CHIEF COMPLAINT: cardiac arrest

PRESENT ILLNESS: 47 year old male who complains of CARDIAC ARREST. 47-year-old
man transferred from outside hospital per a friend he is only a
history of hypertension and was
normal all weekend. Today while riding a bike race he had a
witnessed collapse. Bystander CPR was in nearly started and
within 5 minutes a basic life support team arrived and placed in
the AED was recommended a shock. After one shock
it return spontaneous circulation. At the outside hospital he
was hypertensive and withdrawn only to painful stimuli. An EKG
showed Q waves inferiorly and anteriorly. A CT head neck and
abdomen was negative. A chest CT was not performed.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: Lisinopril 40 mg daily
Atenolol 50mg daily

ALLERGIES: Zosyn / Seroquel

PHYSICAL EXAM: VS: T (on Arctic Sun) 91.2 (Bladder), 92.1 (Rectal) BP=157/109
HR=56 RR=16 O2 sat=100% on CMV/Assist
GENERAL: Intubated and sedated.
HEENT: NCAT. Sclera anicteric. ET tube in place. Pupils 2mm and
sluggish bilaterally.
NECK: In cervical collar.
CARDIAC: RR, normal S1, S2. No m/r/g appreciated, though
difficult exam on this patient who is intubated.
LUNGS: Occasional inspiratory wheeze.
ABDOMEN: Soft, nondistended, +BS.
EXTREMITIES: No c/c/e. Cool to the touch.
NEURO: Not assessed in sedated and paralyzed patient other than
pupils as above.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Mr. [**Known lastname 9579**] is divorced with two children
Per friends he does not smoke, use drugs, or drink alcohol.
Coronary atherosclerosis of native coronary artery,Acute respiratory failure,Other encephalopathy,Acute and subacute necrosis of liver,Ventilator associated pneumonia,Acute kidney failure, unspecified,Other convulsions,Other primary cardiomyopathies,Unspecified essential hypertension,Anemia, unspecified,Contusion of knee,Contusion of face, scalp, and neck except eye(s),Dermatitis due to drugs and medicines taken internally,Pedal cycle accident injuring pedal cyclist,Personal history of sudden cardiac arrest,Activities involving bike riding,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Penicillins causing adverse effects in therapeutic use,Hemophilus influenzae [H. influenzae] infection in conditions classified elsewhere and of unspecified site
Crnry athrscl natve vssl,Acute respiratry failure,Encephalopathy NEC,Acute necrosis of liver,Ventltr assoc pneumonia,Acute kidney failure NOS,Convulsions NEC,Prim cardiomyopathy NEC,Hypertension NOS,Anemia NOS,Contusion of knee,Contusion face/scalp/nck,Drug dermatitis NOS,Ped cycl acc-ped cyclist,Hx sudden cardiac arrest,Bike riding,Abn react-procedure NEC,Adv eff penicillins,H. influenzae infect NOS
Admission Date:  [**2181-5-20**]              Discharge Date:   [**2181-6-19**]

Date of Birth:  [**2133-9-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Zosyn / Seroquel

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
cardiac arrest

Major Surgical or Invasive Procedure:
[**2181-5-26**] Endotracheal intubation
[**2181-5-27**] PICC placement
[**2181-5-31**] central line placement
[**2181-6-11**] cardiac catheterization
[**2181-6-15**] Coronary artery bypass graft surgery x 5 (left
internal mammary artery > left anterior descending, saphenous
vein graft > diagonal, saphenous vein graft > obtuse marginal,
saphenous vein graft > posterior descending artery > PLV)


History of Present Illness:
47 year old male who complains of CARDIAC ARREST. 47-year-old
man transferred from outside hospital per a friend he is only a
history of hypertension and was
normal all weekend. Today while riding a bike race he had a
witnessed collapse. Bystander CPR was in nearly started and
within 5 minutes a basic life support team arrived and placed in
the AED was recommended a shock. After one shock
it return spontaneous circulation. At the outside hospital he
was hypertensive and withdrawn only to painful stimuli. An EKG
showed Q waves inferiorly and anteriorly. A CT head neck and
abdomen was negative. A chest CT was not performed.


Past Medical History:
Hypertension

Social History:
Mr. [**Known lastname 9579**] is divorced with two children
Per friends he does not smoke, use drugs, or drink alcohol.

Family History:
non contributory

Physical Exam:
VS: T (on Arctic Sun) 91.2 (Bladder), 92.1 (Rectal) BP=157/109
HR=56 RR=16 O2 sat=100% on CMV/Assist
GENERAL: Intubated and sedated.
HEENT: NCAT. Sclera anicteric. ET tube in place. Pupils 2mm and
sluggish bilaterally.
NECK: In cervical collar.
CARDIAC: RR, normal S1, S2. No m/r/g appreciated, though
difficult exam on this patient who is intubated.
LUNGS: Occasional inspiratory wheeze.
ABDOMEN: Soft, nondistended, +BS.
EXTREMITIES: No c/c/e. Cool to the touch.
NEURO: Not assessed in sedated and paralyzed patient other than
pupils as above.

Pertinent Results:
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Left Atrium - Long Axis Dimension:  *5.3 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  5.1 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  *1.5 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.3 cm  <= 5.6 cm
Aorta - Annulus:  2.7 cm  <= 3.0 cm
Aorta - Sinus Level:  *3.7 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  *3.4 cm  <= 3.0 cm
Aorta - Ascending:  *3.9 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm
LEFT ATRIUM: Moderate LA enlargement. Good (>20 cm/s) LAA
ejection velocity. No thrombus in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. No ASD by 2D or color
Doppler.
LEFT VENTRICLE: Mild (non-obstructive) focal hypertrophy of the
basal septum. Normal LV cavity size. Overall normal LVEF (>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Mildly dilated ascending aorta. Normal descending aorta
diameter. Simple atheroma in descending aorta. No thoracic
aortic dissection.
AORTIC VALVE: Normal aortic valve leaflets (3). No AS. Mild (1+)
AR.
MITRAL VALVE: Normal mitral valve leaflets with trivial MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) PR.
PERICARDIUM: Very small pericardial effusion.
PRE-CPB:
The left atrium is moderately dilated. No thrombus is seen in
the left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler.
Thereis mild (non-obstructive) focal hypertrophy of the basal
septum. The left ventricular cavity size is normal. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal.
The ascending aorta is mildly dilated. There are simple atheroma
in the descending thoracic aorta. No thoracic aortic dissection
is seen. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic stenosis. Mild
(1+) aortic regurgitation is seen.
The mitral valve appears structurally normal with trivial mitral
regurgitation. There is a very small pericardial effusion.

POST-CPB:
The LV systolic function remains normal, estimated EF>60%. There
is no change in valvular function. There is no evidence of
aortic dissection.



[**2181-6-19**] 05:47AM BLOOD Hct-24.2*
[**2181-6-18**] 05:06AM BLOOD WBC-5.7 RBC-2.69* Hgb-8.4* Hct-23.7*
MCV-88 MCH-31.3 MCHC-35.7* RDW-15.5 Plt Ct-196
[**2181-5-20**] 06:20PM BLOOD WBC-12.1* RBC-4.89 Hgb-16.0 Hct-42.9
MCV-88 MCH-32.8* MCHC-37.4* RDW-13.8 Plt Ct-160
[**2181-5-22**] 07:05PM BLOOD Neuts-86.5* Lymphs-9.1* Monos-3.2 Eos-0.7
Baso-0.5
[**2181-6-18**] 05:06AM BLOOD Plt Ct-196
[**2181-6-15**] 12:57PM BLOOD PT-13.9* PTT-28.8 INR(PT)-1.2*
[**2181-5-20**] 06:20PM BLOOD PT-12.4 PTT-24.3 INR(PT)-1.0
[**2181-5-20**] 06:20PM BLOOD Plt Ct-160
[**2181-5-20**] 06:20PM BLOOD Fibrino-256
[**2181-6-7**] 05:27AM BLOOD Ret Aut-6.4*
[**2181-6-19**] 05:47AM BLOOD UreaN-20 Creat-1.2 Na-141 K-4.4 Cl-107
[**2181-5-20**] 06:20PM BLOOD UreaN-23* Creat-1.3*
[**2181-5-29**] 01:08AM BLOOD Glucose-92 UreaN-18 Creat-1.7* Na-141
K-3.9 Cl-105 HCO3-25 AnGap-15
[**2181-6-15**] 05:10AM BLOOD ALT-44* AST-23 AlkPhos-129 TotBili-0.2
[**2181-5-20**] 06:20PM BLOOD ALT-165* AST-131* LD(LDH)-609*
CK(CPK)-1193* AlkPhos-73 TotBili-0.7
[**2181-6-5**] 03:04AM BLOOD Lipase-177*
[**2181-5-29**] 07:20AM BLOOD Lipase-276* GGT-1046*
[**2181-6-1**] 06:42AM BLOOD CK-MB-3 cTropnT-0.04*
[**2181-5-20**] 06:20PM BLOOD cTropnT-0.18*
[**2181-5-20**] 06:20PM BLOOD CK-MB-15* MB Indx-1.3
[**2181-6-19**] 05:47AM BLOOD Mg-2.1
[**2181-5-20**] 09:16PM BLOOD Calcium-8.7 Phos-3.4 Mg-2.3
[**2181-6-7**] 05:27AM BLOOD calTIBC-290 Ferritn-941* TRF-223
[**2181-6-11**] 03:40PM BLOOD %HbA1c-5.4 eAG-108
[**2181-6-8**] 05:50AM BLOOD Triglyc-319* HDL-26 CHOL/HD-6.0
LDLcalc-66
[**2181-5-21**] 02:38PM BLOOD Triglyc-141 HDL-57 CHOL/HD-3.4
LDLcalc-108
[**2181-6-5**] 03:04AM BLOOD TSH-1.9
[**2181-5-25**] 02:44AM BLOOD Prolact-13
[**2181-5-20**] 06:20PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

sputum
GRAM STAIN (Final [**2181-5-23**]):
      >25 PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   TINY PLEOMORPHIC GRAM
NEGATIVE
      COCCOBACILLI.
                                    CONSISTENT WITH HAEMOPHILUS
SPECIES.
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CHAINS.
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
      1+    (<1 per 1000X FIELD):   YEAST(S).
      SMEAR REVIEWED; RESULTS CONFIRMED.

   RESPIRATORY CULTURE (Final [**2181-5-26**]):
      SPARSE GROWTH Commensal Respiratory Flora.
      HAEMOPHILUS INFLUENZAE, BETA-LACTAMASE NEGATIVE.
MODERATE GROWTH.

Sinus rhythm. Possible old anterior wall myocardial infarction.
Possible old
inferior myocardial infarction. Compared to the previous tracing
there is no
change.
TRACING #2


Read by: [**Last Name (LF) **],[**First Name3 (LF) **]

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
72 190 90 396/417 31 -24 14



Brief Hospital Course:
Mr. [**Known lastname 9579**] is a 47 year old male on [**2181-5-20**] while bike riding
had a cardiac arrest s/p AED shock with a complicated hospital
stay, initially admitted to OSH, then to the CCU for
continuation of cooling protocol.

Neuro: Seizure morning of [**5-25**], lasting about 10??????15 minutes. On
[**5-26**] EEG showed generalized slowing consistent with
encephalopathy or diffuse subcortical pathology. No focal
findings, no seizure activity. Repeat EEG on [**5-27**] no seizure
activity or epileptiform. CT head negative for intracranial
bleed. Phenytoin was used for seizure prophylaxis until his LFTs
trended upward. He was switched to Keppra on [**2181-6-3**]. He has
had no further seizure activity since [**5-24**]. Keppra 500 mg [**Hospital1 **]
will continue until seen by neurologist as an outpatient. Head
MRI [**2181-6-10**] with no acute infarctions.  Throughout the rest of
his hospital course he was alert and oriented with no focal
deficits.

He was seen by Speech [**2181-6-12**] for absent memory of the day
before, day
of and several days after his arrest, but otherwise his short
and long term memory appear functional for tasks attempted
today. There are mild deficits in the area of working memory. He
underwent swallow evaluation preoperatively with strictions to
thin liquids and regular diet.

Physical therapy worked with him post operatively, and he was
cleared for discharge home

Respiratory: He was transferred from outside hospital intubated
and had prolonged intubation due to hypoxia related to
ventilator associated pneumonia.  Preoperatively that was
resolved and remained extubated for multiple days prior to
surgery. Post operative cardiac surgery he was weaned and
extubated with in the first twenty four hours without
complications

Cardiac: He was transferred in from outside hospital after
witnessed cardiac arrest and defibrillated with AED, for
hypothermia cooling post arrest.  He underwent cardiac
evaluation which included cardiac MRI which showed reversible
ischemia.  He then underwent cardiac catheterization [**6-11**] that
revealed coronary artery disease and surgery was consulted.  He
underwent coronary artery bypass graft surgery on [**6-15**].  He has
had no arrythmias postoperatively and remained stable.

GI: He received GI prophalaxis.

Renal: Baseline creatinine 1.1, elevated to 1.7 on [**5-29**] post
arrest acute kidney injury.  His creatinine trended up and down
throughout admission but was back to 1.2 on discharge

ID: Treated preoperatively for Haemophilus influenza, ventilator
associated pneumonia with ten day course of meropenum and
vancomycin.  Then he received vancomycin and cefazolin for
perioperative coverage.

Endocrine: insulin drip and then sliding scale utilized post
operatively for glucose management, preoperative HgbA1C 5.4 and
no history of diabetes.

Pain: Dilaudid and tylenol or post operative pain management

He was ready for discharge home with visiting nurse on hospital
day 31 and post operative day 4


Medications on Admission:
Lisinopril 40 mg daily
Atenolol 50mg daily

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
5. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
6. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours): around the clock for 5 days then change to as
needed .
7. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
Disp:*45 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
coronary artery disease s/p CABG
Ventilator associated pneumonia
Seizures
Cardiac arrest undetermined etiology
Normocytic anemia
Hypertension
Left ankle plating with subsequent plate removal


Discharge Condition:
Alert and oriented x3 nonfocal, anxious at times calms with
talking
Ambulating with steady gait
Incisional pain managed with Dilaudid and tylenol
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage
Edema none


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] Date/Time:[**2181-7-11**] 1:30
Cardiologist: Dr [**Last Name (STitle) 73**] [**Telephone/Fax (1) 62**] Date/Time:[**2181-7-12**] 2:00
Neurologist: Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 9580**] on [**8-15**] at 2:30pm

Wound check - cardiac surgery office [**Hospital **] medical building
[**6-27**] at 10:00am [**Telephone/Fax (1) 170**]

Please call to schedule appointments with your
Primary Care Physician [**Last Name (NamePattern4) **] [**4-3**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2181-6-19**]
{'Coronary atherosclerosis of native coronary artery,Acute respiratory failure,Other encephalopathy,Acute and subacute necrosis of liver,Ventilator associated pneumonia,Acute kidney failure, unspecified,Other convulsions,Other primary cardiomyopathies,Unspecified essential hypertension,Anemia, unspecified,Contusion of knee,Contusion of face, scalp, and neck except eye(s),Dermatitis due to drugs and medicines taken internally,Pedal cycle accident injuring pedal cyclist,Personal history of sudden cardiac arrest,Activities involving bike riding,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Penicillins causing adverse effects in therapeutic use,Hemophilus influenzae [H. influenzae] infection in conditions classified elsewhere and of unspecified site'}


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: cardiac arrest

PRESENT ILLNESS: 47 year old male who complains of CARDIAC ARREST. 47-year-old
man transferred from outside hospital per a friend he is only a
history of hypertension and was
normal all weekend. Today while riding a bike race he had a
witnessed collapse. Bystander CPR was in nearly started and
within 5 minutes a basic life support team arrived and placed in
the AED was recommended a shock. After one shock
it return spontaneous circulation. At the outside hospital he
was hypertensive and withdrawn only to painful stimuli. An EKG
showed Q waves inferiorly and anteriorly. A CT head neck and
abdomen was negative. A chest CT was not performed.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: Lisinopril 40 mg daily
Atenolol 50mg daily

ALLERGIES: Zosyn / Seroquel

PHYSICAL EXAM: VS: T (on Arctic Sun) 91.2 (Bladder), 92.1 (Rectal) BP=157/109
HR=56 RR=16 O2 sat=100% on CMV/Assist
GENERAL: Intubated and sedated.
HEENT: NCAT. Sclera anicteric. ET tube in place. Pupils 2mm and
sluggish bilaterally.
NECK: In cervical collar.
CARDIAC: RR, normal S1, S2. No m/r/g appreciated, though
difficult exam on this patient who is intubated.
LUNGS: Occasional inspiratory wheeze.
ABDOMEN: Soft, nondistended, +BS.
EXTREMITIES: No c/c/e. Cool to the touch.
NEURO: Not assessed in sedated and paralyzed patient other than
pupils as above.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Mr. [**Known lastname 9579**] is divorced with two children
Per friends he does not smoke, use drugs, or drink alcohol. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute respiratory failure,Other encephalopathy,Acute and subacute necrosis of liver,Ventilator associated pneumonia,Acute kidney failure, unspecified,Other convulsions,Other primary cardiomyopathies,Unspecified essential hypertension,Anemia, unspecified,Contusion of knee,Contusion of face, scalp, and neck except eye(s),Dermatitis due to drugs and medicines taken internally,Pedal cycle accident injuring pedal cyclist,Personal history of sudden cardiac arrest,Activities involving bike riding,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Penicillins causing adverse effects in therapeutic use,Hemophilus influenzae [H. influenzae] infection in conditions classified elsewhere and of unspecified site'}
