CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 70 year old
male with a history of bilateral lung cancer, status post
resection and chemotherapy and radiation who experienced
shortness of breath and diaphoresis the morning of his
admission.  He called his family and they found him to be
short of breath, diaphoretic and they called Emergency
Medical Services.  The patient then had a PEA witnessed
arrest, cardiopulmonary resuscitation was initiated.  The
patient was intubated in the field.  He was given Epinephrine
via his endotracheal tube, Atropine and his pulse and blood
pressure were covered in the ambulance.  The patient was
taken to [**Hospital 882**] Hospital.  At [**Hospital 882**] Hospital he again
arrested (PEA arrest), cardiopulmonary resuscitation was
initiated again and he was resuscitated with 2 mg of
Epinephrine, 1 mg of bicarbonate and his first arterial blood
gas was 6.90 pH, pCO2 of 111 and pAO2 of 123.  He was started
on a Dopamine drip.  A left subclavian central line was
placed and the patient was started on a Versed drip.  He was
transferred to [**Hospital6 256**] for
further management as he received his care here.

MEDICAL HISTORY: 1.  Right upper lung cancer, right
upper lobe biopsy in [**2166-4-26**] consistent with
adenocarcinoma, status post wedge resection, left upper lobe
bronchial washings with poorly differentiated large cell
cancer, status post lobectomy.  The patient underwent
chemotherapy with Carboplatin and Taxol and radiation there
which he finished the week prior to his admission.  2.
Hypertension.  3.  Hypercholesterolemia.  4.  Peptic ulcer
disease.  5.  Chronic sinusitis.

MEDICATION ON ADMISSION: Amiodarone 200 mg p.o. q. day,
Atenolol 25 mg p.o. q. day, Hydrochlorothiazide 25 mg p.o. q.
day, Lipitor 10 mg p.o. q. day, Colace and Percocet prn,
Trazodone 50 mg p.o. q.h.s., Tylenol, Flovent, Atrovent,
Nasocort, Levaquin 500 q. day times seven days, Compazine
prn, Metamucil, Robitussin, Oxycodone prn, Oxacillin prn.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for skin cancer, question melanoma,
grandfather with carcinoma of the lip.

SOCIAL HISTORY: Positive tobacco use with a 50 pack year
history until [**2165**].  He had a history of occupational
exposure to asbestos.
Other pulmonary embolism and infarction,Acute respiratory failure,Cardiac arrest,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure with lesion of tubular necrosis,Thrombocytopenia, unspecified,Acute and subacute necrosis of liver,Acidosis,Chronic airway obstruction, not elsewhere classified
Pulm embol/infarct NEC,Acute respiratry failure,Cardiac arrest,Meth sus pneum d/t Staph,Ac kidny fail, tubr necr,Thrombocytopenia NOS,Acute necrosis of liver,Acidosis,Chr airway obstruct NEC
Admission Date:  [**2166-11-29**]       Discharge Date:

Date of Birth:   [**2096-7-26**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 70 year old
male with a history of bilateral lung cancer, status post
resection and chemotherapy and radiation who experienced
shortness of breath and diaphoresis the morning of his
admission.  He called his family and they found him to be
short of breath, diaphoretic and they called Emergency
Medical Services.  The patient then had a PEA witnessed
arrest, cardiopulmonary resuscitation was initiated.  The
patient was intubated in the field.  He was given Epinephrine
via his endotracheal tube, Atropine and his pulse and blood
pressure were covered in the ambulance.  The patient was
taken to [**Hospital 882**] Hospital.  At [**Hospital 882**] Hospital he again
arrested (PEA arrest), cardiopulmonary resuscitation was
initiated again and he was resuscitated with 2 mg of
Epinephrine, 1 mg of bicarbonate and his first arterial blood
gas was 6.90 pH, pCO2 of 111 and pAO2 of 123.  He was started
on a Dopamine drip.  A left subclavian central line was
placed and the patient was started on a Versed drip.  He was
transferred to [**Hospital6 256**] for
further management as he received his care here.

PAST MEDICAL HISTORY:  1.  Right upper lung cancer, right
upper lobe biopsy in [**2166-4-26**] consistent with
adenocarcinoma, status post wedge resection, left upper lobe
bronchial washings with poorly differentiated large cell
cancer, status post lobectomy.  The patient underwent
chemotherapy with Carboplatin and Taxol and radiation there
which he finished the week prior to his admission.  2.
Hypertension.  3.  Hypercholesterolemia.  4.  Peptic ulcer
disease.  5.  Chronic sinusitis.

SOCIAL HISTORY:  Positive tobacco use with a 50 pack year
history until [**2165**].  He had a history of occupational
exposure to asbestos.

FAMILY HISTORY:  Positive for skin cancer, question melanoma,
grandfather with carcinoma of the lip.

MEDICATIONS ON ADMISSION:  Amiodarone 200 mg p.o. q. day,
Atenolol 25 mg p.o. q. day, Hydrochlorothiazide 25 mg p.o. q.
day, Lipitor 10 mg p.o. q. day, Colace and Percocet prn,
Trazodone 50 mg p.o. q.h.s., Tylenol, Flovent, Atrovent,
Nasocort, Levaquin 500 q. day times seven days, Compazine
prn, Metamucil, Robitussin, Oxycodone prn, Oxacillin prn.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  Physical examination on admission
revealed temperature 93.3, blood pressure 75/54, heartrate
129.  Ventilator settings, assist control 800 by 16 with a
rate of 16, 100% FIO2 and 5 positive end-expiratory pressure.
In general he was intubated and not responsive to painful
stimuli.  Head, eyes, ears, nose and throat, pupils dilated,
not responsive to light.  Neck, unable to assess jugulovenous
pressure.  Cardiovascular, tachycardiac, regular rate, no
murmurs.  Lungs, coarse breathsounds bilaterally anterior
with question of slightly diminished breathsounds at the left
base.  Abdomen, decreased bowel sounds, soft, nondistended.
Rectal deferred.  Obstetrics negative at outside hospital.
Extremities, cool, mottled, positive dorsalis pedis pulses
bilaterally.  No edema and no urine was noted in his Foley
catheter bag.

LABORATORY DATA:  On admission white count was 4.3,
hematocrit 33.1, platelets 161, INR 1.4, PTT 38.5, ALT 314,
AST 325, ALV 922, alkaline phosphatase 133, amylase 148,
calcium 1.1, free calcium 1.17, lactate 6.9, sodium 142,
potassium 3.3, chloride 101, bicarbonate 20, BUN 23,
creatinine 1.1, anion gap of 20.  Phosphorus 7.8, albumin
3.0.  His electrocardiogram showed sinus tachycardia with
right bundle branch block, T wave inversions in V1 and V2, T
wave inversion in V3.  Lower extremity ultrasound showed
bilateral common femoral deep vein thrombosis and left
superior clot.  Chest x-ray showed right upper lobe
infiltrate.

HOSPITAL COURSE:  1.  Pulmonary - The patient underwent a
computed tomographic angiography which showed multiple
pulmonary embolisms.  He underwent thrombectomy with directed
total parenteral alimentation.  An inferior vena cava filter
was placed by Interventional Radiology.  He was started on
heparin.  He experienced hypoxemia and ventilatory failure
secondary to pulmonary embolism but he also has a history of
underlying lung disease including wedge resections,
radiation, likely chronic obstructive pulmonary disease.

During his hospital course the patient was treated for his
pulmonary emboli and he was able to be slowly weaned from the
ventilator.  On [**2166-12-5**], the patient had a
self-extubation which failed.  He was reintubated and
experienced likely intubation-associated pneumonia.  His
sputum grew out Methicillin-resistant Staphylococcus aureus.
He was started on Vancomycin.  He had a bedside tracheostomy
performed and has since that time been slowly able to be
weaned from the ventilator.  He, at this time, is able to be
weaned to tracheostomy mask for three to four hours per day.

2.  Infectious disease - The patient had 2 out of 2 positive
blood cultures from a left subclavian line that was
discontinued and he was started on Vancomycin.  His
peripheral cultures remained no growth deep.  He had
Methicillin-resistant Staphylococcus aureus pneumonia and has
been treated with Vancomycin to complete a two week course.

3.  Heme - The patient received one unit of blood.  His
hematocrit remained stable.  His platelets initially
decreased but later recovered and have since then been
normal.  It was felt that he had likely consumption from his
large clot burden as well as poor production given his recent
chemotherapy.  He was therapeutic on heparin and Coumadin was
started prior to discharge.

4.  Renal - Initially the patient had his creatinine bumped
to 2.5, likely secondary to acute tubular necrosis from his
arrest and also in the setting of large diload for computed
tomographic angiography and angiogram.  His creatinine
trended down.  He had good urine output and his kidney
function was normal at the time of discharge.

5.  Gastrointestinal - He initially had elevated liver
function tests which recovered over his initial hospital
stay.  It was felt this was secondary to shock liver.  He
also had coffee ground emesis through his nasogastric tube
after his total parenteral alimentation.  He was started on
Protonix and he had no further bleeding.  At the time of
discharge he was having normal bowel movements that were
guaiac negative.

6.  Nutrition - The patient was started on tube feeds via his
percutaneous endoscopic gastrostomy that was placed at the
bedside by Gastroenterology.  He was tolerating them well.

7.  Cardiovascular - The patient remained off of his
antihypertensive medications during his hospital stay.  These
can be restarted as needed after discharge.

8.  Access - The patient will be evaluated for a PICC line to
be placed prior to discharge to complete his course of
antibiotics.  He has a tracheostomy and percutaneous
endoscopic gastrostomy tube.

The remaining discharge summary will be dictated as an
addendum with discharge medications.




                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3795**]

Dictated By:[**Last Name (NamePattern1) 9422**]
MEDQUIST36

D:  [**2166-12-14**]  10:50
T:  [**2166-12-14**]  10:56
JOB#:  [**Job Number 43212**]


Admission Date:  [**2166-11-29**]       Discharge Date:  [**2166-12-19**]

Date of Birth:   [**2096-7-26**]       Sex:  M

Service:

ADDENDUM:  There is one correction from initial discharge
summary under hospital course.

HOSPITAL COURSE:  The patient underwent thrombectomy with
directed TPA, which is tissue plasminogen activator not total
parenteral alimentation.

From an pulmonary standpoint the patient remained off the
ventilator and on a 40% tracheostomy mask for greater periods
of time throughout the day.  He was off the ventilator for a
total of 48 hours and on the trach mask at which time he then
fatigued and required resting on minimal amounts of pressure
support and at this time is able to tolerate tracheostomy
mask for over twelve hours per day.  He had a Passy Muir
valve placed and tolerates it well.  His cough has improved.
He is able to clear his own secretions requires less
suctioning.

From an infectious disease standpoint, the patient is to
complete his course of Vancomycin for MRSA pneumonia on
[**2166-11-19**].  At this time he remains afebrile, although his
white count has been slowly rising, all remaining cultures
have been no growth to date and he will need to be monitored
after discharge for any evidence of persistent infection
after his antibiotics are completed.  Blood cultures were
sent on [**12-19**] from his right sided PICC line as well as C-diff
stool cultures sent on [**12-18**], which is pending at this time.

Hematology, the patient received one additional unit of
packed red blood cells on [**11-17**] for a hematocrit of 23.
There has been no evidence of active bleeding.  His stools
have been guaiac negative.  This was felt secondary to
frequent phlebotomy.  His hematocrit bumped to 28
appropriately and has remained stable.

Nutrition, the patient remained on tube feeds at his goal
rate of 60 cc per hour.  He is having normal bowel movements
and remains on Prevacid for a history of upper
gastrointestinal bleed, which is stable.

Cardiovascular, the patient was restarted on Lopresor as well
as Lipitor for his history of hypertension and
hypercholesterolemia.  He was not restarted on Amiodarone
given the potential lung toxicity.

Psychiatric, over the past several days the patient had
episodes of increased confusion and agitation.  His
benzodiazepines and opiates were discontinued and the patient
was started on Zyprexa, which will be increased to 5 mg po
q.h.s., which has improved his overall mental status.  On the
day of this dictation the patient is oriented to person and
time, but not to place, but he is less agitated and is
pleasant and cooperative.  On [**11-17**] he had an episode of
agitation where he removed his tracheostomy, which was
replaced without incident and he has been doing well since
that time.

Access, the patient has a right sided PICC line placed on
[**12-15**], tracheostomy placed [**12-9**] and changed on [**12-18**], PEG
placed on [**12-10**], Foley catheter and he will have a voiding
trial today remains in place at this time.

DISCHARGE MEDICATIONS:  Lipitor 10 mg per G tube q day,
Lopressor 50 mg per G tube b.i.d., intravenous heparin,
regular insulin sliding scale b.i.d., Prevacid 30 mg per G
tube q day, Zyprexa 5 mg po q.h.s., Atrovent nebulizers one
neb q six hours.  Coumadin 5 mg po q day and Vancomycin 1
gram intravenous q 18 hours until [**2166-11-19**].  Nystatin
applied topically as needed and Lidocaine jelly 2% applied
topically as needed to his sacrum.  Desitin and Miconazole
powder applied as needed.  Nystatin oral solution 5 ml po
t.i.d. prn swish and swallow.  Albuterol one to two puffs
inhaled q 4 hours prn.  Trazodone 75 mg po q.h.s. prn.






                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3795**]

Dictated By:[**Last Name (NamePattern1) 9422**]
MEDQUIST36

D:  [**2166-12-19**]  12:50
T:  [**2166-12-19**]  12:55
JOB#:  [**Job Number 43213**]
{'Other pulmonary embolism and infarction,Acute respiratory failure,Cardiac arrest,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure with lesion of tubular necrosis,Thrombocytopenia, unspecified,Acute and subacute necrosis of liver,Acidosis,Chronic airway obstruction, not elsewhere classified'}


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: 

PRESENT ILLNESS: The patient is a 70 year old
male with a history of bilateral lung cancer, status post
resection and chemotherapy and radiation who experienced
shortness of breath and diaphoresis the morning of his
admission.  He called his family and they found him to be
short of breath, diaphoretic and they called Emergency
Medical Services.  The patient then had a PEA witnessed
arrest, cardiopulmonary resuscitation was initiated.  The
patient was intubated in the field.  He was given Epinephrine
via his endotracheal tube, Atropine and his pulse and blood
pressure were covered in the ambulance.  The patient was
taken to [**Hospital 882**] Hospital.  At [**Hospital 882**] Hospital he again
arrested (PEA arrest), cardiopulmonary resuscitation was
initiated again and he was resuscitated with 2 mg of
Epinephrine, 1 mg of bicarbonate and his first arterial blood
gas was 6.90 pH, pCO2 of 111 and pAO2 of 123.  He was started
on a Dopamine drip.  A left subclavian central line was
placed and the patient was started on a Versed drip.  He was
transferred to [**Hospital6 256**] for
further management as he received his care here.

MEDICAL HISTORY: 1.  Right upper lung cancer, right
upper lobe biopsy in [**2166-4-26**] consistent with
adenocarcinoma, status post wedge resection, left upper lobe
bronchial washings with poorly differentiated large cell
cancer, status post lobectomy.  The patient underwent
chemotherapy with Carboplatin and Taxol and radiation there
which he finished the week prior to his admission.  2.
Hypertension.  3.  Hypercholesterolemia.  4.  Peptic ulcer
disease.  5.  Chronic sinusitis.

MEDICATION ON ADMISSION: Amiodarone 200 mg p.o. q. day,
Atenolol 25 mg p.o. q. day, Hydrochlorothiazide 25 mg p.o. q.
day, Lipitor 10 mg p.o. q. day, Colace and Percocet prn,
Trazodone 50 mg p.o. q.h.s., Tylenol, Flovent, Atrovent,
Nasocort, Levaquin 500 q. day times seven days, Compazine
prn, Metamucil, Robitussin, Oxycodone prn, Oxacillin prn.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for skin cancer, question melanoma,
grandfather with carcinoma of the lip.

SOCIAL HISTORY: Positive tobacco use with a 50 pack year
history until [**2165**].  He had a history of occupational
exposure to asbestos. 

### Response:
{'Other pulmonary embolism and infarction,Acute respiratory failure,Cardiac arrest,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure with lesion of tubular necrosis,Thrombocytopenia, unspecified,Acute and subacute necrosis of liver,Acidosis,Chronic airway obstruction, not elsewhere classified'}
