CHIEF COMPLAINT: Unwitnessed fall

PRESENT ILLNESS: Pt is a 71m who was found down at the bottom of six steps
and noted to be apneic. EMS was called and he was transfered to
[**Hospital1 18**] for further evaluation. Upon arrival pt O2 sats noted to
be
in the 80's and he was intubated. Trauma workup obtained in ER
and CT C spine showed a right c6 lamina fracture and small
associated posteral
epidural hematoma, and hyperextension injury. An MRI Cspine was
also done which showed further spinal cord injury. ETOH level
upon arrival was 238.

MEDICAL HISTORY: Unknown

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
PHYSICAL EXAM:
BP: 88/60   HR: 60    R 20      O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:  Pupils reactive
Neck: Supple.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives alone, independent. Has a friend [**Name (NI) 2563**] and a [**Name (NI) **] that
are involved in his care.
Closed fracture of C5-C7 level with complete lesion of cord,Cerebral artery occlusion, unspecified with cerebral infarction,Dissection of vertebral artery,Paralytic ileus,Alkalosis,Ventilator associated pneumonia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Alcohol abuse, unspecified,Accidental fall on or from other stairs or steps
C5-c7 fx-cl/com cord les,Crbl art ocl NOS w infrc,Dissect vertebral artery,Paralytic ileus,Alkalosis,Ventltr assoc pneumonia,Mth sus Stph aur els/NOS,Hypertension NOS,Alcohol abuse-unspec,Fall on stair/step NEC
Admission Date:  [**2134-8-29**]              Discharge Date:   [**2134-9-7**]

Date of Birth:  [**2063-8-14**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2724**]
Chief Complaint:
Unwitnessed fall

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Pt is a 71m who was found down at the bottom of six steps
and noted to be apneic. EMS was called and he was transfered to
[**Hospital1 18**] for further evaluation. Upon arrival pt O2 sats noted to
be
in the 80's and he was intubated. Trauma workup obtained in ER
and CT C spine showed a right c6 lamina fracture and small
associated posteral
epidural hematoma, and hyperextension injury. An MRI Cspine was
also done which showed further spinal cord injury. ETOH level
upon arrival was 238.


Past Medical History:
Unknown

Social History:
Lives alone, independent. Has a friend [**Name (NI) 2563**] and a [**Name (NI) **] that
are involved in his care.

Family History:
Unknown

Physical Exam:
On Admission:
PHYSICAL EXAM:
BP: 88/60   HR: 60    R 20      O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:  Pupils reactive
Neck: Supple.

Neuro:
Mental status: Intubated, awake with eyes open. Not following
commands.

Motor: No spontaneous movement in extremities, no movement to
noxious in extremities and does not appear to grimmace to pain.

Toes downgoing bilaterally

On Discharge:
xxxxxxxxxxxxxx


Pertinent Results:
Head CT [**2134-8-29**]:
No acute blood.

CT Torso [**2134-8-29**]:
IMPRESSION:
1. No traumatic sequelae in the torso.
2. A 14 mm left upper lobe pulmonary nodule. Given the
background of
emphysema, follow up with a dedicated CT of the chest is
recommended within three months.
3. Hepatic steatosis.

CT Cspine [**2134-8-29**]:
IMPRESSION:
1. Nondisplaced right C6 lamina fracture with small associated
posteral
epidural hematoma.
2. Fracture of the anterior inferior corner of C4 and possible
fracture of the anterior bridging osteophytes at C3-4, with
prevertebral edema, suggestive of hyperextension injury. Given
the presence of moderate spinal canal stenosis which deforms the
spinal cord at C3-4 and C4-5, as well as minimal retrolisthesis
at C3-4 of unknown chronicity, the spinal cord is at risk for
contusion with hyperextension injury. Further evaluation for
cord and ligamentous injury is suggested by MRI.

MRI Brain:
IMPRESSION: Acute infarction in the left occipital lobe.

MRI Cspine:
IMPRESSION:
1. Hyperextension injury in the setting of underlying spinal
canal stenosis results in hemorrhagic contusion of the spinal
cord at C3 and C4.
2. Fractures of the C4 anterior-inferior corner and of the C3-4
bridging
osteophytes, with associated focal disruption of the anterior
longitudinal
ligament. Grade 1 retrolisthesis of C3 on C4 of unknown
chronicity.
Interspinous ligament edema at C1-2 and from C3-4 through C5-6.
3. The nondisplaced fracture of the right C6 lamina is better
seen on the
preceding CT scan.
4. Severe bilateral neural foraminal narrowing at multiple
levels.



Brief Hospital Course:
71M admitted on [**2134-8-29**] after sustaining a unwitnessed fall.
Patient suffered a complete spinal cord injury and occipital
infarct. He was placed in a hard collar. He admitted to the
Acute Care Service and the Trauma ICU. He was intubated upon
arrival. On exam patient had no motor or sensory exam on BUE and
BLE. Triple flexion was noted to BLE. Imaging was reviewed which
showed a complete spinal cord injury at C3, Occipital brain
infarct, and vertebral artery dissection at C3-4. ASA was
started on [**9-1**]. He was transferred to the Neurosurgery service
on [**9-1**]. Patient was notified he would need a Trach and expressed
refusal. On [**9-2**] a family meeting with clinicians, Ethics,
patient, and family was held to determine capacity and clarify
patient's wishes. Patient expressed denial of diagnosis and
prognosis. He expressed desire to live but desire not to live
vent dependent. Health Care Proxy was determined with the
patient's input. More time was given to the family and patient
to discuss diagnosis and goals of care.

The developed copious respiratory secretions [**Date range (1) 29177**] was
bronched with Bal  and found to be growing staph and hflu in
sputum was started on Cipro and Naficillin on [**9-6**] he was weaned
to CPAP. He had high residuals of his tube feeds during this
time and was found to have an ileus, he was given multiple
medications to stimulate a bowel movement. He required 2 days of
NG tube suction. In the evening of [**9-6**] he had began having
bowel movements. His neurological exam remained unchanged he
would open eyes to voice, mouth words and appeared to be
orientated to self. He had a complete spinal cord injury at the
C3 level.

On [**9-7**] the patients health care proxy, [**Name (NI) 2563**] [**Name (NI) 64151**], had a
lengthy discussion with Dr [**Last Name (STitle) **] between moving forward with
PEG and trach or withdrawing care. After considering past
conversations with Mr [**Known lastname 3517**] and ethics committee Ms [**Name13 (STitle) 64151**]
decided to withdraw care. He was given Versed and Morphine and
extubated. He died shortly after extubation.

Medications on Admission:
Unknown

Discharge Medications:
None

Discharge Disposition:
Extended Care

Discharge Diagnosis:
Spinal Cord Injury Right C6 non displaced lamina fracture
Acute Occipital Infarct
Vertebral artery occlusion


Discharge Condition:
Expired


Discharge Instructions:
Expired

Followup Instructions:
N/A



Completed by:[**2134-9-7**]
{'Closed fracture of C5-C7 level with complete lesion of cord,Cerebral artery occlusion, unspecified with cerebral infarction,Dissection of vertebral artery,Paralytic ileus,Alkalosis,Ventilator associated pneumonia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Alcohol abuse, unspecified,Accidental fall on or from other stairs or steps'}


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: Unwitnessed fall

PRESENT ILLNESS: Pt is a 71m who was found down at the bottom of six steps
and noted to be apneic. EMS was called and he was transfered to
[**Hospital1 18**] for further evaluation. Upon arrival pt O2 sats noted to
be
in the 80's and he was intubated. Trauma workup obtained in ER
and CT C spine showed a right c6 lamina fracture and small
associated posteral
epidural hematoma, and hyperextension injury. An MRI Cspine was
also done which showed further spinal cord injury. ETOH level
upon arrival was 238.

MEDICAL HISTORY: Unknown

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
PHYSICAL EXAM:
BP: 88/60   HR: 60    R 20      O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:  Pupils reactive
Neck: Supple.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives alone, independent. Has a friend [**Name (NI) 2563**] and a [**Name (NI) **] that
are involved in his care. 

### Response:
{'Closed fracture of C5-C7 level with complete lesion of cord,Cerebral artery occlusion, unspecified with cerebral infarction,Dissection of vertebral artery,Paralytic ileus,Alkalosis,Ventilator associated pneumonia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Alcohol abuse, unspecified,Accidental fall on or from other stairs or steps'}
