CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 68 year old female who was at home, her husband
heard a "thud" and found her at the bottom of the stairs
unconscious with snoring respirations.  She was taken to
[**Hospital 1474**] Hospital where evaluation showed a large subarachnoid
hemorrhage.  She was intubated at the outside hospital and was
transferred to [**Hospital1 18**] ED for further care.  On arrival she was
intubated and sedated.  She also had facial fractures and left
rib [**5-16**] fractures.

MEDICAL HISTORY: diabetes, legally blind, HTN

MEDICATION ON ADMISSION: ASA 325, HCTZ 25, lisinopril 40, toprol 50, lipitor 20,
glipizide 10, lantus 25 units, amitriptyline 10

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: non contributory

SOCIAL HISTORY: married, has a son who lives in [**Name (NI) 108**] and a daughter who lives
locally
Subarachnoid hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of multiple ribs, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonitis due to inhalation of food or vomitus,Closed fracture of malar and maxillary bones,Accidental fall on or from other stairs or steps,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Gastroparesis,Other and unspecified complications of medical care, not elsewhere classified,Anemia, unspecified,Unspecified acquired hypothyroidism,Legal blindness, as defined in U.S.A.
Subarach hem-coma NOS,Fx mult ribs NOS-closed,Acute respiratry failure,Acute kidney failure NOS,Urin tract infection NOS,Food/vomit pneumonitis,Fx malar/maxillary-close,Fall on stair/step NEC,DMII neuro uncntrld,Gastroparesis,Complic med care NEC/NOS,Anemia NOS,Hypothyroidism NOS,Legal blindness-usa def
Admission Date:  [**2178-3-11**]              Discharge Date:   [**2178-4-7**]

Date of Birth:  [**2110-1-22**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
[**2178-3-22**] Open tracheostomy and [**Last Name (un) **] gastrostomy with [**Last Name (un) **] G-J
feeding tube.


History of Present Illness:
Mrs. [**Known lastname **] is a 68 year old female who was at home, her husband
heard a "thud" and found her at the bottom of the stairs
unconscious with snoring respirations.  She was taken to
[**Hospital 1474**] Hospital where evaluation showed a large subarachnoid
hemorrhage.  She was intubated at the outside hospital and was
transferred to [**Hospital1 18**] ED for further care.  On arrival she was
intubated and sedated.  She also had facial fractures and left
rib [**5-16**] fractures.

Past Medical History:
diabetes, legally blind, HTN

Social History:
married, has a son who lives in [**Name (NI) 108**] and a daughter who lives
locally

Family History:
non contributory

Pertinent Results:
[**3-11**]: CTA head: Subarachnoid hemorrhage largely fills the left
sylvian fissure, tracking along the surface of the left temporal
lobe. There is also a small amount of subarachnoid blood within
the right sylvian fissure, along the right superior sagittal
sinus, and along the right tentorium cerebelli. Blood-fluid
levels are seen within the dependent posterior horns of
bilateral lateral ventricles. A hypodense fluid collection
lining the left frontal lobe is consistent with a chronic
subdural hematoma.

A fracture through the anterolateral aspect of the left
zygomatic bone extends to the lateral orbit. A small amount of
increased soft tissue directly beneath the lateral rectus muscle
likely represents hematoma. A fracture through the left lateral
nasal bone is minimally displaced. No other fractures are
identified. A large subgaleal hematoma covers the left cerebral
hemisphere, with mixed areas of high attenuation, suggesting
acute hemorrhage. The hematoma partially cover the anterior
orbit. The left globe appears in tact. The intraconal fat is
clear.

Fluid within bilateral ethmoid air cells, bilateral sphenoid air
cells, maxillary sinuses is likely related to trauma and
intubation. Oropharyngeal and endotracheal tubes are in place.

The intracranial vertebral and internal carotid arteries and
their major branches appear normal, without evidence of
stenosis, occlusion, or aneurysm formation.

[**3-13**] Echo: The left atrium is mildly dilated. Left ventricular
wall thickness, cavity size and regional/global systolic
function are normal (LVEF >55%) Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Trivial mitral
regurgitation is seen. There is moderate pulmonary artery
systolic hypertension. There is a small pericardial effusion.

IMPRESSION: Normal global and regional biventricular systolic
function. Moderate pulmonary hypetension.

[**3-28**] CT head: The previously demonstrated subarachnoid
hemorrhage appears to have resolved. A tiny focus of
high-density of the cortex of the left frontal lobe (series 2A,
image 19) is not as dense as typically seen with acute
subarachnoid hemorrhage and is thought more likely to represent
sequela of prior subarachnoid hemorrhage or alternatively a
cortical vein. There is a low-density extra-axial collection
overlying the left convexity, without a hyperdense component to
suggest acute hemorrhage. The previously demonstrated
intraventricular hemorrhage layering in the occipital horns of
the lateral ventricles is no longer appreciated. Subdural
hematoma along the tentorium is not appreciated on today's
study. There is no shift of the normally midline structures.
There is no evidence of hydrocephalus or infarction. The left
frontal scalp hematoma has significantly improved. There is a
fluid level in the left sphenoid sinus air cell. There is a
sphenoid Onodi cell on the right, which is opacified, as is a
posterior right ethmoid air cell. There is a small mucus
retention cyst in the right maxillary sinus. There is mild
mucosal thickening of the left maxillary sinus.


Brief Hospital Course:
Mrs. [**Known lastname **] was admitted on [**3-11**] by the trauma surgery service
to the trauma ICU for close monitoring and care.  She was seen
by the neurosurgery service in the ED and was loaded and
continued on Dilantin for seizure prophylaxis with strict blood
pressure control and neuro checks.  Her creatinine on admission
was 1.6 and she was treated for hyperglycemia.  Repeat head CTs
showed stable SAH and small bifrontal SDH.  She remained
intubated with attempts to wean the ventilator and showed some
neurologic improvement while intermittently following commands.
She was started on tube feeds for nutrition.  She was seen by
ophthalmology on [**3-12**] for L orbital wall fracture who
recommended lacrilube and erthyromycin ointment to each eye.
They also recommended follow up as an outpatient with her
regular eye doctor or in clinic for a complete eye exam.  She
continued to be monitored and treated for hyperglycemia as well
as for decreased urine output with increasing creatinine.  She
was treated with antibiotics for fever and finding of L lung
infiltrate on [**3-14**].  She failed a trial of extubation on [**3-19**].
She also did not tolerate tube feeding well and went to the
operating room on [**3-22**] for an open tracheostomy and placement of
a G-J tube.  She was started on tube feeds which she tolerated
well.  She completed her course of antibiotics on [**3-26**].  Her
fluid status was monitored and managed closely.  She was started
on trials of trach mask which she tolerated well during the day
but tired and had to go back on CPAP in the evening and
overnight.  She had an episode of respiratory distress on [**3-31**]
with PEA in which 2 cycles of atropine and epinephrine were
given with return to sinus tachycardia.  She continued to be
seen by physical therapy and was screened for vent rehab.

Her current issues are as follows:

Neuro: able to communicate, awake, alert and apparently aware.
Stable from a neurological perspective. A repeated CT scan of
the head done about a week ago shows healing/resolving
subarachnoid hemorrhage and subdural hemorrhage.

CV: she is receiving metoprolol 75mg via J-tube TID,
atorvastatin 40mg daily and at present, furosemide 60mg IV BID
in an attempt to diurese gently. She had a surface
echocardiogram which was reassuring - mild LVH with >55% LVEF,
no valvular disease, no R heart disease. Multiple CXRs show that
she has pulmonary congestion, but when she is diuresed to clear
her pulmonary edema, her renal function promptly worsens. We
have resorted to gentle diuresis, goal 500cc negative per day.

Resp: on trach mask during the day, on CPAP/PSV at nights. She
has a #8 [**Last Name (un) 295**] in place.

GI/FEN: she is on Nutren Renal 3/4 strength tube feeds at a goal
of 55ml/hour. She tolerates these feeds via the J-tube. The
G-tube is clampled at present, but may be used to vent the
gastric contents if the patient becomes nauseated or has signs
of worsened gastroparesis.

GU/Renal: Her renal function has stabilized with a Cr of 3.1. As
mentioned above in the 'CV' section, aggressive diuresis
promptly worsens her azotemia.

Heme: she is on heparin sc BID and a baby aspirin daily.

Endo: she is on NPH insulin, 30units [**Hospital1 **], and a regular insulin
sliding scale. She is also on glipizide 5mg daily. Her blood
glucose levels are from 110 to 160. She is also on levothyroxine
for hypothyroidism.

ID: she has no active infections and is stable from this
perspective.

Tubes, Lines and Drains: she has a 2-lumen PICC, a #8 [**Last Name (un) 295**]
tracheostomy tube, a double lumen feeding tube with one lumen in
the stomach and one in the jejunum. She also has a foley
catheter.

Disposition: she is to be discharged to [**Hospital1 **], a
long-term acute care facility with a ventilator unit.

Medications on Admission:
ASA 325, HCTZ 25, lisinopril 40, toprol 50, lipitor 20,
glipizide 10, lantus 25 units, amitriptyline 10

Discharge Medications:
1. Artificial Tear with Lanolin 0.1-0.1 % Ointment Sig: One (1)
Appl Ophthalmic PRN (as needed).
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
3. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
4. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: 6-10 Puffs
Inhalation Q6H (every 6 hours).
5. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2)  Inhalation
every four (4) hours.
6. Amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
7. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24
hours).
9. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day) as needed.
10. Zinc Oxide-Cod Liver Oil 40 % Ointment Sig: One (1) Appl
Topical PRN (as needed).
11. Lidocaine HCl 5 % Ointment Sig: One (1) Appl Topical PRN (as
needed).
12. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
14. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: Five (5)
ML PO Q6H (every 6 hours) as needed.
15. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
16. Albuterol Sulfate 2.5 mg/3 mL Solution for Nebulization Sig:
One (1)  Inhalation Q6H (every 6 hours) as needed.
17. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
18. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for no stool.
19. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for no
stool.
20. Olanzapine 10 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO BID (2 times a day) as needed.
21. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
22. Glipizide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

23. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
24. Ferrous Sulfate 325 mg (65 mg Iron) Capsule, Sustained
Release Sig: One (1) Capsule, Sustained Release PO every twelve
(12) hours.
25. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

26. Multivitamins     Tablet, Chewable Sig: One (1) Cap PO DAILY
(Daily).
27. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: 30
units  Subcutaneous twice a day.
28. Furosemide 60 mg IV BID
29. Metoclopramide 5 mg/mL Solution Sig: One (1)  Injection Q6H
(every 6 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
S/p fall (traumatic)
Subarachnoid hemorrhage
Subdural hemorrhage
Multiple L-sided rib fractures
Legal blindness
Diabetes mellitus type II - uncontrolled
Hypertension
Chronic renal failure
Acute renal failure
Respiratory failure
Gastroparesis
Anemia of chronic disease
Hypothyroidism


Discharge Condition:
Stable


Discharge Instructions:
See below.

Followup Instructions:
See Dr. [**Last Name (STitle) **] in his office in 1 month. Call [**Telephone/Fax (1) 6429**] for
an appointment.



Completed by:[**2178-4-7**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of multiple ribs, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonitis due to inhalation of food or vomitus,Closed fracture of malar and maxillary bones,Accidental fall on or from other stairs or steps,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Gastroparesis,Other and unspecified complications of medical care, not elsewhere classified,Anemia, unspecified,Unspecified acquired hypothyroidism,Legal blindness, as defined in U.S.A.'}


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: s/p fall

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 68 year old female who was at home, her husband
heard a "thud" and found her at the bottom of the stairs
unconscious with snoring respirations.  She was taken to
[**Hospital 1474**] Hospital where evaluation showed a large subarachnoid
hemorrhage.  She was intubated at the outside hospital and was
transferred to [**Hospital1 18**] ED for further care.  On arrival she was
intubated and sedated.  She also had facial fractures and left
rib [**5-16**] fractures.

MEDICAL HISTORY: diabetes, legally blind, HTN

MEDICATION ON ADMISSION: ASA 325, HCTZ 25, lisinopril 40, toprol 50, lipitor 20,
glipizide 10, lantus 25 units, amitriptyline 10

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: non contributory

SOCIAL HISTORY: married, has a son who lives in [**Name (NI) 108**] and a daughter who lives
locally 

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of multiple ribs, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonitis due to inhalation of food or vomitus,Closed fracture of malar and maxillary bones,Accidental fall on or from other stairs or steps,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Gastroparesis,Other and unspecified complications of medical care, not elsewhere classified,Anemia, unspecified,Unspecified acquired hypothyroidism,Legal blindness, as defined in U.S.A.'}
