CHIEF COMPLAINT: right hip and neck pain

PRESENT ILLNESS: [**Age over 90 **] year old female who complains of ACUTE
DENS FX. she was apparently reaching for an object when she
fell landing on her right hip. She complains of right hip
and neck pain. She is very hard of hearing. She was seen at
outside hospital diagnosed with a dens fracture.
                       Timing: Sudden Onset
                      Quality: Sharp
                     Severity: Mild
                     Location: Fall with right hip pain
    Associated Signs/Symptoms: No weakness

MEDICAL HISTORY: Past Medical History: afib.  thyroid, HTN

MEDICATION ON ADMISSION: Medications: Coumadin

ALLERGIES: Codeine / Penicillins

PHYSICAL EXAM: PHYSICAL EXAMINATION upon admission:  [**2138-11-4**]

FAMILY HISTORY: son

SOCIAL HISTORY: NC
Closed fracture of ilium,Acute posthemorrhagic anemia,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Aseptic necrosis of head and neck of femur,Hyposmolality and/or hyponatremia,Fall from other slipping, tripping, or stumbling,Cervicalgia,Long-term (current) use of anticoagulants,Atrial fibrillation,Unspecified essential hypertension
Fracture of ilium-closed,Ac posthemorrhag anemia,Peritoneum injury-closed,Aseptic necrosis femur,Hyposmolality,Fall from slipping NEC,Cervicalgia,Long-term use anticoagul,Atrial fibrillation,Hypertension NOS
Admission Date:  [**2138-11-4**]              Discharge Date:   [**2138-11-10**]


Service: SURGERY

Allergies:
Codeine / Penicillins

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
right hip and neck pain

Major Surgical or Invasive Procedure:
[**11-5**]: uncomplicated gel foam embolisation on ant division of
RIIA for pelvic hematoma and fractures.


History of Present Illness:
 [**Age over 90 **] year old female who complains of ACUTE
DENS FX. she was apparently reaching for an object when she
fell landing on her right hip. She complains of right hip
and neck pain. She is very hard of hearing. She was seen at
outside hospital diagnosed with a dens fracture.
                       Timing: Sudden Onset
                      Quality: Sharp
                     Severity: Mild
                     Location: Fall with right hip pain
    Associated Signs/Symptoms: No weakness



Past Medical History:
Past Medical History: afib.  thyroid, HTN


Social History:
NC

Family History:
son

Physical Exam:
PHYSICAL EXAMINATION upon admission:  [**2138-11-4**]

 Temp:96.7 HR:74 BP:187/80 Resp:12 O(2)Sat:98 normal

Constitutional: C-spine immobilized
Chest: Clear to auscultation
Cardiovascular: Irregular
Abdominal: Soft, Nontender, Nondistended
Extr/Back: Right hip shortened and internally rotated.
Percussion test positive on the right. Pelvis stable on exam
Neuro: Speech fluent. No CT LS tenderness to palpation
Psych: Normal mood


Pertinent Results:
[**2138-11-4**] 07:10PM BLOOD WBC-9.7 RBC-3.75* Hgb-12.0 Hct-35.5*
MCV-95 MCH-32.1* MCHC-34.0 RDW-13.6 Plt Ct-153
[**2138-11-5**] 01:28AM BLOOD WBC-5.5 RBC-1.79*# Hgb-5.8*# Hct-17.3*#
MCV-97 MCH-32.4* MCHC-33.5 RDW-13.4 Plt Ct-100*
[**2138-11-5**] 01:51AM BLOOD WBC-6.5 RBC-2.32*# Hgb-7.6*# Hct-22.8*#
MCV-98 MCH-32.7* MCHC-33.3 RDW-13.5 Plt Ct-117*
[**2138-11-6**] 02:48AM BLOOD WBC-9.3 RBC-2.94*# Hgb-9.4* Hct-27.3*
MCV-93 MCH-32.0 MCHC-34.4 RDW-14.9 Plt Ct-111*
[**2138-11-7**] 06:20AM BLOOD WBC-8.7 RBC-3.03* Hgb-9.7* Hct-28.4*
MCV-94 MCH-32.0 MCHC-34.2 RDW-14.7 Plt Ct-107*
[**2138-11-8**] 04:20AM BLOOD WBC-7.2 RBC-2.86* Hgb-9.2* Hct-26.5*
MCV-93 MCH-32.0 MCHC-34.6 RDW-14.6 Plt Ct-108*
[**2138-11-9**] 04:40AM BLOOD Hct-26.7*
[**2138-11-4**] 07:10PM BLOOD PT-19.6* PTT-34.2 INR(PT)-1.8*
[**2138-11-4**] 07:10PM BLOOD Plt Ct-153
[**2138-11-5**] 01:28AM BLOOD PT-18.2* PTT-33.9 INR(PT)-1.6*
[**2138-11-5**] 07:54AM BLOOD PT-16.8* PTT-37.9* INR(PT)-1.5*
[**2138-11-6**] 02:48AM BLOOD PT-14.7* PTT-29.3 INR(PT)-1.3*
[**2138-11-7**] 06:20AM BLOOD PT-14.4* INR(PT)-1.2*
[**2138-11-9**] 04:40AM BLOOD PT-15.6* INR(PT)-1.4*
[**2138-11-4**] 07:10PM BLOOD Glucose-112* UreaN-31* Creat-1.1 Na-132*
K-6.7* Cl-96 HCO3-29 AnGap-14
[**2138-11-5**] 01:28AM BLOOD Glucose-234* UreaN-23* Creat-1.0 Na-149*
K-4.1 Cl-86* HCO3-23 AnGap-44*
[**2138-11-5**] 01:51AM BLOOD Glucose-570* UreaN-26* Creat-0.9 Na-132*
K-6.2* Cl-96 HCO3-26 AnGap-16
[**2138-11-7**] 06:20AM BLOOD Glucose-184* UreaN-30* Creat-0.8 Na-139
K-3.7 Cl-104 HCO3-23 AnGap-16
[**2138-11-8**] 04:20AM BLOOD Glucose-149* UreaN-26* Creat-0.8 Na-137
K-3.4 Cl-102 HCO3-28 AnGap-10
[**2138-11-5**] 01:28AM BLOOD ALT-22 AST-40 CK(CPK)-133 AlkPhos-58
TotBili-0.6
[**2138-11-4**] 07:10PM BLOOD cTropnT-0.02*
[**2138-11-5**] 01:28AM BLOOD cTropnT-<0.01
[**2138-11-7**] 06:20AM BLOOD Calcium-8.8 Phos-2.0*# Mg-2.1
[**2138-11-8**] 04:20AM BLOOD Calcium-8.5 Phos-1.9* Mg-1.8
[**2138-11-9**] 04:40AM BLOOD Calcium-8.5 Phos-1.7* Mg-2.0
[**2138-11-5**] 02:58PM BLOOD Lactate-0.9
[**2138-11-5**] 02:58PM BLOOD freeCa-1.20

[**2138-11-6**]: Urine:

GENERAL URINE INFORMATION Type Color Appear Sp [**Last Name (un) **]
[**2138-11-6**] 02:48      Yellow Clear 1.041*
Source: Catheter
DIPSTICK URINALYSIS Blood Nitrite Protein Glucose Ketone Bilirub
Urobiln pH Leuks
[**2138-11-6**] 02:48    MOD NEG 25 NEG 50 NEG NEG 5.0 NEG
Source: Catheter
MICROSCOPIC URINE EXAMINATION RBC WBC Bacteri Yeast Epi TransE
RenalEp
[**2138-11-6**] 02:48    [**2-14**]* [**2-14**] FEW NONE 0
Source: Catheter

[**2138-11-4**]:  EKG:

Atrial fibrillation. Right bundle-branch block. Non-specific
inferior
ST-T wave changes. No previous tracing available for comparison

[**2138-11-4**]:  Cat scan of abdomen and pelvis:

IMPRESSION:
1. Comminuted and minimally displaced right pelvic fractures
involving the
ilium with widening of inferior right SI joint, as well as
fractures of the right superior and inferior pubic rami. There
is a large right pelvic
hematoma, and active extravasation within this hematoma cannot
be evaluated due to non-contrast technique. Contrast enhanced CT
can be acquired for further evaluation.

2. Severe anterior wedging of T8 vertebral body with less severe
loss of
height of T11 vertebral body. No definite evidence of
retropulsion or
significant spinal canal impingement.

3. Biapical pulmonary interlobular septal thickening with small
pleural
effusions, suggestive of volume overload.

4. Colonic diverticulosis. Ventral hernia without obstruction.

5. Severe diffuse atherosclerotic disease

[**2138-11-4**]:  Head cat scan:

IMPRESSION: No evidence of acute intracranial process.
Age-related
involution and small vessel ischemic disease

[**2138-11-4**]:  Cat scan of c-spine:

 IMPRESSION:
1. Type 2 dens fracture with 6-mm distraction of fracture
fragments, with
sclerotic appearance of the fracture fragments, indicating
chronic injury.
2. Grade I anterolisthesis of C4 on C5.
3. Moderate multilevel cervical spine spondylosis.
4. Biapical pulmonary scarring with interlobular septal
thickening

[**2138-11-4**]: Hip x-ray:

IMPRESSION: Fracture of the right iliac [**Doctor First Name 362**] with widening of
the right
sacroiliac joint. Mildly displaced superior and inferior pubic
rami fractures on the right. Extensive degenerative changes of
both hips, right worse than left.

[**2138-11-5**]:  CTA pelvis:

IMPRESSION:
1. Large right pelvic hematoma with active contrast
extravasation, most
likely from the internal pudendal artery.
2. Comminuted fracture of the right iliac [**Doctor First Name 362**] with widening of
the right
sacroiliac joint, fractures of the right inferior and superior
pubic rami also noted.
3. Sigmoid diverticulosis.
4. Calcification of the aorta and common iliac vessels
consistent with
atherosclerotic changes

[**2138-11-5**]:  Procedural:

FINDINGS:
1. Atherosclerosis is noted in the aorta, iliac arteries and
their pelvic
branches. There is eccentric plaque significantly narrowing the
lumen of the
anterior division of the internal iliac artery.
2. Abnormal blushes noted from smaller branches of the obturator
and the
vesicle arteries in the pelvis. No evidence of AVMs or AV
fistulas noted.
However, there is a small suspicious looking pseudoaneurysm in
the lateral
branch of the obturator artery.
3. Post-Gelfoam embolization demonstrating disappearance of the
abnormal-appearing blushes in the pelvis.

IMPRESSION:
Successful Gelfoam embolization at the anterior division of the
right internal iliac artery targeting the smaller branches of
obturator and the superior vesicle artery which demonstrated
abnormal blushes in the pelvis. No immediate complications noted

[**2138-11-5**]:  Procedural:

IMPRESSION:
Successful Gelfoam embolization at the anterior division of the
right internal iliac artery targeting the smaller branches of
obturator and the superior vesicle artery which demonstrated
abnormal blushes in the pelvis. No immediate complications noted

[**2138-11-5**]:  MR cervical spine:

 IMPRESSION:

1. Non-united Type II dens fracture appears chronic, without
marginal bone
marrow edema to suggest an acute element. Increased signal
within the
fracture space suggests non-[**Hospital1 **] and possible pseudoarthrosis;
fluid-signal at the atlantodental articulation likely is
degenerative.
2. Non-specific prevertebral soft tissue edema in the superior
cervical
spine, without evidence of underlying ligamentous or other soft
tissue injury.
This may reflect intubation.
3. Degenerative changes in the lower cervical spine at C6-7 and
C7-T1 levels, with resultant mild canal narrowing. Elevated
signal within the C6-7 and C7-T1 disc spaces is likely
degenerative.
4. No evidence of spinal cord edema or contusion

[**2138-11-6**]:  MR [**Name13 (STitle) 1092**]:

Marked kyphosis with severe loss of height of the T8 vertebral
body
(counting from C2 downwards) predominantly in the anterior and
the mid
portions; angulation of the posteroinferior aspect of the T8
vertebral body, with mild-to-moderate canal stenosis, effacement
of the ventral CSF space and some degree of deformity of the
left side of the cord.
Increased signal intensity in the adjacent discs may relate to
degenerative changes/superimposed inflammation. Correlate
clinically and with labs and follow up if necessary. Evaluation
for any subtle focal lesions within the cord at this level is
limited due to the small caliber of the cord and the deformity.


2. No obvious hyperintense areas on the sagittal STIR sequence
to suggest
acute compression fracture. However, given the extent of
deformity on the
cord, mild compression is possible; Consider spine consult.
Bilateral
pleural effusions, small-to-moderate in size.

3. Multilevel degenerative changes in the thoracic spine with
bilateral
neural foraminal narrowing at the level of T7-T8 and T8-T9
levels and in the lower cervical spine, the latter is better
evaluated on the prior MR of the cervical spine study with type
2 dens fracture.















Brief Hospital Course:
  [**Age over 90 **] year old female who was admitted to the Acute Care Service
after a fall while she was reaching for an object. Upon
admission to the Trauma Intensive Care Unit, she was made NPO,
given intravenous fluids, and had blood work done.  She had a
cat scan of her head, torso and c-spine which demonstrated a
pelvic hematoma, R inf/sup pubic rami fx, R hip fx, and old T7
compression fracture. A  CT of her C-spine did show a C2 dens
fracture with grade I anterolith C4 on C5.  Neurology and
orthopedics were consulted. Her pelvic hematoma was treated in
IR with gel foam embolization of the right internal iliac.
Because of her hematoma, she did require blood transfusions to
maintain her hematocrit.  Her current hematocrit is stable at
26.7.  Her orthopedic injuries are non-operable and she is WBAT.
 Her cervical spine shows no ligamentous injury and she only
requires a collar for pain. She has denied neck pain and she is
not wearing a soft collar.
  She is preparing for discharge to an extended care facility.
Her vital signs are stable.  She is tolerating a regular diet.
She has been out of bed with assistance.  She will follow-up in
the Spine center in 1 month. Her primary care provider, [**Last Name (NamePattern4) **].
[**Last Name (STitle) **], agrees with holding the coumadin.

Medications on Admission:
Medications: Coumadin


Discharge Medications:
1. captopril 25 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
2. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day): hold for bp < 110, hr<60.
4. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. hydrocodone-acetaminophen 5-500 mg Tablet Sig: One (1) Tablet
PO every six (6) hours as needed for pain.
Disp:*10 Tablet(s)* Refills:*0*
6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day:
hold for diarrhea.
7. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day: hold
for diarrhea.


Discharge Disposition:
Extended Care

Facility:
Aberjona Nursing Center - [**Hospital1 2436**]

Discharge Diagnosis:
comminuted R iliac [**Doctor First Name 362**] fx
R inf/sup pelvic rami fracture
T7 compression fx (old), no lig. injury
R hip chronic AVN changes


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
You are being discharged from the hospital after you were
admitted after you fell and hit your head.  You did sustain
pelvic fracture and bleeding into the tissue related to your
being on coumadin.  You are being discharged with the following
instructions:

*please resume your pre-hospital medications
*please check with Dr. [**Last Name (STitle) **] before resuming coumadin
*WBAT
*resume your regular diet
*you may wear a soft collar if your neck is bothering you
*follow up in the Spine Center in 1 month

Please follow up in the Emergency room if you experience:

*weakness
*worsening hematoma around hip
*fever
*abdominal pain
*back pain
*dizziness
*fainting
*weakness in your arms


Followup Instructions:
Please follow up with the Spine Service in 1 month.  You can
schedule this appointment by calling:  #[**Telephone/Fax (1) 87696**]

Please follow up with your primary care [**Provider Number 32176**] weeks. Dr.
[**Last Name (STitle) **], you can schedule this appointment by callling
[**Telephone/Fax (1) 73950**]


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2138-11-10**]
{'Closed fracture of ilium,Acute posthemorrhagic anemia,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Aseptic necrosis of head and neck of femur,Hyposmolality and/or hyponatremia,Fall from other slipping, tripping, or stumbling,Cervicalgia,Long-term (current) use of anticoagulants,Atrial fibrillation,Unspecified essential hypertension'}


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: right hip and neck pain

PRESENT ILLNESS: [**Age over 90 **] year old female who complains of ACUTE
DENS FX. she was apparently reaching for an object when she
fell landing on her right hip. She complains of right hip
and neck pain. She is very hard of hearing. She was seen at
outside hospital diagnosed with a dens fracture.
                       Timing: Sudden Onset
                      Quality: Sharp
                     Severity: Mild
                     Location: Fall with right hip pain
    Associated Signs/Symptoms: No weakness

MEDICAL HISTORY: Past Medical History: afib.  thyroid, HTN

MEDICATION ON ADMISSION: Medications: Coumadin

ALLERGIES: Codeine / Penicillins

PHYSICAL EXAM: PHYSICAL EXAMINATION upon admission:  [**2138-11-4**]

FAMILY HISTORY: son

SOCIAL HISTORY: NC 

### Response:
{'Closed fracture of ilium,Acute posthemorrhagic anemia,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Aseptic necrosis of head and neck of femur,Hyposmolality and/or hyponatremia,Fall from other slipping, tripping, or stumbling,Cervicalgia,Long-term (current) use of anticoagulants,Atrial fibrillation,Unspecified essential hypertension'}
