CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: 82 yo Female who usually ambulates with walker s/p witnessed
mechanical fall. No LOC, no head strike. Patient has a left leg
motor neuropathy with drop foot that causes her much difficulty
with ambulation and resulted in this fall. Neuropathy of unknown
origin.  Patient immediately felt pain in left knee and was
taken to OSH. They were referred here for futher Orthopaedic
Care.

MEDICAL HISTORY: 3V CABG ~ 7 years ago
Hypothyroid
HTN
Left leg neuropathy with drop foot
s/p olecranon and humerus ORIF

MEDICATION ON ADMISSION: Cymbalta 30 QD, alprazolam 0.5 mg QD, amitriptyline 10 mg QD,
HCTZ 25 QD, Protonix 40 [**Last Name (LF) 244**], [**First Name3 (LF) **] 81, Lisinopril 5 QD, Synthroid
25 mcg', simvastatin 40 QD, Metroprol 50 QD

ALLERGIES: morphine / Erythromycin Base

PHYSICAL EXAM: Admission Physical Exam:
98 84 111/63 18 93% RA
A&O x 3 , NAD
Cor: well perfused
Pulm: No respiratory distress

FAMILY HISTORY: N/A

SOCIAL HISTORY: Lives alone. Ambulates with walker. denies smoking, drinking,
drugs.
Closed supracondylar fracture of femur,Critical illness polyneuropathy,Acute posthemorrhagic anemia,Unspecified fracture of ankle, closed,Accidental fall on or from other stairs or steps,Other acquired deformities of ankle and foot,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Aortocoronary bypass status
Supracondyl fx femur-cl,Crit illness neuropathy,Ac posthemorrhag anemia,Fx ankle NOS-closed,Fall on stair/step NEC,Acq ankle-foot def NEC,Hypothyroidism NOS,Hypertension NOS,Aortocoronary bypass
Admission Date:  [**2200-3-24**]              Discharge Date:   [**2200-3-27**]

Date of Birth:  [**2117-7-7**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
morphine / Erythromycin Base

Attending:[**First Name3 (LF) 8587**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
Open reduction internal fixation left femur and right tibia


History of Present Illness:
82 yo Female who usually ambulates with walker s/p witnessed
mechanical fall. No LOC, no head strike. Patient has a left leg
motor neuropathy with drop foot that causes her much difficulty
with ambulation and resulted in this fall. Neuropathy of unknown
origin.  Patient immediately felt pain in left knee and was
taken to OSH. They were referred here for futher Orthopaedic
Care.


Past Medical History:
3V CABG ~ 7 years ago
Hypothyroid
HTN
Left leg neuropathy with drop foot
s/p olecranon and humerus ORIF


Social History:
Lives alone. Ambulates with walker. denies smoking, drinking,
drugs.


Family History:
N/A

Physical Exam:
Admission Physical Exam:
98 84 111/63 18 93% RA
A&O x 3 , NAD
Cor: well perfused
Pulm: No respiratory distress

RLE: Compartments soft, skin intact. Full supple, painless ROM
of
hip, knee. + swelling at ankle. No joint effusions or crepitus
appreciated. 5/5 strength to hf, kf, ke. 0/5 [**Last Name (un) **], adf, apf - at
baseline. foot is wwp, dp and pt pulses are 2+. SilT
s/s/dp/sp/tn
distributions.
LLE:Compartments soft, skin intact. Full supple, painless ROM of
hip, ankle. + swelling superior to knee. no crepitus
appreciated.
5/5 strength adf, apf, [**Last Name (un) **]. foot is wwp, dp and pt pulses are
2+.
SilT s/s/dp/sp/tn distributions.


Pertinent Results:
TT Echo:
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Left ventricular systolic
function is hyperdynamic (EF>75%). There is no ventricular
septal defect. Right ventricular chamber size and free wall
motion are normal. The aortic root is mildly dilated at the
sinus level. The ascending aorta is mildly dilated. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Trivial mitral regurgitation is
seen. The tricuspid valve leaflets are mildly thickened. There
is mild pulmonary artery systolic hypertension. There is no
pericardial effusion.

Xray films in ED revealed right distal tibia fracture and left
distal femur fractures.

[**2200-3-27**] 05:20AM BLOOD Hct-28.7*
[**2200-3-27**] 12:40AM BLOOD Hct-29.3*
[**2200-3-27**] 09:20AM BLOOD Glucose-144* UreaN-9 Creat-0.6 Na-135
K-3.2* Cl-95* HCO3-33* AnGap-10

Brief Hospital Course:
Ms. [**Known lastname **] was evaluated in the emergency room by the
orthopaedic trauma service and found to have a left femur
fracture and right tibia fracture. She was admitted to ortho and
prepped for surgery. On HD 2, she was taken to the OR. See
operative report for full details. She tolerated the procedure
well, however post-operatively there were concerning EKG changes
consistent with ischemia. A TTE was performed, see report for
full details and cardiac enzymes were cycled. Cardiac enzymes
were negative x3.  Patient spent post-operative period in ICU
for increased monitoring. During the peri-operative period she
received 4 units of blood due to acute blood loss. On POD#2 she
received an additional 2 units of blood and 1 of FFP.
She was started on lovenox daily for DVT prophylaxis on POD#1.
At the time of discharge, she was afebrile with stable vital
signs, tolerating a regular diet, voiding spontaneously, and
with her pain well controlled.

Medications on Admission:
Cymbalta 30 QD, alprazolam 0.5 mg QD, amitriptyline 10 mg QD,
HCTZ 25 QD, Protonix 40 [**Last Name (LF) 244**], [**First Name3 (LF) **] 81, Lisinopril 5 QD, Synthroid
25 mcg', simvastatin 40 QD, Metroprol 50 QD


Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
8. amitriptyline 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
9. alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) as needed for Anxiety.
10. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q3H (every 3
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
11. metoprolol succinate 50 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
13. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) 40 mg
Subcutaneous DAILY (Daily): Continue for 4 weeks post-op.
14. ipratropium bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for wheezing.


Discharge Disposition:
Extended Care

Facility:
Radius [**Hospital 36748**] HealthCare Center - [**Hospital1 189**]

Discharge Diagnosis:
Left distal femur fracture and Right distal tibia fracture


Discharge Condition:
Stable. Alert and Oriented.


Discharge Instructions:
Wound Care:
- Keep Incision clean and dry.
- Do not soak the incision in a bath or pool.

Activity:
- Continue to be non weight bearing on your left and right leg.

Other Instructions
- Resume your regular diet.
- Avoid nicotine products to optimize healing.
- Resume your home medications. Take all medications as
instructed.
- Continue taking the Lovenox to prevent blood clots.
- You have also been given Additional Medications to control
your pain. Please allow 72 hours (Monday through Friday, 9am to
4pm) for refill of narcotic prescriptions, so plan ahead. There
will be no prescription refils on Saturdays, Sundays, or
holidays. You can either have them mailed to your home or pick
them up at the clinic located on [**Hospital Ward Name 23**] 2. We are not allowed
to call in narcotic (oxycontin, oxycodone, percocet)
prescriptions to the pharmacy. In addition, we are only allowed
to write for pain medications for 90 days from the date of
surgery.
- Narcotic pain medication may cause drowsiness. Do not drink
alcohol while taking narcotic medications. Do not operate any
motor vehicle or machinery while taking narcotic pain
medications. Taking more than recommended may cause serious
breathing problems.
Physical Therapy:
Non weight bearing bilateral lower extremity.
Treatments Frequency:
Dressing changes as needed.

Followup Instructions:
Please follow-up in [**Hospital 1957**] Clinic with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**MD Number(3) 49252**] weeks. Please call [**Telephone/Fax (1) 9769**] for an appointment.



Completed by:[**2200-3-27**]

Name:  [**Known lastname 14127**],[**Known firstname 13025**]                 Unit No:   [**Numeric Identifier 14128**]

Admission Date:  [**2200-3-24**]              Discharge Date:   [**2200-3-27**]

Date of Birth:  [**2117-7-7**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
morphine / Erythromycin Base

Attending:[**First Name3 (LF) 3564**]
Addendum:
Please follow-up in [**Hospital **] Clinic with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2577**], [**MD Number(3) 14129**] weeks. Please call [**Telephone/Fax (1) 14130**] for an appointment.
Please follow-up with your PCP and Cardiologist in the next [**12-1**]
weeks for further evaluation of your cardiac status given EKG
changes post-operatively.


Discharge Disposition:
Extended Care

Facility:
Radius [**Hospital 14131**] HealthCare Center - [**Hospital1 1612**]

Followup Instructions:
Please follow-up in [**Hospital **] Clinic with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2577**], [**MD Number(3) 14129**] weeks. Please call [**Telephone/Fax (1) 14130**] for an appointment.
Please follow-up with your PCP and Cardiologist in the next [**12-1**]
weeks for further evaluation of your cardiac status given EKG
changes post-operatively.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3565**] MD [**MD Number(2) 3566**]

Completed by:[**2200-3-27**]
{'Closed supracondylar fracture of femur,Critical illness polyneuropathy,Acute posthemorrhagic anemia,Unspecified fracture of ankle, closed,Accidental fall on or from other stairs or steps,Other acquired deformities of ankle and foot,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Aortocoronary bypass status'}


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: 82 yo Female who usually ambulates with walker s/p witnessed
mechanical fall. No LOC, no head strike. Patient has a left leg
motor neuropathy with drop foot that causes her much difficulty
with ambulation and resulted in this fall. Neuropathy of unknown
origin.  Patient immediately felt pain in left knee and was
taken to OSH. They were referred here for futher Orthopaedic
Care.

MEDICAL HISTORY: 3V CABG ~ 7 years ago
Hypothyroid
HTN
Left leg neuropathy with drop foot
s/p olecranon and humerus ORIF

MEDICATION ON ADMISSION: Cymbalta 30 QD, alprazolam 0.5 mg QD, amitriptyline 10 mg QD,
HCTZ 25 QD, Protonix 40 [**Last Name (LF) 244**], [**First Name3 (LF) **] 81, Lisinopril 5 QD, Synthroid
25 mcg', simvastatin 40 QD, Metroprol 50 QD

ALLERGIES: morphine / Erythromycin Base

PHYSICAL EXAM: Admission Physical Exam:
98 84 111/63 18 93% RA
A&O x 3 , NAD
Cor: well perfused
Pulm: No respiratory distress

FAMILY HISTORY: N/A

SOCIAL HISTORY: Lives alone. Ambulates with walker. denies smoking, drinking,
drugs. 

### Response:
{'Closed supracondylar fracture of femur,Critical illness polyneuropathy,Acute posthemorrhagic anemia,Unspecified fracture of ankle, closed,Accidental fall on or from other stairs or steps,Other acquired deformities of ankle and foot,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Aortocoronary bypass status'}
