CHIEF COMPLAINT: S/P Fall

PRESENT ILLNESS: 89F s/p mechanical fall at home. Taken to OSH where CT showed
right superior and inferior pubic rami fractures with an
associated hematoma tracking up the rectus sheath measuring 10 x
3.5 x 6. The patient was hypotensive with low BP's in the
80s-90s at the OSH. She was given blood for a HCT 28.1 and
transferred to [**Hospital1 18**] for further management. Head CT at the OSH
was negative.

MEDICAL HISTORY: PMH: crohn's, bell's palsy, HTN, glaucoma
PSH: unknown

MEDICATION ON ADMISSION: macrobid 100'', pepcid 20', vitC 500', combigan 0.2-0.05% 1gtt
each eye'', proair, caltrate 800 + VitD 1'', timoptic 0.5mg eye
gtt 1gtt each eye', miabalicin spr 200 1 spray daily per nostril
alternating,

ALLERGIES: Cipro / Quinolones

PHYSICAL EXAM: Temp:96.4 HR:80 BP:98/58 Resp:16 O(2)Sat:100

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: No tobacco, no ETOH, lives alone
Closed fracture of pubis,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Regional enteritis of unspecified site,Unspecified transient mental disorder in conditions classified elsewhere,Unspecified fall,Urinary complications, not elsewhere classified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Unspecified essential hypertension
Fracture of pubis-closed,Pneumonia, organism NOS,Ac kidny fail, tubr necr,Ac posthemorrhag anemia,Regional enteritis NOS,Transient mental dis NOS,Fall NOS,Surg compl-urinary tract,Adv eff medicinal NEC,Hypertension NOS
Admission Date:  [**2196-3-16**]              Discharge Date:   [**2196-3-24**]


Service: SURGERY

Allergies:
Cipro / Quinolones

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
S/P Fall

Major Surgical or Invasive Procedure:
Pelvic arteriogram [**2196-3-16**]


History of Present Illness:
89F s/p mechanical fall at home. Taken to OSH where CT showed
right superior and inferior pubic rami fractures with an
associated hematoma tracking up the rectus sheath measuring 10 x
3.5 x 6. The patient was hypotensive with low BP's in the
80s-90s at the OSH. She was given blood for a HCT 28.1 and
transferred to [**Hospital1 18**] for further management. Head CT at the OSH
was negative.

Past Medical History:
PMH: crohn's, bell's palsy, HTN, glaucoma
PSH: unknown


Social History:
No tobacco, no ETOH, lives alone


Family History:
non-contributory


Physical Exam:
Temp:96.4 HR:80 BP:98/58 Resp:16 O(2)Sat:100

Constitutional: Awake alert and oriented
HEENT: Normocephalic, atraumatic, Pupils equal, round and
reactive to light
There is no tenderness to palpation of the posterior
cervical C-spine
Chest: Clear to auscultation
Cardiovascular: Regular Rate and Rhythm
Pelvic: Tenderness to palpation over the anterior pelvis
Extr/Back: Distal sensation and capillary refill are intact
in both lower extremities
Neuro: Speech fluent
Psych: Normal mood


Pertinent Results:
IMAGING:

[**2196-3-16**] CTA torso:
1. Right superior pubic ramus fracture with associated complex
fluid collection seen along the anterior abdominal wall and
within the right side of pelvis, consistent with hematoma.
Findings are stable and unchanged when compared to prior
imaging. No evidence of active arterial extravasation on this
study. However, this is within the limits of suboptimal IV bolus
timing and acute extravasation cannot be fully excluded;
however, given that the size of the hematomas have not changed
significantly since the prior examination, these are likely
stable.
2. There is infrarenal abdominal aortic aneurysm measuring
maximum 4.3 in
anterior-posterior diameter and 4.3 cm in transverse diameter.
2. There is infrarenal abdominal aortic aneurysm measuring
maximum 4.3 in
anterior-posterior diameter and 4.3 cm in transverse diameter.

[**2196-3-16**] Pelvic arteriogram
Unsuccessful right common femoral artery access. Successful left

common femoral artery access with a pelvic arteriogram
performed. AP and
oblique projections did not demonstrate evidence of active
contrast
extravasation at this time. No further intervention was
performed. The
patient tolerated the procedure well, and there were no early
complications.

[**2196-3-18**] CXR :
Pulmonary vasculature previously engorged on [**3-16**], is now
normal to
slightly increased in caliber. There is no pulmonary edema.
Pleural effusion is small on the left, if any. Heart size
normal. Left subclavian line ends close to the superior
cavoatrial junction. No pneumothorax or mediastinal widening.


Brief Hospital Course:
The patient was admitted to the ACS service was taken for urgent
IR angio given that there was active extravasation seen on her
CTA torso. However, they did not visualize any active bleeding
and no intervention was performed.

Post-procedure, the patient was admitted to the TSICU for close
monitoring. Serial hcts were checked. These initially remained
stable but then began trending down during the latter part of
the day on post-procedure day 1 to a nadir of 21.3. She was
transfused two units of blood and one unit of platelets (for a
platelet count of 49) and her post-transfusion bumped
appropriately to 31.7.

Hemodynamically, the patient remained stable. Her diet was
liberalized and she tolerated a regular diet without problems.
She transferred to a regular floor bed on [**3-18**]. Pt did spike a
fever up to 101.3 once on the floor.

On [**3-19**] Pt continued to be HD stable. HCT remained stable. Pt did
begin to show sign of delirium and agitation which was addressed
with Zyprexa. Cultures and CXR were obtained and pt was started
on empiric vanc/zosyn.

On [**3-20**] pt continued to wax and wane. A geriatric consult was
obtained, and Seroquel was started instead of Zyprexa. Her blood
cultures were preliminarily negative as was her urine culture.
A sputum culture could not be obtained but the working diagnosis
was pneumonia based on a slightly elevated WBC and increased
opacity of the left lower lobe on chest xray.

She developed ATN on [**2196-3-21**] possibly from the dye load from the
angiogram.  Her urine output was adequate with additional IV
hydration and gradually it declined.  Her admission creatinine
actually was 1.5 but it decreased to a low of 1.0. Her
Vancomycin was stopped in order to eliminate nephrotoxic drugs
and she continued to improve.

The Physical Therapy service recommended short term rehab to try
to increase her mobility and endurance.


Medications on Admission:
macrobid 100'', pepcid 20', vitC 500', combigan 0.2-0.05% 1gtt
each eye'', proair, caltrate 800 + VitD 1'', timoptic 0.5mg eye
gtt 1gtt each eye', miabalicin spr 200 1 spray daily per nostril
alternating,


Discharge Medications:
1. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. timolol maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic
DAILY (Daily): Both eyes.
4. oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours)
as needed for pain.
5. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
6. Vitamin C 500 mg Tablet Sig: One (1) Tablet PO once a day.
7. Pepcid 20 mg Tablet Sig: One (1) Tablet PO once a day.
8. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: [**1-17**]
Puffs Inhalation Q6H (every 6 hours) as needed for shortness of
breath or wheezing.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 3137**] Care Center - [**Location (un) 1468**]

Discharge Diagnosis:
S/P Fall
1. Right superior/inferior rami fracture
2. Pneumonia
3. Acute blood loss anemia
4. Delirium
5. Acute renal failure/ATN


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
* You were admitted to the hospital after falling and you have a
pelvic fracture.
* Your blood count has been stable and the Orthopedic doctors
[**Name5 (PTitle) 9004**] [**Name5 (PTitle) **] to bear weight as long as the pain is tolerable.
* You also have been treated with antibiotics for pneumonia.
* Continue to eat well and stay hydrated.
* Your kidney function wasa bit abnormal in the hospital
probably from the contrast dye used during some of your xrays.
It is getting better and actually is back to normal.
* You are being transferred to rehab to try to increase your
mobility and endurance prior to returning home.

Followup Instructions:
Call the Acute Care Clinic at [**Telephone/Fax (1) 600**] for a follow up
appointment in [**2-18**] weeks.

Call the [**Hospital **] Clinic at [**Telephone/Fax (1) 1228**] for a follow up
appointment in 4 weeks.


Completed by:[**2196-3-24**]
{'Closed fracture of pubis,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Regional enteritis of unspecified site,Unspecified transient mental disorder in conditions classified elsewhere,Unspecified fall,Urinary complications, not elsewhere classified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Unspecified essential hypertension'}


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: 89F s/p mechanical fall at home. Taken to OSH where CT showed
right superior and inferior pubic rami fractures with an
associated hematoma tracking up the rectus sheath measuring 10 x
3.5 x 6. The patient was hypotensive with low BP's in the
80s-90s at the OSH. She was given blood for a HCT 28.1 and
transferred to [**Hospital1 18**] for further management. Head CT at the OSH
was negative.

MEDICAL HISTORY: PMH: crohn's, bell's palsy, HTN, glaucoma
PSH: unknown

MEDICATION ON ADMISSION: macrobid 100'', pepcid 20', vitC 500', combigan 0.2-0.05% 1gtt
each eye'', proair, caltrate 800 + VitD 1'', timoptic 0.5mg eye
gtt 1gtt each eye', miabalicin spr 200 1 spray daily per nostril
alternating,

ALLERGIES: Cipro / Quinolones

PHYSICAL EXAM: Temp:96.4 HR:80 BP:98/58 Resp:16 O(2)Sat:100

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: No tobacco, no ETOH, lives alone 

### Response:
{'Closed fracture of pubis,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Acute posthemorrhagic anemia,Regional enteritis of unspecified site,Unspecified transient mental disorder in conditions classified elsewhere,Unspecified fall,Urinary complications, not elsewhere classified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Unspecified essential hypertension'}
