CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75-year-old
white gentleman who was in his usual state of health until
the day prior to admission; when, after eating, the patient
felt nauseated and vomited three times.  The patient denies
hematemesis.

MEDICAL HISTORY: (Past medical history is significant
for)
1.  Aortic valve replacement in [**2187**].
2.  Coronary artery disease; status post 4-vessel coronary
artery bypass graft in [**2187**].
3.  Hypercholesterolemia.
4.  Benign prostatic hypertrophy.

MEDICATION ON ADMISSION: PHYSICAL EXAMINATION ON PRESENTATION:  On admission physical
examination the patient's temperature was 99 degrees
Fahrenheit, his heart rate was 123, his oxygen saturation was
100% on three liters, and his blood pressure was 134/76.  In
general, the patient was well-appearing, in no apparent
distress.  Head, eyes, ears, nose, and throat examination
revealed pupils were equal, round, and reactive to light.
The mucous membranes were slightly dry.  The neck was supple.
Cardiovascular examination revealed a regular rate and
rhythm.  A 3/6 systolic murmur at the left upper sternal
border and a metallic click.  Pulmonary examination revealed
the lungs were clear to auscultation bilaterally.  Abdominal
examination revealed the abdomen was soft, nontender, and
nondistended.  Normal active bowel sounds.  Extremity
examination revealed no cyanosis, clubbing, or edema.  Good
distal pulses.  Neurologic examination revealed cranial
nerves II through XII were intact.  Motor strength was [**5-16**]
bilaterally in all muscle groups.  Sensation was intact
throughout.  Reflexes were 2+ bilaterally throughout.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Acute posthemorrhagic anemia,Esophageal hemorrhage,Syncope and collapse,Fall from other slipping, tripping, or stumbling,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Heart valve replaced by other means,Long-term (current) use of anticoagulants
Subdural hemorr-coma NOS,Ac posthemorrhag anemia,Esophageal hemorrhage,Syncope and collapse,Fall from slipping NEC,Stomach ulcer NOS,Heart valve replac NEC,Long-term use anticoagul
Admission Date:  [**2191-8-4**]     Discharge Date:  [**2191-8-8**]

Date of Birth:   [**2115-9-8**]     Sex:  M

Service:  [**Location (un) **]

HISTORY OF PRESENT ILLNESS:  The patient is a 75-year-old
white gentleman who was in his usual state of health until
the day prior to admission; when, after eating, the patient
felt nauseated and vomited three times.  The patient denies
hematemesis.

On the morning following this episode of emesis, the patient
experienced a syncopal episode characterized as dizziness and
lightheadedness.  He awoke with emergency medical technicians
putting him in an ambulance.  He denies a postictal state.
He denied loss of bowel or bladder continence.

The patient was taken to [**Hospital 26200**] Hospital where a
head computed tomography demonstrated a subdural and
subarachnoid hemorrhage.  He was then transferred to [**Hospital1 1444**] for evaluation by
Neurosurgery.

In the Emergency Department, the patient vomited bright red
blood one time.  In the Emergency Department, the patient
received fresh frozen plasma, activated factor VII, and two
units of packed red blood cells.  Of note, the patient had a
mechanical aortic valve for which he was taking Coumadin and
was found to supratherapeutic on admission.

PAST MEDICAL HISTORY:  (Past medical history is significant
for)
1.  Aortic valve replacement in [**2187**].
2.  Coronary artery disease; status post 4-vessel coronary
artery bypass graft in [**2187**].
3.  Hypercholesterolemia.
4.  Benign prostatic hypertrophy.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:

PHYSICAL EXAMINATION ON PRESENTATION:  On admission physical
examination the patient's temperature was 99 degrees
Fahrenheit, his heart rate was 123, his oxygen saturation was
100% on three liters, and his blood pressure was 134/76.  In
general, the patient was well-appearing, in no apparent
distress.  Head, eyes, ears, nose, and throat examination
revealed pupils were equal, round, and reactive to light.
The mucous membranes were slightly dry.  The neck was supple.
Cardiovascular examination revealed a regular rate and
rhythm.  A 3/6 systolic murmur at the left upper sternal
border and a metallic click.  Pulmonary examination revealed
the lungs were clear to auscultation bilaterally.  Abdominal
examination revealed the abdomen was soft, nontender, and
nondistended.  Normal active bowel sounds.  Extremity
examination revealed no cyanosis, clubbing, or edema.  Good
distal pulses.  Neurologic examination revealed cranial
nerves II through XII were intact.  Motor strength was [**5-16**]
bilaterally in all muscle groups.  Sensation was intact
throughout.  Reflexes were 2+ bilaterally throughout.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Laboratories on
admission were notable for a white blood cell count of 11.6,
his hematocrit was 20.4, and his platelets were 257.
Chemistry-7 was notable for a blood urea nitrogen of 63 with
a creatinine of 0.7.  The patient's INR was 5 with a partial
thromboplastin time of 33.  Urinalysis showed trace ketones.
Urine culture was negative.

PERTINENT RADIOLOGY/IMAGING:  Electrocardiogram revealed a
right bundle-branch block with a rate of 120 (sinus rhythm).

CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM:

1.  INTRACRANIAL BLEED ISSUES:  Neurosurgery was consulted.
The patient's anticoagulation was reversed with a goal INR of
less than 1.3 and platelets of greater than 100.
Anticoagulation was held while the intracranial hemorrhage
was further worked up.

A head computed tomography was done.  There was no
significant change compared to the study done at the
[**Hospital 26200**] Hospital.  The computed tomography showed
bilateral low density subdural collections with the left
greater than the right.  There was also an area of hemorrhage
in the inferior left frontal lobe.

There was a question of whether the bleed represented an
acute or chronic process.  The patient was maintained on
every 1-hour neurologic checks.

The patient had a computed tomography angiogram which showed
no evidence of aneurysm.  The patient also had a magnetic
resonance angiography which also did not show any evidence of
aneurysm.

As the patient was stable with no active bleeding, he was
transferred out the Medical Intensive Care Unit and onto the
floor.  Neurosurgery did not feel it necessary for
intervention at this time as the patient was stable.

2.  GASTROINTESTINAL BLEED ISSUES:  The patient was initially
placed on Protonix and monitored for repeat hematemesis.  The
Gastrointestinal Service was consulted.

An esophagogastroduodenoscopy was done which showed [**Doctor Last Name 15532**]
esophagus and ulcer at the gastroesophageal junction, changes
in the prepyloric region compatible with gastritis, and
changes in the duodenal bulb compatible with duodenitis.

As per recommendations from the Gastrointestinal Service, the
patient was continued on Protonix 40 mg by mouth twice per
day, and the patient would need a follow-up
esophagogastroduodenoscopy with a biopsy in four to six
weeks.  No active bleeding was seen during this
esophagogastroduodenoscopy.

During the rest of the hospital admission, the patient
remained stable with no further evidence of active
gastrointestinal bleeding, and his hematocrit remained
stable.

3.  ANTICOAGULATION ISSUES:  The patient required
anticoagulation for an artificial aortic valve.  However, due
to the presence of intracranial hemorrhage, anticoagulation
with Coumadin was held initially upon admission.
Neurosurgery was consulted for recommendations regarding
restarting the anticoagulation.

As per the Neurosurgery Service, it was decided to hold off
any anticoagulation for two months; at which point the
patient was instructed to follow up with his local
neurosurgeon for reassessment of restarting his
anticoagulation.

4.  CORONARY ARTERY DISEASE ISSUES:  The patient was
continued on a statin.  He was started on atenolol 25 mg by
mouth every day.   Aspirin was not given the patient
secondary to his intracranial bleeding.  The patient was
ruled out for a myocardial infarction during his hospital
admission.

CONDITION AT DISCHARGE:  Condition on discharge was stable.
The patient was afebrile and hemodynamically stable.  His
hematocrit was stable with no evidence of gastrointestinal
bleeding.  The patient's mental status was at baseline.  He
was ambulating without difficulty and tolerating a by mouth
diet.

MEDICATIONS ON DISCHARGE:
1.  Protonix 40 mg by mouth twice per day.
2.  Lipitor 10 mg by mouth once per day.
3.  Flomax 0.4 mg by mouth at bedtime.
4.  Colace 100 mg by mouth twice per day.
5.  Atenolol 25 mg by mouth once per day.

DISCHARGE DIAGNOSES:
1.  Subdural hematoma.
2.  Subarachnoid hemorrhage.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with his local
neurosurgeon upon returning to his home in [**State 108**].
2.  The patient was also instructed to follow up with a
gastroenterologist locally in [**State 108**] for a repeat
esophagogastroduodenoscopy in four to six weeks.
3.  The patient was instructed not to take any
anticoagulation medications such as aspirin or Coumadin for
two months after discharge; or as advised by his local
neurosurgeon.
4.  The patient was given a copy of head computed tomography
report and esophagogastroduodenoscopy report to take with him
for local followup.





                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 2506**]

Dictated By:[**Name8 (MD) 5709**]

MEDQUIST36

D:  [**2191-9-26**]  16:45
T:  [**2191-9-28**]  09:54
JOB#:  [**Job Number 52324**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Acute posthemorrhagic anemia,Esophageal hemorrhage,Syncope and collapse,Fall from other slipping, tripping, or stumbling,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Heart valve replaced by other means,Long-term (current) use of anticoagulants'}


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: 

PRESENT ILLNESS: The patient is a 75-year-old
white gentleman who was in his usual state of health until
the day prior to admission; when, after eating, the patient
felt nauseated and vomited three times.  The patient denies
hematemesis.

MEDICAL HISTORY: (Past medical history is significant
for)
1.  Aortic valve replacement in [**2187**].
2.  Coronary artery disease; status post 4-vessel coronary
artery bypass graft in [**2187**].
3.  Hypercholesterolemia.
4.  Benign prostatic hypertrophy.

MEDICATION ON ADMISSION: PHYSICAL EXAMINATION ON PRESENTATION:  On admission physical
examination the patient's temperature was 99 degrees
Fahrenheit, his heart rate was 123, his oxygen saturation was
100% on three liters, and his blood pressure was 134/76.  In
general, the patient was well-appearing, in no apparent
distress.  Head, eyes, ears, nose, and throat examination
revealed pupils were equal, round, and reactive to light.
The mucous membranes were slightly dry.  The neck was supple.
Cardiovascular examination revealed a regular rate and
rhythm.  A 3/6 systolic murmur at the left upper sternal
border and a metallic click.  Pulmonary examination revealed
the lungs were clear to auscultation bilaterally.  Abdominal
examination revealed the abdomen was soft, nontender, and
nondistended.  Normal active bowel sounds.  Extremity
examination revealed no cyanosis, clubbing, or edema.  Good
distal pulses.  Neurologic examination revealed cranial
nerves II through XII were intact.  Motor strength was [**5-16**]
bilaterally in all muscle groups.  Sensation was intact
throughout.  Reflexes were 2+ bilaterally throughout.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Acute posthemorrhagic anemia,Esophageal hemorrhage,Syncope and collapse,Fall from other slipping, tripping, or stumbling,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Heart valve replaced by other means,Long-term (current) use of anticoagulants'}
