CHIEF COMPLAINT: Fall

PRESENT ILLNESS: 65F transfer from OSH s/p fall down 7 stairs at noon, [**2-19**]. She
states she was climbing stairs and lost her balance.  Reports
loss of consciousness for approximately ten minutes.  Called her
son at 5pm. Next memory is of EMS. On admission, mild memory
difficulties, with GCS 14.  Compalaining of back and rib pain.

MEDICAL HISTORY: PMH: spinal cord injury, fibromyalgia, GERD, neurogenic bladder,
hypothyroidism, Crohn's disease
PSH: recent left shoulder surgery, hysterectomy, appendectomy,
lumpectomy left breast x4, cholecystectomy, centralobular
emphasyma

MEDICATION ON ADMISSION: oxycontin 80''', oxycodone [**3-31**] QID, Hydroxyzine 25mg Q4H:PRN,
valium 10 QID, amitriptyline 75 QHS, amlodipine 5', mirtazapine
15 QHS, nystatin 1tsp QID:PRN, mycelex

ALLERGIES: Iodine / Hydromorphone / Talwin / Talwin NX / Codeine / MS
Contin / Cefazolin / Penicillins / Dicloxacillin /
Prochlorperazine / Nsaids / Duragesic / Fluconazole / Fish
Product Derivatives

PHYSICAL EXAM: On presentation:

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: noncontributory
Other alteration of consciousness,Unspecified disease of spinal cord,Accidental fall on or from other stairs or steps,Other conditions of brain,Other opiates and related narcotics causing adverse effects in therapeutic use,History of fall,Other chronic pain,Opioid type dependence, unspecified,Abnormality of gait,Late effect of unspecified injury,Late effects of unspecified accident,Unspecified acquired hypothyroidism
Other alter consciousnes,Spinal cord disease NOS,Fall on stair/step NEC,Brain conditions NEC,Adv eff opiates,Personal history of fall,Chronic pain NEC,Opioid dependence-unspec,Abnormality of gait,Late effect injury NOS,Late eff accident NOS,Hypothyroidism NOS
Admission Date:  [**2110-2-19**]              Discharge Date:   [**2110-2-24**]

Date of Birth:  [**2053-12-16**]             Sex:   F

Service: SURGERY

Allergies:
Iodine / Hydromorphone / Talwin / Talwin NX / Codeine / MS
Contin / Cefazolin / Penicillins / Dicloxacillin /
Prochlorperazine / Nsaids / Duragesic / Fluconazole / Fish
Product Derivatives

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
Fall

Major Surgical or Invasive Procedure:
None

History of Present Illness:
65F transfer from OSH s/p fall down 7 stairs at noon, [**2-19**]. She
states she was climbing stairs and lost her balance.  Reports
loss of consciousness for approximately ten minutes.  Called her
son at 5pm. Next memory is of EMS. On admission, mild memory
difficulties, with GCS 14.  Compalaining of back and rib pain.

Past Medical History:
PMH: spinal cord injury, fibromyalgia, GERD, neurogenic bladder,
hypothyroidism, Crohn's disease
PSH: recent left shoulder surgery, hysterectomy, appendectomy,
lumpectomy left breast x4, cholecystectomy, centralobular
emphasyma

Social History:
noncontributory

Family History:
noncontributory

Physical Exam:
On presentation:

PE:
HEENT: PERRLA
Neck: Collar in place
Resp:Clear to ascultation throughout all fields, no crepitus
CA:RRR
GI: soft, nontender, nondistended, RUQ pain, nl tone
GU/GYN/pelvis: pelvis stable
Musculoskeletal: Left toes with minimal movement, Right leg
moving, Right shoulder pain, thoracic and lumbar, sacral notch
tenderness, no step off deformity, +pulses
Neuro: GCS=15, confused

Pertinent Results:
[**2110-2-19**] 08:50PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2110-2-19**] 08:50PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.003
[**2110-2-19**] 08:50PM   WBC-6.4 RBC-4.49 HGB-13.4 HCT-39.9 MCV-89
MCH-29.8 MCHC-33.5 RDW-13.6
[**2110-2-19**] 08:50PM   PLT COUNT-326
[**2110-2-19**] 08:50PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-POS barbitrt-NEG tricyclic-NEG
[**2110-2-19**] 08:50PM   LIPASE-67*
[**2110-2-19**] 08:57PM   GLUCOSE-103 LACTATE-1.4 NA+-146 K+-3.3*
CL--99* TCO2-28
[**2110-2-19**] 08:50PM   UREA N-5* CREAT-0.7

CT Head: No acute intracranial abnormality.
CT C-spine: 1. No acute cervical fracture or malalignment.
2. Severe centrilobular pulmonary emphysema.
CT T-spine: 1. No acute thoracic spine fracture or malalignment.

2. Severe centrilobular pulmonary emphysema.

R Shoulder XR: No evidence of acute fracture or dislocation.
CXR: Underlying trauma board partially obscures the view, given
this,
no acute cardiopulmonary process.


Brief Hospital Course:
56F s/p fall down stairs with loss of consciousness and was
admitted for observation. Extensive CT imaging was preformed
which was determined to show no acute injury. A CT of her
C-spine ruled out fracture and her collar was removed, a soft
collar was provided for comfort.

The patient takes a large amount of narcotic medications for
chronic pain which were continued during her hospital admission.
On [**2110-2-20**] the patient was found to be unresponsive. A code blue
was called and responded to appropriately, it was determine that
the patient was in respiratory distress. She was given Narcan
and ventilated by Ambu until she began to respond. The patient
was able to breath on her own and was transferred to the TSICU
for further monitoring. Social work was consulted while the
patient was admitted to the TSICU and she was stable without any
further respiratory events.

The patient was transferred back to the floor [**2110-2-21**] and chronic
pain was consulted. The chronic pain team recommendations
included: 1) decreasing OxyContin to 60mg [**Hospital1 **] or 40mg TID 2)
continue oxycodone 5-10mg Q4h, 3) continue Amitriptyline 75mg
qhs, 4) continue Mirtazapine 15mg qhs, 5) continue Diazepam 5 mg
Q6H. DO NOT increase dose back to 10mg per home regimen, and 6)
Hold doses of narcotics or benzodiazepines for any signs of
sedation. These recommendations were carefully considered and
the appropriate orders were written.

An echocardiogram was preformed [**2110-2-21**] to rule out a cardiac
cause of the patients fall which showed normal left ventricular
function with an EF >55%.

Because of the complicated social history of the patient,
disorganization of thoughts during interviews, a high level of
frustration and anxiety when discussing her pain regimen, and a
concern for the patients safety as documented by the social work
department, the patient was seen by psychiatry. Psychiatry
recommended following recommendations made by chronic pain,
continuing to optimize established antidepressant regimen,
possible outpatient psychiatrist/therapist, and pastoral care
while inpatient.

Throughout the rest of the patients inpatient stay she remained
stable. Her blood pressure ran in the 90's systolically however
there were no episodes of hypotension or orthostasis. Because of
concern of a low oxygen saturation level while the patient was
in bed on [**2110-2-24**], her ambulating oxygen saturation level was
tested and she remained stable at 93% RA. Physical therapy was
consulted and she was evaluated as safe to return home.


Medications on Admission:
oxycontin 80''', oxycodone [**3-31**] QID, Hydroxyzine 25mg Q4H:PRN,
valium 10 QID, amitriptyline 75 QHS, amlodipine 5', mirtazapine
15 QHS, nystatin 1tsp QID:PRN, mycelex


Discharge Medications:
1. Hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO every
four (4) hours as needed for itching.
2. Amitriptyline 75 mg Tablet Sig: One (1) Tablet PO at bedtime.

3. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO once a day.
4. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO at bedtime.
5. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety/pain.
6. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
9. Bethanechol Chloride 25 mg Tablet Sig: One (1) Tablet PO QID
(4 times a day).
10. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
11. Ipratropium Bromide 17 mcg/Actuation HFA Aerosol Inhaler
Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for
dyspnea.
12. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
14. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation four times a day as needed for shortness of
breath or wheezing.
15. Aciphex 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO twice a day.
16. Caltrate 600+D Plus Minerals 600-400 mg-unit Tablet Sig: One
(1) Tablet PO twice a day.
17. Valium 5 mg Tablet Sig: One (1) Tablet PO four times a day.

18. OxyContin 40 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO every eight (8) hours.
Disp:*qs Tablet Sustained Release 12 hr(s)* Refills:*0*
19. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for breakthrough pain.


Discharge Disposition:
Home

Discharge Diagnosis:
s/p Fall

Discharge Condition:
Mental Status: Clear and coherent
Level of Consciousness: Alert and interactive

Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You are taking multiple medications prescribed by other
prescribers. Your medications were confirmed via a fax received
from Dr.[**Name (NI) 86128**] office. These medications were added to
your discharge medication list. The only medication that you
received a prescription for was for the reduced Oxycontin dose
that was recommneded by our Pain Service.

You were evaluated after a fall down stairs.  You had multiple
imaging studies that do not show evidence of abnormalities.  You
will likely feel sore for the next few days while you are
recovering from this injury.  You also reported that you hit
your head during the fall and a CT scan of your head did not
show evidence of bleeding.

IT IS BEING RECOMMENDED THAT YOUR VALIUM DOSE BE REDUCED TO HALF
OF THE REGULAR DOSE.

You can take your regular pain medication for the aches from
this injury.  You can also take tylenol every six hours and can
use ice for twenty minutes at a time.

It is important that you do not take to many pain medications at
the same time, this puts you at risk to loose conciousness or
stop breathing. You were seen by the chronic pain service for
managment of your pain and sedation. Your valium was decreased
from 5mg to 10mg. It is important to follow all of the
instructions for your medications carefully and correctly.

Followup Instructions:
Follow up with your primary care providers within the next week.
You will need to call for an appointment.

It is being recommended that you follow up with a Psychiatrist
as an outpatient for managing your psychiatric medications. Your
primary care doctor can make the referral for you.



Completed by:[**2111-9-3**]
{'Other alteration of consciousness,Unspecified disease of spinal cord,Accidental fall on or from other stairs or steps,Other conditions of brain,Other opiates and related narcotics causing adverse effects in therapeutic use,History of fall,Other chronic pain,Opioid type dependence, unspecified,Abnormality of gait,Late effect of unspecified injury,Late effects of unspecified accident,Unspecified acquired hypothyroidism'}


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: 65F transfer from OSH s/p fall down 7 stairs at noon, [**2-19**]. She
states she was climbing stairs and lost her balance.  Reports
loss of consciousness for approximately ten minutes.  Called her
son at 5pm. Next memory is of EMS. On admission, mild memory
difficulties, with GCS 14.  Compalaining of back and rib pain.

MEDICAL HISTORY: PMH: spinal cord injury, fibromyalgia, GERD, neurogenic bladder,
hypothyroidism, Crohn's disease
PSH: recent left shoulder surgery, hysterectomy, appendectomy,
lumpectomy left breast x4, cholecystectomy, centralobular
emphasyma

MEDICATION ON ADMISSION: oxycontin 80''', oxycodone [**3-31**] QID, Hydroxyzine 25mg Q4H:PRN,
valium 10 QID, amitriptyline 75 QHS, amlodipine 5', mirtazapine
15 QHS, nystatin 1tsp QID:PRN, mycelex

ALLERGIES: Iodine / Hydromorphone / Talwin / Talwin NX / Codeine / MS
Contin / Cefazolin / Penicillins / Dicloxacillin /
Prochlorperazine / Nsaids / Duragesic / Fluconazole / Fish
Product Derivatives

PHYSICAL EXAM: On presentation:

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: noncontributory 

### Response:
{'Other alteration of consciousness,Unspecified disease of spinal cord,Accidental fall on or from other stairs or steps,Other conditions of brain,Other opiates and related narcotics causing adverse effects in therapeutic use,History of fall,Other chronic pain,Opioid type dependence, unspecified,Abnormality of gait,Late effect of unspecified injury,Late effects of unspecified accident,Unspecified acquired hypothyroidism'}
