CHIEF COMPLAINT: status post cardiac arrest

PRESENT ILLNESS: [**Age over 90 **] year old female with a history of atrial fibrillation, CAD
s/p MI, PVD, CVA who presents s/p cardiac arrest.  Pt was found
down at a rehab facility.  EMT was called when she was found
down in the nursing home.  She was intubated in the field and
was noted to be in PEA arrest.  CPR was performed and she was
given epinephrine and atropine x 3.  CPR performed by EMTs and
3Xepi plus 3X atropine.  In our ED CPR continued for 2-3 mins
and then regained pulse. Noted to have crepitis likely from CPR
on left so got a left sided chest tube. ETT pulled back because
in right main stem. CXR good placement ETT after pulling back.
EKG afib with wide QRS but cards thought from acidemia.  Pupils
fixed. Right CVL Fem line placed (initially had IO line). VBG
6.76/58/76/9. Got an amp bicarb and on a bicarb drip at 150ml an
hour. 2 units ffp ordered as well as two units prbcs. Had CT
head negative for bleed. Hypotensive in Ed (70/40) so started
levophed drip. VS prior to transfer: 101/62 levo on
1.2mc/kg/min. Temp rectally 96.6. HR 106 101/62 vented 450X18.
.

MEDICAL HISTORY: CHF with EF of 75% from echo
Atrial Fib on coumadin
s/p PCM
CAD s/p MI in 79
DM II (diet controlled )
Multiple CVA
PVD s/p femoral embolectomy

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Intubated, sedated
HEENT: Pupils fixed, non-reactive, MM dry
Neck: No LAD
Lungs: Diffuse rhonchi
CV: Tachy, heart sounds obscured by diffuse rhonchi
Abdomen: Firm, distended, hypoactive bowel sounds
Ext: Cool, no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt lives in [**Location **] and is independant of ADLs.  Communication:
Patient via russian interpreter.  Grand Niece & HCP-- [**Name (NI) 83407**]
[**Telephone/Fax (1) 83408**] cell [**Telephone/Fax (1) 83409**]
[**Female First Name (un) 83410**] Daughter & 2nd HCP-- [**Telephone/Fax (1) 83411**]
NH-->[**Telephone/Fax (1) **]
Anoxic brain damage,Pulmonary congestion and hypostasis,Acidosis,Cardiac arrest,Hypothermia not associated with low environmental temperature
Anoxic brain damage,Pulm congest/hypostasis,Acidosis,Cardiac arrest,Hypothrm-wo low env tmp
Admission Date:  [**2103-3-17**]              Discharge Date:   [**2103-3-17**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
status post cardiac arrest

Major Surgical or Invasive Procedure:
Chest tube
Arterial line
Central line

History of Present Illness:
[**Age over 90 **] year old female with a history of atrial fibrillation, CAD
s/p MI, PVD, CVA who presents s/p cardiac arrest.  Pt was found
down at a rehab facility.  EMT was called when she was found
down in the nursing home.  She was intubated in the field and
was noted to be in PEA arrest.  CPR was performed and she was
given epinephrine and atropine x 3.  CPR performed by EMTs and
3Xepi plus 3X atropine.  In our ED CPR continued for 2-3 mins
and then regained pulse. Noted to have crepitis likely from CPR
on left so got a left sided chest tube. ETT pulled back because
in right main stem. CXR good placement ETT after pulling back.
EKG afib with wide QRS but cards thought from acidemia.  Pupils
fixed. Right CVL Fem line placed (initially had IO line). VBG
6.76/58/76/9. Got an amp bicarb and on a bicarb drip at 150ml an
hour. 2 units ffp ordered as well as two units prbcs. Had CT
head negative for bleed. Hypotensive in Ed (70/40) so started
levophed drip. VS prior to transfer: 101/62 levo on
1.2mc/kg/min. Temp rectally 96.6. HR 106 101/62 vented 450X18.
.


Past Medical History:
CHF with EF of 75% from echo
Atrial Fib on coumadin
s/p PCM
CAD s/p MI in 79
DM II (diet controlled )
Multiple CVA
PVD s/p femoral embolectomy

Social History:
Pt lives in [**Location **] and is independant of ADLs.  Communication:
Patient via russian interpreter.  Grand Niece & HCP-- [**Name (NI) 83407**]
[**Telephone/Fax (1) 83408**] cell [**Telephone/Fax (1) 83409**]
[**Female First Name (un) 83410**] Daughter & 2nd HCP-- [**Telephone/Fax (1) 83411**]
NH-->[**Telephone/Fax (1) **]


Family History:
NC

Physical Exam:
General: Intubated, sedated
HEENT: Pupils fixed, non-reactive, MM dry
Neck: No LAD
Lungs: Diffuse rhonchi
CV: Tachy, heart sounds obscured by diffuse rhonchi
Abdomen: Firm, distended, hypoactive bowel sounds
Ext: Cool, no edema


Pertinent Results:
[**2103-3-17**] 01:24PM   TYPE-ART PH-7.21*
[**2103-3-17**] 01:24PM   freeCa-1.02*
[**2103-3-17**] 12:10PM   TYPE-ART PO2-174* PCO2-37 PH-7.18* TOTAL
CO2-15* BASE XS--13
[**2103-3-17**] 12:10PM   TYPE-ART PO2-174* PCO2-37 PH-7.18* TOTAL
CO2-15* BASE XS--13
[**2103-3-17**] 12:10PM   LACTATE-13.1*
[**2103-3-17**] 12:10PM   freeCa-0.63*
[**2103-3-17**] 11:56AM   TYPE-ART PO2-48* PCO2-62* PH-7.03* TOTAL
CO2-18* BASE XS--16
[**2103-3-17**] 11:56AM   LACTATE-13.9*
[**2103-3-17**] 11:56AM   freeCa-0.88*
[**2103-3-17**] 11:14AM   LACTATE-14.2*
[**2103-3-17**] 11:14AM   LACTATE-14.2*
[**2103-3-17**] 11:14AM   freeCa-0.89*
[**2103-3-17**] 11:13AM   GLUCOSE-124* UREA N-45* CREAT-1.9*
SODIUM-151* POTASSIUM-5.8* CHLORIDE-114* TOTAL CO2-13* ANION
GAP-30*
[**2103-3-17**] 11:13AM   GLUCOSE-299* UREA N-39* CREAT-1.7*
SODIUM-149* POTASSIUM-5.7* CHLORIDE-111* TOTAL CO2-11* ANION
GAP-33*
[**2103-3-17**] 11:13AM   ALT(SGPT)-414* AST(SGOT)-942* LD(LDH)-2219*
CK(CPK)-284* ALK PHOS-76 TOT BILI-1.2
[**2103-3-17**] 11:13AM   ALT(SGPT)-399* AST(SGOT)-947* LD(LDH)-1891*
CK(CPK)-386* ALK PHOS-53 TOT BILI-1.1
[**2103-3-17**] 11:13AM   CK-MB-26* MB INDX-9.2* cTropnT-0.50*
[**2103-3-17**] 11:13AM   CK-MB-35* MB INDX-9.1 cTropnT-0.66*
[**2103-3-17**] 11:13AM   WBC-7.0 RBC-3.14* HGB-9.0* HCT-30.3* MCV-97
MCH-28.8 MCHC-29.8* RDW-19.0*
[**2103-3-17**] 11:13AM   WBC-5.4 RBC-1.90*# HGB-5.6*# HCT-18.4*#
MCV-97 MCH-29.3 MCHC-30.4* RDW-18.4*
[**2103-3-17**] 11:13AM   HYPOCHROM-1+ ANISOCYT-2+ POIKILOCY-2+
MACROCYT-2+ MICROCYT-1+ POLYCHROM-1+ BURR-OCCASIONAL
STIPPLED-OCCASIONAL PAPPENHEI-OCCASIONAL
[**2103-3-17**] 11:13AM   NEUTS-75* BANDS-1 LYMPHS-16* MONOS-3 EOS-0
BASOS-0 ATYPS-0 METAS-5* MYELOS-0 NUC RBCS-4*
[**2103-3-17**] 11:13AM   PT-30.8* PTT-150* INR(PT)-3.1*
[**2103-3-17**] 11:13AM   PT-24.2* PTT-150* INR(PT)-2.3*

Brief Hospital Course:
On arrival to MICU, she was noted to be persistently hypotensive
despite max levophed.  Started on vasopressin followed by
escalating neosynephrine.  With severe metabolic acidosis
6.76/58/76 with lacate peak at 14.2, given 2 amps bicarb
followed by bicarb drip.  Also given FFP given severe
coagulopathy and concern for bleed (hct down to 18.4 from
baseline ~30s).  In setting of blood products with worsening
oxygenation with desaturations to 85% on FiO2 100%, PEEP 15. The
patient was continued on three pressors for blood pressure
support and her BP still remained low.

The health care proxy was called to bedside. The patient was s/p
cardiac arrest and in DIC, unable to be cooled. She remained
hypotensive despite maximal pressors. After discussions with the
housestaff and attending physician, [**Name10 (NameIs) **] health care proxy did
not wish to further escalate care and made the patient DNR. The
patient died of PEA cardiac arrest with her HCP at her side.

The case was referred to the medical examiner, however, the
medical examiner declined the case. The family did not want an
autopsy.

Medications on Admission:
Unknown

Discharge Medications:
n/a


Discharge Disposition:
Expired

Discharge Diagnosis:
-Sepsis, multisystem organ failure
-status post cardiac arrest
-disseminated intravascular cogulation

Discharge Condition:
Expired, not applicable

Discharge Instructions:
Expired

Followup Instructions:
Expired
{'Anoxic brain damage,Pulmonary congestion and hypostasis,Acidosis,Cardiac arrest,Hypothermia not associated with low environmental temperature'}


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: status post cardiac arrest

PRESENT ILLNESS: [**Age over 90 **] year old female with a history of atrial fibrillation, CAD
s/p MI, PVD, CVA who presents s/p cardiac arrest.  Pt was found
down at a rehab facility.  EMT was called when she was found
down in the nursing home.  She was intubated in the field and
was noted to be in PEA arrest.  CPR was performed and she was
given epinephrine and atropine x 3.  CPR performed by EMTs and
3Xepi plus 3X atropine.  In our ED CPR continued for 2-3 mins
and then regained pulse. Noted to have crepitis likely from CPR
on left so got a left sided chest tube. ETT pulled back because
in right main stem. CXR good placement ETT after pulling back.
EKG afib with wide QRS but cards thought from acidemia.  Pupils
fixed. Right CVL Fem line placed (initially had IO line). VBG
6.76/58/76/9. Got an amp bicarb and on a bicarb drip at 150ml an
hour. 2 units ffp ordered as well as two units prbcs. Had CT
head negative for bleed. Hypotensive in Ed (70/40) so started
levophed drip. VS prior to transfer: 101/62 levo on
1.2mc/kg/min. Temp rectally 96.6. HR 106 101/62 vented 450X18.
.

MEDICAL HISTORY: CHF with EF of 75% from echo
Atrial Fib on coumadin
s/p PCM
CAD s/p MI in 79
DM II (diet controlled )
Multiple CVA
PVD s/p femoral embolectomy

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Intubated, sedated
HEENT: Pupils fixed, non-reactive, MM dry
Neck: No LAD
Lungs: Diffuse rhonchi
CV: Tachy, heart sounds obscured by diffuse rhonchi
Abdomen: Firm, distended, hypoactive bowel sounds
Ext: Cool, no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Pt lives in [**Location **] and is independant of ADLs.  Communication:
Patient via russian interpreter.  Grand Niece & HCP-- [**Name (NI) 83407**]
[**Telephone/Fax (1) 83408**] cell [**Telephone/Fax (1) 83409**]
[**Female First Name (un) 83410**] Daughter & 2nd HCP-- [**Telephone/Fax (1) 83411**]
NH-->[**Telephone/Fax (1) **] 

### Response:
{'Anoxic brain damage,Pulmonary congestion and hypostasis,Acidosis,Cardiac arrest,Hypothermia not associated with low environmental temperature'}
