CHIEF COMPLAINT: Hypoxia, hypotension.

PRESENT ILLNESS: Patient is a [**Age over 90 **]-year-old female
with recent admission for colonic obstruction, deep venous
thrombosis complicated by GI bleed on heparin who developed
80s and increased to 92% on two liters.  She was also noted
to have a decreased blood pressure to 70/palp which improved
with IV fluids.  In the emergency room, blood, sputum and
urine cultures were sent.  The patient was started on
Ceftriaxone, Flagyl and Vancomycin for aspiration pneumonia.
Chest x-ray demonstrated white out of the right lung with
some left lower lobe collapse versus consolidation.  ABG on
aspiration in the past.

MEDICAL HISTORY: 1.  Coronary artery disease status post MI times two.
2.  PTCA in [**2191**].
3.  Colonic pseudo-obstruction status post PEG in [**2196-11-8**].
4.  Guaiac positive stools.
5.  Bradycardia status post pacemaker.
6.  Anemia.
7.  Urinary retention.
8.  Increased cholesterol.
9.  Hypertension.
10. Dementia.
11. Left lower extremity deep venous thrombosis in [**2196-10-9**].
12. Left upper extremity deep venous thrombosis in [**2196-11-8**].
13. GI bleed on heparin.
14. Aspiration pneumonia in [**2196-11-8**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives in [**Hospital **] Rehab.  [**Name (NI) **]
husband is her primary decision maker and her nephew, [**Name (NI) **]
[**Name (NI) 4640**] is very involved in her care.
Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Unspecified pleural effusion,Intestinal infection due to Clostridium difficile,Congestive heart failure, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status
Food/vomit pneumonitis,Acute respiratry failure,Pleural effusion NOS,Int inf clstrdium dfcile,CHF NOS,Mental disor NEC oth dis,Hypertension NOS,Status-post ptca
Admission Date:  [**2196-12-10**]       Discharge Date:  [**2196-12-28**]


Service:  MICU
CHIEF COMPLAINT:  Hypoxia, hypotension.

HISTORY OF PRESENT ILLNESS:  Patient is a [**Age over 90 **]-year-old female
with recent admission for colonic obstruction, deep venous
thrombosis complicated by GI bleed on heparin who developed
80s and increased to 92% on two liters.  She was also noted
to have a decreased blood pressure to 70/palp which improved
with IV fluids.  In the emergency room, blood, sputum and
urine cultures were sent.  The patient was started on
Ceftriaxone, Flagyl and Vancomycin for aspiration pneumonia.
Chest x-ray demonstrated white out of the right lung with
some left lower lobe collapse versus consolidation.  ABG on
aspiration in the past.

PAST MEDICAL HISTORY:
1.  Coronary artery disease status post MI times two.
2.  PTCA in [**2191**].
3.  Colonic pseudo-obstruction status post PEG in [**2196-11-8**].
4.  Guaiac positive stools.
5.  Bradycardia status post pacemaker.
6.  Anemia.
7.  Urinary retention.
8.  Increased cholesterol.
9.  Hypertension.
10. Dementia.
11. Left lower extremity deep venous thrombosis in [**2196-10-9**].
12. Left upper extremity deep venous thrombosis in [**2196-11-8**].
13. GI bleed on heparin.
14. Aspiration pneumonia in [**2196-11-8**].

ALLERGIES:  No known drug allergies.

MEDICATIONS:
1.  Protonix 40 b.i.d.
2.  Neutra-Phos.
3.  Celexa.
4.  Risperdal.
5.  Folate.
6.  Colace.
7.  Epogen.
8.  Lopressor.
9.  Subcutaneous heparin.

SOCIAL HISTORY:  Lives in [**Hospital **] Rehab.  [**Name (NI) **]
husband is her primary decision maker and her nephew, [**Name (NI) **]
[**Name (NI) 4640**] is very involved in her care.

PHYSICAL EXAMINATION:  Temperature 96.3 F, pulse 63, blood
pressure 82/33.  Pulse oximetry 99% on nonrebreather.
Generally normocephalic, atraumatic in moderate respiratory
distress.  Head, eyes, ears, nose and throat:  Pupils
minimally reactive.  Neck:  Supple, no lymphadenopathy.
Heart: Regular, normal S1, S2, no murmurs, rubs, or gallops.
Lungs: Coarse rhonchi bilaterally.  Abdomen is soft,
nontender with mild distention, positive bowel sounds.  PEG
tube in place.  Extremities:  No edema.  Palpable pulses
distally.  Neuro:  Opens eyes to voice.

LABORATORY:  White count 18.8, hematocrit 30.4, platelets
221.  Sodium 151, potassium 3.8, chloride 118, bicarbonate
28, BUN 50, creatinine 1.2, glucose 87, calcium 8.8,
magnesium 1.7, phos 1.5.  ALT 13, AST 25, alkaline
phosphatase 85, LDH 405, total bilirubin 0.3.  Urinalysis
with six to 10 RBCs, three to five WBCs, few bacteria, 38
protein, moderate blood, no leukocyte esterase.

ABG 7.27, 62, 172 on nonrebreather.  Lactate at 1.3.

Chest x-ray with persistent right pleural effusion with
increase in size, near complete opacification of the right
hemithorax.  Left lower lobe consolidation versus collapse.

EKG per report, normal sinus rhythm with a rate of 63, left
bundle branch block and paced.

SUMMARY OF HOSPITAL COURSE:
1.  CLOSTRIDIUM DIFFICILE COLITIS:  Patient was admitted to
the Intensive Care Unit and intubated secondary to worsening
respiratory status.  She had positive Clostridium difficile
which was treated with IV and p.o. Flagyl and Vancomycin for
one week.  She became hypotensive requiring pressors and
remained intubated for one week in the Intensive Care Unit.
The patient gradually improved.  After over 20 liters of IV
hydration, she came off pressors.  She had no other culture
date indicating sepsis.  Patient's Clostridium difficile
toxin cleared.

2.  RESPIRATORY FAILURE:  Patient originally required
intubation for hypoxia and acidosis.  That resolved initially
and she was extubated after seven days.  The patient went to
the floor for three days, developed increasing respiratory
and collapse of the right lung secondary to secretions.  The
patient was brought back to the Intensive Care Unit and
intubated on the 15th.  She underwent two thoracenteses each
withdrawing 1500 cc of fluid.  The pleural effusions were
exudate.  Cytology was negative.

Patient was gradually weaned off the ventilator again and
extubated.  She continued to have persistent respiratory
distress requiring frequent suctioning.  She was diuresed.
The patient had an extremely weak cough and was unable to
clear her secretions adequately.  She continued to have
atelectasis and collapse after her second extubation.

3.  CODE STATUS:  Multiple family discussions were held with
[**First Name8 (NamePattern2) **] [**Known lastname 4640**] and [**Last Name (un) 16514**] [**Last Name (un) 16515**], her husband.  The family
initially wanted everything done in order to prolong her
life.  She was aggressively treated with intubation and
pressors for two weeks.  After her second extubation and
realization that she is too weak to clear her secretions and
continues to having difficulty with plugging and concerns for
future aspiration pneumonias, the family discussion with Mr.
[**Name14 (STitle) 16515**] and [**First Name8 (NamePattern2) **] [**Known lastname 4640**], the decision was to make her a DNR,
DNR with no further intubations. She was continued on Lasix
and given Morphine for comfort.

Discharge status will be updated on an addendum.  Discharge
condition will be updated.




                        DR.[**Last Name (STitle) **],[**First Name3 (LF) 251**] 12-988

Dictated By:[**Last Name (NamePattern1) 16516**]
MEDQUIST36

D:  [**2196-12-28**]  13:15
T:  [**2196-12-28**]  13:13
JOB#:  [**Job Number 16517**]


Name:  [**Known lastname 2583**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 2584**]

Admission Date:  [**2196-12-10**]     Discharge Date:  [**2196-12-29**]

Date of Birth:   [**2106-1-16**]     Sex:  F

Service:
The patient was transferred to Acove service Intensive Care
Unit after being made comfort measures only by family.  The
patient was initially treated with Morphine intravenous
p.r.n. for discomfort but, as her needs increased, she was
started on a Morphine drip.  The patient expired on [**2196-12-29**],

Immediate cause of death was respiratory arrest, minutes, and
congestive heart failure years.

Family was notified by Dr. [**First Name (STitle) **] [**Name (STitle) **] - the husband was
spoken to and he requested an autopsy by saying, "Yes, it would
be interesting / important to figure out the precise cause of



                          [**Name6 (MD) 116**] [**Name8 (MD) 117**], M.D.  [**MD Number(1) 118**]

Dictated By:[**Last Name (NamePattern1) 1464**]

MEDQUIST36

D:  [**2196-12-30**]  08:31
T:  [**2197-1-1**]  10:26
JOB#:  [**Job Number 2585**]
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Unspecified pleural effusion,Intestinal infection due to Clostridium difficile,Congestive heart failure, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status'}


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: Hypoxia, hypotension.

PRESENT ILLNESS: Patient is a [**Age over 90 **]-year-old female
with recent admission for colonic obstruction, deep venous
thrombosis complicated by GI bleed on heparin who developed
80s and increased to 92% on two liters.  She was also noted
to have a decreased blood pressure to 70/palp which improved
with IV fluids.  In the emergency room, blood, sputum and
urine cultures were sent.  The patient was started on
Ceftriaxone, Flagyl and Vancomycin for aspiration pneumonia.
Chest x-ray demonstrated white out of the right lung with
some left lower lobe collapse versus consolidation.  ABG on
aspiration in the past.

MEDICAL HISTORY: 1.  Coronary artery disease status post MI times two.
2.  PTCA in [**2191**].
3.  Colonic pseudo-obstruction status post PEG in [**2196-11-8**].
4.  Guaiac positive stools.
5.  Bradycardia status post pacemaker.
6.  Anemia.
7.  Urinary retention.
8.  Increased cholesterol.
9.  Hypertension.
10. Dementia.
11. Left lower extremity deep venous thrombosis in [**2196-10-9**].
12. Left upper extremity deep venous thrombosis in [**2196-11-8**].
13. GI bleed on heparin.
14. Aspiration pneumonia in [**2196-11-8**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives in [**Hospital **] Rehab.  [**Name (NI) **]
husband is her primary decision maker and her nephew, [**Name (NI) **]
[**Name (NI) 4640**] is very involved in her care. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Unspecified pleural effusion,Intestinal infection due to Clostridium difficile,Congestive heart failure, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status'}
