CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 66 year-old
woman who fell down a flight of stairs and was found face
down unresponsive.  On transfer from an outside hospital she
was answering questions.  She did ETOH in her system the even
of admission.

MEDICAL HISTORY: Hypertension.  Question of no known
allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Bacteremia,Urinary tract infection, site not specified,Closed fracture of mandible, symphysis of body,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Open wound of forehead, without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Subdural hemorr-coma NOS,Bacteremia,Urin tract infection NOS,Fx symphy mandib body-cl,Other staphylococcus,Open wound of forehead,DMII wo cmp nt st uncntr
Admission Date:  [**2197-3-26**]       Discharge Date:  [**2197-4-7**]

Date of Birth:   [**2130-3-23**]       Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 66 year-old
woman who fell down a flight of stairs and was found face
down unresponsive.  On transfer from an outside hospital she
was answering questions.  She did ETOH in her system the even
of admission.

PAST MEDICAL HISTORY:  Hypertension.  Question of no known
allergies.

PHYSICAL EXAMINATION:  Her temperature was 97.8, heart rate
88, blood pressure 18/palp, respiratory rate 20, saturation
100 percent, GCS was 14.  She was confused.  Pupils - her
right was 6 mm, her left was 5 and was sluggish to react and
irregular.  She had 1 cm laceration over the right eye with
hematoma.  Her trachea was midline.  Her voice was clear.
Her lungs were clear to auscultation.  Her abdomen was soft,
nontender, nondistended.  Cardiac:  Regular rate and rhythm.
Extremities:  no clubbing, cyanosis or edema or evidence of
fractures.

EKG showed left bundle branch block.  Chest x-ray showed no
midline shift of the trachea, clear.  Pelvis was clear.  Head
CT:  Left subdural hematoma, epidural hematoma.  Facial CT
shows right orbital floor and zygomatic arch fracture and
also mandible fracture.  Cervical spine was negative.
Thoracic and lumbar spine was also negative.

Patient was taken emergently to the operating room for
evacuation of acute subdural hematoma on [**2197-3-26**].  A left
frontotemporal craniotomy for evacuation of the subdural.
There was no complication.  Postoperatively she was monitored
in Trauma Intensive Care Unit.  She was intubated and
sedated.  Her pupil 4 down to 3 on left, 4.5 on the right and
poorly reactive.  Following commands on the left, not moving
on the right.  Repeat head CT without contrast shows good
evacuation of the subdural hematoma but persistent falcine
subdural hematoma. She was also followed
by the plastic surgery service for her facial fractures and
mandible fracture.

On [**3-30**] she was opening her eyes, moving her left leg
spontaneously, squeezing the left hand purposely, slight
wiggling of toes.  Pupils left 3.5 on the left, trace
reactive, right 4.5 and nonreactive.  Can medialize with the
right eye.  Repeat head CT on [**3-28**] was stable in appearance.
She eventually had MRI of the brain with DWI which just
showed evidence of possible shear injury, external injury
versus old white matter infarcts.  There was no large infarct
and there was still evidence of small amount of contusion and
hemorrhage from the initial fall on the cortex.  The patient had
an extended stay in the Intensive Care Unit and was finally
discharged to the regular floor on [**2197-3-31**].  She was
successfully extubated on [**3-30**].  She did have a PEG placed.
She continued to be purposeful in her movements on the left
side but plegic on the right side.  Right pupil
slugishly reactive,
left 4 down to 3 mm and still continued with the facial
fractures and the mandible fracture.  She had some
respiratory distress on the floor and was transferred back to
the medical Intensive Care Unit.  She did not require
reintubation.  Her respiratory status did improve and she was
then transferred back to the floor where she has remained
stable respiratory-wise and neurologically, obeying some
commands on the left . She was seen by physical therapy and
occupational therapy and felt to require acute
rehabilitation.  She was also taken to the operating room on
[**2197-4-6**] by plastic surgery and had her mandible repaired.
Her jaw is not wired, though.  She was also seen by the
[**Hospital **] Clinic for her elevated blood sugars.  She has
basically been new onset of type 2 diabetes and was started
on Lantus for that and will need to follow up with primary
care physician for further blood sugar monitoring after
discharge from rehabilitation.  Currently she has tube
feeding Impact with fiber at 65 cc an hour through her G
tube.  Her neurologic status is stable.  She follows commands
on the left, has fixed right pupil on the right and plegic on
the right side.  Her incisions are clean, dry and intact.
She is stable for discharge to rehabilitation with follow up
with Dr. [**Last Name (STitle) 739**] in one month with a repeat head CT and
also follow up with plastic surgery in two to three weeks
with her primary care doctor for her new onset of diabetes.

MEDICATIONS AT TIME OF DISCHARGE:
Metoprolol 50 mg p.o. b.i.d., hold for systolic pressure less
than 110.
Colace 100 mg p.o. b.i.d.
Fluconazole product 2 percent topical application.
Furosemide 40 mg p.o. q. day.
Lansoprazole oral suspension 30 mg nasogastric q day.
Neutra-Phos 1 package p.o. nasogastric b.i.d.
Artificial tears 1 to 2 drops o.u. p.r.n.
Chlorhexidine gluconate 15 ml p.o. t.i.d. p.r.n. for mouth
injury.
Heparin 5,000 units subcutaneous q 12 hours.
Dilantin 100 mg intravenous q 8 hours.

CONDITION:  Stable at the time of discharge.




                       [**Name6 (MD) 742**] [**Name8 (MD) **], M.D.  [**MD Number(1) 743**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2197-4-7**]  12:42
T:  [**2197-4-7**]  12:48
JOB#:  [**Job Number 25830**]


Admission Date:  [**2197-3-25**]     Discharge Date:  [**2197-4-11**]

Date of Birth:   [**2130-3-23**]     Sex:  F

Service:

                        ADDENDUM

The patient's discharge was delayed secondary to urinary
tract infection and positive blood culture.  The patient grew
out gram Staphylococcus coag positive, 1 out of 2 bottles of
her blood cultures.  She had a white count of 19 and also
greater than 100,000 yeasts and greater than 100,000
Staphylococcus coag negative in her urine treated with
Vancomycin 1 g IV q.12 hours for five days, and Fluconazole
100 mg IV for seven days, which was started on [**2197-4-10**].

The patient had further blood cultures drawn which to date
have not grown out anything.

Her condition is stable.  Her white count is down to 15.1
today.  Hematocrit is 35.1.  Her other labs are within normal
limits.  Sodium is 135, potassium 4.1, BUN and creatinine 12
and 0.2, glucose 145.

CONDITION ON DISCHARGE:  Stable.

FOLLOW-UP:  She will follow-up with Dr. [**Last Name (STitle) 25918**] in one
month with a repeat head CT.  She should have the staples on
her G-tube removed on the 15th.  Her dressings are clean,
dry, and intact.



           DR.[**Last Name (STitle) **],[**First Name3 (LF) 742**] 14-AAA


Dictated By:[**Last Name (NamePattern1) 344**]

MEDQUIST36

D:  [**2197-4-11**]  12:36
T:  [**2197-4-11**]  13:10
JOB#:  [**Job Number 25919**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Bacteremia,Urinary tract infection, site not specified,Closed fracture of mandible, symphysis of body,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Open wound of forehead, without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: 

PRESENT ILLNESS: The patient is a 66 year-old
woman who fell down a flight of stairs and was found face
down unresponsive.  On transfer from an outside hospital she
was answering questions.  She did ETOH in her system the even
of admission.

MEDICAL HISTORY: Hypertension.  Question of no known
allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Bacteremia,Urinary tract infection, site not specified,Closed fracture of mandible, symphysis of body,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Open wound of forehead, without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
