to assess JVP secondary to
cervical collar.
CARDIAC: Very difficult to auscultate secondary to loud, coarse
breath sounds. RRR. No murmur, gallops, or rubs appreciated.
LUNGS: Diffusely course breath sounds.
ABDOMEN: Soft, NT/ND.
EXTREMITIES: There is edema in all 4 extremities. Radial and DP
pulses are 1+.
NEURO: Intubated. Sedated. Pupils fixed at 2-3 mm. Not
responsive to pain in any extremity.

FAMILY HISTORY: Father died with rectal cancer
Mother has [**Name2 (NI) **] of colon ca, rheumatic valvular dz
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: Former smoker
-ETOH: no etoh
Is not married. 

### Response:
{'Paroxysmal ventricular tachycardia,Acute respiratory failure,Other primary cardiomyopathies,Chronic systolic heart failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Automatic implantable cardiac defibrillator in situ,Long-term (current) use of anticoagulants,Nontoxic multinodular goiter'}
