CHIEF COMPLAINT: The patient was admitted to the MICU
service after a code.

PRESENT ILLNESS: The patient is a 60-year-old
male with diabetes, borderline hypertension, with a three
week history of nocturnal cough elicited when supine as well
as recent peripheral edema who presented to the Emergency
Room with the complaint of fatigue, malaise, and collapse in
the Triage Area.

MEDICAL HISTORY: 1.  Diabetes.
2.  Borderline hypertension.
3.  Recent peripheral edema.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's mother had [**Name (NI) 2481**].  No
other known family history.  He is a former smoker, quit 30
years ago.  Occasional alcohol.  He is a retired tailor.  He
is married with several children.

SOCIAL HISTORY: 
Pneumonia, organism unspecified,Cardiac arrest,Acute respiratory failure,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute kidney failure with lesion of tubular necrosis,Acidosis,Unspecified septicemia,Candidiasis of mouth,Unspecified hypertensive heart disease with heart failure
Pneumonia, organism NOS,Cardiac arrest,Acute respiratry failure,React-oth vasc dev/graft,Ac kidny fail, tubr necr,Acidosis,Septicemia NOS,Thrush,Hyp ht dis NOS w ht fail
Admission Date:  [**2106-2-25**]     Discharge Date:

Date of Birth:   [**2045-4-14**]     Sex:  M

Service:  MEDICAL ICU/CARDIOLOGY SERVICE

CHIEF COMPLAINT:  The patient was admitted to the MICU
service after a code.

HISTORY OF THE PRESENT ILLNESS:  The patient is a 60-year-old
male with diabetes, borderline hypertension, with a three
week history of nocturnal cough elicited when supine as well
as recent peripheral edema who presented to the Emergency
Room with the complaint of fatigue, malaise, and collapse in
the Triage Area.

After collapse, the patient was found to be ashen in color,
unresponsive.  Paddle showed questionable artifact versus
ventricular fibrillation.  The patient was shocked and went
into sinus bradycardia and was given epinephrine and
Atropine.  She went into wide complex tachycardia that seemed
to be a left bundle branch block supraventricular
tachycardia.  He was shocked three times.  He was given
Amiodarone 300 mg.  He went into sinus tachycardia.  The
patient was intubated after the first shock.  D50 was given
during the code.  The ABG was 7.20, 49, 93, 16.  After
intubation, the ABG improved to 7.31, 37, 242, and 20.

The family reports a three week history of dry cough at night
when supine.  No paroxysmal nocturnal dyspnea.  He slept on
two pillows.  He has had recent leg edema bilaterally for the
last several days.  He also had shortness of breath on the
morning of admission.  He denied any fevers or chills, no
nausea, vomiting, or chest pain.

After the code, the patient's heart rate was 110, blood
pressure 232/110, glucose 451.  Cardiology did a bedside
echocardiogram that showed good wall motion.  The patient was
taken to the Cardiac Catheterization Laboratory emergently
which showed moderate elevated right and left-sided filling
pressures, high-normal cardiac index, mild anterolateral
hypokinesis of the LV.  No mitral regurgitation.  EF of about
50%.  Pulmonary wedge pressure was 25.  There was 80%
stenosis in the small third diagonal and 80% in the ostium of
the oblique marginal II, but otherwise diffuse disease.  PA
pressures were 40 systolic, 18 diastolic, with a mean of 28.
The pulmonary capillary wedge pressure was again 25.

PAST MEDICAL HISTORY:
1.  Diabetes.
2.  Borderline hypertension.
3.  Recent peripheral edema.

ALLERGIES:  The patient has no known drug allergies.

ADMISSION MEDICATIONS:
1.  Amaryl 400 q.d.
2.  Glucophage 500 mg p.o. b.i.d.

FAMILY HISTORY:  The patient's mother had [**Name (NI) 2481**].  No
other known family history.  He is a former smoker, quit 30
years ago.  Occasional alcohol.  He is a retired tailor.  He
is married with several children.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  The patient
was afebrile on admission.  Temperature 98.2, blood pressure
115/59, heart rate 47, respiratory rate 20, assist control of
60%, tidal volume of 750, rate 20, PEEP 5 with ABG
7.47/24/165/18, saturating 99%.  He was sedated and
intubated.  HEENT:  The pupils were equally round and
reactive to light.  The conjunctivae were pale.  No
lymphadenopathy.  No JVD.  Neck:  He had tinea on the neck.
Lungs: Bronchial sounds at the left base, otherwise his PMI
was in the midclavicular line in the fifth intercostal space.
Cardiovascular:  He was bradycardiac, regular rhythm, S1, S2,
a soft I/VI systolic murmur, split S2.  Abdomen:  Soft, no
hepatomegaly, nontender.  Extremities:  He had 1+ edema
bilaterally in the lower extremities.  No clubbing or
cyanosis.  He had 1+ DP pulses bilaterally, palpable PT
pulses bilaterally.  He had fungal nail infections.  He had
four peripheral IVs, right femoral venous, and arterial
sheaths.  Neurological:  He had positive Babinski's
bilaterally.  He was sedated.

LABORATORY DATA ON ADMISSION:  Chemistries:  Sodium 135,
potassium 4.8, chloride 104, bicarbonate 19, BUN and
creatinine 29 and 1.5, glucose 451.  Corrected sodium was
141.  ALT and AST 19 and 22.  CK 163, troponin less than 0.3,
amylase 63.  He had a white count of 18.6, hematocrit 31.0,
platelets 251,000.  He had a left shift, 93% neutrophils.

The EKG showed a normal sinus rhythm at 66 beats per minute,
normal axis, normal PR interval.  He had a left bundle branch
block with T wave inversion in V5 and V6, T wave inversion in
aVL and I.

Chest x-ray showed increased interstitial markings,
cardiomegaly.  Air bronchogram right greater than left.  No
focal consolidations at that time.

HOSPITAL COURSE:  The patient was treated for presumed
pneumonia.  He was started on levofloxacin on [**2106-2-25**] and
proceeded to have increased thick tannish secretions.  He
continued to spike fevers despite levofloxacin and was
started on vancomycin on [**2106-2-28**] to cover for line
infection.  His central line was changed at that time and
vancomycin was also to cover for any resistant strains of
Streptococcus that might have caused his pneumonia.

The patient continued to spike fevers despite vancomycin and
levofloxacin.  The levofloxacin was changed to Zosyn on
[**2106-3-3**] and the patient defervesced after that.
Vancomycin was stopped on [**2106-3-5**] due to lack of
any resistant organisms growing from the cultures.  All
cultures were essentially negative or pending at the time of
transfer from the MICU.

In terms of the patient's respiratory status, the patient
maintained good 02 saturation with good ABG on pressure
support, decreased secretions.  He was extubated.  He had a
sympathetic surge.  He became tachycardiac and hypertensive
and then had flash pulmonary edema and was hypoxic to the 70s
and had to be reintubated on [**2106-2-26**].

The patient was then aggressively diuresed and continued on
IV antibiotics and was extubated on [**2106-3-4**].

In terms of the patient's congestive heart failure, an
echocardiogram was done on the night of [**2106-2-25**] showing
moderate to severe depressed LV function with an EF of 30%.
However, a Swan-Ganz catheter was placed to assess the
patient's hemodynamics and it revealed a high wedge with
cardiac output of [**9-22**].  A systemic vascular resistance of
about 500-550 with a mixed venous 02 saturation of 76-79%.
It was consistent with a more distributive picture.  It
showed good cardiac output.  The Swan-Ganz catheter was
discontinued.  The patient continued to be aggressively
diuresed to bring his wedge pressure down.

The patient diuresed well to IV Lasix but needed increasing
doses of up to 80 mg IV b.i.d.  The patient was also started
on nitroglycerin and hydralazine for preload and afterload
reduction and for blood pressure control.  He continued to be
hypertensive at times.  He was also started on metoprolol
after significant diuresis for rate control and for his heart
failure and coronary artery disease.

When his renal function improved, he was started on Captopril
to transition from Hydralazine to Captopril.  The
nitroglycerin drip was discontinued.

In terms of his acute renal failure, his urinalysis revealed
muddy brown casts consistent with acute tubular necrosis
which was thought to be secondary to the hypotensive episode
on presentation to the Emergency Room as well as to the large
dye load during cardiac catheterization.  His creatinine
continued to improve despite aggressive diuresis, proving
good cardiac flow to the kidneys.  His Zosyn dose was
increased with improving creatinine clearance.

Other issues during the hospital course were his anemia.  The
patient was found to have a drop in hematocrit from 33 to 27
post catheterization.  He was given a total of [**2-15**] units of
packed red blood cells throughout the hospital stay.
Hemolysis workup was negative.  A CAT scan of the abdomen
ruled out any retroperitoneal bleed.  The patient's
hematocrit remained stable throughout the rest of the
hospital course.

The patient was transferred to the floor on [**2106-3-6**]
to the Cardiology Service to be followed-up.  The plan was
also to get an Electrophysiology evaluation to assess for any
possible tachycardiac/bradycardiac arrhythmias.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3090**], M.D.
                          [**MD Number(1) 3091**]

Dictated By:[**Name8 (MD) 6371**]

MEDQUIST36

D:  [**2106-3-6**]  12:18
T:  [**2106-3-6**]  14:02
JOB#:  [**Job Number 26175**]


Admission Date:  [**2106-2-25**]       Discharge Date:  [**2106-3-9**]

Date of Birth:   [**2045-4-14**]       Sex:  M

Service:

ADDENDUM TO HOSPITAL COUSRE:  The patient was transferred to
the [**Hospital Unit Name 196**] Service on [**3-6**] of [**2106**] and remained in
stable condition.  He was continued on Zosyn for presumptive
pneumonia and remained afebrile.  His white blood cells
counts also went down to 10 on the day prior to discharge.
He had no signs of active infection on the day of discharge.
Given his cardiac arrest on presentation he also had been
evaluated by the Electric Physiology Consult Service in the
hospital.  It was thought that his initial cardiac arrest was
most likely secondary to pulmonary causes.  Since the initial
stress was most likely sinus bradycardia.  He had a repeat
echocardiogram on the day prior to his discharge.  The full
reports will follow.  The left atrium is normal in size.  The
right atrium is moderately dilated.  A small secundum, atrial
septal defect is present.  There is mild symmetrical left
ventricular hypertrophy.  The left ventricular cavity size is
normal.  Overall left ventricular systolic function is
moderately depressed, ejection fraction estimated to be 345
to 40%.  Resting regional wall motion abnormalities include
septal inferolateral and inferior hypokinesis.  Right
ventricular chamber size and free wall motion are normal.
The aortic root is moderately dilated.  The ascending aorta
is mildly dilated.  The aortic valve leaflets are mildly
thickened.  1+ aortic regurgitation is seen.  Mitral valve
leaflets are mildly thickened, 1+ mitral regurgitation is
seen.  There is moderate pulmonary artery systolic
hypertension.  There is no pericardial effusion.  He also
went for EP study on the day prior to his discharge, which
showed only 9% polymorphic ventricular tachycardia.
Therefore there is no indication for defibrillator placement.
 Given his persistently high blood pressure in the hospital
antihypertensive medication had been titrated up.  He was
discharged on Metoprolol 50 mg po b.i.d., Lisinopril 20 mg po
q day and Norvasc 5 mg po q day for blood pressure control.
Since he suffered acute renal failure on presentation it is
important to follow his creatinine level until it returns to
normal.  On the day prior to discharge his creatinine level
was down to 1.8.  During this hospital stay his creatinine
level was up to 2.5 on [**3-3**].

The day prior to discharge the patient also complained of
frequent bowel movements, however, C-diff was still pending
on the day of discharge.  Since the patient is also on
multiple laxatives it would be wise to hold the bowel regimen
while the patient has diarrhea.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  Rehab.

DISCHARGE DIAGNOSES:
1.  Status post cardiac arrest.
2.  Status post intubation.
3.  Pneumonia.
4.  Urinary tract infection.
5.  Congestive heart failure.
6.  Hypertension.
7.  Diabetes.

DISCHARGE MEDICATIONS:  Augmentin 500/125 po b.i.d. for four
more days for a total of a ten day course, Metoprolol 50 mg
po b.i.d. held for systolic blood pressure less then 100 and
heart rate less then 55.  Lisinopril 20 mg po q day held for
systolic blood pressure less then 100.  Norvasc 5 mg po q day
hold for systolic blood pressure less then 100.  Aspirin 325
mg po q day, Colace 100 mg po b.i.d. held for bowel movements
greater then twice a day, Dulcolax 10 mg po q day hold for
bowel movement greater then twice a day.  Protonix 40 mg po q
day, regular insulin sliding scale.  Tylenol prn, Albuterol
inhaler prn.

DIET:  Diabetic and cardiac healthy diet.

DISCHARGE FOLLOW UP:  The patient will see Dr. [**Last Name (STitle) **] in
congestive heart failure clinic on [**3-29**] of [**2106**] at 10:00
a.m.  The patient will also follow up at the [**Hospital 191**] clinic in
one month.  The patient will call for an appointment.  The
phone number is [**Telephone/Fax (1) 250**] was given.  Other follow up
instructions the rehab facility was asked to check the BUN
and creatinine level and titrate up blood pressure medication
as needed for a goal systolic blood pressure 120 to 130.  The
patient's daily weight and ins and outs should also be
followed up closely.  Po daily Lasix may be needed if the
patient appeared to be fluid overloaded.  The patient's
previous oral hypoglycemics may also be restarted once the
renal function improved.






                            [**Name6 (MD) **] [**Last Name (NamePattern4) 5837**], M.D.  [**MD Number(1) 8285**]

Dictated By:[**First Name8 (NamePattern2) 26176**]
MEDQUIST36

D:  [**2106-3-9**]  12:07
T:  [**2106-3-9**]  12:15
JOB#:  [**Job Number 26177**]
{'Pneumonia, organism unspecified,Cardiac arrest,Acute respiratory failure,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute kidney failure with lesion of tubular necrosis,Acidosis,Unspecified septicemia,Candidiasis of mouth,Unspecified hypertensive heart disease with heart failure'}


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: The patient was admitted to the MICU
service after a code.

PRESENT ILLNESS: The patient is a 60-year-old
male with diabetes, borderline hypertension, with a three
week history of nocturnal cough elicited when supine as well
as recent peripheral edema who presented to the Emergency
Room with the complaint of fatigue, malaise, and collapse in
the Triage Area.

MEDICAL HISTORY: 1.  Diabetes.
2.  Borderline hypertension.
3.  Recent peripheral edema.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's mother had [**Name (NI) 2481**].  No
other known family history.  He is a former smoker, quit 30
years ago.  Occasional alcohol.  He is a retired tailor.  He
is married with several children.

SOCIAL HISTORY:  

### Response:
{'Pneumonia, organism unspecified,Cardiac arrest,Acute respiratory failure,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute kidney failure with lesion of tubular necrosis,Acidosis,Unspecified septicemia,Candidiasis of mouth,Unspecified hypertensive heart disease with heart failure'}
