CHIEF COMPLAINT: SDH

PRESENT ILLNESS: This is an 89 year man with with a history of a subdural
hematoma who underwent a craniotomy with evacuation of bilateral
SDH with drains on [**2103-9-17**] at [**Hospital **] Hospital.
Originally Mr. [**Known lastname 46825**] [**Last Name (Titles) 50921**] and fell on [**2103-7-23**] while
gardening. This seemed to be related to his chronic right foot
drop.  There was no LOC. He immediately ambulated. His family
noticed an altered mental status; however, he did not seek
medical attention until [**2103-8-2**] when he was found to have
bilateral SDH's on CT and MR [**First Name8 (NamePattern2) **] [**Last Name (Titles) **]. He went on vacation for
a week, had increased headaches and returned to OSH for CT/MR of
the head which revealed no significant SDH change, but
evacuation was required and performed on [**9-17**] with placement of
bilateral subdural drains.

MEDICAL HISTORY: Hypertension (usually runs 140/80 per pt and family)
EF of 50% ([**2103**])
Left BBB
Nephrolithiasis
Osteoarthritis
BPH Chronic LBP
PSH:
B/l carotid endarterectomy (Dr. [**Last Name (STitle) 8521**], [**First Name3 (LF) **])
cataract surgery
utereral stone removal/cystoscopy

MEDICATION ON ADMISSION: Lisinopril 20mg qd
sertraline 50mg qd
atenolol 25 mg qd
doxazosin 4 mg qd
diclofenac 25 mg qd

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
The patient was intubated.
T:97  BP:140/52  HR: 66   R 7      O2Sats: 97%
Gen: intubated
HEENT: atraumatic, normocephalic
Pupils: 2-1.5mm bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: lives alone and is independent, mobile, Tobacco: 50+ pack year
hx (quit 20 years ago), EtOH: family endorses at least
6oz/scotch/day, no known illicits
Dissection of aorta, abdominal,Subdural hemorrhage,Diastolic heart failure, unspecified,Other primary cardiomyopathies,Unspecified essential hypertension,Other acquired deformities of ankle and foot,Personal history of tobacco use,Other specified cardiac dysrhythmias
Dsct of abdominal aorta,Subdural hemorrhage,Diastolc hrt failure NOS,Prim cardiomyopathy NEC,Hypertension NOS,Acq ankle-foot def NEC,History of tobacco use,Cardiac dysrhythmias NEC
Admission Date:  [**2103-9-18**]              Discharge Date:   [**2103-9-21**]


Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
SDH

Major Surgical or Invasive Procedure:
.

History of Present Illness:
This is an 89 year man with with a history of a subdural
hematoma who underwent a craniotomy with evacuation of bilateral
SDH with drains on [**2103-9-17**] at [**Hospital **] Hospital.
Originally Mr. [**Known lastname 46825**] [**Last Name (Titles) 50921**] and fell on [**2103-7-23**] while
gardening. This seemed to be related to his chronic right foot
drop.  There was no LOC. He immediately ambulated. His family
noticed an altered mental status; however, he did not seek
medical attention until [**2103-8-2**] when he was found to have
bilateral SDH's on CT and MR [**First Name8 (NamePattern2) **] [**Last Name (Titles) **]. He went on vacation for
a week, had increased headaches and returned to OSH for CT/MR of
the head which revealed no significant SDH change, but
evacuation was required and performed on [**9-17**] with placement of
bilateral subdural drains.

Per the outside records, he had postop abdominal pain relieved
in decubitus position. He became confused, diaphoretic,
hypertensive was intubated and sedated in the early am of POD
#1. Head CT showed increase in R subdural collection no change
in the left. Abdominal CT showed 18mm infrarenal abdominal
aortic dissection. He had SBPs in 200s, became bradycardic to
50s despite IV hydralazine. He was then transfered to the [**Hospital1 18**].



Past Medical History:
Hypertension (usually runs 140/80 per pt and family)
EF of 50% ([**2103**])
Left BBB
Nephrolithiasis
Osteoarthritis
BPH Chronic LBP
PSH:
B/l carotid endarterectomy (Dr. [**Last Name (STitle) 8521**], [**First Name3 (LF) **])
cataract surgery
utereral stone removal/cystoscopy


Social History:
lives alone and is independent, mobile, Tobacco: 50+ pack year
hx (quit 20 years ago), EtOH: family endorses at least
6oz/scotch/day, no known illicits

Family History:
NC

Physical Exam:
On Admission:
The patient was intubated.
T:97  BP:140/52  HR: 66   R 7      O2Sats: 97%
Gen: intubated
HEENT: atraumatic, normocephalic
Pupils: 2-1.5mm bilaterally

Neuro:
Patient is intubated
EO to noxious stimuli
follows simple commands on R UE (shows thumbs up)
wiggles toes bilaterally
w/d LUE to noxious
Bilateral subdural drains in place
L drain 100cc since admission
R drain minimal out put since admission


Pertinent Results:
[**2103-9-18**] 01:29PM   PT-13.1 PTT-26.5 INR(PT)-1.1
[**2103-9-18**] 01:29PM   PLT COUNT-151
[**2103-9-18**] 01:29PM   NEUTS-92.5* LYMPHS-3.9* MONOS-3.1 EOS-0.4
BASOS-0.1
[**2103-9-18**] 01:29PM   WBC-14.8* RBC-4.17* HGB-14.1 HCT-38.7* MCV-93
MCH-33.9* MCHC-36.5* RDW-13.9
[**2103-9-18**] 01:29PM   CALCIUM-8.4 PHOSPHATE-2.9 MAGNESIUM-1.7
[**2103-9-18**] 01:29PM   CK-MB-3 cTropnT-<0.01
[**2103-9-18**] 01:29PM   CK(CPK)-21*
[**2103-9-18**] 01:29PM   estGFR-Using this
[**2103-9-18**] 01:29PM   GLUCOSE-175* UREA N-18 CREAT-0.4* SODIUM-140
POTASSIUM-4.1 CHLORIDE-107 TOTAL CO2-24 ANION GAP-13

ECHO [**2103-9-18**]
The left atrium is elongated. No atrial septal defect is seen by
2D or color Doppler. The estimated right atrial pressure is at
least 15 mmHg. There is moderate symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. There
is probably mild global left ventricular hypokinesis (LVEF = 50
%) (the degree of bradycardia and conduction delay associated LV
dysynchrony make an accurate estimate of LVEF more difficult).
No masses or thrombi are seen in the left ventricle. Tissue
Doppler imaging suggests an increased left ventricular filling
pressure (PCWP>18mmHg). There is no ventricular septal defect.
Right ventricular chamber size and free wall motion are normal.
The diameters of aorta at the sinus, ascending and arch levels
are normal. The aortic valve leaflets (3) are mildly thickened
but aortic stenosis is not present. No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. There is
no mitral valve prolapse. Mild (1+) mitral regurgitation is
seen. The tricuspid valve leaflets are mildly thickened. There
is mild pulmonary artery systolic hypertension. There is no
pericardial effusion.

CXR [**2103-9-18**]
1. Progression of left perihilar and lower hemithorax opacities
may represent aspiration or consolidation.
2. Esophageal catheter with side port in the distal esophagus
and would need to be advanced 7 cm to ensure most proximal side
port within the stomach.

CT head [**2103-9-19**]
1. Marked reduction in size of a right subdural hematoma, with a
drain in
place, and some residual blood products, layering dependently.
2. Bifrontal pneumocephalus, increased on the left, following
removal of this drain.
3. No new focus of hemorrhage.
4. Partial sinus opacification, particular of the sphenoid air
cells, which may relate to intubation and supine positioning.


Brief Hospital Course:
Mr. [**Known lastname 46825**] was admitted to [**Hospital1 18**] TSICU. On arrival,
intubated, he was sedated with bradycardia to the 30s requiring
x1 atropine with good response. A right axillary arterial line
placed. Neurosurgery evaluated the patient and removed the L JP
drain. The right drain was less functional and was milked with
improved output.

A chest X-rays showed progression of left perihilar and lower
hemithorax opacities may represent aspiration or consolidation.
An ECHO was done showed
EF 50% (the degree of bradycardia and conduction delay
associated LV dysynchrony make an accurate estimate of LVEF more
difficult).

He was on a nitro drip at 1mcg/kg/min with SBP goal < 140. EPS
was consulted.
They agreed with the plan for Hydralazine PRN for BP control
and approved restarting home dose of lisinopril and amlodipine
when tolerating po's.  He was extubated overnight.

Vascular surgery consulted and they felt that this abdominal
pain at OSH was likely not due to his 18mm dissection. There are
no plan for intervention at this point.
He was trasnfered to the Neurosurgery service under the care of
Dr. [**Last Name (STitle) 739**]. He was getting Dilantin 100mg TID with 1000mg
initial load.  CT head on [**9-19**] showed improvement in right SDH
but the drain was left in place for further evacuation in the am
and this was removed in the pm. Orders for trasnfer to SDU were
written.

CT head in the am of [**2103-9-20**] showed...He had expiratory whezzing
and nebulizer treatment was started. SQH was started for DVT
prophylaxis. Foley cathter was discontinued. PT was consulted.
They recommended rehab.  Now DOD he is set for d/c to rehab and
will f/u accordingly.

Medications on Admission:
Lisinopril 20mg qd
sertraline 50mg qd
atenolol 25 mg qd
doxazosin 4 mg qd
diclofenac 25 mg qd


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain/fever: max 4g/24 hrs.
4. hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours): hold sbp<100.
Disp:*60 Tablet(s)* Refills:*2*
5. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
6. phenytoin sodium extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
Disp:*90 Capsule(s)* Refills:*2*
7. sertraline 50 mg Tablet Sig: One (1) Tablet PO once a day.
8. doxazosin 4 mg Tablet Sig: One (1) Tablet PO once a day.
9. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
10. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

11. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 931**] House Nursing & Rehabilitation Center - [**Location (un) 932**]

Discharge Diagnosis:
Bilateral SDH
Brain Compression
AAA
Bradycardia
Hypertension
COPD
Back pain
PVC
Ventricular Tachycardia


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:
General Instructions

??????	Have a friend/family member check your incision daily for
signs of infection.
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	You may wash your hair only after sutures and/or staples have
been removed.
??????	You may shower before this time using a shower cap to cover
your head.
??????	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, Aspirin, Advil, and
Ibuprofen etc.
??????	If 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**].
If you have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion 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.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to see your Neurosurgeon at [**Location (un) **] on [**9-26**] for
removal of your staples. You may also have these removed at
rehab
??????Please call your Neurosurgeon at [**Location (un) **] for a one month follow
up appointment.
-      Please follow up with your PCP as soon as possible
regarding you Abdominal Aortic Aneurysm


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2103-9-21**]
{'Dissection of aorta, abdominal,Subdural hemorrhage,Diastolic heart failure, unspecified,Other primary cardiomyopathies,Unspecified essential hypertension,Other acquired deformities of ankle and foot,Personal history of tobacco use,Other specified cardiac dysrhythmias'}


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: SDH

PRESENT ILLNESS: This is an 89 year man with with a history of a subdural
hematoma who underwent a craniotomy with evacuation of bilateral
SDH with drains on [**2103-9-17**] at [**Hospital **] Hospital.
Originally Mr. [**Known lastname 46825**] [**Last Name (Titles) 50921**] and fell on [**2103-7-23**] while
gardening. This seemed to be related to his chronic right foot
drop.  There was no LOC. He immediately ambulated. His family
noticed an altered mental status; however, he did not seek
medical attention until [**2103-8-2**] when he was found to have
bilateral SDH's on CT and MR [**First Name8 (NamePattern2) **] [**Last Name (Titles) **]. He went on vacation for
a week, had increased headaches and returned to OSH for CT/MR of
the head which revealed no significant SDH change, but
evacuation was required and performed on [**9-17**] with placement of
bilateral subdural drains.

MEDICAL HISTORY: Hypertension (usually runs 140/80 per pt and family)
EF of 50% ([**2103**])
Left BBB
Nephrolithiasis
Osteoarthritis
BPH Chronic LBP
PSH:
B/l carotid endarterectomy (Dr. [**Last Name (STitle) 8521**], [**First Name3 (LF) **])
cataract surgery
utereral stone removal/cystoscopy

MEDICATION ON ADMISSION: Lisinopril 20mg qd
sertraline 50mg qd
atenolol 25 mg qd
doxazosin 4 mg qd
diclofenac 25 mg qd

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
The patient was intubated.
T:97  BP:140/52  HR: 66   R 7      O2Sats: 97%
Gen: intubated
HEENT: atraumatic, normocephalic
Pupils: 2-1.5mm bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: lives alone and is independent, mobile, Tobacco: 50+ pack year
hx (quit 20 years ago), EtOH: family endorses at least
6oz/scotch/day, no known illicits 

### Response:
{'Dissection of aorta, abdominal,Subdural hemorrhage,Diastolic heart failure, unspecified,Other primary cardiomyopathies,Unspecified essential hypertension,Other acquired deformities of ankle and foot,Personal history of tobacco use,Other specified cardiac dysrhythmias'}
