CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 83 year-old male
status post fall from a roof with no loss of consciousness.
The patient fell 30 minutes prior to EMS activation.  The
patient complained of back pain and was noted to have a
distended abdomen at the scene.  The patient had a GCS of 15
when seen and on arrival and was stable throughout transport.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of T1-T6 level with unspecified spinal cord injury,Traumatic hemothorax without mention of open wound into thorax,Dissection of aorta, thoracic,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Iron deficiency anemia secondary to blood loss (chronic),Accidental fall from or out of building or other structure
T1-t6 fx-cl/cord inj NOS,Traum hemothorax-closed,Dsct of thoracic aorta,Atrial fibrillation,Food/vomit pneumonitis,Chr blood loss anemia,Fall from building
Admission Date:  [**2132-12-5**]       Discharge Date:  [**2132-12-30**]

Date of Birth:   [**2057-11-9**]       Sex:  M

Service:  TRAUMA

HISTORY OF PRESENT ILLNESS:  This is an 83 year-old male
status post fall from a roof with no loss of consciousness.
The patient fell 30 minutes prior to EMS activation.  The
patient complained of back pain and was noted to have a
distended abdomen at the scene.  The patient had a GCS of 15
when seen and on arrival and was stable throughout transport.

PAST MEDICAL HISTORY:  Hypertension.

MEDICATIONS:  Unknown on admission.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION ON ADMISSION;  vital signs blood
pressure 132/70.  Pulse 69.  Respirations 16.  O2 sat 100% on
room air.  The patient was in no acute distress answering
questions appropriately.  Head was normocephalic, atraumatic.
Pupils are equal, round and reactive to light bilaterally.
Tympanic membranes were clear.  Oropharynx was clear.  The
patient had positive C spine tenderness to palpation.
Regular rate and rhythm.  Clear and equal bilateral breath
sounds.  Abdomen was slightly distended and tender.  ________
was negative.  The patient had palpable pulses bilaterally.
Feet were warm.  The patient had a stable pelvis and was
tender to palpation over the thoracic region of the back,
moving all extremities to command.  Neurovascularly intact.
Rectal was guaiac negative with normal tone.

LABORATORIES:  White blood cell count 10, hematocrit 35,
electrolytes were all normal.  Fibrinogen 165, amylase 85,
serum and urine tox screen were negative.  The patient had a
CT of his C spine, which showed an unstable C2 fracture.  CT
of his chest showing three left sided rib fractures in a
thoracic aortic dissection in the descending portion of the
aorta.  CT of the abdomen was negative.  CT of the pelvis was
negative.  Chest x-ray initially showed a questionable
widened mediastinum.  Pelvic x-ray was negative with TLS
showing possible compression of L1 fracture and a left tibia
fibula x-ray that was negative for fracture.

HOSPITAL COURSE:  The patient was admitted to the Trauma
Service with neurosurgery consult and a CT Surgery consult.
The patient was admitted to the SICU for q one hour neuro
checks.  Thoracic surgery saw the patient and decided that
the location of the aortic dissection was not consistent with
a traumatic injury and was likely chronic in nature or may
have precipitated the fall. The patient was seen by
neurosurgery.  Recommendations were to place the patient in a
hard collar at all times and MRI with sternum images were
obtained, q one hour neurological checks, strict fluid
restrictions and laying flat in bed.  A TLSO brace was
recommended and surgical intervention would be required at
some point in the hospitalization.  On [**12-9**] after several
days in the Intensive Care Unit the patient developed some
hypoxia likely secondary to aspiration from lying flat for
several days while awaiting surgical intervention for his
spine fractures.  The patient was electively fiberoptically
intubated on [**12-9**].  The patient was then being prepared to
go to the Operating Room.  He was cleared preoperatively by
cardiology to go to the Operating Room.  The patient had an
MRI on [**12-10**] showing an epidural hematoma in the thoracic
region.  The patient was taken on [**12-11**] to the Operating Room
by neurosurgery for a thoracolumbar fusion with evacuation of
the spinal epidural hematoma.  On [**12-14**] the patient was
extubated, but then required reintubation on [**12-15**] for
hypoxia.  The patient had a bronchoscopy done at that time,
which showed collapse of the left lobe.  On the following day
[**12-16**] the patient had a chest tube placed into the left chest
with one liter drainage of serosanguinous fluid that looked
like old on chronic drainage of blood potentially from rib
fractures.

On [**12-18**] the chest tube had ceased to drain and was removed.
On [**12-19**] the patient had a chest x-ray showing an effusion on
the left side.  It was attempted to be drained.  Ultrasound
guided tap, but no drainage was obtained.  The patient was
finally extubated on [**12-27**] and remained stable from a
respiratory standpoint.  On [**12-28**] the chest tube was
discontinued.  The patient began to spike fevers and had
elevation of bilirubin.  The patient underwent an ultrasound
guided cholecystostomy on [**12-23**].  A drain is to remain in
place.  The patient has remained afebrile since this
procedure.  The patient was transferred to the floor on
[**2132-12-29**] in stable condition.  The patient was seen by
physical therapy and determined to require rehabilitation.
The patient was discharged.  Of note also while the patient
was on the unit his blood pressure was being controlled with
Lopresor and Enalapril.  The patient was noted to have an
episode of bradycardia on telemetry.  The Lopresor was held
and the patient was monitored on telemetry on the floor with
no further episodes.

DISCHARGE DIAGNOSES:
1.  Descending aortic dissection nonoperative medical
management only with blood pressure control.
2.  T2 fracture.
3.  T11 to T12 compression fracture.
4.  Thoracic epidural hematoma.
5.  Cholecystitis.
6.  Left burst metatarsal fracture.
7.  Hemothorax left rib 8 through 10 fractures.

FOLLOW UP:  The patient is to follow up with Dr. [**Last Name (STitle) 1327**]
neurosurgery in two weeks, [**Telephone/Fax (1) 1669**] and with the trauma
clinic in two weeks, [**Telephone/Fax (1) 2359**] and with primary care
physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 20784**] [**Telephone/Fax (1) 53777**].

MEDICATIONS ON DISCHARGE:
1.  Albuterol one nebulizer q 4 hours as needed.
2.  Bisacodyl 10 mg one suppository q.h.s. as needed.
3.  Nystatin 5 mg po q.i.d. as needed.
4.  Campho menthol lotion applied topical q.i.d. as needed.
5.  Protonix 40 mg po q day.
6.  Docusate 100 mg po b.i.d.
7.  Enalapril 40 mg po q.d.





                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9325**], M.D.
[**MD Number(1) 14131**]

Dictated By:[**Name8 (MD) 53778**]
MEDQUIST36

D:  [**2132-12-30**]  11:03
T:  [**2132-12-30**]  11:04
JOB#:  [**Job Number 53779**]
{'Closed fracture of T1-T6 level with unspecified spinal cord injury,Traumatic hemothorax without mention of open wound into thorax,Dissection of aorta, thoracic,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Iron deficiency anemia secondary to blood loss (chronic),Accidental fall from or out of building or other structure'}


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: This is an 83 year-old male
status post fall from a roof with no loss of consciousness.
The patient fell 30 minutes prior to EMS activation.  The
patient complained of back pain and was noted to have a
distended abdomen at the scene.  The patient had a GCS of 15
when seen and on arrival and was stable throughout transport.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of T1-T6 level with unspecified spinal cord injury,Traumatic hemothorax without mention of open wound into thorax,Dissection of aorta, thoracic,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Iron deficiency anemia secondary to blood loss (chronic),Accidental fall from or out of building or other structure'}
