CHIEF COMPLAINT: Fall

PRESENT ILLNESS: Mr. [**Known lastname **] is a 74 year old gentleman with dementia, COPD,
HTN, CAD, PVD, seizure d/o, distant EtOH abuse admitted on
[**2157-12-15**] from nursing home after mechanical fall from his bed.

MEDICAL HISTORY: COPD
HTN
PVD, s/p fem-fem bypass
Seizure Disorder
Anemia
Dysphagia
s/p c1-c2 fusion

MEDICATION ON ADMISSION: metoprolol 25mg PO bid
tramadol 50mg PO tid
simvastatin 5mg PO qhs
hytrin 5mg PO qhs
celexa 30mg PO daily
cilostazol 100mg PO bid
omeprazole 20mg PO bid
colace 100mg PO bid
advair 250/50
proair 90mcg IH q4prn
keppra 500mg PO bid
asa 325 po daily
folic acid 1mg po daily
multivitamin 1 tablet daily
vitamin b1 100mg po q daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITAL SIGNS: T= 99.5 BP= 164/77 HR= 114, RR 22, SATS= 98% on
face mask
GEN: frail elderly man, lying on bed, not in acute distress,
follows simple commends, moaning when repositioned
HEENT: PERRL, oral mucosa dry, NG in place on tube feeding
NECK: no LAD, no JVD
CV: RRR, tachy, no mumurs
RESP: poor inspirtary effort, no wheezes, no crackles
ABD: + BS, soft, +distended, non-tender, no masses, no guarding
or rebound
PULSES: 2+radial B, 2+ PT/DP B
GU: Foley catheter
EXT: no edema, no cyanosis, no clubbing
SKIN : no rash, no ulceration, no erythema in decubiti
NEURO: awake alert to person only, no tremor; no rigidity, gait=
not assessed
CAM: A/F: Y Inat: ? Disorg: ? Consc: N total:/4
Attention test: demented, unable to test at this time

FAMILY HISTORY: Unable to obtain

SOCIAL HISTORY: Metoprolol 25mg [**Hospital1 **],
Lidoderm Patch 5% daily,
Tramadol 50mg tid,
Simvastatin 5mg ? qhs,
Terazosin 5mg qhs,
Aspirin 325mg daily,
Folic Acid 1mg daily,
MVI,
Celexa 30mg daily,
cilostazol 100mg [**Hospital1 **],
Prilosec 20mg [**Hospital1 **],
Colace 100mg [**Hospital1 **],
Advair Diskus 1 puff [**Hospital1 **],
Levetiracetam 500mg [**Hospital1 **],
Albuterol prn,
Vit B1 100mcg daily
Closed fracture of acetabulum,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Paroxysmal supraventricular tachycardia,Hematemesis,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Benign essential hypertension,Hypopotassemia,Arthrodesis status,Accidental fall from bed
Fracture acetabulum-clos,Pneumonia, organism NOS,Food/vomit pneumonitis,Acute respiratry failure,Retroperitoneum inj-cl,Parox atrial tachycardia,Hematemesis,Chr airway obstruct NEC,Athscl extrm ntv art NOS,Epilep NOS w/o intr epil,Alzheimer's disease,Dementia w/o behav dist,Benign hypertension,Hypopotassemia,Arthrodesis status,Fall from bed
Admission Date:  [**2157-12-15**]              Discharge Date:   [**2158-1-6**]

Date of Birth:  [**2083-5-20**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2751**]
Chief Complaint:
Fall

Major Surgical or Invasive Procedure:
Endotracheal Intubation
Central Venous Line Placement
[**Last Name (un) 1372**]-Intestinal Dobhoff Feeding Tube Placement

History of Present Illness:
Mr. [**Known lastname **] is a 74 year old gentleman with dementia, COPD,
HTN, CAD, PVD, seizure d/o, distant EtOH abuse admitted on
[**2157-12-15**] from nursing home after mechanical fall from his bed.

Per outside hospital records, he fell from bed, approximately 2
feet to the ground.  He was found on the floor complaining of
left hip pain. He presented to the [**Location **] where a CT
abdomen/pelvis revealed a left acetabular and iliac crest
fracture with a retroperitoneal hematoma.  He was given IV
fentanyl and dilaudid for pain and transferred to [**Hospital1 18**] for
further management.

In the ED his VS were HR 88 BP 136/73  RR18  SpO2 99.  He had a
distended abdomen and was tender to palpation over his right
hip.  He has one episode of coffee ground emesis.  A CT abdoemn
pelvis showeda comminuted, intra-articular left acetabular
fracture with extension into left superior pubic ramus, ischium,
and inferior left iliac bone with surrounding large
retroperitoneal hematoma. HCt was 28 and he was given 2U of
PRBC. He was admitted to the trauma SICU for management of his
pelvic fracture and retroperitoneal bleed.


Past Medical History:
COPD
HTN
PVD, s/p fem-fem bypass
Seizure Disorder
Anemia
Dysphagia
s/p c1-c2 fusion

Social History:
Metoprolol 25mg [**Hospital1 **],
Lidoderm Patch 5% daily,
Tramadol 50mg tid,
Simvastatin 5mg ? qhs,
Terazosin 5mg qhs,
Aspirin 325mg daily,
Folic Acid 1mg daily,
MVI,
Celexa 30mg daily,
cilostazol 100mg [**Hospital1 **],
Prilosec 20mg [**Hospital1 **],
Colace 100mg [**Hospital1 **],
Advair Diskus 1 puff [**Hospital1 **],
Levetiracetam 500mg [**Hospital1 **],
Albuterol prn,
Vit B1 100mcg daily

Family History:
Unable to obtain

Physical Exam:
VITAL SIGNS: T= 99.5 BP= 164/77 HR= 114, RR 22, SATS= 98% on
face mask
GEN: frail elderly man, lying on bed, not in acute distress,
follows simple commends, moaning when repositioned
HEENT: PERRL, oral mucosa dry, NG in place on tube feeding
NECK: no LAD, no JVD
CV: RRR, tachy, no mumurs
RESP: poor inspirtary effort, no wheezes, no crackles
ABD: + BS, soft, +distended, non-tender, no masses, no guarding
or rebound
PULSES: 2+radial B, 2+ PT/DP B
GU: Foley catheter
EXT: no edema, no cyanosis, no clubbing
SKIN : no rash, no ulceration, no erythema in decubiti
NEURO: awake alert to person only, no tremor; no rigidity, gait=
not assessed
CAM: A/F: Y Inat: ? Disorg: ? Consc: N total:/4
Attention test: demented, unable to test at this time

Pertinent Results:
[**12-15**] CT c-spine: s/p post c1-c2 fusion. metallic nail through L
lat C2 extends w/tip in retropharnyngeal/prevertebral jxn soft
tissues ant to C1. mild anterolisthesis of C4 over C5. very min
retrolisthesis C5 over C6. mult-level [**Last Name (un) **] change. no acute fx
seen. pulmonary emphysema. coarse vertebral and carotid artery
calcs. 6mm R thyroid lobe hypodensity.
[**12-15**] CT torso: 1.6 x 1.2 cm focal hypodensity in ant
mediastinum (S2:im15). ?focal hematoma vs thymic cystic lesion.
No overlying sternal fx or aortic injury. dense aortic calcs.
LLL atelect/scarring. comminuted, intra-art L acetabular fx
involv ant &post columns and ext to L sup pubic ramus. adj mod
pelvic hematoma w/out active extrav. hematoma crosses midline,
extends superiorly ant to L psoas muscle and iliacus. mild loss
of ht of L2 & L3 vert bodies. Grade 1 spondylolisthesis L5/S1.
bladder diverticula .

[**12-15**] CT head: No acute ICH. opacification of inf L maxillary
sinus w/focal loss of ant inf L max sinus/ant L alveolar bone,
adj soft tissue swelling and foci of gas. ?infectious process
involving L alveolar process of maxilla, dental in nature vs
chronic sinusitis vs injury. recommend direct visualization.

[**12-17**] CXR: No consolidation

[**12-17**] CXR (pm): Increased lung volumes c/w emphysema.
Peribronchial cuffing and predominantly R-sided interstitial
opacities likely fluid overload. Subtle opacity @R apex
?superimposition of external
ventilator apparatus vs. consolidation.

[**1-1**] CXR:
The Dobbhoff tube tip is in the stomach. Cardiomediastinal
silhouette is
stable. There is no change in upper lobe interstitial opacities
in this
patient with hyperinflated lungs. The lower lungs are
unremarkable. There is no pleural effusion. There is no
pneumothorax.

[**2158-1-4**] ECG:
Normal sinus rhythm. Q waves in leads V1-V2 consistent with
prior anteroseptal myocardial infarction. Compared to the
previous tracing of [**2157-12-19**] there has been no diagnostic
interim change.
 	Intervals	Axes
Rate	PR	QRS	QT/QTc	P	QRS	T
88	168	78	378/427	81	57	52

Admission Labs:

[**2157-12-15**] 06:00PM BLOOD WBC-6.6 RBC-3.25* Hgb-9.7* Hct-28.3*
MCV-87 MCH-29.8 MCHC-34.3 RDW-15.6* Plt Ct-269
[**2157-12-15**] 06:00PM BLOOD Neuts-88.2* Lymphs-6.2* Monos-4.9 Eos-0.6
Baso-0.1
[**2157-12-15**] 06:00PM BLOOD PT-12.8 PTT-26.9 INR(PT)-1.1
[**2157-12-15**] 06:00PM BLOOD Glucose-120* UreaN-18 Creat-0.8 Na-128*
K-4.2 Cl-97 HCO3-22 AnGap-13
[**2157-12-21**] 02:18PM BLOOD ALT-14 AST-16 CK(CPK)-50 AlkPhos-61
TotBili-0.6
[**2157-12-15**] 09:47PM BLOOD Calcium-8.3* Phos-4.9* Mg-1.9
[**2157-12-16**] 10:07PM BLOOD TSH-3.8
[**2157-12-16**] 07:59PM BLOOD Lactate-0.9

Discharge Labs:

[**2158-1-5**] 05:05AM BLOOD WBC-7.8 RBC-3.15* Hgb-9.3* Hct-28.3*
MCV-90 MCH-29.4 MCHC-32.7 RDW-14.6 Plt Ct-607*
[**2158-1-5**] 05:05AM BLOOD Glucose-110* UreaN-18 Creat-0.6 Na-139
K-3.2* Cl-105 HCO3-22 AnGap-15
[**2158-1-4**] 06:10AM BLOOD Calcium-9.0 Phos-4.5 Mg-2.3

Brief Hospital Course:
#. Pelvic fracture. He was initially admitted to the trauma
surgery service.  He was seen by orthopedic surgery and a pin
was placed through the distal femur and the leg was placed in
traction in anticipation of possible surgery.  3d reconstructive
CT imaging of the pelvis was performed.  Ultimately, it was
decided to treat this fracture non operatively given his
baseline functional status and the severity of his fracture on
imaging.  The pin was removed. Pain was controlled with IV
morphine and PO oxycodone.

# Retroperitoneal Bleed.  On CT, retroperitoneal and pelvic
bleeding was discovered. Interventional radiology was consulted
and patient was monitored clinically.  He remained
hemodynamically stable and his hematocrit remained stable and no
intervention was necessary. His hematocrit remained stable for
the remainder of his hospitalization.

# Hospital Acquired Pneumonia - On [**2149-12-21**], patient developed a
fever, hypoxia and an infiltrate was noted on CXR.  He was
started on empiric therapy for hospital acquired pneumonia of
vancomycin, ciprofloxacin, and cefepime IV.  A 7 day course was
completed with an improvement in his breathing, and a reduction
in his oxygen requirement.  On the floor he was given standing
albuterol and Atrovent nebs, and was had regular chest PT with
respiratory therapy with a significant improvement in function.


# Tachycardia - Patient had tachycardia, alternating between
sinus tachycardia and multifocal atrial tachycardia in the range
of 110-140 early in his SICU course.  Cardiology was consulted
and recommended up titration of his metoprolol. His metoprolol
was gradually up titrated to 200mg PO tid.  As his clinical
picture improved, this dose was gradually reduced to 50mg PO
bid, with rates in the 80s-90s on discharge.

# Nutrition - Initial speech and swallow evaluation found that
it was unsafe for him to take anything PO due to aspiration
risk. A Dobbhoff feeding tube was placed for nutrition and given
tube feeds.  He pulled the feeding tube once, and it needed to
be replaced.  Repeat speech/swallow evaluation with video
swallow found him to be safe to eat pureed solids with nectar
thickened liquids.  Feeding tube was removed and he was started
on the recommended diet on discharge.

#. Goals of care - The patient had severe dementia, and had no
health care proxy on admission.  Guardianship was obtained
emergently given the patient initially tenuous clinical status.
[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 80570**] ([**PO Box 84306**], [**Location (un) 47**] [**Telephone/Fax (1) 84307**]) has agreed to be Mr. [**Known lastname **] guardian.  On
discussion with Mr. [**Last Name (Titles) 80570**], [**First Name3 (LF) 282**] tube placement was declined
and it was decided to change Mr. [**Known lastname **] code status to
DNR/DNI.

Medications on Admission:
metoprolol 25mg PO bid
tramadol 50mg PO tid
simvastatin 5mg PO qhs
hytrin 5mg PO qhs
celexa 30mg PO daily
cilostazol 100mg PO bid
omeprazole 20mg PO bid
colace 100mg PO bid
advair 250/50
proair 90mcg IH q4prn
keppra 500mg PO bid
asa 325 po daily
folic acid 1mg po daily
multivitamin 1 tablet daily
vitamin b1 100mg po q daily

Discharge Medications:
1. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for pain.
4. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: 0.5 Tablet, Rapid
Dissolve PO TID (3 times a day) as needed for agitation.
5. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1)  PO
DAILY (Daily) as needed for constipation.
8. Advair Diskus 250-50 mcg/Dose Disk with Device Sig: One (1)
puff Inhalation twice a day.
9. Celexa 10 mg Tablet Sig: Three (3) Tablet PO once a day.
10. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
12. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
13. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation every four (4) hours as needed for
shortness of breath or wheezing.
14. Simvastatin 5 mg Tablet Sig: One (1) Tablet PO once a day.
15. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
16. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
17. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
18. Vitamin B-1 100 mg Tablet Sig: One (1) Tablet PO once a day.



Discharge Disposition:
Extended Care

Facility:
Resident Care Rehab & Nursing

Discharge Diagnosis:
Pelvic Fracture
Retroperitoneal Bleed
Multifocal Atrial Tachycardia
Pneumonia
COPD
Dementia


Discharge Condition:
Baseline dementia, not oriented to place or time. Ambulating
with assistance.


Discharge Instructions:
You were admitted for a fall.  You were found to have a pelvic
fracture, and surgery was not needed.  You developed a bleed
into your back and pelvis that resolved.  You also developed a
high heart rate which was controlled with medications.  You
developed a pneumonia which was treated with intravenous
antibiotics.  Your pain was controlled with oxycodone.

Followup Instructions:
Please arrange a follow up appointment with your PCP.
{"Closed fracture of acetabulum,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Paroxysmal supraventricular tachycardia,Hematemesis,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Benign essential hypertension,Hypopotassemia,Arthrodesis status,Accidental fall from bed"}


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: Mr. [**Known lastname **] is a 74 year old gentleman with dementia, COPD,
HTN, CAD, PVD, seizure d/o, distant EtOH abuse admitted on
[**2157-12-15**] from nursing home after mechanical fall from his bed.

MEDICAL HISTORY: COPD
HTN
PVD, s/p fem-fem bypass
Seizure Disorder
Anemia
Dysphagia
s/p c1-c2 fusion

MEDICATION ON ADMISSION: metoprolol 25mg PO bid
tramadol 50mg PO tid
simvastatin 5mg PO qhs
hytrin 5mg PO qhs
celexa 30mg PO daily
cilostazol 100mg PO bid
omeprazole 20mg PO bid
colace 100mg PO bid
advair 250/50
proair 90mcg IH q4prn
keppra 500mg PO bid
asa 325 po daily
folic acid 1mg po daily
multivitamin 1 tablet daily
vitamin b1 100mg po q daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITAL SIGNS: T= 99.5 BP= 164/77 HR= 114, RR 22, SATS= 98% on
face mask
GEN: frail elderly man, lying on bed, not in acute distress,
follows simple commends, moaning when repositioned
HEENT: PERRL, oral mucosa dry, NG in place on tube feeding
NECK: no LAD, no JVD
CV: RRR, tachy, no mumurs
RESP: poor inspirtary effort, no wheezes, no crackles
ABD: + BS, soft, +distended, non-tender, no masses, no guarding
or rebound
PULSES: 2+radial B, 2+ PT/DP B
GU: Foley catheter
EXT: no edema, no cyanosis, no clubbing
SKIN : no rash, no ulceration, no erythema in decubiti
NEURO: awake alert to person only, no tremor; no rigidity, gait=
not assessed
CAM: A/F: Y Inat: ? Disorg: ? Consc: N total:/4
Attention test: demented, unable to test at this time

FAMILY HISTORY: Unable to obtain

SOCIAL HISTORY: Metoprolol 25mg [**Hospital1 **],
Lidoderm Patch 5% daily,
Tramadol 50mg tid,
Simvastatin 5mg ? qhs,
Terazosin 5mg qhs,
Aspirin 325mg daily,
Folic Acid 1mg daily,
MVI,
Celexa 30mg daily,
cilostazol 100mg [**Hospital1 **],
Prilosec 20mg [**Hospital1 **],
Colace 100mg [**Hospital1 **],
Advair Diskus 1 puff [**Hospital1 **],
Levetiracetam 500mg [**Hospital1 **],
Albuterol prn,
Vit B1 100mcg daily 

### Response:
{"Closed fracture of acetabulum,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Paroxysmal supraventricular tachycardia,Hematemesis,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Benign essential hypertension,Hypopotassemia,Arthrodesis status,Accidental fall from bed"}
