CHIEF COMPLAINT: Fall with SDH and traumatic SAH

PRESENT ILLNESS: This is a [**Age over 90 **]yo W with a history of hypertension, hyperlipidemia,
ischemic stroke s/p TPA in [**2163**], dementia and lower extremity
edema who sustained in the early morning hours of [**2169-9-26**].
Per her daughter, she was in her
USOH last night and was doing well. Her daughter heard her
mother
fall down the stairs in the early morning hours, and found her
flat on her back. There was no eye fluttering activity, shaking
of her extremities or any other features to suggest seizure. EMS
was immediately called. On arrival, she was noted to have
problems with [**Name2 (NI) 56971**] and was given morphine and zofran for
symptomatic relief.

MEDICAL HISTORY: - Hypertension
- Dementia (unspecified)
- Hypercholesterolemia
- History of ischemic stroke [**2163**] s/p TPA, no residual deficits
- "Leg swelling", treated with lower extremity compression
stockings
- Urinary incontinence s/p sling procedure ([**2163**]).

MEDICATION ON ADMISSION: Atenolol
Lisionpril
Aggrenox
Simvastatin

ALLERGIES: Codeine / Oxycodone / Thioridazine / Tolmetin / Egg

PHYSICAL EXAM: On Admission:
Vitals: AF, 142/62, 97%, 12, 62
General: Elderly frail woman, eyes closed, opens eyes to calling
her name
HEENT: Tender region of swelling over the occipital scalp
without
open laceration or bleeding
Neck: C-spine stabilized with C-collar, difficult to examine. No
gross thyroid enlargement or adenopathy
Pulmonary: Lungs CTA anteriorly
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, no masses or organomegaly noted, positive
bowel sounds
Extremities:warm and well perfused, 2+ nonpitting edema.
Skin: no rashes or lesions noted.

FAMILY HISTORY: Family History: Mother died of cancer at 42, father with
dementia

SOCIAL HISTORY: No alcohol, tobacco or drugs. Per daughter, she is "allergic to
cigarette smoke". Currently, the daughter reports that the
patient has "dementia". She does speak, but it is often
difficult to comprehend and nonsensical. She does
walk with a cane or walker, but sometimes she may walk by
herself. She does need help bathing. She does not manage her own
finances, etc.
Pure hypercholesterolemia,Do not resuscitate status,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Acute respiratory failure,Accidental fall on or from other stairs or steps,Home accidents,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance
Pure hypercholesterolem,Do not resusctate status,Cl skul base fx w/o coma,Acute respiratry failure,Fall on stair/step NEC,Accident in home,Hypertension NOS,Demen NOS w/o behv dstrb
Admission Date:  [**2169-9-26**]              Discharge Date:   [**2169-10-1**]


Service: NEUROSURGERY

Allergies:
Codeine / Oxycodone / Thioridazine / Tolmetin / Egg

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Fall with SDH and traumatic SAH

Major Surgical or Invasive Procedure:
none

History of Present Illness:
This is a [**Age over 90 **]yo W with a history of hypertension, hyperlipidemia,
ischemic stroke s/p TPA in [**2163**], dementia and lower extremity
edema who sustained in the early morning hours of [**2169-9-26**].
Per her daughter, she was in her
USOH last night and was doing well. Her daughter heard her
mother
fall down the stairs in the early morning hours, and found her
flat on her back. There was no eye fluttering activity, shaking
of her extremities or any other features to suggest seizure. EMS
was immediately called. On arrival, she was noted to have
problems with [**Name2 (NI) 56971**] and was given morphine and zofran for
symptomatic relief.

ROS: not obtained from patient, per daughter, no recent sick
symptoms, no recent fever or weight loss, no change in
medications, no anticoagulation



Past Medical History:
- Hypertension
- Dementia (unspecified)
- Hypercholesterolemia
- History of ischemic stroke [**2163**] s/p TPA, no residual deficits
- "Leg swelling", treated with lower extremity compression
stockings
- Urinary incontinence s/p sling procedure ([**2163**]).


Social History:
No alcohol, tobacco or drugs. Per daughter, she is "allergic to
cigarette smoke". Currently, the daughter reports that the
patient has "dementia". She does speak, but it is often
difficult to comprehend and nonsensical. She does
walk with a cane or walker, but sometimes she may walk by
herself. She does need help bathing. She does not manage her own
finances, etc.



Family History:
Family History: Mother died of cancer at 42, father with
dementia


Physical Exam:
On Admission:
Vitals: AF, 142/62, 97%, 12, 62
General: Elderly frail woman, eyes closed, opens eyes to calling
her name
HEENT: Tender region of swelling over the occipital scalp
without
open laceration or bleeding
Neck: C-spine stabilized with C-collar, difficult to examine. No
gross thyroid enlargement or adenopathy
Pulmonary: Lungs CTA anteriorly
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, no masses or organomegaly noted, positive
bowel sounds
Extremities:warm and well perfused, 2+ nonpitting edema.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: GCS 14 (E4M4V6). Awake, but poorly
communicative.
Eyes are closed at baseline. Grimaces to pain and turning her
head. Only whispers few words if any, "I'm cold", "I'm feeling
better". Language, praxis, naming, memory is difficult to
assess.
Speech is minimal. Follows some commands intermittently.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 2 to 1mm and brisk.  VFF not assessed.
III, IV and VI: EOM are intact and full, no nystagmus
V: Facial sensation intact to light touch.
VII: No facial droop, facial musculature symmetric. Grimace is
symmetric.
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.

-Motor: Normal bulk, tone. No tremor.
- Upper extremities are antigravity
- Lower extremities withdraw to babinski testing, poor effort
for
formal strength testing.

- Sensory: Grossly intact to light touch

-DTRs: Diffusely arefleix
-Plantar response: Toes are up bilaterally
-Coordination/Gait: not tested


Pertinent Results:
[**2169-9-26**] 08:03PM   GLUCOSE-152* UREA N-21* CREAT-1.2* SODIUM-141
POTASSIUM-3.9 CHLORIDE-104 TOTAL CO2-27 ANION GAP-14
[**2169-9-26**] 08:03PM   CK(CPK)-108
[**2169-9-26**] 08:03PM   CK-MB-2 cTropnT-<0.01
[**2169-9-26**] 08:03PM   CALCIUM-9.4 PHOSPHATE-3.5 MAGNESIUM-2.0
[**2169-9-26**] 05:37AM   PLT COUNT-278
[**2169-9-26**] 05:37AM   PT-11.2 PTT-20.9* INR(PT)-0.9
[**2169-9-26**] 05:37AM   WBC-13.9* RBC-4.20 HGB-13.2 HCT-39.8 MCV-95
MCH-31.4 MCHC-33.1 RDW-12.7
[**2169-9-26**] 05:37AM   GLUCOSE-165* LACTATE-2.9* NA+-143 K+-3.9
CL--103 TCO2-25
[**2169-9-26**] 05:37AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2169-9-26**] 06:00AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-TR KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG

[**2169-9-26**]: Chest Xray: There is bibasilar atelectasis with no
focal opacification concerning for pneumonia. There are no
pleural effusions or pneumothorax. The cardiomediastinal and
hilar contours are unremarkable demonstrating tortuosity of the
thoracic aorta with atherosclerotic calcification. Accounting
for technique, the heart is mildly enlarged. Pulmonary
vascularity is normal.  The trauma board overlies the film and
obscures fine detail. There is a moderate hiatal hernia.
Incidentally noted is a bone island within the left scapula.

[**2169-9-26**]: CT head IMPRESSION:
1. Multicompartmental hemorrhage with a smaller area of
extraaxial hemorrhage demonstrated adjacent to the right
cerebellar hemisphere, immediately adjacent to a fracture,
left-sided frontal and temporal subarachnoid hemorrhage and
subdural hemorrhage layering along the tentorium and adjacent to
the cerebellar hemispheres.
2. Large mixed density cephalohematoma involving the posterior
occiput.
3. Minimally displaced fracture involving the left aspect of the
occipital
bone extending through the foramen magnum.
4. Minimally displaced fracture of the clivus as better depicted
on concurrent CT of the cervical spine.

[**2169-9-26**]: CT cervical spine: IMPRESSION:
1. Mildly displaced (C-spine 1 to 2 mm) complex occipital bone
fracture
extending along the right aspect of the occipital bone
inferiorly.
2. Minimally displaced fracture of the clivus.
3. No cervical spine fracture or malalignment.
4. Multilevel degenerative changes, most prominent at the level
of C5-C6

[**2169-9-26**] CT Chest/Abdomen/Pelvis IMPRESSION:
1. No evidence of traumatic injury within the chest, abdomen or
pelvis.
2. Right inguinal hernia containing nonobstructed small bowel.
3. Moderate-to-large hiatal hernia.
4. Non-specific periesophageal prominent lymph node with a
hiatal hernia and mild esophageal wall thickening. When
clinically appropriate, follow-up barium esophagram or endoscopy
is suggested, or alternatively CT follow-up could be considered
as a possible alterative in [**2-5**] months.
5. Incompletely characterized hyperenhancing 11mm liver lesion
in segment II for which MRI can be performed or alternatively
follow-up CT in [**2-5**] months as clinically indicated.

[**2169-9-26**] repeat CT head: There is no new intracranial
hemorrhage. There is no increased mass effect or evidence of
infarct. Right occipital fracture extending to the foramen
magnum with associated overlying soft tissue contusion is
redemonstrated.

[**2169-9-28**] LENI's: IMPRESSION: No evidence of deep vein thrombosis
in either leg.

Brief Hospital Course:
Mrs. [**Known lastname 83147**] was admitted to the ICU on the neurosurgery service
for Q1 hour neurochecks and SBP control less than 140.  Repeat
Head CT demonstrated stable intracranial hemorrhages, no new
bleeding.  CT torso was negative for trauma.

Neurologically the patient remained stable on [**9-27**]. She had an
episode of chest pain in the late morning. An EKG was performed
which was stable. The patient also required an increased O2
requirement at this time.
On [**9-28**] the patient was still requiring increased supplemental
O2. CE's were sent and negative. A CTA was requested to rule out
PE, but put on hold due to patient's renal status and inability
to receive anticoagulation. A D-dimer revealed was elevated
however given history of trauma no further interventin was
recommended per ICU.  A family meeting was held on [**9-28**] to
discuss her current O2 requirements.  Family confirmed DNR/DNI
but wanted to think about comfort measures.
 On [**9-29**], family had another family meeting and it was decided
to make her comfort measures only. She remained in the ICU until
[**10-1**] AM when she was transferred to the floor. At 14:45 a
family friend (hospitalist at [**Hospital1 18**]) was visiting the patients
family when they noticed that she had stopped breathing. This
was confirmed with auscultation.
Report of Death Paperwork was completed.

Medications on Admission:
Atenolol
Lisionpril
Aggrenox
Simvastatin


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
Right cerebellar contusion
Left Frontotemporal traumatic Subarachnoid and subdural
hemorrhages
Right occipital skull fracture
Respiratory Failure


Discharge Condition:
n/a


Discharge Instructions:
n/a

Followup Instructions:
n/a



Completed by:[**2169-10-1**]
{'Pure hypercholesterolemia,Do not resuscitate status,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Acute respiratory failure,Accidental fall on or from other stairs or steps,Home accidents,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance'}


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 with SDH and traumatic SAH

PRESENT ILLNESS: This is a [**Age over 90 **]yo W with a history of hypertension, hyperlipidemia,
ischemic stroke s/p TPA in [**2163**], dementia and lower extremity
edema who sustained in the early morning hours of [**2169-9-26**].
Per her daughter, she was in her
USOH last night and was doing well. Her daughter heard her
mother
fall down the stairs in the early morning hours, and found her
flat on her back. There was no eye fluttering activity, shaking
of her extremities or any other features to suggest seizure. EMS
was immediately called. On arrival, she was noted to have
problems with [**Name2 (NI) 56971**] and was given morphine and zofran for
symptomatic relief.

MEDICAL HISTORY: - Hypertension
- Dementia (unspecified)
- Hypercholesterolemia
- History of ischemic stroke [**2163**] s/p TPA, no residual deficits
- "Leg swelling", treated with lower extremity compression
stockings
- Urinary incontinence s/p sling procedure ([**2163**]).

MEDICATION ON ADMISSION: Atenolol
Lisionpril
Aggrenox
Simvastatin

ALLERGIES: Codeine / Oxycodone / Thioridazine / Tolmetin / Egg

PHYSICAL EXAM: On Admission:
Vitals: AF, 142/62, 97%, 12, 62
General: Elderly frail woman, eyes closed, opens eyes to calling
her name
HEENT: Tender region of swelling over the occipital scalp
without
open laceration or bleeding
Neck: C-spine stabilized with C-collar, difficult to examine. No
gross thyroid enlargement or adenopathy
Pulmonary: Lungs CTA anteriorly
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, no masses or organomegaly noted, positive
bowel sounds
Extremities:warm and well perfused, 2+ nonpitting edema.
Skin: no rashes or lesions noted.

FAMILY HISTORY: Family History: Mother died of cancer at 42, father with
dementia

SOCIAL HISTORY: No alcohol, tobacco or drugs. Per daughter, she is "allergic to
cigarette smoke". Currently, the daughter reports that the
patient has "dementia". She does speak, but it is often
difficult to comprehend and nonsensical. She does
walk with a cane or walker, but sometimes she may walk by
herself. She does need help bathing. She does not manage her own
finances, etc. 

### Response:
{'Pure hypercholesterolemia,Do not resuscitate status,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Acute respiratory failure,Accidental fall on or from other stairs or steps,Home accidents,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance'}
