CHIEF COMPLAINT: Fall

PRESENT ILLNESS: HPI: 44 y/o female found down in water for unknown amount of
time
after an [**9-10**] ft. Found at bottom of cliff wedged between rocks
unknown mechanism in [**Location (un) 50240**], MA. Per EMT report pt was found
with GCS of [**8-9**], cold hypotensive in 80's with occassional eye
opening, was found by a stranger. She was intubated at the
scene

MEDICAL HISTORY: ROS: Pt Intubated and sedated
PMH: Chronically low BP
PSH: None

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: Vitals: 96.4 Rectal, P 45 BP 138/56, 15 100%
Examined off sedation for was paralyed
HEENT:
Chest: clear bilaterally
CV: RRR S1 S2
ABD: soft non tender report from ER Fast -
Neuro: Examined on off Propathol for 20 minutes, pt is
intubated
PERRLA [**5-4**] brisk
Moves all extremeties very strongly spontaneously and withdraws
to pain
Opens eyes to voice does not track

FAMILY HISTORY: not obtained

SOCIAL HISTORY: SH: Pt is a minister lives in [**State 3914**] with husband and children
was on retreat to [**Location (un) 50240**], MA
Other closed skull fracture with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Hypotension, unspecified,Accidental fall from cliff
Cl skull fx NEC-coma NOS,Food/vomit pneumonitis,Hypotension NOS,Fall from cliff
Admission Date:  [**2166-10-10**]              Discharge Date:   [**2166-10-17**]

Date of Birth:  [**2122-8-5**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Fall

Major Surgical or Invasive Procedure:
none this admisssion


History of Present Illness:
HPI: 44 y/o female found down in water for unknown amount of
time
after an [**9-10**] ft. Found at bottom of cliff wedged between rocks
unknown mechanism in [**Location (un) 50240**], MA. Per EMT report pt was found
with GCS of [**8-9**], cold hypotensive in 80's with occassional eye
opening, was found by a stranger. She was intubated at the
scene

Past Medical History:
ROS: Pt Intubated and sedated
PMH: Chronically low BP
PSH: None

Social History:
SH: Pt is a minister lives in [**State 3914**] with husband and children
was on retreat to [**Location (un) 50240**], MA

Family History:
not obtained

Physical Exam:
PE: Vitals: 96.4 Rectal, P 45 BP 138/56, 15 100%
Examined off sedation for was paralyed
HEENT:
Chest: clear bilaterally
CV: RRR S1 S2
ABD: soft non tender report from ER Fast -
Neuro: Examined on off Propathol for 20 minutes, pt is
intubated
PERRLA [**5-4**] brisk
Moves all extremeties very strongly spontaneously and withdraws
to pain
Opens eyes to voice does not track


Pertinent Results:
[**2166-10-10**] 05:00PM   WBC-7.6 RBC-3.81* HGB-12.7 HCT-37.4 MCV-98
MCH-33.4* MCHC-34.0 RDW-12.8
[**2166-10-10**] 05:00PM   PLT COUNT-162
[**2166-10-10**] 05:00PM   PT-13.1 PTT-23.7 INR(PT)-1.1
[**2166-10-10**] 05:00PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.018
[**2166-10-10**] 05:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2166-10-10**] 05:16PM   GLUCOSE-123* LACTATE-1.7 NA+-141 K+-4.0
CL--107 TCO2-25
[**2166-10-10**] 05:00PM   UREA N-12 CREAT-0.9
[**2166-10-10**] 05:00PM   AMYLASE-48: Non-contrast head CT.

FINDINGS: There has been slight interval evolution of the
previously identified scattered peripheral intraparenchymal
hemorrhages, most pronounced in the inferior temporal lobes.
There is also slight increase conspicuously of subarachnoid
hemorrhage in the left frontal lobe as well as a lesser degree
in the right frontal lobe. No other areas of hemorrhage are
identified. There remains no shift of normally midline
structures or mass effect. The appearance of the brain
parenchyma is otherwise unchanged. The osseous structures and
paranasal sinuses are unchanged in short interval.

IMPRESSION:
1. Slight interval evolution of previously identified
intraparenchymal hemorrhages and slight increase conspicuously
of bilateral frontal subarachnoid hemorrhage.
2. No new areas of hemorrhage identified.


Brief Hospital Course:
Pt was admitted to the trauma ICU for close monitoring. She was
sedated but had neuro checks q1h off meds.  Repeat Head CTs were
stable. She was able to be extubated [**10-13**]. She did spike fevers
and was found to have an aspiration pneumonia and started on
antibiotics.  She was transferred to the floor on [**10-14**]. She
improved neurologically but continued to have problems with
memory. She underwent swallowing study which found her able to
tolerate regular diet.  Her foley was removed.  Trauma service
cleared her c-spine after negative CT and her collar was
removed.
Her CBC showed a hematocrit of 32.4, a anemia panel was sent
showing a cal TIBC 215, B12 516 Folate of 6.0 and TRF of 165.
These numbers were felt to be related to her traumatic injury
and pneumonia and not any chronic process.

She was evaluated by PT and OT felt she would benefit from acute
inpatient physical and cognitive rehab.

Medications on Admission:
none

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
3. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection every twelve (12) hours.
4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day): Last dose 9/21.
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours): Last dose 9/21.
6. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) 7635**] [**Last Name (NamePattern1) **] Rehab

Discharge Diagnosis:
Traumatice brain injury


Discharge Condition:
Neurologically stable


Discharge Instructions:
Watch for any signs of neurological change.
Remove suture in head on Monday [**10-21**]

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] and Head CT in [**7-9**] weeks - call
[**Telephone/Fax (1) 2731**] for appt.



Completed by:[**2166-10-17**]
{'Other closed skull fracture with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Hypotension, unspecified,Accidental fall from cliff'}


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

PRESENT ILLNESS: HPI: 44 y/o female found down in water for unknown amount of
time
after an [**9-10**] ft. Found at bottom of cliff wedged between rocks
unknown mechanism in [**Location (un) 50240**], MA. Per EMT report pt was found
with GCS of [**8-9**], cold hypotensive in 80's with occassional eye
opening, was found by a stranger. She was intubated at the
scene

MEDICAL HISTORY: ROS: Pt Intubated and sedated
PMH: Chronically low BP
PSH: None

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: Vitals: 96.4 Rectal, P 45 BP 138/56, 15 100%
Examined off sedation for was paralyed
HEENT:
Chest: clear bilaterally
CV: RRR S1 S2
ABD: soft non tender report from ER Fast -
Neuro: Examined on off Propathol for 20 minutes, pt is
intubated
PERRLA [**5-4**] brisk
Moves all extremeties very strongly spontaneously and withdraws
to pain
Opens eyes to voice does not track

FAMILY HISTORY: not obtained

SOCIAL HISTORY: SH: Pt is a minister lives in [**State 3914**] with husband and children
was on retreat to [**Location (un) 50240**], MA 

### Response:
{'Other closed skull fracture with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Hypotension, unspecified,Accidental fall from cliff'}
