CHIEF COMPLAINT: s/p PEA arrest/cardiac arrest

PRESENT ILLNESS: 82M with h/o CABG 7 yrs ago, s/p ICD ([**Hospital3 **]) for ?CHF (5yrs
ago), afib on coumadin, COPD with baseline SOB, presented with
acute dyspnea and found to be in respiratory distress overnight
on Am on [**7-29**] around 1-1:30am with syncope/collapse onto soft
couch. CPR started within 5-10 minutes of patient being found
down. First rhythm was PEA, was in agonal breathing, regained
pulse s/p epi, atropine, and intubation. Sent to OSH (arrived
2:55am), per OSH, had pulse but lost pulse around 3:15am,
patient given epi, atropine, heparin bolus and gtt, then
regained pulse with v-pacing so cooling protocol started
(patient down to 30 degrees). Possible report that ICD fired
twice - then was V-paced, got bolus/gtt of amiodarone, 20mcg of
dopa, 2L IVF, CK and trop flat, INR therapeutic, sent to [**Hospital1 18**].

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: 3V disease, CABG [**2152**]
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD: (5 years prior) placed in [**2154**]
3. OTHER PAST MEDICAL HISTORY: Asthma, hyperlipidemia,
hypertension

MEDICATION ON ADMISSION: MEDICATIONS:
Coumadin 2.5mg / 5mg alternating daily
Carvedilol 12.5mg [**Hospital1 **]
Spironolactone 12.5 mg QHS
Simvastatin 40mg QHS
Aspirin 81 mg daily
Albuterol inhaler PRN wheezing
Aricept 5mg QHS

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: VS: T= 88.7 BP= 129/45 HR=71 RR= 20 O2 sat= 100% Vt 550 /PEEP 8

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: SOCIAL HISTORY: No tobacco use, rare alcohol socially. Lives
with wife, continues to be quite active golfing several times
per week.
Acute respiratory failure,Mechanical complication of automatic implantable cardiac defibrillator,Atrioventricular block, complete,Mixed acid-base balance disorder,Hematemesis,Paroxysmal ventricular tachycardia,Ventilator associated pneumonia,Acute kidney failure with lesion of tubular necrosis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Congestive heart failure, unspecified,Chronic obstructive asthma, unspecified,Other and unspecified hyperlipidemia,Personal history of sudden cardiac arrest,Long-term (current) use of anticoagulants,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiogenic shock
Acute respiratry failure,Mch cmp autm mplnt dfbrl,Atriovent block complete,Mixed acid-base bal dis,Hematemesis,Parox ventric tachycard,Ventltr assoc pneumonia,Ac kidny fail, tubr necr,Abn react-artif implant,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,CHF NOS,Chronic obst asthma NOS,Hyperlipidemia NEC/NOS,Hx sudden cardiac arrest,Long-term use anticoagul,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Cardiogenic shock
Admission Date:  [**2159-7-29**]              Discharge Date:   [**2159-7-31**]

Date of Birth:  [**2076-10-31**]             Sex:   M

Service: MEDICINE

Allergies:
No Drug Allergy Information on File

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

Major Surgical or Invasive Procedure:
cooling protocol

History of Present Illness:
82M with h/o CABG 7 yrs ago, s/p ICD ([**Hospital3 **]) for ?CHF (5yrs
ago), afib on coumadin, COPD with baseline SOB, presented with
acute dyspnea and found to be in respiratory distress overnight
on Am on [**7-29**] around 1-1:30am with syncope/collapse onto soft
couch. CPR started within 5-10 minutes of patient being found
down. First rhythm was PEA, was in agonal breathing, regained
pulse s/p epi, atropine, and intubation. Sent to OSH (arrived
2:55am), per OSH, had pulse but lost pulse around 3:15am,
patient given epi, atropine, heparin bolus and gtt, then
regained pulse with v-pacing so cooling protocol started
(patient down to 30 degrees). Possible report that ICD fired
twice - then was V-paced, got bolus/gtt of amiodarone, 20mcg of
dopa, 2L IVF, CK and trop flat, INR therapeutic, sent to [**Hospital1 18**].

.
Arrived at [**Hospital1 18**] ED around 5:20am, initial 31.4 R, 66, 80/37,
22, 88% of FiO2 100, PEEP 5, PiP 44. ECG showing wide right
bundle with possible complete heart block. Found to have small R
apical pneumothorax s/p R chest tube but not large enough to be
culprit for causing . RIJ, PIVs placed. Bedside ECHO showed no
pericardial effusion, ventricles beating. On cooling protocol.
Kept on amio gtt, started max dopa (20mcg), levophed (0.12). K
was high, given calcium, bicarb. Vitals on transfer were T30.8
(getting 1L warm saline fluid, warming blankets), 72, 132/56,
95% FiO2 60, RR18 - 60, PEEP 6, peak P 36, TV 400. CVP 17. ABG
on transfer was 7/15/64/555
.
On arrival to CCU, patient was unresponsive, not withdrawing to
any noxious stimulation. Patient was transferred on amiodarone
gtt at 1, levophed at 0.14, and dopamine at 20 weaned down to
10.

Past Medical History:
1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: 3V disease, CABG [**2152**]
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD: (5 years prior) placed in [**2154**]
3. OTHER PAST MEDICAL HISTORY: Asthma, hyperlipidemia,
hypertension

Social History:
SOCIAL HISTORY: No tobacco use, rare alcohol socially. Lives
with wife, continues to be quite active golfing several times
per week.

Family History:
non-contributory

Physical Exam:
VS: T= 88.7 BP= 129/45 HR=71 RR= 20 O2 sat= 100% Vt 550 /PEEP 8

GENERAL: WDWN, nonresponsive to verbal stimuli or sternal rub.
HEENT: NCAT. Sclera anicteric, pupils fixed and dilated
bilaterally. Conjunctiva were pink, no pallor or cyanosis of the
oral mucosa. ET tube in place
NECK: Supple
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.
Ventilated. CTAB anteriorly without no crackles, wheezes or
rhonchi.
ABDOMEN: Soft, NTND. No HSM.
EXTREMITIES: No c/c/e. Cool.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
NEURO: Minimal withdrawal to painful stimuli in LLE, no other
purposeful movement, pupils nonreactive


Pertinent Results:
[**2159-7-29**] 05:40AM   WBC-12.2* RBC-4.09* HGB-13.4* HCT-41.7
MCV-102* MCH-32.7* MCHC-32.1 RDW-13.6
[**2159-7-29**] 05:40AM   PLT COUNT-185
[**2159-7-29**] 05:40AM   CK-MB-12* MB INDX-4.3 cTropnT-0.10*
[**2159-7-29**] 05:40AM   CK(CPK)-277*
[**2159-7-29**] 05:40AM   GLUCOSE-406* UREA N-31* CREAT-1.6* SODIUM-134
POTASSIUM-8.8* CHLORIDE-106 TOTAL CO2-18* ANION GAP-19
[**2159-7-29**] 05:43AM   GLUCOSE-376* LACTATE-3.3* NA+-135 K+-8.0*
CL--103 TCO2-21
[**2159-7-29**] 05:55AM   PT-28.9* PTT-150* INR(PT)-2.9*
[**2159-7-29**] 06:21AM   TYPE-ART TEMP-30 TIDAL VOL-370 PO2-555*
PCO2-64* PH-7.15* TOTAL CO2-24 BASE XS--7 -ASSIST/CON
INTUBATED-INTUBATED

Brief Hospital Course:
# s/p cardiac arrest: Unclear etiology which prompted initial
PEA arrest. No anticedent illness. No e/o ischemia on EKG.
Anticoagulated so unlikely to be PE & no e/o EKG. Small R-sided
pneumothorax with no e/o tension prior to arrival. No e/o
hypovolemia. With profound acidosis. Thus, unclear but
potentially primary cardiac vs pulmonary source.
Patient underwent cooling protocol. The cardiac arrest team,
including neuro, was involved. Patient was monitored on
continuous 48hr bedside EEG per protocol. EEG on [**2159-7-30**] showed
some higher amplitude spikes, but since early morning of [**2159-7-31**],
EEG was flatline. Neuro felt that there was very little hope of
significant recovery of brain function. Patient also continued
to require moderately high doses of levophed and dopamine to
maintain blood pressure.
Family meeting was held [**2159-7-31**] with CCU team, neurology consult,
SW. Family agreed that CMO would be in line with patient's
wishes. Patient was extubated and all medications stopped.
Patient received morphine prn for comfort.
.
# Respiratory failure: s/p intubation initially difficult to
ventilate with high auto PEEP, PIP. Patient with h/o asthma and
concern for bronchospasm on exam. No h/o COPD per available
records. Patient received Albuterol / Ipratroprium nebs prn,
daily CXR were followed.
.
# CORONARIES: h/o CAD s/p CABG. No localized ischemia on ECGs,
no elevation in enzymes.

# PUMP: No prior records in our system, family cannot relay any
clear details.
.
# RHYTHM: V-paced, pacer interrogated showing oversensitivity
leading to 2 episodes of inappropriate ICD firing at OSH, none
since. Patient therapeutic on prior coumadin.  Patient was
monitored on telemetry.
.


Medications on Admission:
MEDICATIONS:
Coumadin 2.5mg / 5mg alternating daily
Carvedilol 12.5mg [**Hospital1 **]
Spironolactone 12.5 mg QHS
Simvastatin 40mg QHS
Aspirin 81 mg daily
Albuterol inhaler PRN wheezing
Aricept 5mg QHS

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient passed on [**2159-7-31**].

Discharge Condition:
Patient passed on [**2159-7-31**].

Discharge Instructions:
Patient passed on [**2159-7-31**].

Followup Instructions:
Patient passed on [**2159-7-31**].
{'Acute respiratory failure,Mechanical complication of automatic implantable cardiac defibrillator,Atrioventricular block, complete,Mixed acid-base balance disorder,Hematemesis,Paroxysmal ventricular tachycardia,Ventilator associated pneumonia,Acute kidney failure with lesion of tubular necrosis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Congestive heart failure, unspecified,Chronic obstructive asthma, unspecified,Other and unspecified hyperlipidemia,Personal history of sudden cardiac arrest,Long-term (current) use of anticoagulants,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiogenic shock'}


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/cardiac arrest

PRESENT ILLNESS: 82M with h/o CABG 7 yrs ago, s/p ICD ([**Hospital3 **]) for ?CHF (5yrs
ago), afib on coumadin, COPD with baseline SOB, presented with
acute dyspnea and found to be in respiratory distress overnight
on Am on [**7-29**] around 1-1:30am with syncope/collapse onto soft
couch. CPR started within 5-10 minutes of patient being found
down. First rhythm was PEA, was in agonal breathing, regained
pulse s/p epi, atropine, and intubation. Sent to OSH (arrived
2:55am), per OSH, had pulse but lost pulse around 3:15am,
patient given epi, atropine, heparin bolus and gtt, then
regained pulse with v-pacing so cooling protocol started
(patient down to 30 degrees). Possible report that ICD fired
twice - then was V-paced, got bolus/gtt of amiodarone, 20mcg of
dopa, 2L IVF, CK and trop flat, INR therapeutic, sent to [**Hospital1 18**].

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG: 3V disease, CABG [**2152**]
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD: (5 years prior) placed in [**2154**]
3. OTHER PAST MEDICAL HISTORY: Asthma, hyperlipidemia,
hypertension

MEDICATION ON ADMISSION: MEDICATIONS:
Coumadin 2.5mg / 5mg alternating daily
Carvedilol 12.5mg [**Hospital1 **]
Spironolactone 12.5 mg QHS
Simvastatin 40mg QHS
Aspirin 81 mg daily
Albuterol inhaler PRN wheezing
Aricept 5mg QHS

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: VS: T= 88.7 BP= 129/45 HR=71 RR= 20 O2 sat= 100% Vt 550 /PEEP 8

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: SOCIAL HISTORY: No tobacco use, rare alcohol socially. Lives
with wife, continues to be quite active golfing several times
per week. 

### Response:
{'Acute respiratory failure,Mechanical complication of automatic implantable cardiac defibrillator,Atrioventricular block, complete,Mixed acid-base balance disorder,Hematemesis,Paroxysmal ventricular tachycardia,Ventilator associated pneumonia,Acute kidney failure with lesion of tubular necrosis,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Congestive heart failure, unspecified,Chronic obstructive asthma, unspecified,Other and unspecified hyperlipidemia,Personal history of sudden cardiac arrest,Long-term (current) use of anticoagulants,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiogenic shock'}
