CHIEF COMPLAINT: s/p mechanical fall with right femur fracture

PRESENT ILLNESS: - This is an 85 y/o female with HTN, A fib, HL, COPD, s/p RLL
lobectomy for mycobacterium infection, who presents with a right
femur fracture s/p mechanical fall earlier today. She was out
shopping at [**Company 7546**] earlier today with her family and tripped
over a floor barrier, landing on her right hip. This was a
witnessed fall by her family - per pt and family, no LOC or
hitting of head. Pt denies any preceding dizziness/LH, chest
pain, SOB, palpitations, n/v/. Presented to the ED at 3 pm with
right hip swelling and pain, unable to support weight. She was
found to have a right femur head fracture and was seen by ortho,
plan for OR tomorrow. She now needs medical clearance.
.
At baseline, pt is able to walk [**2-4**] miles comfortably and is
very independent. She can easily climb 2 flights of stair with
groceries. Denies SOB or CP with activity or with rest. Per
daughter, pt had stress test [**10-8**] which was "excellent." No h/o
cardiac intervention. Reports her COPD at baseline, does not use
inhalors.

MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease, right lower lobe
lobectomy for mycobacterium xenopi infection.
2. Atrial fibrillation, status post two failed
cardioversions.
3. Hypertension.
4. Hypercholesterolemia.
5. Diverticulosis.
6. Status post cholecystectomy.
7. Status post total abdominal hysterectomy, bilateral
salpingo-oophorectomy.
8. Arthritis.
9. Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1. Plavix 75 mg qd - for afib, previously on coumadin but d/c'd
due to risk with falls
2. ASA 81 mg qd
3. Lipitor 10 mg qd
4. HCTZ 25 mg qd
5. Protonix 40 mg qd
6. Enablex 7.5 mg qd
7. Diltiazem 180 mg qd (per OMR notes, pt unsure of dose)

ALLERGIES: Codeine / Ultram

PHYSICAL EXAM: VS: Tc 98.4, BP 120/72, HR 88, RR 18, SaO2 100%/RA, wt 163.9 lbs

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: The patient lives alone on [**Hospital3 **] and visits her daughter who
lives in [**Name (NI) 620**]. Former tobacco use, quit thirty years ago. No
alcohol use. Very active and independent with ADL's. Functional
capacity > 4 mets.
Other closed transcervical fracture of neck of femur,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Fall from other slipping, tripping, or stumbling,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia
Fx femur intrcaps NEC-cl,Atrial fibrillation,Chr airway obstruct NEC,Urin tract infection NOS,Ac posthemorrhag anemia,Fall from slipping NEC,Hypertension NOS,Esophageal reflux,Pure hypercholesterolem
Admission Date:  [**2160-12-26**]              Discharge Date:   [**2160-12-31**]


Service: MEDICINE

Allergies:
Codeine / Ultram

Attending:[**First Name3 (LF) 2181**]
Chief Complaint:
s/p mechanical fall with right femur fracture

Major Surgical or Invasive Procedure:
intubation, R hip hemiarthroplasty


History of Present Illness:
- This is an 85 y/o female with HTN, A fib, HL, COPD, s/p RLL
lobectomy for mycobacterium infection, who presents with a right
femur fracture s/p mechanical fall earlier today. She was out
shopping at [**Company 7546**] earlier today with her family and tripped
over a floor barrier, landing on her right hip. This was a
witnessed fall by her family - per pt and family, no LOC or
hitting of head. Pt denies any preceding dizziness/LH, chest
pain, SOB, palpitations, n/v/. Presented to the ED at 3 pm with
right hip swelling and pain, unable to support weight. She was
found to have a right femur head fracture and was seen by ortho,
plan for OR tomorrow. She now needs medical clearance.
.
At baseline, pt is able to walk [**2-4**] miles comfortably and is
very independent. She can easily climb 2 flights of stair with
groceries. Denies SOB or CP with activity or with rest. Per
daughter, pt had stress test [**10-8**] which was "excellent." No h/o
cardiac intervention. Reports her COPD at baseline, does not use
inhalors.

Past Medical History:
1. Chronic obstructive pulmonary disease, right lower lobe
lobectomy for mycobacterium xenopi infection.
2. Atrial fibrillation, status post two failed
cardioversions.
3. Hypertension.
4. Hypercholesterolemia.
5. Diverticulosis.
6. Status post cholecystectomy.
7. Status post total abdominal hysterectomy, bilateral
salpingo-oophorectomy.
8. Arthritis.
9. Gastroesophageal reflux disease.

Social History:
The patient lives alone on [**Hospital3 **] and visits her daughter who
lives in [**Name (NI) 620**]. Former tobacco use, quit thirty years ago. No
alcohol use. Very active and independent with ADL's. Functional
capacity > 4 mets.


Family History:
noncontributory

Physical Exam:
VS: Tc 98.4, BP 120/72, HR 88, RR 18, SaO2 100%/RA, wt 163.9 lbs

General: Pleasant elderly female in NAD while lying still, AO x
3
HEENT: NC/AT, PERRL, EOMI. No scleral icterus. MMM, OP clear
Neck: supple, no JVD or LAD
Chest: CTA-B, no w/r/r
CV: [**Last Name (un) **], s1 s2 normal, no m/g/r
Abd: soft, NT/ND, NABS, no HSM
Ext: right LE externally rotated, no swelling or lesions noted.
Pulses 2+ b/l
Neuro: AO x 3, non-focal

Pertinent Results:
[**2160-12-26**] 06:35PM BLOOD WBC-11.3* RBC-4.21 Hgb-13.0 Hct-36.6
MCV-87 MCH-30.8 MCHC-35.4* RDW-13.9 Plt Ct-237
[**2160-12-28**] 12:31PM BLOOD Hct-31.9*
[**2160-12-29**] 12:18AM BLOOD WBC-13.6* RBC-3.14* Hgb-9.7* Hct-27.4*
MCV-87 MCH-31.0 MCHC-35.4* RDW-14.0 Plt Ct-199
[**2160-12-29**] 02:22PM BLOOD WBC-8.8 RBC-2.58* Hgb-8.1* Hct-22.7*
MCV-88 MCH-31.5 MCHC-35.9* RDW-13.9 Plt Ct-94*#
[**2160-12-30**] 02:50AM BLOOD WBC-9.5 RBC-3.10* Hgb-9.5* Hct-27.2*
MCV-88 MCH-30.6 MCHC-34.9 RDW-14.4 Plt Ct-103*
[**2160-12-30**] 03:10PM BLOOD Hct-27.2* Plt Ct-134*
[**2160-12-31**] 05:10AM BLOOD WBC-11.1* RBC-3.11* Hgb-9.5* Hct-26.8*
MCV-86 MCH-30.5 MCHC-35.4* RDW-14.6 Plt Ct-168
[**2160-12-26**] 06:35PM BLOOD Neuts-85.8* Lymphs-9.9* Monos-2.6 Eos-1.1
Baso-0.7
[**2160-12-26**] 07:12PM BLOOD PT-12.0 PTT-25.9 INR(PT)-1.0
[**2160-12-31**] 05:10AM BLOOD PT-13.5* PTT-27.6 INR(PT)-1.2*
[**2160-12-26**] 06:35PM BLOOD Glucose-121* UreaN-15 Creat-0.8 Na-135
K-4.2 Cl-95* HCO3-28 AnGap-16
[**2160-12-31**] 05:10AM BLOOD Glucose-114* UreaN-8 Creat-0.4 Na-134
K-3.6 Cl-103 HCO3-21* AnGap-14
[**2160-12-29**] 12:18AM BLOOD CK(CPK)-584*
[**2160-12-29**] 08:15AM BLOOD CK(CPK)-489*
[**2160-12-29**] 02:22PM BLOOD CK(CPK)-385*
[**2160-12-29**] 12:18AM BLOOD CK-MB-10 MB Indx-1.7 cTropnT-0.07*
[**2160-12-29**] 02:22PM BLOOD CK-MB-6 cTropnT-0.07*
[**2160-12-27**] 06:47AM BLOOD Calcium-8.7 Phos-3.2 Mg-1.8
[**2160-12-31**] 05:10AM BLOOD Calcium-8.0* Phos-2.0* Mg-1.8
[**2160-12-30**] 02:50AM BLOOD Hapto-171
[**2160-12-29**] 08:15AM BLOOD Cortsol-35.5*
[**2160-12-29**] 10:55AM BLOOD Cortsol-33.4*
[**2160-12-29**] 12:16PM BLOOD Cortsol-36.8*
[**2160-12-28**] 09:38AM BLOOD Type-[**Last Name (un) **] pO2-76* pCO2-41 pH-7.47*
calTCO2-31* Base XS-5 Intubat-INTUBATED
[**2160-12-28**] 09:38AM BLOOD Glucose-152* Lactate-1.9 Na-128* K-2.8*
Cl-93*
[**2160-12-28**] 09:38AM BLOOD freeCa-1.08*
[**2160-12-31**] 05:10AM BLOOD HEPARIN DEPENDENT ANTIBODIES-PND
.
CT head [**12-30**]: IMPRESSION: No evidence of acute intracranial
hemorrhage. No fracture identified.
CXR [**12-26**]: IMPRESSION: No acute cardiopulmonary abnormalities
identified.
R Hip [**12-26**]: AP PELVIS AND RIGHT HIP, THREE VIEWS: There is a
subcapital fracture of the right femur with slight proximal
displacement of the distal fracture fragment. The right femoral
head appears to articulate with the right acetabulum without
evidence of dislocation. No other fractures are identified. Bony
mineralization is normal. There is slight asymmetry in the right
hemipelvis, which may be related to position. Degenerative
changes are seen at the L5-S1 level. The bowel gas pattern is
within normal limits.

IMPRESSION: Subcapital right femur fracture.
.
CT pelvis: IMPRESSION: No retroperitoneal hematoma. Small
intraabdominal ascites. Fluid surrounding the right hemipelvis
is consistent with patient's recent postoperative status.
.
CXR [**12-29**]: IMPRESSION: New left lower lobe opacity representing
airspace disease versus atelectasis. Stable right-sided
post-operative changes.

Brief Hospital Course:
Patient was admitted to the medicine service for medical
clearance for orthopedic management of her right femur fracture.
 (Right femur fx - [**3-6**] mechanical fall. No symptoms or history
suggestive of syncopal episode. Needs OR repair, intermediate
risk surgery. Per ACC guideline, pt falls into minor clinical
predictors with excellent functional capacity. Is medically
clear for OR from cardiac standpoint, no need for additional
testing. Also medically clear from pulmonary standpoint given
baseline COPD and unremarkable CXR. Role of a peri-op BB
controversial in this low-risk pt (minor predictors, excellent
functional capacity, intermediate OR risk).

Patient was made NPO on midnight of HD 2 and taken to the OR
with orthopedics on HD 3.  Pt had R hip hemi-arthroplasty with
700 EBL and no other complications noted.

[**Name (NI) **] pt had an episode of hypotension, was difficult to weane
of ventilator and spiked a temperature to 102.  She was admitted
to the MICU, started on broad abx with ciprofloxacin for UTI and
also had vancomycin added empirically.  She defervesced on this
regimen and fever work-up revealed no other source of infection.
 Vancomycin was stopped after 72 hrs.  Plan to continue cipro
for 3 additional days for a total of 7 day course.
In addition, post-op course was complicated by hypotension
requiring pressors.  She required agressive fluid resuscitation
of about 8 L and 2 Units of PRBC and her hypotension resolved.
Anti-hypertensive medications were initially held and restarted
on [**12-31**].
Initially the pt had rapid atrial fibrillation in the setting of
hypotension and was started on IV digoxin.  No change in BP was
noted with better HR control.  Digoxin was discontinued with
good HR control throughout remainder of her stay and diltiazem
was restarted at home dose on [**12-31**].
She was maintained on atrovent nebulizer intermittently for COPD
with oxygen saturation around 95% on room air, and minimized
albuterol in the setting of atrial fibrillation.  Initial CXR
showed no infiltrate, repeat one at the time of fever showed a
questionable new infiltrate.  Pt had no clinical evidence of
pneumonia, consider repeat CXR in a few days to assess
resolution.
During her MICU stay, her platelets were noted to trend down to
94 in the setting of aggressive fluid resuscitation.  Heparin
was held and HIT antibody was sent.  She was anticoagulated with
fondaparinux and plts increased to 168 on this regimen.  She
should be able to resume lovenox anticoagulation for post-op
prophylaxis should the HIT antibody prove to be negative.  HCT
was also noted to trend down along with this, hemolysis labs was
negative and abdominal CT showed no RP hepatoma.
Pt was restarted on cardiac diet after hypotension resolved,
tolerated well.
FULL code

Medications on Admission:
1. Plavix 75 mg qd - for afib, previously on coumadin but d/c'd
due to risk with falls
2. ASA 81 mg qd
3. Lipitor 10 mg qd
4. HCTZ 25 mg qd
5. Protonix 40 mg qd
6. Enablex 7.5 mg qd
7. Diltiazem 180 mg qd (per OMR notes, pt unsure of dose)

Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
4. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
8. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
9. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Ciprofloxacin 400 mg/40 mL Solution Sig: Four Hundred (400)
mg Intravenous  Q12H (every 12 hours) for 3 days.
11. Morphine 2 mg/mL Syringe Sig: 0.5 mg Injection Q4H (every 4
hours) as needed.
12. Insulin Regular Human 100 unit/mL Solution Sig: as dir
Injection ASDIR (AS DIRECTED): per sliding scale.
13. Fondaparinux 2.5 mg/0.5 mL Syringe Sig: 2.5 mg Subcutaneous
DAILY (Daily).


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Right Hip fracture
Urinary tract infection


Discharge Condition:
fair


Discharge Instructions:
Please follow-up with your regular doctor once you are out of
rehab or within the next few weeks.
Take your medications as prescribed.

Followup Instructions:
Follow-up with your regular doctor within the next few weeks.
Follow-up with Dr. [**Last Name (STitle) 7376**] (orthopedics) on [**1-9**] 1:20 pm, [**Location (un) 1385**] of [**Hospital Ward Name 23**] building at [**Hospital1 18**].


Completed by:[**2160-12-31**]
{'Other closed transcervical fracture of neck of femur,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Fall from other slipping, tripping, or stumbling,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia'}


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 mechanical fall with right femur fracture

PRESENT ILLNESS: - This is an 85 y/o female with HTN, A fib, HL, COPD, s/p RLL
lobectomy for mycobacterium infection, who presents with a right
femur fracture s/p mechanical fall earlier today. She was out
shopping at [**Company 7546**] earlier today with her family and tripped
over a floor barrier, landing on her right hip. This was a
witnessed fall by her family - per pt and family, no LOC or
hitting of head. Pt denies any preceding dizziness/LH, chest
pain, SOB, palpitations, n/v/. Presented to the ED at 3 pm with
right hip swelling and pain, unable to support weight. She was
found to have a right femur head fracture and was seen by ortho,
plan for OR tomorrow. She now needs medical clearance.
.
At baseline, pt is able to walk [**2-4**] miles comfortably and is
very independent. She can easily climb 2 flights of stair with
groceries. Denies SOB or CP with activity or with rest. Per
daughter, pt had stress test [**10-8**] which was "excellent." No h/o
cardiac intervention. Reports her COPD at baseline, does not use
inhalors.

MEDICAL HISTORY: 1. Chronic obstructive pulmonary disease, right lower lobe
lobectomy for mycobacterium xenopi infection.
2. Atrial fibrillation, status post two failed
cardioversions.
3. Hypertension.
4. Hypercholesterolemia.
5. Diverticulosis.
6. Status post cholecystectomy.
7. Status post total abdominal hysterectomy, bilateral
salpingo-oophorectomy.
8. Arthritis.
9. Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1. Plavix 75 mg qd - for afib, previously on coumadin but d/c'd
due to risk with falls
2. ASA 81 mg qd
3. Lipitor 10 mg qd
4. HCTZ 25 mg qd
5. Protonix 40 mg qd
6. Enablex 7.5 mg qd
7. Diltiazem 180 mg qd (per OMR notes, pt unsure of dose)

ALLERGIES: Codeine / Ultram

PHYSICAL EXAM: VS: Tc 98.4, BP 120/72, HR 88, RR 18, SaO2 100%/RA, wt 163.9 lbs

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: The patient lives alone on [**Hospital3 **] and visits her daughter who
lives in [**Name (NI) 620**]. Former tobacco use, quit thirty years ago. No
alcohol use. Very active and independent with ADL's. Functional
capacity > 4 mets. 

### Response:
{'Other closed transcervical fracture of neck of femur,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Fall from other slipping, tripping, or stumbling,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia'}
