CHIEF COMPLAINT: Left temporal SAH/IVH, L ICA aneurysm

PRESENT ILLNESS: 80 yo RHF with hx HTN and likely CAD p/w SAH.  On the day of
admission she
complained of generalized headache, but no nausea or vomiting.
Later that day, she was found down by relatives (unwitnessed
event) and she was taken to Good [**Hospital 39888**] Medical Center and
found to have SAH on CT head.   She was given 1g PHT and
transferred to [**Hospital1 18**].  GCS was initially 13 and decreased to 6.
She was
promptly intubated upon arrival (after failed attempt to
intubate en route).  She was intubated with succinylcholine and
etomidate and then started to bite the ETT and SBP was 80.  She
was given 4mg ativan as well.

MEDICAL HISTORY: HTN
Pacemaker
HLD
? CAD

MEDICATION ON ADMISSION: ASA
cozaar
metoprolol
diltiazem
zocor
MVT
omeprazole
docusate
benadryl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS; T 98.9 BP 100/60 P 70, on ventilator
Gen; lying in bed, intubated
CV; RRR, no murmurs
Pulm; CTA b/l anteriorly
Abd; soft, NT, ND
Extr; no edema
Neuro; (off sedation but had received succinylcholine, etomidate
and ativan 4 mg)
Eyes closed, does not arouse to noxious stimuli.  PERRL
2.5-->2mm, corneals present bilateral, oculovestibular reflex
present, gag present.  Face appears symmetric.  No spontaneous
movement but withdraws to noxious stimuli in all extremities.
Toes equivocal.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Pt lives in [**Location **] and was visiting son in [**State 350**] to assist
in caring for sons children while sons wife is hospitalized at
[**Hospital1 18**] with complicated pregnancy.
Subarachnoid hemorrhage,Acute respiratory failure,Ventilator associated pneumonia,Obstructive hydrocephalus,Intracerebral hemorrhage,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Other convulsions,Dysphagia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Cardiac pacemaker in situ
Subarachnoid hemorrhage,Acute respiratry failure,Ventltr assoc pneumonia,Obstructiv hydrocephalus,Intracerebral hemorrhage,Pseudomonas infect NOS,Convulsions NEC,Dysphagia NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Anemia NOS,Status cardiac pacemaker
Admission Date:  [**2186-10-27**]              Discharge Date:   [**2186-11-15**]

Date of Birth:  [**2106-8-22**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Left temporal SAH/IVH, L ICA aneurysm

Major Surgical or Invasive Procedure:
EVD placement [**2186-10-27**]
Coiling of L ICA [**2186-10-28**]
Trach/PEG [**2186-11-3**]


History of Present Illness:
80 yo RHF with hx HTN and likely CAD p/w SAH.  On the day of
admission she
complained of generalized headache, but no nausea or vomiting.
Later that day, she was found down by relatives (unwitnessed
event) and she was taken to Good [**Hospital 39888**] Medical Center and
found to have SAH on CT head.   She was given 1g PHT and
transferred to [**Hospital1 18**].  GCS was initially 13 and decreased to 6.
She was
promptly intubated upon arrival (after failed attempt to
intubate en route).  She was intubated with succinylcholine and
etomidate and then started to bite the ETT and SBP was 80.  She
was given 4mg ativan as well.


Past Medical History:
HTN
Pacemaker
HLD
? CAD


Social History:
Pt lives in [**Location **] and was visiting son in [**State 350**] to assist
in caring for sons children while sons wife is hospitalized at
[**Hospital1 18**] with complicated pregnancy.

Family History:
Unknown

Physical Exam:
VS; T 98.9 BP 100/60 P 70, on ventilator
Gen; lying in bed, intubated
CV; RRR, no murmurs
Pulm; CTA b/l anteriorly
Abd; soft, NT, ND
Extr; no edema
Neuro; (off sedation but had received succinylcholine, etomidate
and ativan 4 mg)
Eyes closed, does not arouse to noxious stimuli.  PERRL
2.5-->2mm, corneals present bilateral, oculovestibular reflex
present, gag present.  Face appears symmetric.  No spontaneous
movement but withdraws to noxious stimuli in all extremities.
Toes equivocal.

Discharge exam has changed slightly from above admission exam:
The patient is treached.
She opens her eyes to voice, but does not follow commands.
She does not move her extremities to nox stimuli


Pertinent Results:
CTA NECK W&W/OC & RECONS [**2186-10-27**]
1. CT head demonstrates extensive subarachnoid hemorrhage and
ventricular
dilatation.
2. CT angiography of the head demonstrates a posterior
communicating artery aneurysm with some irregularity of the
surface pointing posteriorly and slightly inferiorly.
3. No other intracranial aneurysms are seen.
4. No abnormalities on somewhat limited CT angiography of the
neck.

CT HEAD W/O CONTRAST [**2186-10-27**]
1. New placement of an intraventricular drain from a right
frontal approach with the size of the ventricles appearing
minimally changed from the most recent comparison.
2. Redemonstration of extensive subarachnoid hemorrhage

CAROTID/CEREBRAL UNILAT [**2186-10-28**]
Successful coiling of left supraclinoid internal carotid artery
aneurysm. No additional aneurysm noted on the left internal
carotid artery

CT HEAD W/ & W/O CONTRAST [**2186-10-31**]
1. No new intracranial hemorrhage.
2. Metallic artifact limits assessment of potential vasospasm or
new
hemorrhage of nearby structures.
3. Stable areas of subarachnoid hemorrhage in the bilateral
frontal lobes and within the occipital horns of the lateral
ventricles.
4. Stable ventricle size.

EEG [**2186-11-6**]
This telemetry captured five pushbutton activations, as
described above. There were no epileptiform features noted on
these
files. Routine sampling showed a background that was moderately
encephalopathic with mixed theta and delta frequencies and
occasional
bursts of generalized high voltage delta slowing. There were no
epileptiform features or electrographic seizures on this
recording.

EEG [**2186-11-7**]
This telemetry captured one pushbutton activation which was
not associated with any epileptiform features. Routine sampling
continued to show a generally slow and disorganized background
consisting of mixed theta and delta frequencies consistent with
a
moderate encephalopathy. There were also occasional bursts of
higher
voltage generalized delta activity. There were no epileptiform

CT HEAD W/O CONTRAST [**2186-11-8**]
1. Subarachnoid and intraventricular hemorrhage, overall
unchanged in
appearance when compared to prior study. There is no evidence of
new
hemorrhage.
2. Stable appearance of coiled the left supraclinoid ICA
aneurysm.


Brief Hospital Course:
Pt was admitted to the ICU for close monitoring s/p EVD
placement in OR and then had a coiling of a L ICA aneurysm. She
was then extubated on [**10-29**] and then required re-intubation on
[**10-30**]. Her head CT was negative however her sputum then grew out
Pseudomonas and was started on appropriate treatment. CTAs were
negative for vasospasm. She was trached and PEG'd, She was found
to have possible seizure activity and an EEG confirmed this. She
was started on Dilantin along with her current Keppra
medication. Her clinical exam however was poor although CTAs
continued to be negative for vasospasm and subsequent EEGs
showed no seizures and Dilantin was eventually weaned off. Due
to her poor neurological status and poor progress a family
meeting was conducted however family wanted to continue
treatment.  Her EVD was then d/c'd and she was transferred to
SDU on [**11-8**]. She did spike a fever, CSF cx's were sent and were
negative. Fever is thought to be attributed to PNA. On [**11-10**] she
had episodes of tachypnea although her CXR was improved, sputum
still has gram neg rods/psuedomonas for which she is being
treated with Cefepine and Cipro which ends on [**11-18**].
Additionally her LENIs were negative and  ABG showed no
hypoxemia. [**11-14**] her exam improved slightly to include eye
opening to voice, brief eye contact and attempt to protrude her
tongue.


Medications on Admission:
ASA
cozaar
metoprolol
diltiazem
zocor
MVT
omeprazole
docusate
benadryl


Discharge Medications:
1. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
const.
3. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Six (6) Puff Inhalation Q4H (every 4 hours) as needed for
wheezing.
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
8. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**1-6**]
Drops Ophthalmic PRN (as needed) as needed for dryness.
9. Acetaminophen 160 mg/5 mL Solution Sig: One (1)  PO Q4H
(every 4 hours) as needed for fever.
10. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
11. Levetiracetam 100 mg/mL Solution Sig: 1500 (1500) mg PO BID
(2 times a day): 1500mg [**Hospital1 **].
12. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
13. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours).
14. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: One (1) ML
Intravenous PRN (as needed) as needed for line flush.
15. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every
4 hours) for 4 days.
16. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed for yeast.
17. Hydralazine 20 mg/mL Solution Sig: One (1)  Injection Q6H
(every 6 hours) as needed for SBP > 180.
18. Cefepime 1 gram Recon Soln Sig: One (1) Recon Soln Injection
Q12H (every 12 hours) for 4 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] Northeast - [**Location (un) 701**]

Discharge Diagnosis:
Left teporal subarachnoid hemorrhage
intraventricular hemorrhage
left internal carotid artery aneurysm
ventilator aquired pneumonia
dysphagia
respiratory failure
hydrocephalus

Discharge Condition:
Stable


Discharge Instructions:
General Instructions

??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, or
Ibuprofen etc.
-  you have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion, lethargy or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	New onset of the loss of function, or decrease of function on
one whole side of your body.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**First Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.



Completed by:[**2186-11-15**]
{'Subarachnoid hemorrhage,Acute respiratory failure,Ventilator associated pneumonia,Obstructive hydrocephalus,Intracerebral hemorrhage,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Other convulsions,Dysphagia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Cardiac pacemaker in situ'}


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: Left temporal SAH/IVH, L ICA aneurysm

PRESENT ILLNESS: 80 yo RHF with hx HTN and likely CAD p/w SAH.  On the day of
admission she
complained of generalized headache, but no nausea or vomiting.
Later that day, she was found down by relatives (unwitnessed
event) and she was taken to Good [**Hospital 39888**] Medical Center and
found to have SAH on CT head.   She was given 1g PHT and
transferred to [**Hospital1 18**].  GCS was initially 13 and decreased to 6.
She was
promptly intubated upon arrival (after failed attempt to
intubate en route).  She was intubated with succinylcholine and
etomidate and then started to bite the ETT and SBP was 80.  She
was given 4mg ativan as well.

MEDICAL HISTORY: HTN
Pacemaker
HLD
? CAD

MEDICATION ON ADMISSION: ASA
cozaar
metoprolol
diltiazem
zocor
MVT
omeprazole
docusate
benadryl

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS; T 98.9 BP 100/60 P 70, on ventilator
Gen; lying in bed, intubated
CV; RRR, no murmurs
Pulm; CTA b/l anteriorly
Abd; soft, NT, ND
Extr; no edema
Neuro; (off sedation but had received succinylcholine, etomidate
and ativan 4 mg)
Eyes closed, does not arouse to noxious stimuli.  PERRL
2.5-->2mm, corneals present bilateral, oculovestibular reflex
present, gag present.  Face appears symmetric.  No spontaneous
movement but withdraws to noxious stimuli in all extremities.
Toes equivocal.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Pt lives in [**Location **] and was visiting son in [**State 350**] to assist
in caring for sons children while sons wife is hospitalized at
[**Hospital1 18**] with complicated pregnancy. 

### Response:
{'Subarachnoid hemorrhage,Acute respiratory failure,Ventilator associated pneumonia,Obstructive hydrocephalus,Intracerebral hemorrhage,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Other convulsions,Dysphagia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Cardiac pacemaker in situ'}
