CHIEF COMPLAINT: Unresponsive

PRESENT ILLNESS: Pt is an 86 yo female w/ PMhx sig for COPD, CHF, schizophrenia,
dementia, discharged from [**Hospital1 18**] yesterday who presents from
rehab unresponsive.  The patient was hospitalized from [**Date range (1) 14195**]
for COPD exacerbation c/b sepsis secondary to diarrhea and
hypovolemia.  She was treated in the ICU and was on
pressors for a period of time.  Her course was also complicated
by hypernatremia requiring free water boluses.  She eventually
stabilized and was d/c back to rehab on levofloxacin and a
steroid taper.
This afternoon in rehab she was found to be unresponsive. She
was brought into [**Hospital1 18**] ED.
Previously her code status was DNR/DNI. At the time her
healthcare proxy (son Mr. [**First Name8 (NamePattern2) **] [**Known lastname **]) was contact[**Name (NI) **] from [**Name (NI) **],
he changed code status and wished to intubate patient and pursue
full treatment.  The patient had a GCS of 3 on arrival to the ED
and was intubated.  CT scan of the head showed a large R
hemisphere ICH.
Patient was stabilized at ED and admitted to Neurology ICU
service for further care.

MEDICAL HISTORY: Past Medical History:
-[**Hospital1 5595**] has a [**Location (un) 27292**] epidemic-symptom free for 10 days
-Influenza vaccine [**2151-12-7**]
-COPD/emphysema with CO2 retention:  admitted in [**2152-2-14**] to

MEDICATION ON ADMISSION: Heparin (Porcine) 5,000 unit/mL SC TID
Divalproex 500 mg Tablet PO QAM
Divalproex 250 mg Tablet PO QPM
Risperidone 1 mg PO BID
Donepezil 5 mg PO HS
Levofloxacin 500 mg PO Q24H for 4 days.
Albuterol Sulfate IH q6hr PRN
Ipratropium Bromide IH q6hr PRN
Multi-Vitamin
Ditropan 5 mg Tablet PO once a day.
Trazodone 50 mg PO at bedtime.
Lasix 40 mg PO once a day
Prednisone 20 mg Tablet Sig: Two (2) Tablet PO once a day
for 2 days: Give 40 mg on [**5-3**] and [**5-4**].
Prednisone 20 mg Tablet Sig: One (1) Tablet PO once a day
for 2 days: Give 20mg on [**5-5**] and [**2152-5-6**].

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 98.7; BP 151/44; P 66; RR 14; o2sat 100%

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: At baseline, she is able to hold a superficial conversation. Her
memory is quite poor. Dependent for all ADL. She could feed
herself after the tray was set up. Spoke to [**First Name8 (NamePattern2) 47532**] [**Last Name (NamePattern1) 4894**] at
[**Hospital 100**] Rehab who notes that patient is dependent in all ADLS
except feeding. Total care. Been at [**Hospital1 5595**] for 2 weeks.
Intracerebral hemorrhage,Obstructive chronic bronchitis with (acute) exacerbation,Unspecified schizophrenia, unspecified,Congestive heart failure, unspecified,Amyloidosis, unspecified,Cerebral edema,Other persistent mental disorders due to conditions classified elsewhere
Intracerebral hemorrhage,Obs chr bronc w(ac) exac,Schizophrenia NOS-unspec,CHF NOS,Amyloidosis NOS,Cerebral edema,Mental disor NEC oth dis
Admission Date:  [**2152-5-3**]              Discharge Date:   [**2152-5-4**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Unresponsive

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Pt is an 86 yo female w/ PMhx sig for COPD, CHF, schizophrenia,
dementia, discharged from [**Hospital1 18**] yesterday who presents from
rehab unresponsive.  The patient was hospitalized from [**Date range (1) 14195**]
for COPD exacerbation c/b sepsis secondary to diarrhea and
hypovolemia.  She was treated in the ICU and was on
pressors for a period of time.  Her course was also complicated
by hypernatremia requiring free water boluses.  She eventually
stabilized and was d/c back to rehab on levofloxacin and a
steroid taper.
This afternoon in rehab she was found to be unresponsive. She
was brought into [**Hospital1 18**] ED.
Previously her code status was DNR/DNI. At the time her
healthcare proxy (son Mr. [**First Name8 (NamePattern2) **] [**Known lastname **]) was contact[**Name (NI) **] from [**Name (NI) **],
he changed code status and wished to intubate patient and pursue
full treatment.  The patient had a GCS of 3 on arrival to the ED
and was intubated.  CT scan of the head showed a large R
hemisphere ICH.
Patient was stabilized at ED and admitted to Neurology ICU
service for further care.


Past Medical History:
Past Medical History:
-[**Hospital1 5595**] has a [**Location (un) 27292**] epidemic-symptom free for 10 days
-Influenza vaccine [**2151-12-7**]
-COPD/emphysema with CO2 retention:  admitted in [**2152-2-14**] to

NEBH with fever, hypoxia and respiratory distress with
improvement with bipap, nebulizers, Levaquin and steroids. ABG
on admission in [**2-20**] was 7.38/64/70-per d/c summary report. In
[**2152-2-14**], found to have bilateral lower lobe PNA and
presented with hypotension with BP 83/50 requiring ICU
admission.
-Schizophrenia
-Cataracts, status post iridectomy ROS
-Congestive heart failure: EF 55% and mild pulmonary
hypertension ([**2152-4-13**])
-Vitamin B12 deficiency, with macrocytic anemia
-Dementia
-Bladder spasm
-Urinary incontinence
-Partial lung collapse in [**2149**]
-Diabetes Type II, with creatinine in [**2152-2-14**] of 0.8


Social History:
At baseline, she is able to hold a superficial conversation. Her
memory is quite poor. Dependent for all ADL. She could feed
herself after the tray was set up. Spoke to [**First Name8 (NamePattern2) 47532**] [**Last Name (NamePattern1) 4894**] at
[**Hospital 100**] Rehab who notes that patient is dependent in all ADLS
except feeding. Total care. Been at [**Hospital1 5595**] for 2 weeks.


Family History:
Noncontributory.


Physical Exam:
Vitals: T 98.7; BP 151/44; P 66; RR 14; o2sat 100%

General: intubated, sedated
HEENT: NCAT
Neck: supple, no carotid bruit
Pulmonary: CTA b/l
Cardiac: regular rate and rhythm, with no m/r/g
Carotids: no blood flow murmur
Abdomen: obese soft, nontender, non distended, normal bowel
sounds
Extremities: no c/c/e.

Neurological Exam:
Mental status: intubated, non-resposive to verbal commands
Cranial Nerves: R surgical pupil, L cornea was opaque, + corneal
reflex, eyes deviated L, face symmetric.
Motor/[**Last Name (un) **]: reacts to painful stimuli on L side, minimally on
Right. These responses were stereotypical triple flexion or
extensor.
Reflexes: 2+ oin UEs.  1+ patella, absent ankle jerks. Planter
reflexes showed upgoing toes bilaterally.

Pertinent Results:
ABG: pH 7.50 pCO2 44 pO2 459 HCO3 36 BaseXS 10

148  108  20  119    AGap=10
4.3  34  0.7
CK: 22  MB: Notdone  Trop-T: <0.01
Comments: cTropnT: Ctropnt > 0.10 Ng/Ml Suggests Acute Mi
Serum ASA, EtOH, Acetmnphn, Benzo, Barb, Tricyc Negative
Valproate: Pnd

14.4 >9.4/30.0< 343
N:78 Band:1 L:14 M:3 E:0 Bas:0 Atyps: 1 Metas: 1 Myelos: 2
Hypochr: 1+ Macrocy: 3+ Polychr: 1+ Schisto: 1+ Stipple: 1+

U/A Straw  Appear Clear  SpecGr 1.013  pH  7.0  Urobil Neg  Bili
Neg
Leuk Neg  Bld Neg  Nitr Neg  Prot Neg  Glu Neg  Ket Neg

Head CT:
FINDINGS:  There has been interval development of acute large
right intraparenchymal hemorrhage, extending from the basal
ganglia out to the cortex, measuring approximately 10 x 4 cm.
There is extensive surrounding
edema and mass effect on adjacent cortex and the ipsilateral
lateral ventricles, as well as uncal herniation, and
approximately 12 mm of leftward shift of normally midline
structures. Dilatation of the occipital [**Doctor Last Name 534**] of the ontralateral
left lateral ventricle suggests compression of the third
ventricle by the hemorrhage and associated edema. There is no
intraventricular blood. Surrounding osseous and soft tissue
structures are unremarkable.
IMPRESSION:  Acute large 10 x 4 cm right intraparenchymal
hemorrhage and
associated edema causing mass effect on adjacent cortex and
ipsilateral
lateral ventricles, as well as uncal herniation and 12 mm of
leftward shift of normally midline structures.

CXR: 1.  Interval placement of an ET and OG tube, with good
position.
2.  Atelectasis at the left lung base, with likely small
associated pleural effusion.

Brief Hospital Course:
Pt is a 86 yo female w/ PMhx sig for COPD, dementia,
schizophrenia recently d/c yesterday from [**Hospital1 18**] for COPD flare
found to be unresponsive at rehabilitation hospital. Head CT
scan shows large R hemisphere ICH.  Neurological exam was
significant for intact brainstem reflexes, L eye deviation,
withdrawal to nailbed pressure of L, minimal on R, b/l upgoing
toes.  From the examination, the location of the hemorrhage
appears cortical/subcortical.  Given her history of dementia,
amyloid angiopathy appears likely.  Other possibilities include
metastatic disease, aneurysm, secondary transformation of an
ischemic stroke.  Eye deviation may represent pressure on L
frontal eye field from midline shift or alternatively seizure.

Patient was admitted to Neurology ICU (SICU) and received
Prednisone taper, Valproic acid. We controlled blood pressure to
achieve SBP<180, MAP<130.
Considering her prognosis, due to location and the size of
hemorrhage, it was considered to be very poor functionally and
mortality wise.
We communicated and kept in touch with her son regarding to her
condition and possible poor outcome.
Her son wished to place her comfortable measures only
considering poor prognosis.
Patient was extubated at 11:45AM. Patient became bradycardic,
apneic and became asystolic. Patient's death was announced on
[**2152-5-4**] 2:45PM.

Death was announced to her health care proxy, son, Mr. [**First Name8 (NamePattern2) **] [**Known lastname **].
New Englan Organ Bank was contact[**Name (NI) **] prior to extubation,
declined the case.
Patient'd death was reported to Medical Examiner, declined the
case.
The family requested to perform autopsy to identify underline
pathology of hemorrhage.

Medications on Admission:
Heparin (Porcine) 5,000 unit/mL SC TID
Divalproex 500 mg Tablet PO QAM
Divalproex 250 mg Tablet PO QPM
Risperidone 1 mg PO BID
Donepezil 5 mg PO HS
Levofloxacin 500 mg PO Q24H for 4 days.
Albuterol Sulfate IH q6hr PRN
Ipratropium Bromide IH q6hr PRN
Multi-Vitamin
Ditropan 5 mg Tablet PO once a day.
Trazodone 50 mg PO at bedtime.
Lasix 40 mg PO once a day
Prednisone 20 mg Tablet Sig: Two (2) Tablet PO once a day
for 2 days: Give 40 mg on [**5-3**] and [**5-4**].
Prednisone 20 mg Tablet Sig: One (1) Tablet PO once a day
for 2 days: Give 20mg on [**5-5**] and [**2152-5-6**].

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Intracranial hemorrhage (Intraparenchymal, likely due to amyloid
angiopathy)
Cerebral herniation


Discharge Condition:
Expired.


Discharge Instructions:
N/A

Followup Instructions:
N/A


                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2152-5-5**]
{'Intracerebral hemorrhage,Obstructive chronic bronchitis with (acute) exacerbation,Unspecified schizophrenia, unspecified,Congestive heart failure, unspecified,Amyloidosis, unspecified,Cerebral edema,Other persistent mental disorders due to conditions classified elsewhere'}


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: Unresponsive

PRESENT ILLNESS: Pt is an 86 yo female w/ PMhx sig for COPD, CHF, schizophrenia,
dementia, discharged from [**Hospital1 18**] yesterday who presents from
rehab unresponsive.  The patient was hospitalized from [**Date range (1) 14195**]
for COPD exacerbation c/b sepsis secondary to diarrhea and
hypovolemia.  She was treated in the ICU and was on
pressors for a period of time.  Her course was also complicated
by hypernatremia requiring free water boluses.  She eventually
stabilized and was d/c back to rehab on levofloxacin and a
steroid taper.
This afternoon in rehab she was found to be unresponsive. She
was brought into [**Hospital1 18**] ED.
Previously her code status was DNR/DNI. At the time her
healthcare proxy (son Mr. [**First Name8 (NamePattern2) **] [**Known lastname **]) was contact[**Name (NI) **] from [**Name (NI) **],
he changed code status and wished to intubate patient and pursue
full treatment.  The patient had a GCS of 3 on arrival to the ED
and was intubated.  CT scan of the head showed a large R
hemisphere ICH.
Patient was stabilized at ED and admitted to Neurology ICU
service for further care.

MEDICAL HISTORY: Past Medical History:
-[**Hospital1 5595**] has a [**Location (un) 27292**] epidemic-symptom free for 10 days
-Influenza vaccine [**2151-12-7**]
-COPD/emphysema with CO2 retention:  admitted in [**2152-2-14**] to

MEDICATION ON ADMISSION: Heparin (Porcine) 5,000 unit/mL SC TID
Divalproex 500 mg Tablet PO QAM
Divalproex 250 mg Tablet PO QPM
Risperidone 1 mg PO BID
Donepezil 5 mg PO HS
Levofloxacin 500 mg PO Q24H for 4 days.
Albuterol Sulfate IH q6hr PRN
Ipratropium Bromide IH q6hr PRN
Multi-Vitamin
Ditropan 5 mg Tablet PO once a day.
Trazodone 50 mg PO at bedtime.
Lasix 40 mg PO once a day
Prednisone 20 mg Tablet Sig: Two (2) Tablet PO once a day
for 2 days: Give 40 mg on [**5-3**] and [**5-4**].
Prednisone 20 mg Tablet Sig: One (1) Tablet PO once a day
for 2 days: Give 20mg on [**5-5**] and [**2152-5-6**].

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 98.7; BP 151/44; P 66; RR 14; o2sat 100%

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: At baseline, she is able to hold a superficial conversation. Her
memory is quite poor. Dependent for all ADL. She could feed
herself after the tray was set up. Spoke to [**First Name8 (NamePattern2) 47532**] [**Last Name (NamePattern1) 4894**] at
[**Hospital 100**] Rehab who notes that patient is dependent in all ADLS
except feeding. Total care. Been at [**Hospital1 5595**] for 2 weeks. 

### Response:
{'Intracerebral hemorrhage,Obstructive chronic bronchitis with (acute) exacerbation,Unspecified schizophrenia, unspecified,Congestive heart failure, unspecified,Amyloidosis, unspecified,Cerebral edema,Other persistent mental disorders due to conditions classified elsewhere'}
