CHIEF COMPLAINT: CC: Unresponsive, hypotensive

PRESENT ILLNESS: HPI: 70yo male w/hx of Multiple Sclerosis and chronic indwelling
foley who was brought to ED via EMS after having a witnessed
syncopal event on [**2-26**]. While eating dinner, he lost
conciousness and his head fell back and his arms went up. He was
noted by his wife and son to be gurgling. His family denies any
prodromal complaints aside from fatigue a few days prior. The
EMS team found him to be unresponsive with some emesis in his
mouth. Pt brought to ED, intubated for airway protection.
Received Vanco/Cefepime/Clinda initially and an additional
2Liters of NS. MICU course notable for hypotension unresponsive
to IVF requiring intermittient Levophed gtt.
Additionally a CT head postive for L post/temp intraparenchymal
bleed which was then re-read as an AVM. CT Angiogram of the
Chest was performed and revealed a R subsegmental non-occlusive
thrombi with a chronic appearance. While in the MICU the pt
failed [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 104**] stim test, developed aspiration pneumonia, had
labile blood pressures requiring Nitroprusside gtt, and [**11-21**]
positive bld cx for Staph Epi. Pt ruled out for MI, Echo was
nml, and EKG with old AV delay and type I 2nd degree AV block
(Wenkebach)with a normal rate.

MEDICAL HISTORY: 1. Multiple Sclerosis
2. Hypertension
3. Neurogenic Bladder (chronic indwelling catheter)
4. Hyperlipidemia
5. GERD
7. s/p L foot 1st, 3rd and 4th metatarsal fractures
8. s/p L knee arthroscopy, resection of plica [**2-/2139**]
9. Bradycardia with first deg AV block
10. BPH

MEDICATION ON ADMISSION: ASA 81 qd
Colace
Senna
Nexium 40 qd
Enalapril 10 qd
Lipitor 10 qd
HCTZ 25 qd
Baclofen 20 [**Hospital1 **]
Ativan prn
Neurontin
Detrol
Cytoxan

ALLERGIES: Quinolones / Morphine

PHYSICAL EXAM: T99.6, Tc 98.6, 140-170/55-72, 72-80, 12, 95% 3LNC
GEN: NAD, A & O x 3
HEENT: PERRL, EOMI, OP: clear
CV:Reg rate, S2, S2
PULM:Bilat course BS, crackles at bases
ABD:Distended, soft +BS
EXT:+1 Bilat lower ext edema
Neuro: grossly intact, strength 4/5, able to get to edge of bed
but difficulty ambulating.

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: occasional EtOH use; no tobacco or an IV recreational drug use;
worked as a judge, currently lives at home with good social
support
Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Multiple sclerosis,Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Intracerebral hemorrhage,Syncope and collapse,Methicillin susceptible pneumonia due to Staphylococcus aureus,Infection with microorganisms resistant to penicillins,First degree atrioventricular block
Food/vomit pneumonitis,Acute respiratry failure,Multiple sclerosis,Pulm embol/infarct NEC,Acute kidney failure NOS,Intracerebral hemorrhage,Syncope and collapse,Meth sus pneum d/t Staph,Inf mcrg rstn pncllins,Atriovent block-1st degr
Admission Date:  [**2148-2-26**]              Discharge Date:   [**2148-3-7**]

Date of Birth:  [**2077-7-1**]             Sex:   M

Service: MEDICINE

Allergies:
Quinolones / Morphine

Attending:[**First Name3 (LF) 905**]
Chief Complaint:
CC: Unresponsive, hypotensive


Major Surgical or Invasive Procedure:
Intubation/Extubation
Central Line placement
Arterial Line placement
PICC line placment.


History of Present Illness:
HPI: 70yo male w/hx of Multiple Sclerosis and chronic indwelling
foley who was brought to ED via EMS after having a witnessed
syncopal event on [**2-26**]. While eating dinner, he lost
conciousness and his head fell back and his arms went up. He was
noted by his wife and son to be gurgling. His family denies any
prodromal complaints aside from fatigue a few days prior. The
EMS team found him to be unresponsive with some emesis in his
mouth. Pt brought to ED, intubated for airway protection.
Received Vanco/Cefepime/Clinda initially and an additional
2Liters of NS. MICU course notable for hypotension unresponsive
to IVF requiring intermittient Levophed gtt.
Additionally a CT head postive for L post/temp intraparenchymal
bleed which was then re-read as an AVM. CT Angiogram of the
Chest was performed and revealed a R subsegmental non-occlusive
thrombi with a chronic appearance. While in the MICU the pt
failed [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 104**] stim test, developed aspiration pneumonia, had
labile blood pressures requiring Nitroprusside gtt, and [**11-21**]
positive bld cx for Staph Epi. Pt ruled out for MI, Echo was
nml, and EKG with old AV delay and type I 2nd degree AV block
(Wenkebach)with a normal rate.


Past Medical History:
1. Multiple Sclerosis
2. Hypertension
3. Neurogenic Bladder (chronic indwelling catheter)
4. Hyperlipidemia
5. GERD
7. s/p L foot 1st, 3rd and 4th metatarsal fractures
8. s/p L knee arthroscopy, resection of plica [**2-/2139**]
9. Bradycardia with first deg AV block
10. BPH


Social History:
occasional EtOH use; no tobacco or an IV recreational drug use;
worked as a judge, currently lives at home with good social
support

Family History:
Non contributory

Physical Exam:
T99.6, Tc 98.6, 140-170/55-72, 72-80, 12, 95% 3LNC
GEN: NAD, A & O x 3
HEENT: PERRL, EOMI, OP: clear
CV:Reg rate, S2, S2
PULM:Bilat course BS, crackles at bases
ABD:Distended, soft +BS
EXT:+1 Bilat lower ext edema
Neuro: grossly intact, strength 4/5, able to get to edge of bed
but difficulty ambulating.

Pertinent Results:
[**2148-2-26**] 11:00PM   TYPE-ART TEMP-37.8 RATES-/14 TIDAL VOL-650
PEEP-5 O2-40 PO2-185* PCO2-40 PH-7.41 TOTAL CO2-26 BASE XS-1
INTUBATED-INTUBATED VENT-SPONTANEOU
[**2148-2-26**] 03:49PM   WBC-9.9 RBC-3.24* HGB-10.1* HCT-29.2* MCV-90
MCH-31.0 MCHC-34.4 RDW-13.8
[**2148-2-26**] 03:49PM   GLUCOSE-202* UREA N-33* CREAT-1.0 SODIUM-147*
POTASSIUM-3.5 CHLORIDE-113* TOTAL CO2-23 ANION GAP-15
[**2148-2-26**] 03:53PM   LACTATE-3.4*
[**2148-2-26**] 05:03AM   CORTISOL-23.3*
[**2148-2-26**] 05:30AM   CORTISOL-24.7*
[**2148-2-26**] 03:13AM   ALT(SGPT)-20 AST(SGOT)-21 LD(LDH)-197
CK(CPK)-67 ALK PHOS-67 AMYLASE-368* TOT BILI-0.3
[**2148-2-26**] 03:13AM   LIPASE-32
[**2148-2-26**] 03:13AM   CK-MB-NotDone cTropnT-0.01
[**2148-2-26**] 03:13AM   CALCIUM-7.6* PHOSPHATE-3.5 MAGNESIUM-2.1
[**2148-2-26**] 03:13AM URINE  BLOOD-TR NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-SM
[**2148-2-25**] 10:15PM   FIBRINOGE-525*
[**2148-2-25**] 10:15PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2148-2-26**] 03:49PM   PLT COUNT-130*

Brief Hospital Course:
70yo male with hx of Multiple Sclerosis and chronic indwelling
foley catheter a/w syncope, aspiration pneumonia, and possible
intraparenchymal CNS bleed.
1. Hypotension/Syncope: Hypotension resolved while in MICU. [**Month (only) 116**]
have been related to septic physiology on presentation. CTA with
non-occlusive segmental thrombi in R pulm art. which was thought
to be chronic and not related to primary event. Echo w/ nml EF
and wall motion, and valves, CT head with AVM stable on repeat
imaging and confirmed by MRI/MRA, EEG w/o epileptiform activity.
Pt has h/o vaso-vagal symptoms and was eating at the time of the
event which is the most likely cause. 1st degree AV block with
Wenckebach intermittently would not be a cause of syncope since
his heart rate was always normal. Neurosurgery consultation
recommended anticoagulation with Hep gtt while in house given
the PE and pt is immobile, but no long term anticoagulation is
recommended (pt is a fall risk, risk of CNS bleed, and PE is an
incidental finding)Bilateral LENIS were negative. We
specifically discussed with the patient about all the risks and
benefits of being anticoagulated and also not being
anticoagulated.  He understood everything and agreed with the
plan.  His outpt neurologist at [**Hospital1 2025**] was also contact[**Name (NI) **] and is
aware of his hospitalization.

2. ARF: Likely due to hypotension/ATN vs UTI. Normalized with
fluids.

3. ID: Bilateral aspiration PNA, + MRSA, and possible
bacteremia. Intubated for two days. Blood cultures only [**11-21**] grew
Coag neg staph, thought to be a contaminant. MRSA grew in
sputum. Total body macular rash developed while pt was on Zosyn
and Ceftriaxone.
-initially covered w/Vanco/Zosyn Dced upon transfer to floor.
Was on Clinda for two days but spiked through it to 103. Started
Flagyl/Aztreonam/Vanc [**3-1**] given allergy to quinolone and ? rash
to cephalosporins.
-DC A-line and DC Central Line [**2-28**], sent tip for culture.
-Surveillance cultures were all negative. Repeat CXR with slight
improvement.
-Pt has chronic indwelling foley but U/A has been negative.

4. Neuro: Multiple Sclerosis, and h/o CNS AVM. Pt seen by
neurology and neurosurgery early in hospital course. Pt was
deconditioned, weak, and fatigued for most of his stay with
limited mobility. Will need aggressive PT and cont treatment for
MS. [**Name13 (STitle) **] been on Cytoxan in the past and is followed by [**Hospital1 2025**]
Neurologist.

5. Code: Full

6. Dispo: to rehab

7. Communication: Wife = (o)[**Telephone/Fax (1) 96660**] or (h)[**Telephone/Fax (1) 96661**]
PCP([**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1728**])[**Telephone/Fax (1) 96662**]. (call between 6A and 6P)-

Neurologists: Dr. [**First Name4 (NamePattern1) 401**] [**Last Name (NamePattern1) 45435**] [**Hospital1 2025**] [**Telephone/Fax (1) 88304**] and Dr. [**Last Name (STitle) **] at
[**Hospital1 112**].


Medications on Admission:
ASA 81 qd
Colace
Senna
Nexium 40 qd
Enalapril 10 qd
Lipitor 10 qd
HCTZ 25 qd
Baclofen 20 [**Hospital1 **]
Ativan prn
Neurontin
Detrol
Cytoxan


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO BID (2
times a day).
3. Dorzolamide-Timolol 2-0.5 % Drops Sig: Two (2) Drop
Ophthalmic  [**Hospital1 **] (2 times a day).
4. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic  HS
(at bedtime).
5. Gabapentin 400 mg Capsule Sig: Two (2) Capsule PO TID (3
times a day).
6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

7. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): Regular Sliding scale.
8. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Baclofen 10 mg Tablet Sig: Three (3) Tablet PO QAM (once a
day (in the morning)).
10. Enalapril Maleate 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
11. Baclofen 10 mg Tablet Sig: Four (4) Tablet PO QPM (once a
day (in the evening)).
12. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
13. Baclofen 10 mg Tablet Sig: Three (3) Tablet PO Q NOON ().
14. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
15. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 9 days.
16. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
17. Oxycodone HCl 5 mg Tablet Sig: Two (2) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
18. Zolpidem Tartrate 5 mg Tablet Sig: 1-2 Tablets PO HS (at
bedtime) as needed.
19. Vancomycin HCl 10 g Recon Soln Sig: One (1) gm Intravenous
Q24H (every 24 hours) for 9 days.
20. Aztreonam in Dextrose(IsoOsm) 1 g/50 mL Piggyback Sig: One
(1) gm Intravenous  three times a day for 9 days.
21. Heparin Sodium 5,000 unit/0.5 mL Syringe Sig: One (1)
Injection three times a day: For DVT prophylaxis.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 100**] Rehab-MACU

Discharge Diagnosis:
1. Aspiration Pneumonia
2. MRSA Pneumonia
3. Syncope
4. Stable CNS AVM
5. Subacute Pulmonary Embolus
6. Multiple Sclerosis
7. 1st degree AV block, without bradycardia


Discharge Condition:
Stable to Rehab

Discharge Instructions:
Please see your PCP [**Name Initial (PRE) 176**] 1-2 weeks of discharge.

Followup Instructions:
1. Please see your PCP [**Name Initial (PRE) 176**] 1-2 weeks
2. Provider: [**Name10 (NameIs) 8741**] [**Name11 (NameIs) **], MD Where: [**Hospital6 29**]
ORTHOPEDICS Phone:[**Telephone/Fax (1) 1228**] Date/Time:[**2148-3-13**] 3:00
3. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 11642**], MD Where: [**Hospital6 29**]
ORTHOPEDICS Phone:[**Telephone/Fax (1) 1228**] Date/Time:[**2148-3-14**] 2:20


                             [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**]
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Multiple sclerosis,Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Intracerebral hemorrhage,Syncope and collapse,Methicillin susceptible pneumonia due to Staphylococcus aureus,Infection with microorganisms resistant to penicillins,First degree atrioventricular block'}


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: CC: Unresponsive, hypotensive

PRESENT ILLNESS: HPI: 70yo male w/hx of Multiple Sclerosis and chronic indwelling
foley who was brought to ED via EMS after having a witnessed
syncopal event on [**2-26**]. While eating dinner, he lost
conciousness and his head fell back and his arms went up. He was
noted by his wife and son to be gurgling. His family denies any
prodromal complaints aside from fatigue a few days prior. The
EMS team found him to be unresponsive with some emesis in his
mouth. Pt brought to ED, intubated for airway protection.
Received Vanco/Cefepime/Clinda initially and an additional
2Liters of NS. MICU course notable for hypotension unresponsive
to IVF requiring intermittient Levophed gtt.
Additionally a CT head postive for L post/temp intraparenchymal
bleed which was then re-read as an AVM. CT Angiogram of the
Chest was performed and revealed a R subsegmental non-occlusive
thrombi with a chronic appearance. While in the MICU the pt
failed [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 104**] stim test, developed aspiration pneumonia, had
labile blood pressures requiring Nitroprusside gtt, and [**11-21**]
positive bld cx for Staph Epi. Pt ruled out for MI, Echo was
nml, and EKG with old AV delay and type I 2nd degree AV block
(Wenkebach)with a normal rate.

MEDICAL HISTORY: 1. Multiple Sclerosis
2. Hypertension
3. Neurogenic Bladder (chronic indwelling catheter)
4. Hyperlipidemia
5. GERD
7. s/p L foot 1st, 3rd and 4th metatarsal fractures
8. s/p L knee arthroscopy, resection of plica [**2-/2139**]
9. Bradycardia with first deg AV block
10. BPH

MEDICATION ON ADMISSION: ASA 81 qd
Colace
Senna
Nexium 40 qd
Enalapril 10 qd
Lipitor 10 qd
HCTZ 25 qd
Baclofen 20 [**Hospital1 **]
Ativan prn
Neurontin
Detrol
Cytoxan

ALLERGIES: Quinolones / Morphine

PHYSICAL EXAM: T99.6, Tc 98.6, 140-170/55-72, 72-80, 12, 95% 3LNC
GEN: NAD, A & O x 3
HEENT: PERRL, EOMI, OP: clear
CV:Reg rate, S2, S2
PULM:Bilat course BS, crackles at bases
ABD:Distended, soft +BS
EXT:+1 Bilat lower ext edema
Neuro: grossly intact, strength 4/5, able to get to edge of bed
but difficulty ambulating.

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: occasional EtOH use; no tobacco or an IV recreational drug use;
worked as a judge, currently lives at home with good social
support 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Multiple sclerosis,Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Intracerebral hemorrhage,Syncope and collapse,Methicillin susceptible pneumonia due to Staphylococcus aureus,Infection with microorganisms resistant to penicillins,First degree atrioventricular block'}
