CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: 80 y/o M with history of a-fib on coumadin presents to OSH
s/p unwitnessed fall today at rehab facility. He states that he
does not recall the event, the last thing he remembers is waking
up with people surrounding him. He reports episodes of dizziness
for the past couple of weeks and a mild headache, but denies any
blurred vision, neck tenderness, nausea, or vomiting. He was
transported to OSH where a head CT was performed revealing R
temporal contusion. INR was 2.5 at OSH and was reversed with Vit
K and FFP. Patient was then transferred to [**Hospital1 18**] for further
neurosurgical workup.

MEDICAL HISTORY: DM, HTN, A-fib, COPD (O2 dependent), DMII, CHF, OSA, HLD,
vertigo, adenoidectomy, CAD w/ stent placement x 5, hernia
repair, tonsillectomy, TURP, PNA x 2 in past 6 weeks, diabetic
neuropathy, community acquired MRSA, orbital blowout.

MEDICATION ON ADMISSION: Aspirin, Plavix, Coumadin, Insulin, Fish oil, lumigan, prilosec,
reglan, colace, MVI, prednisone, lasix, metolazone, MS contin,
lopressor, neurontin, cardizem, zocor, cymbalta, celexa, imdur,
nystatin, symbicort, digoxin, ativan, robitussin, ambien

ALLERGIES: Atropine

PHYSICAL EXAM: Upon Discharge:
Alert and oriented x 3. PERRL. EOMs intact.
Face symmetric, tongue midline.
No pronator drift.
Full strength and sensation in all extremities.
Bilateral pedal edema.
Patient is oxygen dependent and desaturates when sleeping.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Previous smoker, quit years ago, [**Hospital **] [**Hospital **]
Transferred to [**Hospital1 18**] from a rehab facility
Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Chronic diastolic heart failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Other chronic pulmonary heart diseases,Mitral valve disorders,Long-term (current) use of anticoagulants,Other dependence on machines, supplemental oxygen,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Dizziness and giddiness
Subarach hem-brief coma,Chr diastolic hrt fail,Atrial fibrillation,Chr airway obstruct NEC,Fall NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Obstructive sleep apnea,Hypertension NOS,Chr pulmon heart dis NEC,Mitral valve disorder,Long-term use anticoagul,Depend-supplement oxygen,Crnry athrscl natve vssl,Status-post ptca,Hyperlipidemia NEC/NOS,Ocl crtd art wo infrct,Dizziness and giddiness
Name:  [**Known lastname 7156**],[**Known firstname **] W                    Unit No:   [**Numeric Identifier 7157**]

Admission Date:  [**2179-12-25**]              Discharge Date:   [**2179-12-29**]

Date of Birth:  [**2099-10-31**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Atropine

Attending:[**First Name3 (LF) 599**]
Addendum:
Please note that in the PMH this patient has diastolic CHF. His
echo during this hospitalization revealed an ejection fraction
of >55% which is normal. He was continued on his home
medications with no new treatments.

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 7158**]

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 603**] MD [**MD Number(2) 604**]

Completed by:[**2180-1-18**]

Admission Date:  [**2179-12-25**]              Discharge Date:   [**2179-12-29**]

Date of Birth:  [**2099-10-31**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Atropine

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
None this Admission


History of Present Illness:
80 y/o M with history of a-fib on coumadin presents to OSH
s/p unwitnessed fall today at rehab facility. He states that he
does not recall the event, the last thing he remembers is waking
up with people surrounding him. He reports episodes of dizziness
for the past couple of weeks and a mild headache, but denies any
blurred vision, neck tenderness, nausea, or vomiting. He was
transported to OSH where a head CT was performed revealing R
temporal contusion. INR was 2.5 at OSH and was reversed with Vit
K and FFP. Patient was then transferred to [**Hospital1 18**] for further
neurosurgical workup.


Past Medical History:
DM, HTN, A-fib, COPD (O2 dependent), DMII, CHF, OSA, HLD,
vertigo, adenoidectomy, CAD w/ stent placement x 5, hernia
repair, tonsillectomy, TURP, PNA x 2 in past 6 weeks, diabetic
neuropathy, community acquired MRSA, orbital blowout.


Social History:
Previous smoker, quit years ago, [**Hospital **] [**Hospital **]
Transferred to [**Hospital1 18**] from a rehab facility

Family History:
Non-contributory

Physical Exam:
Upon Discharge:
Alert and oriented x 3. PERRL. EOMs intact.
Face symmetric, tongue midline.
No pronator drift.
Full strength and sensation in all extremities.
Bilateral pedal edema.
Patient is oxygen dependent and desaturates when sleeping.

Pertinent Results:
CT Head [**2179-12-25**]: Right temporal SAH. No edema, mass effect or
midline shift.

ECHO [**2179-12-27**]:
Conclusions:
The left atrium is moderately dilated. Left ventricular wall
thickness, cavity size, and global systolic function are normal
(LVEF>55%). Due to suboptimal technical quality, a focal wall
motion abnormality cannot be fully excluded. Right ventricular
chamber size and free wall motion are normal. The aortic root is
mildly dilated at the sinus level. The aortic arch is mildly
dilated. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. There is trace aortic
regurgitation. The mitral valve leaflets are mildly thickened.
Mild (1+) mitral regurgitation is seen. [Due to acoustic
shadowing, the severity of mitral regurgitation may be
significantly UNDERestimated.] There is moderate pulmonary
artery systolic hypertension. There is no pericardial effusion.

IMPRESSION: Suboptimal image quality. Mild symmetric left
ventricular hypertrophy with preserved global biventricular
systolic function. Pulmonary artery systolic hypertension. Mild
mitral regurgitation.
Is there a history to suggest a primary pulmonary process (e.g.,
pulmonary embolism).

Carotid Series Complete [**2179-12-27**]:
Impression: Right ICA stenosis 40-59% (low end).
Left ICA stenosis <40%.
Resistive, almost to-fro right vertebral artery flow conistent
with more distal stenosis or occlusion.

Labs Upon Discharge:
[**2179-12-29**] 05:40AM BLOOD WBC-8.3 RBC-3.01* Hgb-8.0* Hct-25.1*
MCV-83 MCH-26.7* MCHC-32.1 RDW-17.9* Plt Ct-145*
[**2179-12-29**] 05:40AM BLOOD PT-11.8 PTT-25.6 INR(PT)-1.0
[**2179-12-29**] 05:40AM BLOOD Glucose-117* UreaN-34* Creat-1.2 Na-138
K-3.9 Cl-95* HCO3-37* AnGap-10
[**2179-12-29**] 05:40AM BLOOD Albumin-3.6 Calcium-8.4 Phos-3.3 Mg-1.8
[**2179-12-29**] 05:40AM BLOOD Phenyto-9.9*

Brief Hospital Course:
The patient was admitted after sustaining a fall and was found
to have a right temporal SAH. He had been on aspirin, plavix,
and coumadin and due to his high risk of increase in hemorrhage
he was admitted to the ICU for Q1 hour neuro checks. The patient
was given FFP and vitamin K to reverse his INR. He was evaluated
by trauma who did not feel there were any other injuries. He had
xrays of the right scapula, right ankle, and hips which showed
no fractures but there was degenerative disease present. The
patient was transferred out of the ICU to the neuro step down
unit on [**12-26**] because his neuro exam was stable and his head CT
was stable as well. His aspirin was restarted that day.

The patient underwent a sycope work-up because his fall was
unwitnessed and he reportedly had a brief LOC. His Echo showed a
normal EF with mild mitral regurgitation and pulmonary
hypertension and his carotid ultrasound revealed mild stenosis
bilaterally. His cardiac enzymes were not elevated. He did not
have chest pain during his hospital course.

Mr. [**Known lastname 39713**] did require oxygen during his hospital course and this
is consistent with his needs at rehab prior to admission. When
he sleeps his oxygen requirement increases.

On [**12-28**] the patient was transferred out of the step down unit to
floor status for Q4 neuro checks because he was neurologically
stable. He was evaluated by PT and OT who felt that he was safe
to go back to rehab. Overnight he required one dose of IV
Lopressor for tachycardia to the 170s. He responded well to
this. Additionally, his medication regimen was adjusted so that
his cardiac medications were given in the morning rather than at
night. His insulin was adjusted due to high blood glucose
levels. On [**12-29**] his heart rate and glucose had improved. He was
discharged to the facility where he was at previously on [**2179-12-29**].


Medications on Admission:
Aspirin, Plavix, Coumadin, Insulin, Fish oil, lumigan, prilosec,
reglan, colace, MVI, prednisone, lasix, metolazone, MS contin,
lopressor, neurontin, cardizem, zocor, cymbalta, celexa, imdur,
nystatin, symbicort, digoxin, ativan, robitussin, ambien

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
3. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety.
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day).
7. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
10. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
11. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO QPM (once
a day (in the evening)).
12. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
13. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: Three
(3) Capsule, Delayed Release(E.C.) PO QPM (once a day (in the
evening)).
15. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
17. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day).
18. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
19. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
20. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

21. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
22. Lumigan 0.03 % Drops Sig: One (1) drop Ophthalmic once a
day: please place 1 drop in both eyes.
23. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
24. Insulin
Please see print out for insulin
25. Coumadin 2 mg Tablet Sig: Two (2) Tablet PO once a day:
RESTART COUMADIN [**2179-12-29**].
26. Outpatient Lab Work
Please have your dilantin level drawn in 1 week. Please have the
results faxed to [**Telephone/Fax (1) 87**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 13314**]

Discharge Diagnosis:
Right Temporal SDH/SAH(traumatic)


Discharge Condition:
Neurologically Stable
Mental Status:Clear and coherent
Level of Consciousness:Alert and interactive
Ambulating with assistance


Discharge Instructions:
General Instructions

??????Take your pain medicine as prescribed.
??????Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Advil, or Ibuprofen
etc.
??????You have been restarted on your Aspirin.
??????You were Coumadin (Warfarin) prior to your injury. You may
safely resume taking this today [**2179-12-29**].
??????You were on Plavix (clopidogrel) prior to your injury. YOU [**Month (only) **]
NOT RESTART THIS UNTIL YOUR FOLLOW-UP APPOINTMENT WITH THE
NEUROSURGEON.
??????You have been prescribed Dilantin (Phenytoin) for anti-seizure
medicine, take it as prescribed and follow up with laboratory
blood drawing in one week.  This can be drawn at your PCP??????s
office, but please have the results faxed to [**Telephone/Fax (1) 87**].

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion, lethargy or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	New onset of the loss of function, or decrease of function on
one whole side of your body.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in 8 weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.

You should schedule an appointment with your primary care
physician to review all of your medications with you. Your
insulin was adjusted while in the hospital due to high blood
sugars. You should also review your echo and carotid ultrasound
results with your doctor.



Completed by:[**2179-12-29**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Chronic diastolic heart failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Other chronic pulmonary heart diseases,Mitral valve disorders,Long-term (current) use of anticoagulants,Other dependence on machines, supplemental oxygen,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Dizziness and giddiness'}


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: 80 y/o M with history of a-fib on coumadin presents to OSH
s/p unwitnessed fall today at rehab facility. He states that he
does not recall the event, the last thing he remembers is waking
up with people surrounding him. He reports episodes of dizziness
for the past couple of weeks and a mild headache, but denies any
blurred vision, neck tenderness, nausea, or vomiting. He was
transported to OSH where a head CT was performed revealing R
temporal contusion. INR was 2.5 at OSH and was reversed with Vit
K and FFP. Patient was then transferred to [**Hospital1 18**] for further
neurosurgical workup.

MEDICAL HISTORY: DM, HTN, A-fib, COPD (O2 dependent), DMII, CHF, OSA, HLD,
vertigo, adenoidectomy, CAD w/ stent placement x 5, hernia
repair, tonsillectomy, TURP, PNA x 2 in past 6 weeks, diabetic
neuropathy, community acquired MRSA, orbital blowout.

MEDICATION ON ADMISSION: Aspirin, Plavix, Coumadin, Insulin, Fish oil, lumigan, prilosec,
reglan, colace, MVI, prednisone, lasix, metolazone, MS contin,
lopressor, neurontin, cardizem, zocor, cymbalta, celexa, imdur,
nystatin, symbicort, digoxin, ativan, robitussin, ambien

ALLERGIES: Atropine

PHYSICAL EXAM: Upon Discharge:
Alert and oriented x 3. PERRL. EOMs intact.
Face symmetric, tongue midline.
No pronator drift.
Full strength and sensation in all extremities.
Bilateral pedal edema.
Patient is oxygen dependent and desaturates when sleeping.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Previous smoker, quit years ago, [**Hospital **] [**Hospital **]
Transferred to [**Hospital1 18**] from a rehab facility 

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Chronic diastolic heart failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Other chronic pulmonary heart diseases,Mitral valve disorders,Long-term (current) use of anticoagulants,Other dependence on machines, supplemental oxygen,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Dizziness and giddiness'}
