CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 85-year-old
woman transferred from an outside hospital after being struck
in the back of the head with a car door earlier on the day of
admission.  She had positive loss of consciousness according
to the EMS report and received Dilantin and Decadron at the
outside hospital.  The patient described the event as the car
moved, and the door hit her.

MEDICAL HISTORY: Alzheimer's.  Non-insulin-dependent
diabetes mellitus.  Breast carcinoma.

MEDICATION ON ADMISSION: 

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: Temp 97.2, pulse 70, BP 186/66, respiratory
rate 16, sats 95%.
HEENT:  She had an ecchymotic area of the occiput of the
head.  Her pupils equal, round and reactive to light, and her
EOMS were full.
NECK:  She was in a C-collar which was cleared, and the
collar was removed.
LUNGS:  Clear to auscultation.
CARDIAC:  Regular rate and rhythm.
ABDOMEN:  Soft, nontender, nondistended, positive bowel
sounds.  She had a right nephrectomy scar.
EXTREMITIES:  No clubbing, cyanosis or edema.
NEUROLOGIC:  Awake, alert, oriented x 1.  Aware that she was
in the hospital, but not able to give the name.  Pupils
equal, round and reactive to light.  EOMS full.  No
nystagmus.  Tongue midline.  No drift.  Strength was [**5-14**] in
all muscle groups.  Following commands x 4.  Stable
neurologically.

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone.
Closed fracture of vault of skull with cerebral laceration and contusion, with brief [less than one hour] loss of consciousness,Alzheimer's disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of breast,Noncollision motor vehicle traffic accident while boarding or alighting injuring passenger in motor vehicle other than motorcycle
Cl skull vlt fx-brf coma,Alzheimer's disease,DMII wo cmp nt st uncntr,Hx of breast malignancy,Mv acc board/alight-psgr
Admission Date:  [**2155-1-28**]       Discharge Date:  [**2155-2-5**]


Service:  NEUROSURGERY

HISTORY OF PRESENT ILLNESS:  The patient is an 85-year-old
woman transferred from an outside hospital after being struck
in the back of the head with a car door earlier on the day of
admission.  She had positive loss of consciousness according
to the EMS report and received Dilantin and Decadron at the
outside hospital.  The patient described the event as the car
moved, and the door hit her.

She denied any headache, neck pain, visual changes, chest
pain, but positive productive cough.

PAST MEDICAL HISTORY:  Alzheimer's.  Non-insulin-dependent
diabetes mellitus.  Breast carcinoma.

ALLERGIES:  NO KNOWN DRUG ALLERGIES.

SOCIAL HISTORY:  She lives alone.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 97.2??????, pulse
70, blood pressure 186/66, respirations 16, oxygen saturation
96%.  HEENT:  She had an ecchymotic area on the occiput of
the head.  Pupils equal, round and reactive to light.
Extraocular movements intact.  Neck:  She had a cervical
collar in place, and she was cleared both clinically and
radiographically.  Lungs:  Clear to auscultation.
Cardiovascular:  Regular, rate and rhythm.  Abdomen:  Soft,
nontender, nondistended.  Positive bowel sounds.  She had a
right nephrectomy scar.  Extremities:  No clubbing, cyanosis,
or edema.  Neurological:  Awake, alert, and oriented times
one; however, aware of hospital and date.  Pupils equal,
round and reactive to light.  Extraocular movements intact.
No nystagmus.  Negative drift.  She was following commands
times four.  Strength 5 out of 5 in all muscle groups.  Toes
upgoing bilaterally.  Tongue midline.  Voice slightly slurred
with some dysarthria.  She was neurologically stable.

IMAGES:  Head CT showed a right temporofrontal contusion with
subarachnoid blood which extended into the suprasellar
cistern and a right parietal skull fracture.

The patient was transferred to [**Hospital6 2018**].  Due to the nature of the subarachnoid hemorrhage, a
CTA was performed to rule out aneurysm which was ruled out.
The patient also, as stated earlier, had cervical spine
cleared.

She was admitted to the Intensive Care Unit for close
observation.  She remained awake, alert, and oriented times
two, with no drift, following commands.  Her strength
remained 5 out of 5 in all muscle groups.

On admission sodium was 138, potassium 4.6, 105/23, 23/0.8,
318.  Her Dilantin was 16.5 on hospital day #1.  Her
hematocrit was 35.3, white count 7.1, platelet count 227.

Due to the lack of Intensive Care Unit bed, the patient
remained in the Emergency Room for 2?????? days.  Upon admission
to the Intensive Care Unit, she had a speech and swallow
evaluation




                            [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D.  [**MD Number(1) 343**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2155-2-5**]  10:56
T:  [**2155-2-5**]  11:09
JOB#:  [**Job Number 52840**]


Admission Date:  [**2155-1-30**]       Discharge Date:  [**2155-2-5**]


Service:  NEUROSURGERY

HISTORY OF PRESENT ILLNESS:  The patient is an 85-year-old
woman transferred from an outside hospital after being struck
in the back of the head with a car door.  The patient had
positive loss of consciousness, but no evidence of seizure
activity.  She was loaded with Dilantin and started on
decadron at the outside hospital, and was transferred to [**Hospital6 1760**] for further management

PAST MEDICAL HISTORY:
1. Alzheimer's.
2. Diabetes.
3. Breast cancer.
4. Right nephrectomy.

ALLERGIES:  No known allergies.

MEDS ON ADMISSION:
1. Glyburide.
2. Lisinopril.
3. Levoxyl.
4. Aricept.

X-RAY:  A CT on admission showed right frontotemporal
contusion with blood and subarachnoid hemorrhage that
extended into the suprasellar cistern.  As a result of the
nature of the subarachnoid hemorrhage, the patient had a CTA
to rule out aneurysm which was ruled out.

PHYSICAL EXAM:  Temp 97.2, pulse 70, BP 186/66, respiratory
rate 16, sats 95%.
HEENT:  She had an ecchymotic area of the occiput of the
head.  Her pupils equal, round and reactive to light, and her
EOMS were full.
NECK:  She was in a C-collar which was cleared, and the
collar was removed.
LUNGS:  Clear to auscultation.
CARDIAC:  Regular rate and rhythm.
ABDOMEN:  Soft, nontender, nondistended, positive bowel
sounds.  She had a right nephrectomy scar.
EXTREMITIES:  No clubbing, cyanosis or edema.
NEUROLOGIC:  Awake, alert, oriented x 1.  Aware that she was
in the hospital, but not able to give the name.  Pupils
equal, round and reactive to light.  EOMS full.  No
nystagmus.  Tongue midline.  No drift.  Strength was [**5-14**] in
all muscle groups.  Following commands x 4.  Stable
neurologically.

HOSPITAL COURSE:  The patient was due to be admitted to an
ICU bed for close observation.  She remained neurologically
stable throughout her ICU stay.  She was transferred to the
regular floor on [**2155-1-31**].  She had a speech and swallow
evaluation which she did fail and required an NG tube to be
placed.  She, neurologically, waxed and waned.  She did have
some episodes of lethargy.  A repeat head CT was done which
showed some swelling in the area of the frontotemporal
contusion.

She also had difficulty with high blood sugars.  The [**Last Name (un) **]
diabetic fellow was consulted, and the patient was started on
Lantus before bed, her insulin sliding scale was increased,
and her po glyburide was increased from 2.5 qd to 10 mg po
bid.  Her blood sugars should be monitored qid.

Her neurologic status, on the day of discharge, is stable.
She is awake, alert, following commands, knows her name and
the hospital, with good strength throughout.  She also was
started on Levofloxacin for a patchy infiltrate on chest
x-ray.  Chest x-ray showed some evidence of density in the
right upper lung zone, as well as a left lung base density
which was beginning to clear.  So, the patient was started on
Levofloxacin for prophylactic treatment of potential
pneumonia.  Her vital signs remained stable.

Today, temp max is 100.2.  Her vital signs are stable.  She
is neurologically awake, alert and oriented x 2.  Her
strength is [**5-14**] in all muscle groups.  [**Last Name (un) **] has made
further recommendations to increase her Levoxyl to 112 mcg.
Her TSH was 13, free T4 0.9.  Therefore, her thyroxine was
increased to 112 mcg.  She also has a hemoglobin A1C which is
pending.

She remains stable with follow-up with Dr. [**First Name (STitle) **] in 1 month with
repeat head CT.  Follow-up with her PCP for glucose control,
and for repeat thyroid function tests in 1 month.

DISCHARGE CONDITION:  Stable.

DISCHARGE MEDICATIONS:
1. Levoxyl 112 mcg po qd.
2. Insulin sliding scale and Lantus 20 U q pm.
3. Levofloxacin 500 mg NG q 24 h for 7 days, started on
[**2155-2-5**].
4. Glyburide 10 mg po q 12 h.
5. Lisinopril 10 mg po qd.
6. Metoprolol 25 mg po bid--hold for SBP less than 110, heart
rate less than 60.
7. Heparin 5,000 U subcu q 12 h.
8. Colace 100 mg po bid.
9. Zantac 150 mg per NG [**Hospital1 **].
10.Dilantin 100 mg NG tid.
11.Donepezil 5 mg po q hs.
The patient was on Dilantin for 1 week.  The Dilantin was
DC'd after 1 week.




                            [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D.  [**MD Number(1) 343**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2155-2-5**]  11:07
T:  [**2155-2-5**]  12:15
JOB#:  [**Job Number 52841**]
{"Closed fracture of vault of skull with cerebral laceration and contusion, with brief [less than one hour] loss of consciousness,Alzheimer's disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of breast,Noncollision motor vehicle traffic accident while boarding or alighting injuring passenger in motor vehicle other than motorcycle"}


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: 

PRESENT ILLNESS: The patient is an 85-year-old
woman transferred from an outside hospital after being struck
in the back of the head with a car door earlier on the day of
admission.  She had positive loss of consciousness according
to the EMS report and received Dilantin and Decadron at the
outside hospital.  The patient described the event as the car
moved, and the door hit her.

MEDICAL HISTORY: Alzheimer's.  Non-insulin-dependent
diabetes mellitus.  Breast carcinoma.

MEDICATION ON ADMISSION: 

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: Temp 97.2, pulse 70, BP 186/66, respiratory
rate 16, sats 95%.
HEENT:  She had an ecchymotic area of the occiput of the
head.  Her pupils equal, round and reactive to light, and her
EOMS were full.
NECK:  She was in a C-collar which was cleared, and the
collar was removed.
LUNGS:  Clear to auscultation.
CARDIAC:  Regular rate and rhythm.
ABDOMEN:  Soft, nontender, nondistended, positive bowel
sounds.  She had a right nephrectomy scar.
EXTREMITIES:  No clubbing, cyanosis or edema.
NEUROLOGIC:  Awake, alert, oriented x 1.  Aware that she was
in the hospital, but not able to give the name.  Pupils
equal, round and reactive to light.  EOMS full.  No
nystagmus.  Tongue midline.  No drift.  Strength was [**5-14**] in
all muscle groups.  Following commands x 4.  Stable
neurologically.

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone. 

### Response:
{"Closed fracture of vault of skull with cerebral laceration and contusion, with brief [less than one hour] loss of consciousness,Alzheimer's disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of breast,Noncollision motor vehicle traffic accident while boarding or alighting injuring passenger in motor vehicle other than motorcycle"}
