CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: 83M s/p [**2072**]4 hours ago.  He was ambulating with his walker
when he lost his balance and fell hitting the left side of his
chest on the edge of a table.  No LOC, he remembers the event.
He felt well until today when he felt very lethargic and tired.
He called his PCP who told him to go to the ED to be evaluated.
He does report left sided chest pain similar to his angina
symptoms and shortness of breath.  He does have a history of
recent falls so he has stopped taking his coumadin.

MEDICAL HISTORY: PMH: OA, CAD, CHF (EF 35-40%), pulmonary HTN, a-fib, HTN,
hyperlipidemia, anemia, prostate cancer s/p XRT, h/o C.diff in
[**2152**]
.
PSH: CABG '[**35**] with multiple stents (last in [**2151**]), Left hip
surgery, s/p TURP

MEDICATION ON ADMISSION: amlodipine 5mg daily, aspirin 162mg daily, metoprolol XL 25mg
daily, sertraline 100mg [**Hospital1 **], vanco 125mg [**Hospital1 **]

ALLERGIES: Ticlid / Lipitor

PHYSICAL EXAM: ON discharge:
Afebrile, VSS
No distress, A&Ox3
[**Year (4 digits) 13775**], EOMI, anicteric
Irregular rhythm, lungs clear
Abdomen firm but nontender
Ext: trace edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Denies tobacco and ETOH use.
Aneurysm of splenic artery,Subendocardial infarction, initial episode of care,Closed fracture of four ribs,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Acute posthemorrhagic anemia,Unspecified fall,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of malignant neoplasm of prostate,Aortocoronary bypass status
Splenic artery aneurysm,Subendo infarct, initial,Fracture four ribs-close,Peritoneum injury-closed,Ac posthemorrhag anemia,Fall NOS,Atrial fibrillation,Crnry athrscl natve vssl,Chr pulmon heart dis NEC,Hypertension NOS,Diaphragmatic hernia,Hyperlipidemia NEC/NOS,Cholelithiasis NOS,Hx-prostatic malignancy,Aortocoronary bypass
Admission Date:  [**2155-11-21**]              Discharge Date:   [**2155-11-24**]

Date of Birth:  [**2072-5-20**]             Sex:   M

Service: SURGERY

Allergies:
Ticlid / Lipitor

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
IR embolization of two splenic artery pseudoaneurysms


History of Present Illness:
83M s/p [**2072**]4 hours ago.  He was ambulating with his walker
when he lost his balance and fell hitting the left side of his
chest on the edge of a table.  No LOC, he remembers the event.
He felt well until today when he felt very lethargic and tired.
He called his PCP who told him to go to the ED to be evaluated.
He does report left sided chest pain similar to his angina
symptoms and shortness of breath.  He does have a history of
recent falls so he has stopped taking his coumadin.

Past Medical History:
PMH: OA, CAD, CHF (EF 35-40%), pulmonary HTN, a-fib, HTN,
hyperlipidemia, anemia, prostate cancer s/p XRT, h/o C.diff in
[**2152**]
.
PSH: CABG '[**35**] with multiple stents (last in [**2151**]), Left hip
surgery, s/p TURP


Social History:
Denies tobacco and ETOH use.

Family History:
Noncontributory

Physical Exam:
ON discharge:
Afebrile, VSS
No distress, A&Ox3
[**Year (4 digits) 13775**], EOMI, anicteric
Irregular rhythm, lungs clear
Abdomen firm but nontender
Ext: trace edema

Pertinent Results:
Admission labs:
[**2155-11-21**] 12:50PM BLOOD WBC-12.1*# RBC-2.37* Hgb-6.9* Hct-20.5*
MCV-86 MCH-29.2 MCHC-33.8 RDW-17.1* Plt Ct-170
[**2155-11-21**] 12:50PM BLOOD Neuts-84.1* Lymphs-12.2* Monos-3.1
Eos-0.3 Baso-0.3
[**2155-11-21**] 12:50PM BLOOD PT-13.6* PTT-21.3* INR(PT)-1.2*
[**2155-11-21**] 12:50PM BLOOD Glucose-202* UreaN-33* Creat-1.4* Na-144
K-3.7 Cl-107 HCO3-22 AnGap-19
[**2155-11-21**] 12:50PM BLOOD cTropnT-<0.01
[**2155-11-21**] 06:47PM BLOOD CK-MB-10 MB Indx-6.0 cTropnT-0.14*
.
Troponin trend:
[**2155-11-21**] 06:47PM BLOOD CK-MB-10 MB Indx-6.0 cTropnT-0.14*
[**2155-11-22**] 12:52AM BLOOD CK-MB-37* MB Indx-9.2* cTropnT-1.48*
[**2155-11-22**] 11:36AM BLOOD CK-MB-28* MB Indx-9.2* cTropnT-1.82*
[**2155-11-23**] 12:39AM BLOOD CK-MB-13* MB Indx-7.4* cTropnT-1.17*
.
Discharge labs:
[**2155-11-23**] 12:39AM BLOOD WBC-12.2* RBC-3.66* Hgb-10.7* Hct-30.8*
MCV-84 MCH-29.2 MCHC-34.7 RDW-18.0* Plt Ct-107*
[**2155-11-23**] 06:18AM BLOOD Hct-28.7*
[**2155-11-23**] 03:20PM BLOOD Hct-30.9*
[**2155-11-23**] 09:30PM BLOOD Hct-29.7*

Brief Hospital Course:
Mr. [**Known lastname 1726**] was admitted 24 hours s/p fall onto left side.  He
now complains of severe fatigue and left sided chest pain.  He
was very pale on physical exam and an EKG demonstrated inverted
T waves in the lateral leads.  His hematocrit was 20 and he was
hypotensive to the 90s.  He was immediately resuscitated with
packed RBCs and his color and feelings of fatigue resolved.  A
CTA was obtained to rule out an actively bleeding injury.  It
showed hemoperitoneum around the liver and in the pelvis along
with two splenic artery pseudoaneurysms but no splenic injury.
He immediately went to IR for emoblization of these two
pseudoaneurysms.  He received a total of 4units of packed RBCs
and he hematocrit stablized in the 30s.  He was monitored in the
ICU.  His troponin continued to peak at a level of 1.8.  It is
now trending down.  His cardiologist was contact[**Name (NI) **] and with the
EKG findings he was diagnosed as having a NSTEMI, which was
treated medically.  His aspirin was initially held and then
restarted when his hematocrit was stable.  His diet was advanced
and he is having bowel function.  His rib pain is well
controlled and he is not having any chest pain.  He was
transferred to the floor where he continued to remain stable.
He was evaluated by Physical Therapy and will need discharge to
rehab.

Medications on Admission:
amlodipine 5mg daily, aspirin 162mg daily, metoprolol XL 25mg
daily, sertraline 100mg [**Hospital1 **], vanco 125mg [**Hospital1 **]

Discharge Medications:
1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for q5 min x3.
2. Aspirin 81 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable
PO DAILY (Daily).
3. Sertraline 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
4. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
5. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
6. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO four times a day.
8. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for pain.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Senna 8.6 mg Capsule Sig: [**1-24**] Capsules PO twice a day as
needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
s/p fall
Left [**9-2**] rib fractures
two splenic artery pseudoaneuryms s/p embolization
NSTEMI


Discharge Condition:
Good


Discharge Instructions:
Call your physician if you experience, new chest pain, shortness
of breath, persistent abdominal pain, nausea/vomiting, inability
to eat or drink, lightheadedness or fatigue.
.
Continuing taking your aspirin and your lopressor.  You had a
heart attack and your cardiologist recommended medical
management.
.
Continue deep breathing with your incentive spirometer.  This
will help prevent you from getting pneumonia.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in [**1-24**] weeks.  Call his office at ([**Telephone/Fax (1) 61154**] to schedule your follow-up appointment.
.
Follow up with your Cardiologist in [**1-24**] weeks.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]
{'Aneurysm of splenic artery,Subendocardial infarction, initial episode of care,Closed fracture of four ribs,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Acute posthemorrhagic anemia,Unspecified fall,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of malignant neoplasm of prostate,Aortocoronary bypass status'}


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: 83M s/p [**2072**]4 hours ago.  He was ambulating with his walker
when he lost his balance and fell hitting the left side of his
chest on the edge of a table.  No LOC, he remembers the event.
He felt well until today when he felt very lethargic and tired.
He called his PCP who told him to go to the ED to be evaluated.
He does report left sided chest pain similar to his angina
symptoms and shortness of breath.  He does have a history of
recent falls so he has stopped taking his coumadin.

MEDICAL HISTORY: PMH: OA, CAD, CHF (EF 35-40%), pulmonary HTN, a-fib, HTN,
hyperlipidemia, anemia, prostate cancer s/p XRT, h/o C.diff in
[**2152**]
.
PSH: CABG '[**35**] with multiple stents (last in [**2151**]), Left hip
surgery, s/p TURP

MEDICATION ON ADMISSION: amlodipine 5mg daily, aspirin 162mg daily, metoprolol XL 25mg
daily, sertraline 100mg [**Hospital1 **], vanco 125mg [**Hospital1 **]

ALLERGIES: Ticlid / Lipitor

PHYSICAL EXAM: ON discharge:
Afebrile, VSS
No distress, A&Ox3
[**Year (4 digits) 13775**], EOMI, anicteric
Irregular rhythm, lungs clear
Abdomen firm but nontender
Ext: trace edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Denies tobacco and ETOH use. 

### Response:
{'Aneurysm of splenic artery,Subendocardial infarction, initial episode of care,Closed fracture of four ribs,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Acute posthemorrhagic anemia,Unspecified fall,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of malignant neoplasm of prostate,Aortocoronary bypass status'}
