CHIEF COMPLAINT: Found down, unresponsive.

PRESENT ILLNESS: The patient is a 29-year-old
female with a history of depression and polysubstance abuse
who was found unresponsive on the street.  The patient was
brought to [**Hospital6 256**] Emergency
Department where she received Narcan and became combative.
She was intubated for airway protection and transferred to
Surgical Intensive Care Unit for further management.

MEDICAL HISTORY: 1.  Depression
2.  Polysubstance abuse, including heroine and cocaine,
benzodiazepines
3.  History of hepatitis C
4.  Human immunodeficiency virus negative four months ago

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: VITAL SIGNS:  Temperature 99.1??????, pulse 71, blood pressure
125/69, respiratory rate 12, O2 saturation 100% on 40% of
oxygen.
GENERAL:  The patient was sedated and paralyzed on arrival to
the Surgical Intensive Care Unit with settings of SIMV 500 x
12 with PEEP of 5 and pressure support of 5.
LUNGS:  Clear to auscultation bilaterally.
HEART:  Regular rate and rhythm without murmurs, rubs or
gallops.
ABDOMEN:  Soft, nontender, nondistended.  There was an old
cesarean section scar.  Bowel sounds were normal.
EXTREMITIES:  No cyanosis, clubbing or edema.
NECK:  No jugular venous distention, was supple.
HEAD, EARS, EYES, NOSE AND THROAT:  Her pupils were reactive
3 to 1 mm bilaterally.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Unknown on admission.  The patient is
currently homeless, has a boyfriend and seven adopted
children.
Poisoning by heroin,Drug withdrawal,Acute hepatitis C without mention of hepatic coma,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Major depressive affective disorder, single episode, unspecified,Iron deficiency anemia, unspecified
Poisoning-heroin,Drug withdrawal,Hpt C acute wo hpat coma,Poison-analgesics,Depress psychosis-unspec,Iron defic anemia NOS
Admission Date:  [**2151-9-25**]       Discharge Date:  [**2151-9-27**]

Date of Birth:   [**2122-1-29**]       Sex:  F

Service:  SICU

CHIEF COMPLAINT:  Found down, unresponsive.

HISTORY OF PRESENT ILLNESS:  The patient is a 29-year-old
female with a history of depression and polysubstance abuse
who was found unresponsive on the street.  The patient was
brought to [**Hospital6 256**] Emergency
Department where she received Narcan and became combative.
She was intubated for airway protection and transferred to
Surgical Intensive Care Unit for further management.

PAST MEDICAL HISTORY:
1.  Depression
2.  Polysubstance abuse, including heroine and cocaine,
benzodiazepines
3.  History of hepatitis C
4.  Human immunodeficiency virus negative four months ago

ALLERGIES:  No known drug allergies.

ADMISSION MEDICATIONS:  Unknown

SOCIAL HISTORY:  Unknown on admission.  The patient is
currently homeless, has a boyfriend and seven adopted
children.

FAMILY HISTORY:  Noncontributory

ADMISSION PHYSICAL EXAM:
VITAL SIGNS:  Temperature 99.1??????, pulse 71, blood pressure
125/69, respiratory rate 12, O2 saturation 100% on 40% of
oxygen.
GENERAL:  The patient was sedated and paralyzed on arrival to
the Surgical Intensive Care Unit with settings of SIMV 500 x
12 with PEEP of 5 and pressure support of 5.
LUNGS:  Clear to auscultation bilaterally.
HEART:  Regular rate and rhythm without murmurs, rubs or
gallops.
ABDOMEN:  Soft, nontender, nondistended.  There was an old
cesarean section scar.  Bowel sounds were normal.
EXTREMITIES:  No cyanosis, clubbing or edema.
NECK:  No jugular venous distention, was supple.
HEAD, EARS, EYES, NOSE AND THROAT:  Her pupils were reactive
3 to 1 mm bilaterally.

LABS:  White count on admission 7.1 with a differential of 55
neutrophils, 36 lymphocytes, 1.5 eosinophils, hematocrit of
35.3 with an MCV of 82, platelet count 272.  Chem-7 showed
sodium 143, potassium 3.6, phosphate 107, bicarbonate 25, BUN
10, creatinine 0.7, glucose 95.  Her serum toxicology screen
was negative for aspirin, ethanol, Tylenol, benzodiazepines,
barbiturates and tricyclics.

Her urine toxicology was positive for benzodiazepines,
opiates and cocaine and negative for methadone, barbiturates
and amphetamines.  Urinalysis showed yellow hazy urine with
specific gravity of 1.025, pH of 5, 0.2 urobilinogen,
negative bilirubin, negative leukocyte, moderate bacteria, 11
to 20 red blood cells, 3 to 5 white blood cells, no bacteria,
no yeast and serial epithelial cells.

STUDIES:  CT showed no intracranial bleed or mass effect.
There was mild mucosal thickening in ethmoid sinuses
consistent with chronic sinusitis.

The chest x-ray showed ETT tube in proper place.
Electrocardiogram showed normal sinus rhythm at 69, normal
axis, normal intervals, no ST-T changes.

HOSPITAL COURSE:  In summary, the patient is a 29-year-old
female with hepatitis C and polysubstance use who presented
with benzodiazepine, opiate, cocaine overdose and was
intubated for airway protection.  During this
hospitalization, her issues included:

1.  Pulmonary:  Overnight, the patient did well with minimal
ventilatory support and was extubated within 12 hours of
intubation.  She was able to maintain her ventilation and
oxygenation without any problems.

2.  Multi-substance overdose with opiates, cocaine and
benzodiazepines:  Before the toxicology screen was back, the
patient received thiamine and folic acid as well as Narcan
and charcoal.  Throughout her stay in the Intensive Care
Unit, she was initially maintained on low dose Ativan drip
followed by continuation of her outpatient Klonopin doses.

Once awake, the patient provided history of having depression
for which the psychiatrist is prescribing Remeron, Klonopin,
Neurontin and Celexa.  All of those medications were
continued on an inpatient basis.  Her narcotic withdrawal was
monitored with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] scale and the patient did not require
any methadone during her Intensive Care Unit stay based on
the [**Doctor Last Name **] scale.

Following extubation, a psychiatric consult was obtained.
The patient denied any suicidal ideation, however since this
is her second overdose admission within the last week, she
was judged to be appropriate for dual diagnosis unit.  She is
being screened and is to be transferred to a detoxification,
psychiatry unit.

DISCHARGE DIAGNOSES:
1.  Drug overdose with cocaine opiates and benzodiazepines
2.  Hepatitis C
3.  Polysubstance abuse
4.  Homelessness




                            DR.[**First Name (STitle) **],[**First Name3 (LF) 734**] 12-944

Dictated By:[**Last Name (NamePattern1) 1762**]
MEDQUIST36

D:  [**2151-9-27**]  13:42
T:  [**2151-9-27**]  13:57
JOB#:  [**Job Number 94505**]
{'Poisoning by heroin,Drug withdrawal,Acute hepatitis C without mention of hepatic coma,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Major depressive affective disorder, single episode, unspecified,Iron deficiency anemia, unspecified'}


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: Found down, unresponsive.

PRESENT ILLNESS: The patient is a 29-year-old
female with a history of depression and polysubstance abuse
who was found unresponsive on the street.  The patient was
brought to [**Hospital6 256**] Emergency
Department where she received Narcan and became combative.
She was intubated for airway protection and transferred to
Surgical Intensive Care Unit for further management.

MEDICAL HISTORY: 1.  Depression
2.  Polysubstance abuse, including heroine and cocaine,
benzodiazepines
3.  History of hepatitis C
4.  Human immunodeficiency virus negative four months ago

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: VITAL SIGNS:  Temperature 99.1??????, pulse 71, blood pressure
125/69, respiratory rate 12, O2 saturation 100% on 40% of
oxygen.
GENERAL:  The patient was sedated and paralyzed on arrival to
the Surgical Intensive Care Unit with settings of SIMV 500 x
12 with PEEP of 5 and pressure support of 5.
LUNGS:  Clear to auscultation bilaterally.
HEART:  Regular rate and rhythm without murmurs, rubs or
gallops.
ABDOMEN:  Soft, nontender, nondistended.  There was an old
cesarean section scar.  Bowel sounds were normal.
EXTREMITIES:  No cyanosis, clubbing or edema.
NECK:  No jugular venous distention, was supple.
HEAD, EARS, EYES, NOSE AND THROAT:  Her pupils were reactive
3 to 1 mm bilaterally.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Unknown on admission.  The patient is
currently homeless, has a boyfriend and seven adopted
children. 

### Response:
{'Poisoning by heroin,Drug withdrawal,Acute hepatitis C without mention of hepatic coma,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Major depressive affective disorder, single episode, unspecified,Iron deficiency anemia, unspecified'}
