CHIEF COMPLAINT: subarachnoid hemorrhage

PRESENT ILLNESS: [**Age over 90 **]yo woman with history of Alzheimer's dementia fell from
standing position and hit head on a bed post at her ALF the
night prior to admission. At the time of the fall, the nursing
aid denies LOC. Did not fall to ground. Per report patient
initally complained of head and right hip pain after the fall.
She was initially evaluated at [**Location (un) 620**] and found to have a
subarachnoid hemorrhage on head CT. VS at [**Location (un) 620**] were T
98.4/HR88/RR15/BP134/73/O296%RA with GCS of 13. She was loaded
with Dilantin x 1g and was transferred to [**Hospital1 18**] for further
evaluation.
.
In the [**Hospital1 18**] ED, she was seen by Neurosurgery who did not feel
there was any surgical intervention. Hip, femur, and knee films
were negative. VS in our ED were BP 130's - 160's/50's to 80's,
HR 69-90, RR 13-22, GCS 15.
.
During her MICU course, she was minimally alert and nearly
unresponsive. She was described to variably answer simple yes
and no questions. She had f/u head CT, which demonstrated stable
subarachnoid hemorrhage, and she was followed by Neurosurgery.
She was treated with Dilantin for seizure prophylaxis, and she
was given Morphine IV prn for pain; nursing reports that she had
pain behavior consisting of moaning and grimacing that responded
well to prn Morphine. The primary MICU team held extensive
discusssion with the caregiver/health care proxy in regards to
her poor prognosis. Additionally, she developed an inferior ST
elevation MI with markedly positive cardiac biomarkers and
associated bradycardia/hypotension. The caretaker was informed
of all this, and decision was made to only provide minimal
supportive care. Specifically, there would be no aggresive
therapy (ASA, heparin, etc) for her STEMI given her overall poor
prognosis and also her intracranial hemorrhage.

MEDICAL HISTORY: Alzheimer's Dementia - baseline MS alert to person only
Hypothyroidism
Right hip replacement

MEDICATION ON ADMISSION: .

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals (on transfer to floor): T 96.3, BP 90/62, HR 43, RR 16,
96% RA
General: Sleepy but arousable, NAD; opens eyes to command,
pupils small, minimally reactive
HEENT: hematoma over right temple
CV: RRR, 2/6 systolic murmur
Lungs: Clear bilaterally (anteriorally)
Abdomen: Soft, nondistended, nontender, +BS
Extremities: warmth/erythema/edema in RUE at previous IV site
Neuro: arousable to voice and painful stimuli; moves all 4
extremities to painful stimuli, not giving verbal answers to
questions.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives at [**Hospital3 **]
Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Subendocardial infarction, initial episode of care,Unspecified fall,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Hip joint replacement
Subarachnoid hem-no coma,Subendo infarct, initial,Fall NOS,Alzheimer's disease,Dementia w/o behav dist,Hypothyroidism NOS,Joint replaced hip
Admission Date:  [**2130-1-12**]              Discharge Date:   [**2130-1-22**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
subarachnoid hemorrhage

Major Surgical or Invasive Procedure:
none

History of Present Illness:
[**Age over 90 **]yo woman with history of Alzheimer's dementia fell from
standing position and hit head on a bed post at her ALF the
night prior to admission. At the time of the fall, the nursing
aid denies LOC. Did not fall to ground. Per report patient
initally complained of head and right hip pain after the fall.
She was initially evaluated at [**Location (un) 620**] and found to have a
subarachnoid hemorrhage on head CT. VS at [**Location (un) 620**] were T
98.4/HR88/RR15/BP134/73/O296%RA with GCS of 13. She was loaded
with Dilantin x 1g and was transferred to [**Hospital1 18**] for further
evaluation.
.
In the [**Hospital1 18**] ED, she was seen by Neurosurgery who did not feel
there was any surgical intervention. Hip, femur, and knee films
were negative. VS in our ED were BP 130's - 160's/50's to 80's,
HR 69-90, RR 13-22, GCS 15.
.
During her MICU course, she was minimally alert and nearly
unresponsive. She was described to variably answer simple yes
and no questions. She had f/u head CT, which demonstrated stable
subarachnoid hemorrhage, and she was followed by Neurosurgery.
She was treated with Dilantin for seizure prophylaxis, and she
was given Morphine IV prn for pain; nursing reports that she had
pain behavior consisting of moaning and grimacing that responded
well to prn Morphine. The primary MICU team held extensive
discusssion with the caregiver/health care proxy in regards to
her poor prognosis. Additionally, she developed an inferior ST
elevation MI with markedly positive cardiac biomarkers and
associated bradycardia/hypotension. The caretaker was informed
of all this, and decision was made to only provide minimal
supportive care. Specifically, there would be no aggresive
therapy (ASA, heparin, etc) for her STEMI given her overall poor
prognosis and also her intracranial hemorrhage.


Past Medical History:
Alzheimer's Dementia - baseline MS alert to person only
Hypothyroidism
Right hip replacement


Social History:
Lives at [**Hospital3 **]

Family History:
Unknown

Physical Exam:
Vitals (on transfer to floor): T 96.3, BP 90/62, HR 43, RR 16,
96% RA
General: Sleepy but arousable, NAD; opens eyes to command,
pupils small, minimally reactive
HEENT: hematoma over right temple
CV: RRR, 2/6 systolic murmur
Lungs: Clear bilaterally (anteriorally)
Abdomen: Soft, nondistended, nontender, +BS
Extremities: warmth/erythema/edema in RUE at previous IV site
Neuro: arousable to voice and painful stimuli; moves all 4
extremities to painful stimuli, not giving verbal answers to
questions.

Pertinent Results:
[**2130-1-12**] 05:13PM   GLUCOSE-137* UREA N-22* CREAT-0.8 SODIUM-139
POTASSIUM-4.2 CHLORIDE-105 TOTAL CO2-24 ANION GAP-14
[**2130-1-12**] 07:33AM   LACTATE-2.3*
[**2130-1-12**] 07:32AM   WBC-15.5* RBC-4.10* HGB-13.1 HCT-36.6 MCV-89
MCH-32.0 MCHC-35.9* RDW-13.7
[**2130-1-12**] 07:32AM   PLT COUNT-236
[**2130-1-12**] 07:32AM   PT-11.1 PTT-18.9* INR(PT)-0.9
[**2130-1-12**] 07:32AM   FIBRINOGE-420*
.
EKG (admission)- NSR @ 78 bpm, 1mm ST depressions in 1 and avL.

Repeat EKG demonstrates several mm ST elevation in inferior
leads w/ reciprocal changes.

.

Imaging:
.
[**2130-1-12**] cxr: Mild cardiac enlargement consistent with systemic
hypertension but no evidence of CHF or acute infiltrates
.
[**2130-1-12**] Head CT - right frontal subarachnoid hemorrhage; right
temporal bone fracture
.
[**2130-1-13**] Head CT -
1. Stable appearance of subarachnoid blood, subdural blood, and
intraventricular blood as described. No new blood noted.
2. Revisualization of multiple opacified right mastoid air cells
and
nondisplaced right longitudinal temporal bone fracture.
Increased air-fluid level as described.
.
[**2130-1-12**] Right Knee - No evidence of fracture or dislocation.
Right total hip replacement.
.
[**2130-1-12**] Right Femur - No evidence of fracture or dislocation.
Right total hip replacement.
.
[**2129-1-12**] Right Hip - No evidence of fracture or dislocation.
Right total hip replacement.
.

Micro data:
.
URINE CULTURE (Final [**2130-1-14**]):    NO GROWTH.


Brief Hospital Course:
[**Age over 90 **] yo with Alzheimer's dementia initially treated in the MICU
for subarachnoid hemorrage and inferior ST elevation MI, called
out to the floor, was kept comfortable with basic measures,
eventuall died on [**2130-1-22**] at 6.20 AM. HCP and PCP were informed.
HCP decided against an autopsy.
.
1. SAH/s/p fall: Pt has suffered a significant intracranial
hemorrhage, and has severe impairments on account of this.
Overall, her prognosis was very poor soon after the event, and
Neurosurgery has indicated that there is no role for surgical
intervention. Her poor/critical prognosis has been extensively
communicated with her only family, namely her guardian
[**Name (NI) **]. It was decided not to do further imaging, to
continue Dilantin for seizure prophylaxis and prn Morhpine for
pain control. Pt eventually died while being kept comfortable.
.
2. STEMI: Pt had ST elevation in inferior distribution and
marked cardiac enzyme elevation. No further intervention given
her intracranial hemorrhage and per discussion with guardian.
.
3. FEN: NPO.
.
4. Code status: DNR/DNI.


Medications on Admission:
.

Discharge Medications:
.

Discharge Disposition:
Expired

Discharge Diagnosis:
Pt died.

Discharge Condition:
.

Discharge Instructions:
.

Followup Instructions:
.

                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{"Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Subendocardial infarction, initial episode of care,Unspecified fall,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Hip joint replacement"}


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: subarachnoid hemorrhage

PRESENT ILLNESS: [**Age over 90 **]yo woman with history of Alzheimer's dementia fell from
standing position and hit head on a bed post at her ALF the
night prior to admission. At the time of the fall, the nursing
aid denies LOC. Did not fall to ground. Per report patient
initally complained of head and right hip pain after the fall.
She was initially evaluated at [**Location (un) 620**] and found to have a
subarachnoid hemorrhage on head CT. VS at [**Location (un) 620**] were T
98.4/HR88/RR15/BP134/73/O296%RA with GCS of 13. She was loaded
with Dilantin x 1g and was transferred to [**Hospital1 18**] for further
evaluation.
.
In the [**Hospital1 18**] ED, she was seen by Neurosurgery who did not feel
there was any surgical intervention. Hip, femur, and knee films
were negative. VS in our ED were BP 130's - 160's/50's to 80's,
HR 69-90, RR 13-22, GCS 15.
.
During her MICU course, she was minimally alert and nearly
unresponsive. She was described to variably answer simple yes
and no questions. She had f/u head CT, which demonstrated stable
subarachnoid hemorrhage, and she was followed by Neurosurgery.
She was treated with Dilantin for seizure prophylaxis, and she
was given Morphine IV prn for pain; nursing reports that she had
pain behavior consisting of moaning and grimacing that responded
well to prn Morphine. The primary MICU team held extensive
discusssion with the caregiver/health care proxy in regards to
her poor prognosis. Additionally, she developed an inferior ST
elevation MI with markedly positive cardiac biomarkers and
associated bradycardia/hypotension. The caretaker was informed
of all this, and decision was made to only provide minimal
supportive care. Specifically, there would be no aggresive
therapy (ASA, heparin, etc) for her STEMI given her overall poor
prognosis and also her intracranial hemorrhage.

MEDICAL HISTORY: Alzheimer's Dementia - baseline MS alert to person only
Hypothyroidism
Right hip replacement

MEDICATION ON ADMISSION: .

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals (on transfer to floor): T 96.3, BP 90/62, HR 43, RR 16,
96% RA
General: Sleepy but arousable, NAD; opens eyes to command,
pupils small, minimally reactive
HEENT: hematoma over right temple
CV: RRR, 2/6 systolic murmur
Lungs: Clear bilaterally (anteriorally)
Abdomen: Soft, nondistended, nontender, +BS
Extremities: warmth/erythema/edema in RUE at previous IV site
Neuro: arousable to voice and painful stimuli; moves all 4
extremities to painful stimuli, not giving verbal answers to
questions.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives at [**Hospital3 **] 

### Response:
{"Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Subendocardial infarction, initial episode of care,Unspecified fall,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified acquired hypothyroidism,Hip joint replacement"}
