CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: 50 y.o. F w/ h/o sucharachnoid cyst & psychiatric history who
presented s/p fall down a flight of stairs. She has a
questionable seizure history and she is also on multiple
psychiatric medications at home. In the ED, she had altered
mental status and was intubated for airway protection.

MEDICAL HISTORY: Chronic hemorrhoids, Hematuria, Anemia of chronic disease, GERD,
Arachnoid cyst fenestration w/ right craniotomy  [**2157-2-22**],
Seizures secondary to above, Glaucoma, Asthma

MEDICATION ON ADMISSION: olanzapine 5mg qam, 15mg qpm
divalproex 250mg am 1000mg qhs
aripiprazole 10 mg daily
ativan 0.5mg daily prn
trazodone 100mg qhs
omeprazole 20mg before first meal
clobetasol 0.05% cream prn eczema flare
vit D 50, 000unit cap- 1cab weekly

ALLERGIES: Codeine / Compazine / Vicodin

PHYSICAL EXAM: ICU physical exam:

FAMILY HISTORY: NC

SOCIAL HISTORY: negative for tobacco or EtOH
Concussion with no loss of consciousness,Bipolar I disorder, most recent episode (or current) depressed, mild,Accidental fall on or from other stairs or steps,Esophageal reflux,Cerebral cysts
Concussion w/o coma,Bipol I cur depress-mild,Fall on stair/step NEC,Esophageal reflux,Cerebral cysts
Admission Date:  [**2161-8-4**]              Discharge Date:   [**2161-8-7**]

Date of Birth:  [**2110-12-29**]             Sex:   F

Service: SURGERY

Allergies:
Codeine / Compazine / Vicodin

Attending:[**First Name3 (LF) 1390**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
none

History of Present Illness:
50 y.o. F w/ h/o sucharachnoid cyst & psychiatric history who
presented s/p fall down a flight of stairs. She has a
questionable seizure history and she is also on multiple
psychiatric medications at home. In the ED, she had altered
mental status and was intubated for airway protection.

Past Medical History:
Chronic hemorrhoids, Hematuria, Anemia of chronic disease, GERD,
Arachnoid cyst fenestration w/ right craniotomy  [**2157-2-22**],
Seizures secondary to above, Glaucoma, Asthma

PSHx: subarachnoid cyst excision ([**2157**]), right cystoperitoneal
shunt ([**2161-6-9**])


Social History:
negative for tobacco or EtOH

Family History:
NC

Physical Exam:
ICU physical exam:

Gen: somnolent, minimally responsive
CV: tachycardic, regular rhythm
Pulm: CTAB
Abd: soft, nontender, nondistended
Ext: WWP, no edema

Exam on discharge:

VS: 98.3 73 126/65 20 94%RA
GEN: A&OX3, NAD
CHEST: CTAB, RRR
ABD: Soft, nontender, nondistended
EXTR: L thigh with lg echymosis, soft. LE warm, pink and well
perfused. No edema. +distal pulses.

Pertinent Results:
[**2161-8-4**] 12:45AM BLOOD WBC-11.1* RBC-4.17* Hgb-12.3 Hct-36.7
MCV-88 MCH-29.6 MCHC-33.6 RDW-13.1 Plt Ct-251
[**2161-8-4**] 06:21AM BLOOD WBC-7.9 RBC-4.01* Hgb-12.0 Hct-35.9*
MCV-90 MCH-29.9 MCHC-33.3 RDW-13.2 Plt Ct-221
[**2161-8-4**] 12:45AM BLOOD Glucose-117* UreaN-11 Creat-0.7 Na-138
K-3.3 Cl-99 HCO3-27 AnGap-15
[**2161-8-4**] 06:21AM BLOOD Glucose-108* UreaN-8 Creat-0.7 Na-141
K-4.3 Cl-103 HCO3-28 AnGap-14
[**2161-8-5**] 02:51AM BLOOD ALT-37 AST-32 AlkPhos-65 TotBili-0.3
[**2161-8-4**] 12:45AM BLOOD Valproa-30*
[**2161-8-4**] 06:21AM BLOOD Valproa-41*

CT Torso [**2161-8-4**]:
Impression: 1.  Endotracheal tube terminates in the bronchus
intermedius, leading to left right upper lobe atelectasis. Left
lower lobe atelectasis is also present. 2.  Fatty infiltration
of the liver

CT C-spine [**2161-8-3**]:
1.  No fracture or malalignment. 2.  Multilevel degenerative
disease. 3.  Small right upper lobe consolidation and
ground-glass opacities in the
imaged left lung are better assessed on the concurrent CT torso.


CT Head [**2161-8-3**]: Stable appearance of the intracranial
structures compared to [**2161-7-22**], without evidence of acute
intracranial injuries.


Brief Hospital Course:
Ms. [**Known lastname 1679**] was admitted to the TSICU after her fall. She was
intubated overnight and successfully extubated on HD 1. Her O2
sats remained stable and she was breathing on her own without
difficulty. She was very somnolent and remained obtunded on HD
1. Neurology was consulted due to her history of questional
seizures but they did not feel that her fall was related to her
seizures. Psychiatry was consulted given her multiple
psychiatric medications and the possibility of an overdose prior
to the fall. The patient denied current suicidal ideation and
psych determined there to be no contraindication to discharge
home once medically cleared. Her mental status improved slightly
throughout the day and when awakened, she would respond
appropriately. She was put back to a regular diet. She was
transferred to the floor on HD 2 in stable condition. She
remained slightly lethargic and her depakote dosing was changed
to 500 mg [**Hospital1 **] from 250mg am 1000mg qhs. She become more alert as
time progressed and by HD 4 she was alert and oriented X 3 to
her baseline mental status.

Occupational therapy was consulted for cognitive evaluation who
recommended outpatient cogntive neurology follow up after
discharge. The patient was given this information.

On [**8-7**] (HD 4) she is alert and oriented at her baseline mental
status. She denies suicidal ideation and has been cleared by
psych with plans for outpatient follow up with her primary
psychiatrist. Her vital signs and respiratory status are stable.
She is tolerating a regular diet. She is out of bed ambulating
independently. She is being discharged home with PCP and
[**Name9 (PRE) 1697**] neurology follow up.

Medications on Admission:
olanzapine 5mg qam, 15mg qpm
divalproex 250mg am 1000mg qhs
aripiprazole 10 mg daily
ativan 0.5mg daily prn
trazodone 100mg qhs
omeprazole 20mg before first meal
clobetasol 0.05% cream prn eczema flare
vit D 50, 000unit cap- 1cab weekly


Discharge Medications:
1. Acetaminophen 325-650 mg PO Q6H:PRN pain, fever
2. Divalproex (DELayed Release) 500 mg PO BID
RX *divalproex 500 mg 1 Tablet(s) by mouth twice a day Disp #*60
Tablet Refills:*1
3. Fluoxetine 40 mg PO DAILY
4. Omeprazole 20 mg PO DAILY
5. Ferrous Sulfate 325 mg PO DAILY
6. Multivitamins 1 TAB PO DAILY
7. Vitamin D 800 UNIT PO DAILY


Discharge Disposition:
Home

Discharge Diagnosis:
s/p Fall
Concussion


Discharge Condition:
Alert with intermittent drowsiness
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital after a fall. You underwent CT
scan imaging and no acute injuries were identified. You were
seen by Psychiatry and Neurology during your hospital stay and
some adjustments to your Depakote were made.

You were also evaluated by the Occupational therapists for
assessing your mental status and you have symptoms consistent
with a mild concussion. It is being recommended that you follow
up with the Cognitive Neurologist (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) in the
next couple of weeks for ongoing evaluation of your memory and
over all mental status.

If you expereince any increased headaches, dizziness, changes in
your vision, nausea, vomiting and/or any other concerning
symptoms please return to the Emergency room for further
evaluation.

Followup Instructions:
Department: Primary Care
Name: Dr. [**First Name (STitle) 1698**] [**Name (STitle) 1699**]
When: Wednesday [**2161-8-19**] at 11:40 AM
Location: [**Hospital1 641**]
Address: 291 INDEPENDENCE DR, [**Location **],[**Numeric Identifier 1700**]
Phone: [**Telephone/Fax (1) 1701**]

Department: [**Hospital1 18**] - Cognitive Neurology Unit
Name: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
When: Dr. [**Last Name (STitle) 1702**] office is working on a follow up
appointment within a month to follow up on your head injury. You
will be called with the appointment date and time. If you have
not heard from the office or have questions please call the
office number listed below.
Phone: ([**Telephone/Fax (1) 1703**]



Completed by:[**2161-8-7**]
{'Concussion with no loss of consciousness,Bipolar I disorder, most recent episode (or current) depressed, mild,Accidental fall on or from other stairs or steps,Esophageal reflux,Cerebral cysts'}


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: 50 y.o. F w/ h/o sucharachnoid cyst & psychiatric history who
presented s/p fall down a flight of stairs. She has a
questionable seizure history and she is also on multiple
psychiatric medications at home. In the ED, she had altered
mental status and was intubated for airway protection.

MEDICAL HISTORY: Chronic hemorrhoids, Hematuria, Anemia of chronic disease, GERD,
Arachnoid cyst fenestration w/ right craniotomy  [**2157-2-22**],
Seizures secondary to above, Glaucoma, Asthma

MEDICATION ON ADMISSION: olanzapine 5mg qam, 15mg qpm
divalproex 250mg am 1000mg qhs
aripiprazole 10 mg daily
ativan 0.5mg daily prn
trazodone 100mg qhs
omeprazole 20mg before first meal
clobetasol 0.05% cream prn eczema flare
vit D 50, 000unit cap- 1cab weekly

ALLERGIES: Codeine / Compazine / Vicodin

PHYSICAL EXAM: ICU physical exam:

FAMILY HISTORY: NC

SOCIAL HISTORY: negative for tobacco or EtOH 

### Response:
{'Concussion with no loss of consciousness,Bipolar I disorder, most recent episode (or current) depressed, mild,Accidental fall on or from other stairs or steps,Esophageal reflux,Cerebral cysts'}
