CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: 82 year old woman with severe baseline dementia who fell in the
[**Doctor Last Name 6641**] at home and was found to have a worsening nasal bridge
hematoma at [**Hospital 4068**] Hospital.  The patient was then transferred
to [**Hospital1 18**] for evaluation and serial monitoring of SDH, the latter
of which revealed no worsening by head CTs and neurologic exams.
 Late in her hospital course, the patient experienced several
episodes of SVT.  Lopressor was attempted for rate control, but
without consistently good effect.  The patient was evaluated by
the EP service who considered ablation.  She was to be
transferred to the [**Hospital Unit Name 196**] service for monitoring peri-procedurally
but anasthesia felt that the patient could not consent for
herself.  She was thus transferred to [**Doctor Last Name 22583**] for further evaluation
where her tachycardia was well managed with medicaiton. After
much consideration, the electrophysiology service decided not to
proceed with ablation since her multiple falls were more likely
resulting from mechanical instability rather than arrhythmia.
Ultimately, she will require placement at an extended care
facility for further monitoring and physical therapy.
-
Was observed by the [**Male First Name (un) 1573**] resident to have 2 episodes of 5
seconds each of staring off to left without responsiveness or
body motions.

MEDICAL HISTORY: severe dementia (baseline oriented x1)
s/p multiple falls

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98.6 74 178/80, 16, 94%RA
Awake alert talkative, oriented x 1
HEENT right frontal hematoma 3cm, R eye ecchymosis, neck supple,
PERRL EOMI
PULM CTAB
RRR, S1S2, II/VI murmur, loudest @ ULSB, no carotid bruits
Soft, NT, ND, NABS
Warm X 4 w/o edema
A&O only to name

FAMILY HISTORY: nc

SOCIAL HISTORY: lives with husband who is proxy
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Contusion of face, scalp, and neck except eye(s),Unspecified fall,Other specified cardiac dysrhythmias,Other persistent mental disorders due to conditions classified elsewhere
Subdural hem w/o coma,Contusion face/scalp/nck,Fall NOS,Cardiac dysrhythmias NEC,Mental disor NEC oth dis
Admission Date:  [**2155-3-8**]              Discharge Date:   [**2155-3-19**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
none


History of Present Illness:
82 year old woman with severe baseline dementia who fell in the
[**Doctor Last Name 6641**] at home and was found to have a worsening nasal bridge
hematoma at [**Hospital 4068**] Hospital.  The patient was then transferred
to [**Hospital1 18**] for evaluation and serial monitoring of SDH, the latter
of which revealed no worsening by head CTs and neurologic exams.
 Late in her hospital course, the patient experienced several
episodes of SVT.  Lopressor was attempted for rate control, but
without consistently good effect.  The patient was evaluated by
the EP service who considered ablation.  She was to be
transferred to the [**Hospital Unit Name 196**] service for monitoring peri-procedurally
but anasthesia felt that the patient could not consent for
herself.  She was thus transferred to [**Doctor Last Name 22583**] for further evaluation
where her tachycardia was well managed with medicaiton. After
much consideration, the electrophysiology service decided not to
proceed with ablation since her multiple falls were more likely
resulting from mechanical instability rather than arrhythmia.
Ultimately, she will require placement at an extended care
facility for further monitoring and physical therapy.
-
Was observed by the [**Male First Name (un) 1573**] resident to have 2 episodes of 5
seconds each of staring off to left without responsiveness or
body motions.

Past Medical History:
severe dementia (baseline oriented x1)
s/p multiple falls

Social History:
lives with husband who is proxy

Family History:
nc

Physical Exam:
98.6 74 178/80, 16, 94%RA
Awake alert talkative, oriented x 1
HEENT right frontal hematoma 3cm, R eye ecchymosis, neck supple,
PERRL EOMI
PULM CTAB
RRR, S1S2, II/VI murmur, loudest @ ULSB, no carotid bruits
Soft, NT, ND, NABS
Warm X 4 w/o edema
A&O only to name


Pertinent Results:
CT abd/pelvis [**3-8**]: IMPRESSION No evidence of acute traumatic
injury within the abdomen or pelvis.

CT Cspine [**3-8**]: IMPRESSION Degenerative change without evidence
of acute fracture.  NODULAR DENSITY NOTED IN THE RIGHT LUNG
APEX. THIS NEEDS TO BE FURTHER EVALUATED WITH CT OF THE CHEST.

CT head [**3-8**]: IMPRESSION Stable right subdural hematoma and
subcutaneous right frontal hematoma.

CT head [**3-9**]: IMPRESSION Stable appearance of right subdural
hematoma compared to the study of one day prior.

CHEST (PORTABLE AP)  [**2155-3-13**] 5:41 AM
FINDINGS: Comparisons made to the previous day. The heart is
enlarged but unchanged when compared to the previous day. The
mediastinal contours are stable. Possible bronchiectasis is seen
within the left lower lobe. There is no evidence of pulmonary
parencnymal consolidation, pleural effusion, or pneumothorax. No
failure is seen.
IMPRESSION: Cardiomegaly with no evidence of CHF or pneumonia.

CHEST (SINGLE VIEW)  [**2155-3-12**] 1:31 PM
FINDINGS:Again note is made of cardiomegaly. The mediastinal and
hilar contours are unchanged compared to the prior study. No
evidence of CHF is noted. No evidence of parenchymal
consolidation noted.
IMPRESSION:Mild cardiomegaly.

KNEE (AP, LAT & OBLIQUE) RIGHT  [**2155-3-11**] 2:29 PM
IMPRESSION:
1. No definite evidence of acute fracture or dislocation in the
right hip or right knee. If clinical suspiscion remains high,
additional imaging would be recommended, as severe osteopenia
limits sensitivity for detection of nondisplaced fractures.
2. Right knee effusion.

FEMUR (AP & LAT) RIGHT  [**2155-3-11**] 2:29 PM
1. No definite evidence of acute fracture or dislocation in the
right hip or right knee. If clinical suspiscion remains high,
additional imaging would be recommended, as severe osteopenia
limits sensitivity for detection of nondisplaced fractures.
2. Right knee effusion.
3. Osteoarthritis at the right hip and right knee with
chondrocalcinosis of the knee.

WRIST(3 + VIEWS) RIGHT  [**2155-3-11**] 2:29 PM
IMPRESSION:
Osteoarthritis of the triscaphe joint.
Calcification of the triangular fibrocartilage complex.

[**2155-3-18**] 05:03AM BLOOD WBC-10.8 RBC-3.74* Hgb-11.2* Hct-34.5*
MCV-92 MCH-29.8 MCHC-32.3 RDW-12.7 Plt Ct-352
[**2155-3-17**] 05:07AM BLOOD WBC-10.0 RBC-3.64* Hgb-11.4* Hct-33.2*
MCV-91 MCH-31.5 MCHC-34.5 RDW-12.6 Plt Ct-321
[**2155-3-16**] 06:20AM BLOOD WBC-10.3 RBC-3.67* Hgb-11.3* Hct-33.3*
MCV-91 MCH-30.8 MCHC-34.0 RDW-12.7 Plt Ct-294
[**2155-3-15**] 05:35AM BLOOD WBC-10.0 RBC-3.66* Hgb-12.0 Hct-33.7*
MCV-92 MCH-32.8* MCHC-35.7* RDW-12.5 Plt Ct-289
[**2155-3-14**] 05:27AM BLOOD WBC-8.1 RBC-3.56* Hgb-11.1* Hct-32.6*
MCV-92 MCH-31.0 MCHC-33.9 RDW-13.0 Plt Ct-265
[**2155-3-12**] 01:23PM BLOOD WBC-12.0* RBC-3.68* Hgb-11.9* Hct-33.0*
MCV-90 MCH-32.2* MCHC-36.0* RDW-12.9 Plt Ct-223
[**2155-3-12**] 05:15AM BLOOD WBC-10.5 RBC-3.68* Hgb-11.6* Hct-33.1*
MCV-90 MCH-31.4 MCHC-34.9 RDW-13.1 Plt Ct-234
[**2155-3-11**] 05:35AM BLOOD WBC-12.7* RBC-3.97* Hgb-12.4 Hct-35.9*
MCV-90 MCH-31.1 MCHC-34.4 RDW-13.0 Plt Ct-229
[**2155-3-10**] 04:18AM BLOOD WBC-8.5 RBC-3.70* Hgb-11.5* Hct-33.6*
MCV-91 MCH-31.1 MCHC-34.2 RDW-13.2 Plt Ct-210
[**2155-3-9**] 02:19AM BLOOD WBC-6.8 RBC-3.91* Hgb-12.2 Hct-34.5*
MCV-88# MCH-31.1 MCHC-35.3*# RDW-13.0 Plt Ct-234
[**2155-3-8**] 10:29PM BLOOD WBC-7.5 RBC-4.59 Hgb-14.1 Hct-44.1 MCV-96
MCH-30.8 MCHC-32.0 RDW-13.2 Plt Ct-263
[**2155-3-9**] 02:19AM BLOOD PT-13.2 PTT-25.6 INR(PT)-1.1
[**2155-3-8**] 04:26PM BLOOD PT-13.0 PTT-25.6 INR(PT)-1.1
[**2155-3-18**] 05:03AM BLOOD Glucose-91 UreaN-13 Creat-0.5 Na-139
K-3.9 Cl-101 HCO3-30* AnGap-12
[**2155-3-17**] 05:07AM BLOOD Glucose-109* UreaN-9 Creat-0.4 Na-134
K-3.8 Cl-99 HCO3-27 AnGap-12
[**2155-3-16**] 06:20AM BLOOD Glucose-102 UreaN-11 Creat-0.5 Na-136
K-3.4 Cl-99 HCO3-28 AnGap-12
[**2155-3-15**] 05:35AM BLOOD Glucose-117* UreaN-10 Creat-0.5 Na-137
K-3.6 Cl-100 HCO3-29 AnGap-12
[**2155-3-14**] 05:27AM BLOOD Glucose-103 UreaN-14 Creat-0.5 Na-137
K-4.0 Cl-103 HCO3-26 AnGap-12
[**2155-3-13**] 05:05AM BLOOD Glucose-110* UreaN-16 Creat-0.7 Na-135
K-4.0 Cl-104 HCO3-22 AnGap-13
[**2155-3-13**] 04:17AM BLOOD Glucose-113* UreaN-16 Creat-0.7 Na-133
K-3.8 Cl-103 HCO3-21* AnGap-13
[**2155-3-12**] 01:23PM BLOOD Glucose-99 UreaN-15 Creat-0.7 Na-134
K-3.9 Cl-101 HCO3-23 AnGap-14
[**2155-3-11**] 05:35AM BLOOD K-3.3
[**2155-3-10**] 04:18AM BLOOD Glucose-95 UreaN-10 Creat-0.6 Na-140
K-3.5 Cl-107 HCO3-27 AnGap-10
[**2155-3-9**] 02:19AM BLOOD Glucose-134* UreaN-10 Creat-0.6 Na-139
K-3.5 Cl-106 HCO3-24 AnGap-13
[**2155-3-8**] 04:15PM BLOOD Glucose-106* UreaN-13 Creat-0.6 Na-140
K-4.1 Cl-103 HCO3-29 AnGap-12
[**2155-3-13**] 05:05AM BLOOD CK(CPK)-841*
[**2155-3-12**] 09:23PM BLOOD CK(CPK)-986*
[**2155-3-12**] 01:23PM BLOOD CK(CPK)-1281*
[**2155-3-12**] 12:50PM BLOOD CK(CPK)-1293*
[**2155-3-12**] 05:15AM BLOOD CK(CPK)-603*
[**2155-3-12**] 05:15AM BLOOD ALT-39 AST-53* LD(LDH)-225 AlkPhos-68
Amylase-19 TotBili-1.2
[**2155-3-10**] 08:20PM BLOOD CK(CPK)-214*
[**2155-3-10**] 01:08PM BLOOD CK(CPK)-209*
[**2155-3-10**] 04:18AM BLOOD CK(CPK)-183*
[**2155-3-12**] 09:23PM BLOOD CK-MB-20* MB Indx-2.0 cTropnT-<0.01
[**2155-3-12**] 01:23PM BLOOD CK-MB-36* MB Indx-2.8 cTropnT-<0.01
[**2155-3-12**] 12:50PM BLOOD CK-MB-36* MB Indx-2.8 cTropnT-<0.01
[**2155-3-12**] 05:15AM BLOOD CK-MB-13* MB Indx-2.2 cTropnT-0.01
[**2155-3-10**] 08:20PM BLOOD CK-MB-6 cTropnT-0.05*
[**2155-3-10**] 01:08PM BLOOD CK-MB-6 cTropnT-0.07*
[**2155-3-10**] 04:18AM BLOOD CK-MB-5 cTropnT-0.12*
[**2155-3-18**] 05:03AM BLOOD Calcium-8.7 Phos-3.0 Mg-1.8
[**2155-3-17**] 05:07AM BLOOD Albumin-3.2* Calcium-8.7 Phos-2.7 Mg-1.6
[**2155-3-16**] 06:20AM BLOOD Calcium-8.6 Phos-2.7 Mg-1.7
[**2155-3-15**] 05:35AM BLOOD Calcium-8.9 Phos-2.7 Mg-1.9
[**2155-3-14**] 05:27AM BLOOD Calcium-8.3* Phos-2.8 Mg-1.9
[**2155-3-13**] 05:05AM BLOOD Calcium-8.9 Phos-2.6* Mg-2.9*
[**2155-3-13**] 04:17AM BLOOD Calcium-9.2 Mg-3.5*
[**2155-3-12**] 01:23PM BLOOD Calcium-8.9 Phos-2.6* Mg-2.0
[**2155-3-13**] 04:17AM BLOOD Calcium-9.2 Mg-3.5*
[**2155-3-11**] 05:35AM BLOOD Calcium-8.8 Mg-1.6 Cholest-203*
[**2155-3-10**] 04:18AM BLOOD Calcium-8.9 Phos-3.1 Mg-2.1
[**2155-3-9**] 02:19AM BLOOD Calcium-8.8 Phos-2.9 Mg-1.8
[**2155-3-8**] 04:15PM BLOOD Calcium-9.6 Phos-3.5 Mg-1.9
[**2155-3-12**] 05:15AM BLOOD VitB12-397
[**2155-3-11**] 05:35AM BLOOD Triglyc-75 HDL-72 CHOL/HD-2.8 LDLcalc-116
[**2155-3-12**] 05:15AM BLOOD TSH-6.2*
[**2155-3-12**] 09:23PM BLOOD Free T4-0.9*
[**2155-3-18**] 05:03AM BLOOD Phenyto-4.5*
[**2155-3-17**] 05:07AM BLOOD Phenyto-6.2*
[**2155-3-16**] 06:20AM BLOOD Phenyto-10.5
[**2155-3-15**] 05:35AM BLOOD Phenyto-14.7

CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2155-3-16**]):
      FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA.
      Reference Range:  Negative.

URINE CULTURE (Final [**2155-3-15**]):
      MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT
WITH SKIN
      AND/OR GENITAL CONTAMINATION.
URINE CULTURE (Final [**2155-3-13**]):    NO GROWTH.

RAPID PLASMA REAGIN TEST (Final [**2155-3-13**]):
      NONREACTIVE.
      Reference Range: Non-Reactive.


Brief Hospital Course:
Admitted for SDH neuro checks by neurosurgery to T-SICU.  Pt
remained stable hemodynamically, by neuro exam, and by
hematocrit for two days.  Transfered to the floor for further
evaluation on HD 3. Two repeat head CTs demonstrated no change
in the subdural hematoma and she did not have any further
worsening of neurologic exam throughout admission.  She will
followup with [**Hospital 4695**] clinic in 2 weeks for interval course
monitoring.
.
Ms [**Known lastname 58648**] does have baseline severe dementia, which manifested
floridly throughout the admission as agitation and confusion.
Neurobehavioral medicine, social work, and geriatric medicine
all were involved in her care here.  She required chemical and
physical restraints early in the admission but not afterward as
she was very pleasant and calm.  Consensus with all contributing
services is that after rehab, Ms [**Known lastname 58648**] likely will need long
term extended care placement, however family continues to be
resistant to this idea.  They were interested in future
neuropsychiatric testing and recommended to contact gerontology.
.
On HD 3, pt had several episodes of supraventricular tachycardia
but remained hemodynamically stable and resolved with lopressor
IV-- On admission her EKG demonstrated a RBBB, following cardiac
enzymes and EKG with cardiology consult elucidated likely demand
ischemia with lateral and inferior ST depressions which remained
stable throughout admission.  She was maintained on metoprolol
PO titrated for HR and BP and remained hemodynamically stable
despite 7 more episodes on subsequent days of SVT that also
resolved either spontaneously or with lopressor IV or adenosine
IV.  EP cardiology considered that her SVT, likely AVNRT, was
appropriately medically managed and deferred ablation at this
time. Instead, Ms [**Known lastname 58648**] will continue to be monitored by
telemetry at rehab while continuing medical management with
diltiazem and metoprolol.  Her blood pressure control was
improved by titrating metoprolol up to 75mg [**Hospital1 **].
.
Her falls were considered most likely mechanical rather than
arrhythmic in nature.  Ms [**Known lastname 58648**] will need intensive physical
therapy as an outpatient.
.
She was started on levothyroxine for hypothyroidism.
.
On transfer to the [**Doctor Last Name 22583**] general medicine service, the patient was
noted to have transient periods of nonresponsiveness
characterized by staring to the right. Neurosurgery was
consulted and the episodes were thought most likely seizure
activity. She was given loading dose and maintained on dilantin
starting [**2155-3-17**]. She has had daily monitoring of dilantin
levels as an inpatient while conservatively increasing the
maintenance dose to approach therapeutic levels.  As the need
for seizure prophylaxis is not urgent, her dilantin dose has
been very slowly increased by 100mg per day every few days.
Dilantin levels will need to be monitored at the rehab facility.

.
She was discharged to rehab in good condition in her usual state
of health, hemodynamically stable and tolerating the oral diet
well.
.
Followup with trauma and neurosurgery, cardiology, geriatrics,
and her PCP [**First Name4 (NamePattern1) 3075**] [**Last Name (NamePattern1) **] were recommended.


Medications on Admission:
none

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Trazodone HCl 50 mg Tablet Sig: 0.25 Tablet PO HS (at
bedtime) as needed.
3. Calcium Carbonate 1250 mg/5 mL Suspension Sig: Ten (10) ML PO
QID (4 times a day) as needed.
4. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
5. Levothyroxine Sodium 25 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
9. Phenytoin 100 mg/4 mL Suspension Sig: Eight (8) ml PO BID (2
times a day).
10. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
three times a day.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] - [**Location (un) 620**]

Discharge Diagnosis:
subdural hematoma due to fall
supraventricular tachycardia
secondary:
severe dementia
multiple falls


Discharge Condition:
good

Discharge Instructions:
-take all medications as prescribed
-return to regular activity as tolerated
-return to regular diet as tolerated

Followup Instructions:
1. Follow up with your PCP [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 3075**] [**Last Name (NamePattern1) **]

2. followup with neurosurgery ([**Telephone/Fax (1) 11314**] in 2 weeks after
discharge for further evaluation of your head injury (subdural
hematoma)

3.followup with trauma surgery clinic at [**Telephone/Fax (1) 56358**]

4. followup with cardiology

5. follow up with geriatrics in a few months for
neuropsychiatric testing if desired ([**Telephone/Fax (1) 6846**]


                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]



Name:  [**Known lastname 10817**],[**Known firstname 1911**]                   Unit No:   [**Numeric Identifier 10818**]

Admission Date:  [**2155-3-8**]              Discharge Date:   [**2155-3-19**]

Date of Birth:  [**2072-7-7**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 342**]
Addendum:
Calcium dose recommended by Dr. [**Last Name (STitle) **] (geriatrics) to be
changed to 500mg TID. Dr. [**Last Name (STitle) **] at [**Location (un) 407**] associates notified
[**2155-3-20**].

Discharge Disposition:
Extended Care

Facility:
[**Location (un) 4641**] - [**Location (un) 407**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 347**] MD [**MD Number(1) 348**]

Completed by:[**2155-3-20**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Contusion of face, scalp, and neck except eye(s),Unspecified fall,Other specified cardiac dysrhythmias,Other persistent mental disorders due to conditions classified elsewhere'}


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 fall

PRESENT ILLNESS: 82 year old woman with severe baseline dementia who fell in the
[**Doctor Last Name 6641**] at home and was found to have a worsening nasal bridge
hematoma at [**Hospital 4068**] Hospital.  The patient was then transferred
to [**Hospital1 18**] for evaluation and serial monitoring of SDH, the latter
of which revealed no worsening by head CTs and neurologic exams.
 Late in her hospital course, the patient experienced several
episodes of SVT.  Lopressor was attempted for rate control, but
without consistently good effect.  The patient was evaluated by
the EP service who considered ablation.  She was to be
transferred to the [**Hospital Unit Name 196**] service for monitoring peri-procedurally
but anasthesia felt that the patient could not consent for
herself.  She was thus transferred to [**Doctor Last Name 22583**] for further evaluation
where her tachycardia was well managed with medicaiton. After
much consideration, the electrophysiology service decided not to
proceed with ablation since her multiple falls were more likely
resulting from mechanical instability rather than arrhythmia.
Ultimately, she will require placement at an extended care
facility for further monitoring and physical therapy.
-
Was observed by the [**Male First Name (un) 1573**] resident to have 2 episodes of 5
seconds each of staring off to left without responsiveness or
body motions.

MEDICAL HISTORY: severe dementia (baseline oriented x1)
s/p multiple falls

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98.6 74 178/80, 16, 94%RA
Awake alert talkative, oriented x 1
HEENT right frontal hematoma 3cm, R eye ecchymosis, neck supple,
PERRL EOMI
PULM CTAB
RRR, S1S2, II/VI murmur, loudest @ ULSB, no carotid bruits
Soft, NT, ND, NABS
Warm X 4 w/o edema
A&O only to name

FAMILY HISTORY: nc

SOCIAL HISTORY: lives with husband who is proxy 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Contusion of face, scalp, and neck except eye(s),Unspecified fall,Other specified cardiac dysrhythmias,Other persistent mental disorders due to conditions classified elsewhere'}
