CHIEF COMPLAINT: Fall, unresponsiveness

PRESENT ILLNESS: Patient is a 75 year old man with hx of Afib on Coumadin,
ESRD on dialysis, HTN, hyperlipidemia who had an unwitnessed
fall
while at home today and transported to [**Hospital3 417**] where he
was intubated for airway protection and found to have large
5X4cm
L ICH with extension into both lateral ventricles and 4th
ventricle.  He was transferred here for further evaluation and
care.  He was initially seen per NSURG who did not recommend
surgical intervention currently hence neurology was consulted.

MEDICAL HISTORY: 1. Afib on Coumadin
2. ESRD - on dialysis 3x/week
3. CAD
4. HTN
5. Hyperlipidemia
6. hx of EtOH abuse - been sober for several years
7. s/p both knee replacements
8. CHF

MEDICATION ON ADMISSION: 1. Coumadin
2. Lipitor
3. Phoslo
4. Coreg
5. Nifedipine
6. Lasix

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: BP 164/93 HR 91 RR 20 O2Sat 100% on AC mode FiO2 40%
Gen: Lying in the ED stretcher, intubated and sedated.
HEENT: Hard cervical collar in place with R eye ecchymotic and
small blood.
Ext: No edema

FAMILY HISTORY: EtoH abuse

SOCIAL HISTORY: Lives alone but girlfriend lives nearby.  Independently
ambulatory although was told that falls are inevitable per PCP.
[**Name10 (NameIs) **] smoker of 1 PPD since adolescence.  Hx of EtOH abuse but
sober for several years.  Retired police officer.
Intracerebral hemorrhage,Cerebral edema,Acute respiratory failure,Ventilator associated pneumonia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Coma,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Atrial fibrillation,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Renal dialysis status,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other and unspecified alcohol dependence, in remission,Tobacco use disorder,Anemia, unspecified,Knee joint replacement
Intracerebral hemorrhage,Cerebral edema,Acute respiratry failure,Ventltr assoc pneumonia,Hyp kid NOS w cr kid V,End stage renal disease,Coma,Other streptococcus,Atrial fibrillation,Abnrml coagultion prfile,Adv eff anticoagulants,Renal dialysis status,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,CHF NOS,Alcoh dep NEC/NOS-remiss,Tobacco use disorder,Anemia NOS,Joint replaced knee
Admission Date:  [**2193-1-31**]              Discharge Date:   [**2193-2-7**]

Date of Birth:  [**2117-8-31**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Fall, unresponsiveness

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Patient is a 75 year old man with hx of Afib on Coumadin,
ESRD on dialysis, HTN, hyperlipidemia who had an unwitnessed
fall
while at home today and transported to [**Hospital3 417**] where he
was intubated for airway protection and found to have large
5X4cm
L ICH with extension into both lateral ventricles and 4th
ventricle.  He was transferred here for further evaluation and
care.  He was initially seen per NSURG who did not recommend
surgical intervention currently hence neurology was consulted.

Patient is intubated and sedated and unable to give own hx.
Spoke to daughter who is next of [**Doctor First Name **] who reports that she has
not
seen him for a few weeks but is aware that he was told per PCP
(Dr. [**First Name (STitle) **] [**Name (STitle) 9404**]) that he is bound to fall given his overall
weakness from co-morbidities including ESRD for which he is
getting 3x/week dialysis for the past 1.5 years.

There is no report of recent illness or infection but the
details
are unclear.  [**Name2 (NI) **] does live alone and independently but
girlfriend lives in an apartment a few units down per daughter.

Patient's INR was 2.5 at OSH hence he received FFP and Vitamin
K.
His INR was 2.3 here on arrival hence he received more FFP,
Vitamin K and Profiline.  He remains intubated and sedated with
repeat head CT showing no enlargement of the head bleed.



Past Medical History:
1. Afib on Coumadin
2. ESRD - on dialysis 3x/week
3. CAD
4. HTN
5. Hyperlipidemia
6. hx of EtOH abuse - been sober for several years
7. s/p both knee replacements
8. CHF


Social History:
Lives alone but girlfriend lives nearby.  Independently
ambulatory although was told that falls are inevitable per PCP.
[**Name10 (NameIs) **] smoker of 1 PPD since adolescence.  Hx of EtOH abuse but
sober for several years.  Retired police officer.

Family History:
EtoH abuse

Physical Exam:
BP 164/93 HR 91 RR 20 O2Sat 100% on AC mode FiO2 40%
Gen: Lying in the ED stretcher, intubated and sedated.
HEENT: Hard cervical collar in place with R eye ecchymotic and
small blood.
Ext: No edema

Neurologic examination:
Mental status: Does not respond to verbal or sternal rub.

Cranial Nerves:
Both pupils small (~2mm) but reactive although minimally.
Positive corneals bilaterally but more brisk on L.  Flickering
facial movement to nasal tickles but no gag, no OCR and no
blinking to visual threats.

Motor:
No increased tone or asymmetry.  Does not withdraw to noxious
stim on both UEs but triple flexes on LEs.  Occ myoclonic jerks
of both LEs where he extends his legs and dorsiflexes feet.

Sensation: Intact to nox stim in LEs.

Reflexes:
2s and symmetric on biceps and brachioradialis but none for
patellar given hx of knee replacements bilaterally - has well
healed scars.  Toes upgoing bilaterally.


Pertinent Results:
[**2193-2-6**] 03:35AM BLOOD WBC-11.7* RBC-3.59* Hgb-11.1* Hct-33.3*
MCV-93 MCH-30.9 MCHC-33.3 RDW-16.2* Plt Ct-270
[**2193-1-31**] 12:00AM BLOOD WBC-12.1* RBC-3.75* Hgb-11.7* Hct-34.8*
MCV-93 MCH-31.1 MCHC-33.5 RDW-16.6* Plt Ct-210
[**2193-2-3**] 01:29AM BLOOD Neuts-83.1* Lymphs-10.4* Monos-5.3
Eos-1.0 Baso-0.2
[**2193-1-31**] 12:00AM BLOOD Neuts-82.4* Lymphs-10.4* Monos-4.4
Eos-2.4 Baso-0.4
[**2193-2-3**] 01:29AM BLOOD WBC-10.1 RBC-3.59* Hgb-11.2* Hct-33.2*
MCV-93 MCH-31.2 MCHC-33.8 RDW-16.4* Plt Ct-206
[**2193-2-6**] 03:35AM BLOOD PT-14.9* PTT-34.9 INR(PT)-1.3*
[**2193-1-31**] 12:00AM BLOOD PT-20.8* PTT-35.6* INR(PT)-2.0*
[**2193-2-6**] 03:35AM BLOOD Glucose-138* UreaN-102* Creat-7.9*#
Na-137 K-4.8 Cl-96 HCO3-22 AnGap-24*
[**2193-1-31**] 12:00AM BLOOD Glucose-139* UreaN-43* Creat-6.1*# Na-136
K-4.2 Cl-97 HCO3-26 AnGap-17
[**2193-1-31**] 05:53AM BLOOD ALT-14 AST-11 LD(LDH)-223 CK(CPK)-98
AlkPhos-113 TotBili-0.4
[**2193-1-31**] 05:53AM BLOOD CK-MB-NotDone cTropnT-0.07*
[**2193-1-31**] 12:00AM BLOOD cTropnT-0.07*
[**2193-2-6**] 03:35AM BLOOD Calcium-9.4 Phos-5.3* Mg-2.4
[**2193-1-31**] 05:53AM BLOOD Albumin-3.6 Calcium-9.4 Phos-4.4 Mg-2.7*
[**2193-2-6**] 03:35AM BLOOD Vanco-18.4
[**2193-2-4**] 06:09PM BLOOD Vanco-11.3
[**2193-1-31**] 12:00AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2193-2-5**] 10:59AM BLOOD Type-ART pO2-162* pCO2-31* pH-7.49*
calTCO2-24 Base XS-2
[**2193-1-31**] 12:06AM BLOOD Type-ART Rates-16/23 Tidal V-500 PEEP-5
FiO2-50 pO2-112* pCO2-45 pH-7.41 calTCO2-30 Base XS-3
-ASSIST/CON Intubat-INTUBATED
[**2193-1-31**] 11:45AM BLOOD Lactate-0.7 Na-137 K-3.8
[**2193-1-31**] 12:06AM BLOOD Glucose-132* Lactate-0.8 Na-136 K-4.1
Cl-95*
[**2193-1-31**] 12:06AM BLOOD Hgb-12.0* calcHCT-36 O2 Sat-96 COHgb-3

NCHCT [**2193-1-31**]:
IMPRESSION:
1. Large left intraparenchymal hemorrhage centered about left
thalamus, but
involving left temporal lobe and intraventricular system.
2. Mass effect, 4-mm right shift of midline structures
indicative of
subfalcine herniation, and surrounding edema.
3. No evidence of transtentorial herniation.


NCHCT [**2193-2-4**]:
IMPRESSION: No significant interval change in extensive left
thalamic and
temporal lobe intraparenchymal hemorrhage with associated edema
and mass
effect.


Brief Hospital Course:
75 M w/ hx AF, previously on coumadin and ESRD on HD, presented
with a large Left ICH with intraventricular extension as
outlined in the HPI. Neurosx felt no intervention was necessary.
He remained intubated with little in the way of neuro exam save
initially some movement of all but his RUE to noxious. Over days
he developed a PNA for which he was treated with Abx and he was
ultimately completely non-responsive to noxious stimulation.
After one week in the ICU, his family decided that they did not
want to proceed with trach/PEG, noting that he would never have
wanted to have been kept alive connected to tubes. He was made
CMO on [**2-6**] and expired on [**2-7**].

Medications on Admission:
1. Coumadin
2. Lipitor
3. Phoslo
4. Coreg
5. Nifedipine
6. Lasix


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
Intracerebral Hemorrhage

Discharge Condition:
deceased

Discharge Instructions:
none

Followup Instructions:
none

                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]

Completed by:[**2193-3-14**]
{'Intracerebral hemorrhage,Cerebral edema,Acute respiratory failure,Ventilator associated pneumonia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Coma,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Atrial fibrillation,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Renal dialysis status,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other and unspecified alcohol dependence, in remission,Tobacco use disorder,Anemia, unspecified,Knee joint replacement'}


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: Fall, unresponsiveness

PRESENT ILLNESS: Patient is a 75 year old man with hx of Afib on Coumadin,
ESRD on dialysis, HTN, hyperlipidemia who had an unwitnessed
fall
while at home today and transported to [**Hospital3 417**] where he
was intubated for airway protection and found to have large
5X4cm
L ICH with extension into both lateral ventricles and 4th
ventricle.  He was transferred here for further evaluation and
care.  He was initially seen per NSURG who did not recommend
surgical intervention currently hence neurology was consulted.

MEDICAL HISTORY: 1. Afib on Coumadin
2. ESRD - on dialysis 3x/week
3. CAD
4. HTN
5. Hyperlipidemia
6. hx of EtOH abuse - been sober for several years
7. s/p both knee replacements
8. CHF

MEDICATION ON ADMISSION: 1. Coumadin
2. Lipitor
3. Phoslo
4. Coreg
5. Nifedipine
6. Lasix

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: BP 164/93 HR 91 RR 20 O2Sat 100% on AC mode FiO2 40%
Gen: Lying in the ED stretcher, intubated and sedated.
HEENT: Hard cervical collar in place with R eye ecchymotic and
small blood.
Ext: No edema

FAMILY HISTORY: EtoH abuse

SOCIAL HISTORY: Lives alone but girlfriend lives nearby.  Independently
ambulatory although was told that falls are inevitable per PCP.
[**Name10 (NameIs) **] smoker of 1 PPD since adolescence.  Hx of EtOH abuse but
sober for several years.  Retired police officer. 

### Response:
{'Intracerebral hemorrhage,Cerebral edema,Acute respiratory failure,Ventilator associated pneumonia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Coma,Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus,Atrial fibrillation,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Renal dialysis status,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other and unspecified alcohol dependence, in remission,Tobacco use disorder,Anemia, unspecified,Knee joint replacement'}
