CHIEF COMPLAINT: STEMI

PRESENT ILLNESS: This is an 80 year old male with largely unknown PMH who
presented to [**Hospital3 3583**] on [**2166-2-11**] with a chief complaint of
feeling "wobbly" on his feet. By report he had a fall the night
prior to admission to the OSH. He was unable to provide any
additional information regarding his fall. The morning of
admission to the OSH he was found unconscious on the floor by
his son. [**Name (NI) **] was disheveled and the house was unkempt. EMS was
called and he was brought to [**Hospital 46**] Hosp for evaluation. On
admission his FS was 40 and he was given [**1-10**] amp of D50 with
good effect. In initial CXR showed a cavitary lesion in the RUL
and a follow up CT showed a cavitary mass in the RUL with R
hilar and R paratracheal LAD as well as multiple hepatic
densities concerning for a metastatic process. Head CT
reportedly negative.  He was given IV fluids for a slightly
elevated CK in the setting of his fall.  The following day,
[**2166-2-12**], he developed bradycardia on the floor and was intubated
and coded, ? of CPR being administrated. An ECG showed ST
elevations in II, III, and aVF and ST-D in V1-3. He was treated
given aspiring and a plavix load and was med flighted to [**Hospital1 18**]
on a heparin gtt. There was one note that the patient was given
zosyn at the OSH, reason not documented.
.
Pt med flighted to [**Hospital1 18**], admitted directly to cath lab, prelim
report with small left system, 50% LAD.  RCA was occluded
proximally with acute thrombus which was removed. BMS placed.
Right heart cath showed PCWP 15, RA [**10-20**].  Hypotensive after,
transferred to CCU on 5mcg dopamine. Still intubated.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: Diabetes, Dyslipidemia, Hypertension
UNKNOWN
2. CARDIAC HISTORY: UNKNOWN
-CABG:
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY: UNKNOWN
per report a history of bladder cancer 10 years ago.

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  94.5 105/63 73 (SR) 25 100% (AC TV 600 20 100% Fi02)
GENERAL: Elderly man. Intubated.  Arousable. Wearing bair
hugger.
HEENT: Right eye constricts to light, surgical left pupil. MM
dry. Intubated.
NECK: IJ (from OSH) left side, bandage on right side, unable to
assess JVP.
CARDIAC: No murmurs, difficult to ascultate over mechanical BS.
LUNGS: Cachectic.  Mechanical clear breath sounds.
ABDOMEN: Soft, NTND. + BS
EXTREMITIES: No edema. distal pulses present.  femoral sheath
still in place on right.
NEURO: Opens eyes, nods on commands. Withdraws to pain.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives alone, son [**Name (NI) **] is contact
Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Acute respiratory failure,Acidosis,Pneumonitis due to inhalation of food or vomitus,Hemorrhage of gastrointestinal tract, unspecified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Heparin-induced thrombocytopenia (HIT)
AMI inferior wall, init,Acute kidney failure NOS,Mal neo upper lobe lung,Second malig neo liver,Secondary malig neo bone,Acute respiratry failure,Acidosis,Food/vomit pneumonitis,Gastrointest hemorr NOS,Cardiac arrest,Crnry athrscl natve vssl,Hypotension NEC,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Chr airway obstruct NEC,Heparin-indu thrombocyto
Admission Date:  [**2166-2-12**]              Discharge Date:   [**2166-2-26**]

Date of Birth:  [**2086-2-4**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
STEMI

Major Surgical or Invasive Procedure:
RIJ
arterial line

History of Present Illness:
This is an 80 year old male with largely unknown PMH who
presented to [**Hospital3 3583**] on [**2166-2-11**] with a chief complaint of
feeling "wobbly" on his feet. By report he had a fall the night
prior to admission to the OSH. He was unable to provide any
additional information regarding his fall. The morning of
admission to the OSH he was found unconscious on the floor by
his son. [**Name (NI) **] was disheveled and the house was unkempt. EMS was
called and he was brought to [**Hospital 46**] Hosp for evaluation. On
admission his FS was 40 and he was given [**1-10**] amp of D50 with
good effect. In initial CXR showed a cavitary lesion in the RUL
and a follow up CT showed a cavitary mass in the RUL with R
hilar and R paratracheal LAD as well as multiple hepatic
densities concerning for a metastatic process. Head CT
reportedly negative.  He was given IV fluids for a slightly
elevated CK in the setting of his fall.  The following day,
[**2166-2-12**], he developed bradycardia on the floor and was intubated
and coded, ? of CPR being administrated. An ECG showed ST
elevations in II, III, and aVF and ST-D in V1-3. He was treated
given aspiring and a plavix load and was med flighted to [**Hospital1 18**]
on a heparin gtt. There was one note that the patient was given
zosyn at the OSH, reason not documented.
.
Pt med flighted to [**Hospital1 18**], admitted directly to cath lab, prelim
report with small left system, 50% LAD.  RCA was occluded
proximally with acute thrombus which was removed. BMS placed.
Right heart cath showed PCWP 15, RA [**10-20**].  Hypotensive after,
transferred to CCU on 5mcg dopamine. Still intubated.


Past Medical History:
1. CARDIAC RISK FACTORS:: Diabetes, Dyslipidemia, Hypertension
UNKNOWN
2. CARDIAC HISTORY: UNKNOWN
-CABG:
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY: UNKNOWN
per report a history of bladder cancer 10 years ago.

Social History:
Lives alone, son [**Name (NI) **] is contact

Family History:
non-contributory

Physical Exam:
VS:  94.5 105/63 73 (SR) 25 100% (AC TV 600 20 100% Fi02)
GENERAL: Elderly man. Intubated.  Arousable. Wearing bair
hugger.
HEENT: Right eye constricts to light, surgical left pupil. MM
dry. Intubated.
NECK: IJ (from OSH) left side, bandage on right side, unable to
assess JVP.
CARDIAC: No murmurs, difficult to ascultate over mechanical BS.
LUNGS: Cachectic.  Mechanical clear breath sounds.
ABDOMEN: Soft, NTND. + BS
EXTREMITIES: No edema. distal pulses present.  femoral sheath
still in place on right.
NEURO: Opens eyes, nods on commands. Withdraws to pain.

Pertinent Results:
[**2166-2-12**] 07:43PM BLOOD WBC-11.3* RBC-3.71* Hgb-10.1* Hct-30.5*
MCV-82 MCH-27.3 MCHC-33.2 RDW-13.8 Plt Ct-366
[**2166-2-12**] 07:43PM BLOOD Neuts-94.7* Lymphs-3.6* Monos-1.2*
Eos-0.1 Baso-0.4
[**2166-2-12**] 07:43PM BLOOD PT-21.3* PTT-38.5* INR(PT)-2.0*
[**2166-2-19**] 10:00AM BLOOD Fibrino-777*
[**2166-2-19**] 10:00AM BLOOD Ret Aut-1.2
[**2166-2-12**] 07:43PM BLOOD Glucose-123* UreaN-41* Creat-1.4* Na-139
K-4.7 Cl-107 HCO3-25 AnGap-12
[**2166-2-12**] 07:43PM BLOOD ALT-42* AST-53* AlkPhos-139*
[**2166-2-12**] 07:43PM BLOOD CK-MB-44* cTropnT-0.23*
[**2166-2-13**] 05:28AM BLOOD CK-MB-48* MB Indx-12.2* cTropnT-0.66*
[**2166-2-14**] 05:49AM BLOOD CK-MB-32* MB Indx-5.4
[**2166-2-15**] 08:23PM BLOOD CK-MB-9 cTropnT-0.42*
[**2166-2-16**] 04:14AM BLOOD CK-MB-13* MB Indx-5.1 cTropnT-0.35*
[**2166-2-12**] 07:43PM BLOOD Calcium-8.6 Phos-5.4* Mg-2.2
[**2166-2-15**] 12:18AM BLOOD calTIBC-94* VitB12-1315* Folate-5.5
Ferritn-1266* TRF-72*
[**2166-2-17**] 04:17AM BLOOD VitB12-1527* Folate-5.3
[**2166-2-20**] 01:55PM BLOOD Hapto-206*
[**2166-2-13**] 05:28AM BLOOD %HbA1c-5.7
[**2166-2-13**] 05:28AM BLOOD Triglyc-50 HDL-24 CHOL/HD-3.0 LDLcalc-39
[**2166-2-17**] 04:17AM BLOOD TSH-0.87
[**2166-2-15**] 06:19AM BLOOD Cortsol-21.5*
[**2166-2-18**] 04:51AM BLOOD Cortsol-16.8
[**2166-2-12**] 05:22PM BLOOD Type-ART pO2-180* pCO2-47* pH-7.32*
calTCO2-25 Base XS--2 Intubat-INTUBATED
[**2166-2-12**] 08:21PM BLOOD Lactate-1.2
.
CTA chest - IMPRESSION:
1. No evidence of pulmonary embolism.
2. Cavitary lesion in the right upper lobe with small air- fluid
level and
contiguous soft tissue density mass extending to the right
hilum.
Differetial diagnosis includes inflammatory and infectious
process, however,
a cavitary neoplasia (squamous cell carcinoma) is also a
consideration.
3. Bilateral large pleural effusions with associated compressive
atelectasis.
4. Hepatic hypodensities, not fully characterized in this study.
Ultrasound
could be performed for further evaluation if clinically
indicated.
5. Ascites and nonspecific soft tissue stranding in the upper
abdomen.
6. T6 lytic lesion. Bone scan is recommended when feasible.
7. Coronary artery calcifications.
.
MRI c-spine - IMPRESSION:

1. Markedly severe spinal canal stenosis at C5-C6 where there is
severe cord compression and extensive cord edema. This is
accompanied by moderate soft tissue edema within the anterior
and posterior soft tissues of the neck centered at this C5-C6
level. There is no acute fracture or subluxation. These findings
in themselves are most suggestive of chronic severe degererative
changes compounded by acute trauma. Note is however made of some
meningeal thickening just posterior to the C6 vertebral body
extending inferiorly from the area of critical stenosis as well
as high T1 signal on delayed post-gadolinium imaging (from prior
MR head). This combination of findings, although probably due to
traumatic etiology, can also be seen with infection or
malignancy.

2. Extensive edema centered at C5-C6 stenosis greater than
typically seen for stenosis, along with possible enhancement
within the cord, raises the possibility of cord infarction
secondary likely to trauma.
.
Echo - There is mild regional left ventricular systolic
dysfunction with mild inferior hypokinesis. The remaining
segments contract normally (LVEF = 45-50%). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. The mitral valve appears structurally normal with
trivial mitral regurgitation. There is mild pulmonary artery
systolic hypertension. There is no pericardial effusion.
.
IMPRESSION: Mild regional left ventricular systolic dysfunction,
c/w CAD. Mild pulmonary hypertension. Limited study.


Brief Hospital Course:
80M with limited known PMH presented from OSH with inferior
STEMI, s/p RCA revascularization.  Patient was intubated at the
OSH.  Patient initially kept intubated after arrival to the CCU
and was unable to be weaned initially off of the ventilator.
Patient was effectively weaned and extubated for less than 36
hours. Patient with 3 code blue for cardiac arrest with episodes
of only P waves visible on telemetry which improved with
atropine. Patient was found to have significant neurologic
deficits of unclear etiology with lack of movement of bilateral
lower extremities and upper extremity weakness left greater than
right.  Patient had extensive neurologic work-up including
evalution by neurology, MRI head and CT spine and was found to
have lesion in the C5/C6 area with edema from either trauma vs.
infection vs. malignancy. Patient had biopsy of cavitary lung
lesion which demonstrated squamous cell cancer with likely
metastasis given lytic lesion seen in thorax. Patient was unable
to be weaned from the ventilator and family was told that long
term prognosis included tracheostomy and PEG with likely
profound permanent neurologic impairment.  Family decided to
make patient comfort measures only. Patient was extubated and
expired with family members present.


Medications on Admission:
none

Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
STEMI

Discharge Condition:
death

Discharge Instructions:
NA

Followup Instructions:
NA


Completed by:[**2166-2-26**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Acute respiratory failure,Acidosis,Pneumonitis due to inhalation of food or vomitus,Hemorrhage of gastrointestinal tract, unspecified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Heparin-induced thrombocytopenia (HIT)'}


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: STEMI

PRESENT ILLNESS: This is an 80 year old male with largely unknown PMH who
presented to [**Hospital3 3583**] on [**2166-2-11**] with a chief complaint of
feeling "wobbly" on his feet. By report he had a fall the night
prior to admission to the OSH. He was unable to provide any
additional information regarding his fall. The morning of
admission to the OSH he was found unconscious on the floor by
his son. [**Name (NI) **] was disheveled and the house was unkempt. EMS was
called and he was brought to [**Hospital 46**] Hosp for evaluation. On
admission his FS was 40 and he was given [**1-10**] amp of D50 with
good effect. In initial CXR showed a cavitary lesion in the RUL
and a follow up CT showed a cavitary mass in the RUL with R
hilar and R paratracheal LAD as well as multiple hepatic
densities concerning for a metastatic process. Head CT
reportedly negative.  He was given IV fluids for a slightly
elevated CK in the setting of his fall.  The following day,
[**2166-2-12**], he developed bradycardia on the floor and was intubated
and coded, ? of CPR being administrated. An ECG showed ST
elevations in II, III, and aVF and ST-D in V1-3. He was treated
given aspiring and a plavix load and was med flighted to [**Hospital1 18**]
on a heparin gtt. There was one note that the patient was given
zosyn at the OSH, reason not documented.
.
Pt med flighted to [**Hospital1 18**], admitted directly to cath lab, prelim
report with small left system, 50% LAD.  RCA was occluded
proximally with acute thrombus which was removed. BMS placed.
Right heart cath showed PCWP 15, RA [**10-20**].  Hypotensive after,
transferred to CCU on 5mcg dopamine. Still intubated.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: Diabetes, Dyslipidemia, Hypertension
UNKNOWN
2. CARDIAC HISTORY: UNKNOWN
-CABG:
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY: UNKNOWN
per report a history of bladder cancer 10 years ago.

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  94.5 105/63 73 (SR) 25 100% (AC TV 600 20 100% Fi02)
GENERAL: Elderly man. Intubated.  Arousable. Wearing bair
hugger.
HEENT: Right eye constricts to light, surgical left pupil. MM
dry. Intubated.
NECK: IJ (from OSH) left side, bandage on right side, unable to
assess JVP.
CARDIAC: No murmurs, difficult to ascultate over mechanical BS.
LUNGS: Cachectic.  Mechanical clear breath sounds.
ABDOMEN: Soft, NTND. + BS
EXTREMITIES: No edema. distal pulses present.  femoral sheath
still in place on right.
NEURO: Opens eyes, nods on commands. Withdraws to pain.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives alone, son [**Name (NI) **] is contact 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Acute respiratory failure,Acidosis,Pneumonitis due to inhalation of food or vomitus,Hemorrhage of gastrointestinal tract, unspecified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Heparin-induced thrombocytopenia (HIT)'}
