CHIEF COMPLAINT: Respiratory failure, status post PEA arrest

PRESENT ILLNESS: 68M PMH T4 level paraplegia, CAD, CHF EF 20%, severe sacral
decubitus ulcers, history of multiple UTI, PE on coumadin and
IVC filter in place transferred from [**Hospital 100**] Rehab with hypoxia -
76% 3L NC, lethargy.
.
Of note, the patient was recently admitted [**Date range (3) 45261**] for
hypotension with likely urosepsis with acinetobacter sensitive
to tobramycin and completed a seven-day course of treatment. He
is transferred with a PICC line dating from this previous
admission.
.
In the ED, VS T: 100.6 HR: 121 BP: 114/15 RR: 23 SaO2: 94% NRB.
Patient lethargic and in respiratory distress on presentaion.
- Narcan 0.5 mg IV - no improvement
- Lasix 40 mg IV - urine output not noted
- Chest x-ray - consistent with aspiration
- Intubated
- Levofloxacin, cefepime for aspiration pneumonia
- RIJ placed (procedure note in chart)
- 15 minutes post-intubation patient had PEA arrest - CPR,
epinephrine 1 mg, atropine 1 mg -> perfusing rhythm (unknown
amount of time, ~5 minutes)
- 1L NS
- Started on levophed

MEDICAL HISTORY: 1. Inflammatory disease of the spinal cord of uncertain
etiology/T4 paraplegia. MRA [**10-16**] negative for vascular
malformation. Initial CSF analysis showed elevated protein (82)
without oligoclonal bands. NMO blood titer negative, RPR
negative, Lyme serology negative, [**Doctor First Name **] negative, Ro and La
negative, ACE level normal, neuromyelitis IgG negative, ESR 70,
CRP 66.8. Ultimately treated with broad spectrum antibiotics,
corticosteroids (two weeks of Solu-Medrol followed by a
prednisone taper), and 5 days of mannitol without improvement.
He is followed by neurology for a dense paraplegia (T4) with
neuropathic pain, restrictive shoulder arthropathy, and a
neurogenic bladder requiring a chronic indwelling foley.
2. Chronic sacral decubitus ulcer, previously treated with a VAC

MEDICATION ON ADMISSION: Calcium Carbonate 1,625 mg [**Hospital1 **]
Aspirin 81 mg DAILY
Baclofen 5 mg TID
Cholecalciferol 1,000 unit DAILY
Celexa 40 mg DAILY
Cyanocobalamin 1,000 mcg DAILY
Advair Diskus 250 mcg-50 mcg INH [**Hospital1 **]
Neurontin 400 mg [**Hospital1 **]
Folic Acid 1 mg DAILY
Keppra 500 mg [**Hospital1 **]
Omeprazole 40 mg [**Hospital1 **]
Oxycodone 5 mg Q6H:PRN pain
Ursodiol 300 mg [**Hospital1 **]
Coumadin for goal INR [**3-14**]
Acetaminophen 325-650 mg Q4H:PRN pain
Nystatin Swish and Swallow

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 99.8 BP: 71/54 HR: 124 RR: 19 SaO2: 98%
AC: Tv 550 RR 18 PEEP 5 FiO2 50%
GEN: Intubated, sedated
HEENT: PERRLA, + conjunctival refelx, no conjuctival injection,
anicteric, ETT in place
NECK: Supple, no LAD
CV: RRR, nl s1, s2, no m/r/g
PULM: CTA anteriorly
ABD: Soft, NT, ND, + BS, no HSM
BACK: Six Stage IV sacral decubitus ulcers with purulent
drainage
EXT: Cool, dry, palpable distal pulses BL
NEURO (30 minutes after holding sedation): Does not follow
commands, withdraws to pain

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Recently living in [**Hospital 100**] Rehab.  He moved here from [**Country 3594**]
(after living in many different countries) in the [**2068**].  He is
retired from a job in the maritime industry.  Divorced 24 years
ago with three children.  Quit smoking in [**2076**], unknown
pack-year history.  Quit drinking in [**2080**].  No history of
illicit drug use or abuse.
Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Paraplegia,Pressure ulcer, lower back,Acute kidney failure, unspecified,Chronic systolic heart failure,Unspecified septicemia,Severe sepsis,Acidosis,Septic shock,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Cardiac arrest,Other specified forms of chronic ischemic heart disease
Food/vomit pneumonitis,Acute respiratry failure,Paraplegia NOS,Pressure ulcer, low back,Acute kidney failure NOS,Chr systolic hrt failure,Septicemia NOS,Severe sepsis,Acidosis,Septic shock,Hx-ven thrombosis/embols,Long-term use anticoagul,Cardiac arrest,Chr ischemic hrt dis NEC
Admission Date:  [**2106-6-23**]              Discharge Date:   [**2106-6-29**]

Date of Birth:  [**2038-4-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1642**]
Chief Complaint:
Respiratory failure, status post PEA arrest

Major Surgical or Invasive Procedure:
Intubation
Central venous catheter placement

History of Present Illness:
68M PMH T4 level paraplegia, CAD, CHF EF 20%, severe sacral
decubitus ulcers, history of multiple UTI, PE on coumadin and
IVC filter in place transferred from [**Hospital 100**] Rehab with hypoxia -
76% 3L NC, lethargy.
.
Of note, the patient was recently admitted [**Date range (3) 45261**] for
hypotension with likely urosepsis with acinetobacter sensitive
to tobramycin and completed a seven-day course of treatment. He
is transferred with a PICC line dating from this previous
admission.
.
In the ED, VS T: 100.6 HR: 121 BP: 114/15 RR: 23 SaO2: 94% NRB.
Patient lethargic and in respiratory distress on presentaion.
- Narcan 0.5 mg IV - no improvement
- Lasix 40 mg IV - urine output not noted
- Chest x-ray - consistent with aspiration
- Intubated
- Levofloxacin, cefepime for aspiration pneumonia
- RIJ placed (procedure note in chart)
- 15 minutes post-intubation patient had PEA arrest - CPR,
epinephrine 1 mg, atropine 1 mg -> perfusing rhythm (unknown
amount of time, ~5 minutes)
- 1L NS
- Started on levophed


Past Medical History:
1. Inflammatory disease of the spinal cord of uncertain
etiology/T4 paraplegia. MRA [**10-16**] negative for vascular
malformation. Initial CSF analysis showed elevated protein (82)
without oligoclonal bands. NMO blood titer negative, RPR
negative, Lyme serology negative, [**Doctor First Name **] negative, Ro and La
negative, ACE level normal, neuromyelitis IgG negative, ESR 70,
CRP 66.8. Ultimately treated with broad spectrum antibiotics,
corticosteroids (two weeks of Solu-Medrol followed by a
prednisone taper), and 5 days of mannitol without improvement.
He is followed by neurology for a dense paraplegia (T4) with
neuropathic pain, restrictive shoulder arthropathy, and a
neurogenic bladder requiring a chronic indwelling foley.
2. Chronic sacral decubitus ulcer, previously treated with a VAC

dressing
3. Multiple UTI (including Pseudomonas)
4. Pulmonary embolus [**11-15**] s/p IVC filter placement
5. Asthma
6. Two-vessel coronary artery disease s/p CABG 4-5 years ago
7. Systolic CHF (EF 25-30% on [**2-15**] TTE)
8. Repaired liver laceration
9. Chronic back pain
10. Vitiligo
11. History of G-tube
12. Depression
13. MRSA from sacral swab and sputum
14. Prior transient episodes of leg paralysis
15. Right frontal lobe brain lesion biopsied [**11-15**] and c/w
gliosis; resolved on repeat imaging
16. Abnormal visual evoked potentials
17. Seizure disorder
18. Cholelithiasis


Social History:
Recently living in [**Hospital 100**] Rehab.  He moved here from [**Country 3594**]
(after living in many different countries) in the [**2068**].  He is
retired from a job in the maritime industry.  Divorced 24 years
ago with three children.  Quit smoking in [**2076**], unknown
pack-year history.  Quit drinking in [**2080**].  No history of
illicit drug use or abuse.

Family History:
Non-contributory.

Physical Exam:
VS: T: 99.8 BP: 71/54 HR: 124 RR: 19 SaO2: 98%
AC: Tv 550 RR 18 PEEP 5 FiO2 50%
GEN: Intubated, sedated
HEENT: PERRLA, + conjunctival refelx, no conjuctival injection,
anicteric, ETT in place
NECK: Supple, no LAD
CV: RRR, nl s1, s2, no m/r/g
PULM: CTA anteriorly
ABD: Soft, NT, ND, + BS, no HSM
BACK: Six Stage IV sacral decubitus ulcers with purulent
drainage
EXT: Cool, dry, palpable distal pulses BL
NEURO (30 minutes after holding sedation): Does not follow
commands, withdraws to pain


Pertinent Results:
Labwork on admission:
[**2106-6-22**] 10:50PM   WBC-5.4 RBC-3.39* HGB-8.9* HCT-27.8* MCV-82
MCH-26.4* MCHC-32.1 RDW-19.0*
[**2106-6-22**] 10:50PM   PLT COUNT-436
[**2106-6-22**] 11:01PM   GLUCOSE-141* LACTATE-1.9 NA+-136 K+-3.2*
CL--109
[**2106-6-22**] 10:50PM   UREA N-30* CREAT-1.1
[**2106-6-22**] 10:50PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2106-6-22**] 10:50PM   CORTISOL-98.6*
[**2106-6-23**] 03:34AM URINE  RBC-0 WBC-[**12-30**]* BACTERIA-MOD YEAST-MANY
EPI-0
[**2106-6-23**] 03:34AM URINE  EOS-NEGATIVE
[**2106-6-23**] 03:34AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-SM
[**2106-6-23**] 03:34AM URINE  COLOR-Straw APPEAR-Hazy SP [**Last Name (un) 155**]-1.008
[**2106-6-23**] 03:34AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2106-6-23**] 05:47PM   O2 SAT-53
.
CHEST (PORTABLE AP)  [**2106-6-22**]
IMPRESSION: Bilateral lower lobe opacity most consistent with
aspiration. Multifocal pneumonia is also aconsideration.
.
TTE (Complete) Done [**2106-6-23**]
The left atrial volume is increased. Left ventricular wall
thicknesses are normal. The left ventricular cavity is mildly
dilated. There is severe global left ventricular hypokinesis
(LVEF = 15 %). [Intrinsic left ventricular systolic function is
likely more depressed given the severity of valvular
regurgitation.] Right ventricular chamber size and free wall
motion are normal. The aortic root is moderately dilated at the
sinus level. The number of aortic valve leaflets cannot be
determined. The aortic valve leaflets are moderately thickened.
There is no aortic valve stenosis. The mitral valve leaflets are
mildly thickened. Mild to moderate ([**2-10**]+) mitral regurgitation
is seen. [Due to acoustic shadowing, the severity of mitral
regurgitation may be significantly UNDERestimated.] The
tricuspid valve leaflets are mildly thickened. Moderate [2+]
tricuspid regurgitation is seen. There is moderate pulmonary
artery systolic hypertension. There is no pericardial effusion.
IMPRESSION: Severe global LV hypokinesis. The basal
inferolateral segment has relatively preserved function.
Moderate mitral and tricuspid regurgitation with moderate
pulmonary artery systolic hypertension.
Compared with the prior study (images reviewed) of [**2105-2-27**],
overall LV systolic function has worsened. The LV cavity has
enlarged. The degrees of mitral and tricuspid regurgitation have
increased.
.
CHEST (PORTABLE AP)  [**2106-6-25**]
The ET tube tip is high, above the level of the clavicular head
had approximately 9 cm above the carina. The right internal
jugular line tip is in distal SVC. The NG tube tip passes below
the diaphragm with its tip in the proximal stomach.
The moderate cardiomegaly is unchanged as well as there is no
change in bilateral perihilar and lower lobe opacities which
might be consistent with pulmonary edema also giving the
asymmetric appearance of the right lower lobe. Right lower lobe
pneumonia/aspiration cannot be excluded. Overall findings
progressed since [**2106-6-23**].

Brief Hospital Course:
A/P: 68M PMH T4 level paraplegia, CAD, CHF EF 15-20%, severe
sacral
decubitus ulcers, history of multiple UTI with chronic
indwelling Foley, PE on coumadin with IVC filter in place p/w
septic shock with likely pulmonary source and s/p PEA arrest.
The patient was initially treated with broad spectrum
antibiotics and with two pressors.  The patient developed
multiorgan dysfunction despite these efforts and the decision
was made with the HCP to change the goals of care to comfort
[**6-25**].
.
He was treated with:
- Morphine 2-4 mg IV Q2H PRN pain
- Ativan 0.5-2 mg PO/IV Q2H PRN pain, agitation
- Scopolamine patch for secretions
.
Pt passed away on [**2106-6-29**].  HCP requested an autopsy.
.
ACCESS: RIJ; was kept in place given desire for autopsy
COMMUNICATION: HCP [**Name (NI) **] [**Name (NI) 45262**] [**Telephone/Fax (1) 45263**]


Medications on Admission:
Calcium Carbonate 1,625 mg [**Hospital1 **]
Aspirin 81 mg DAILY
Baclofen 5 mg TID
Cholecalciferol 1,000 unit DAILY
Celexa 40 mg DAILY
Cyanocobalamin 1,000 mcg DAILY
Advair Diskus 250 mcg-50 mcg INH [**Hospital1 **]
Neurontin 400 mg [**Hospital1 **]
Folic Acid 1 mg DAILY
Keppra 500 mg [**Hospital1 **]
Omeprazole 40 mg [**Hospital1 **]
Oxycodone 5 mg Q6H:PRN pain
Ursodiol 300 mg [**Hospital1 **]
Coumadin for goal INR [**3-14**]
Acetaminophen 325-650 mg Q4H:PRN pain
Nystatin Swish and Swallow


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
n/a

Discharge Condition:
n/a

Discharge Instructions:
n/a

Followup Instructions:
n/a
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Paraplegia,Pressure ulcer, lower back,Acute kidney failure, unspecified,Chronic systolic heart failure,Unspecified septicemia,Severe sepsis,Acidosis,Septic shock,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Cardiac arrest,Other specified forms of chronic ischemic heart disease'}


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: Respiratory failure, status post PEA arrest

PRESENT ILLNESS: 68M PMH T4 level paraplegia, CAD, CHF EF 20%, severe sacral
decubitus ulcers, history of multiple UTI, PE on coumadin and
IVC filter in place transferred from [**Hospital 100**] Rehab with hypoxia -
76% 3L NC, lethargy.
.
Of note, the patient was recently admitted [**Date range (3) 45261**] for
hypotension with likely urosepsis with acinetobacter sensitive
to tobramycin and completed a seven-day course of treatment. He
is transferred with a PICC line dating from this previous
admission.
.
In the ED, VS T: 100.6 HR: 121 BP: 114/15 RR: 23 SaO2: 94% NRB.
Patient lethargic and in respiratory distress on presentaion.
- Narcan 0.5 mg IV - no improvement
- Lasix 40 mg IV - urine output not noted
- Chest x-ray - consistent with aspiration
- Intubated
- Levofloxacin, cefepime for aspiration pneumonia
- RIJ placed (procedure note in chart)
- 15 minutes post-intubation patient had PEA arrest - CPR,
epinephrine 1 mg, atropine 1 mg -> perfusing rhythm (unknown
amount of time, ~5 minutes)
- 1L NS
- Started on levophed

MEDICAL HISTORY: 1. Inflammatory disease of the spinal cord of uncertain
etiology/T4 paraplegia. MRA [**10-16**] negative for vascular
malformation. Initial CSF analysis showed elevated protein (82)
without oligoclonal bands. NMO blood titer negative, RPR
negative, Lyme serology negative, [**Doctor First Name **] negative, Ro and La
negative, ACE level normal, neuromyelitis IgG negative, ESR 70,
CRP 66.8. Ultimately treated with broad spectrum antibiotics,
corticosteroids (two weeks of Solu-Medrol followed by a
prednisone taper), and 5 days of mannitol without improvement.
He is followed by neurology for a dense paraplegia (T4) with
neuropathic pain, restrictive shoulder arthropathy, and a
neurogenic bladder requiring a chronic indwelling foley.
2. Chronic sacral decubitus ulcer, previously treated with a VAC

MEDICATION ON ADMISSION: Calcium Carbonate 1,625 mg [**Hospital1 **]
Aspirin 81 mg DAILY
Baclofen 5 mg TID
Cholecalciferol 1,000 unit DAILY
Celexa 40 mg DAILY
Cyanocobalamin 1,000 mcg DAILY
Advair Diskus 250 mcg-50 mcg INH [**Hospital1 **]
Neurontin 400 mg [**Hospital1 **]
Folic Acid 1 mg DAILY
Keppra 500 mg [**Hospital1 **]
Omeprazole 40 mg [**Hospital1 **]
Oxycodone 5 mg Q6H:PRN pain
Ursodiol 300 mg [**Hospital1 **]
Coumadin for goal INR [**3-14**]
Acetaminophen 325-650 mg Q4H:PRN pain
Nystatin Swish and Swallow

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 99.8 BP: 71/54 HR: 124 RR: 19 SaO2: 98%
AC: Tv 550 RR 18 PEEP 5 FiO2 50%
GEN: Intubated, sedated
HEENT: PERRLA, + conjunctival refelx, no conjuctival injection,
anicteric, ETT in place
NECK: Supple, no LAD
CV: RRR, nl s1, s2, no m/r/g
PULM: CTA anteriorly
ABD: Soft, NT, ND, + BS, no HSM
BACK: Six Stage IV sacral decubitus ulcers with purulent
drainage
EXT: Cool, dry, palpable distal pulses BL
NEURO (30 minutes after holding sedation): Does not follow
commands, withdraws to pain

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Recently living in [**Hospital 100**] Rehab.  He moved here from [**Country 3594**]
(after living in many different countries) in the [**2068**].  He is
retired from a job in the maritime industry.  Divorced 24 years
ago with three children.  Quit smoking in [**2076**], unknown
pack-year history.  Quit drinking in [**2080**].  No history of
illicit drug use or abuse. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Paraplegia,Pressure ulcer, lower back,Acute kidney failure, unspecified,Chronic systolic heart failure,Unspecified septicemia,Severe sepsis,Acidosis,Septic shock,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Cardiac arrest,Other specified forms of chronic ischemic heart disease'}
