CHIEF COMPLAINT: Intraparenchymal hemorrhage

PRESENT ILLNESS: Patient is a 55M found down after fall from bike; he was taken
to OSH were he was initially conscious. He then complained of
several hours of right sided headache, had a seizure and
developed subsequent left sided weakness. CT scan of the head
was performed and a large IPH was identified. He was intubated
for airway protection and transferred to [**Hospital1 18**] for definitive
neurosurgical care.

MEDICAL HISTORY: dyslipidemia

MEDICATION ON ADMISSION: ASA, fluoxetine, lipitor

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission-PHYSICAL EXAM:
125/73  82  12  100
Intubated; minimally sedated;
Grimaces to stim but not opening his eyes; follows simple
command
on Rt;
PERLA; Face symetric
Moves appropriately Rt side; withdraws Rt LE; almost posturing
Rt
UE
Toes: equivocal on Rt, upgoing on Lt; downgoing bilaterally

FAMILY HISTORY: non contributory

SOCIAL HISTORY: non contributory
Intracerebral hemorrhage,Cerebral edema,Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hemiplegia, unspecified, affecting unspecified side,Unspecified protein-calorie malnutrition,Subarachnoid hemorrhage,Other convulsions,Dysphagia, unspecified,Atrial fibrillation,Other and unspecified hyperlipidemia,Acute myocardial infarction of other inferior wall, episode of care unspecified,Pedal cycle accident injuring pedal cyclist,Street and highway accidents
Intracerebral hemorrhage,Cerebral edema,Crbl art ocl NOS w infrc,Acute respiratry failure,Food/vomit pneumonitis,Unsp hemiplga unspf side,Protein-cal malnutr NOS,Subarachnoid hemorrhage,Convulsions NEC,Dysphagia NOS,Atrial fibrillation,Hyperlipidemia NEC/NOS,AMI inferior wall,unspec,Ped cycl acc-ped cyclist,Accid on street/highway
Admission Date:  [**2108-7-28**]              Discharge Date:   [**2108-8-8**]

Date of Birth:  [**2053-1-11**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
Intraparenchymal hemorrhage

Major Surgical or Invasive Procedure:
right craniotomy
right hemicraniectomy
tracheostomy
peg placement
left subclavian line




History of Present Illness:
Patient is a 55M found down after fall from bike; he was taken
to OSH were he was initially conscious. He then complained of
several hours of right sided headache, had a seizure and
developed subsequent left sided weakness. CT scan of the head
was performed and a large IPH was identified. He was intubated
for airway protection and transferred to [**Hospital1 18**] for definitive
neurosurgical care.

Past Medical History:
dyslipidemia

Social History:
non contributory

Family History:
non contributory

Physical Exam:
On admission-PHYSICAL EXAM:
125/73  82  12  100
Intubated; minimally sedated;
Grimaces to stim but not opening his eyes; follows simple
command
on Rt;
PERLA; Face symetric
Moves appropriately Rt side; withdraws Rt LE; almost posturing
Rt
UE
Toes: equivocal on Rt, upgoing on Lt; downgoing bilaterally

On Discharge:Oriented x3, speech dysarthric, left facial, tongue
ML, left hemiparesis (w/d's to noxious on that side), purposeful
on right, follows commands. Improved overall today.


Pertinent Results:
Cardiology Report ECG Study Date of [**2108-7-28**]  8:03:56 PM
Sinus rhythm. Inferior myocardial infarction, age indeterminate.
No previous tracing available for comparison.
Intervals Axes
Rate PR QRS QT/QTc P QRS T
85 168 92 400/443 57 -18 9

Radiology Report CTA HEAD W&W/O C & RECONS Study Date of
[**2108-7-28**] 8:15 PM
CTA HEAD W&W/O C & RECONS   IMPRESSION PER Radiology Report: 1.
Interval enlargement of the right parenchymal hematoma with
increased mass effect, including increased sulcal effacement in
the right cerebral hemisphere. 2. New intraventricular extension
of hemorrhage, with slightly increased
compression of portions of the right lateral ventricle. New
dilatation of the left lateral ventricle and of the occipital
[**Doctor Last Name 534**] of the right lateral
ventricle. 3. No evidence of intracranial aneurysm,
arteriovenous malformation, or stenosis.

Radiology Report CT C-SPINE W/O CONTRAST Study Date of [**2108-7-28**]
8:25 PM
CT C-SPINE W/O CONTRAST; OUTSIDE FILMS READ ONLY BY Radiology
Final Report CT OF THE CERVICAL SPINE, [**2108-7-28**]
IMPRESSION: Multilevel degenerative changes with no evidence of
acute cervical spine injury.

Radiology Report CT HEAD W/O CONTRAST Study Date of [**2108-7-29**]
9:17 AM
Final Report By Radiologist
CT HEAD COMPARISON: [**2108-7-28**].
IMPRESSION: 1. Essentially unchanged right basal ganglia
hematoma which also involves the coronal radiata and the
anterior temporal white matter, with unchanged mass effect. 2.
Apparent new small subarachnoid hemorrhage in a left paramedian
frontal sulcus. 3. Unchanged intraventricular hemorrhage.
Unchanged dilatation of the left lateral ventricle and right
occipital [**Doctor Last Name 534**]. Unchanged compression of other components of the
right lateral ventricle.

Radiology Report [**Numeric Identifier 78740**] CAROTID/CEREBRAL BILAT Study Date of
[**2108-7-29**] 2:06 PM CAROT/CEREB [**Hospital1 **]  IMPRESSION: [**Known firstname **] [**Known lastname **]
underwent cerebral angiography to look for a source of his
hemorrhage in the right deep basal ganglia area. There was no
evidence of any arteriovenous malformations or fistula.

Cardiology Report ECG Study Date of [**2108-7-31**]  3:12:54 PM
Atrial fibrillation with rapid ventricular response. Poor
precordial
QRS progression. Non-specific inferior T wave changes. Compared
to the previous tracing of [**2108-7-28**] atrial fibrillation is now
present.
Intervals Axes
Rate PR QRS QT/QTc P QRS T
110 0 94 328/415 0 10 12

Radiology Report CT HEAD W/O CONTRAST Study Date of [**2108-7-31**]
5:22 AM
Radiologist final IMPRESSION: 1. The large right basal ganglia
hemorrhage extending to the corona radiata and anterior temporal
white matter is unchanged, but surrounding edema has increased,
resulting in increased leftward shift of midline structures,
partial effacement of the right aspect of the suprasellar
cistern, and mild right uncal herniation. 2.Persistent
intraventricular hemorrhage. Slightly increased dilatation of
the left lateral ventricle. Unchanged compression of the right
lateral ventricle. 3. Possible evolving acute infarction in the
right caudate head.

Radiology Report CT HEAD W/O CONTRAST Study Date of [**2108-8-1**]
11:55 AM
Final Report by Radiologist IMPRESSION: The patient is status
post right frontal temporoparietal craniectomy, no significant
change since the prior examination, persistent midline shift
with approximately 5 mm of deviation towards the left, stable
intracranial and intraventricular hemorrhage. Unchanged edema
surrounding the area of intraparenchymal hemorrhage and similar
mass effect along the left frontal ventricular [**Doctor Last Name 534**].

Radiology Report CHEST (PORTABLE AP) Study Date of [**2108-8-1**] 2:32
PM
REASON FOR EXAM: Fever. Cardiac size is top normal. Bibasilar
opacities have increased compared to [**7-28**], pneumonia cannot
be excluded.
Biapical atelectasis have improved. Cardiac size is normal. ET
tube tip is 5.3 cm above the carina. NG tube is coiled in the
stomach and the tip is in the lower esophagus. Bilateral pleural
effusions are small.

Radiology Report CHEST (PORTABLE AP) Study Date of [**2108-8-4**] 4:17
AM
Final Report SUPINE CHEST X-RAY PERFORMED AT 5:00 A.M.:
Tracheostomy tube is seen in the upper mediastinum 4.4 cm above
the carina. The left subclavian central line catheter is seen
with its tip at cavoatrial junction. PEG catheter is seen at the
paravertebral left upper quadrant abdomen. The patient is
rotated to the left. The cardiomediastinal silhouette is within
normal limits. There is no acute parenchymal abnormality. The
left CP angle is not in the field of the x-ray.

Radiology Report BILAT LOWER EXT VEINS Study Date of [**2108-8-4**]
11:41 AM
BILATERAL LOWER EXTREMITY VENOUS ULTRASOUND: IMPRESSION: No
evidence of DVT in either lower extremity.
[**Known lastname 971**],[**Known firstname **] [**Medical Record Number 83111**] M  55  [**2053-1-11**]

Radiology Report CHEST (PORTABLE AP) Study Date of [**2108-8-5**] 6:49
PM


[**Last Name (LF) **],[**First Name3 (LF) 742**] NSURG FA11 [**2108-8-5**] 6:49 PM
CHEST (PORTABLE AP)   Clip # [**Clip Number (Radiology) 83112**]
Reason: pna?



[**Hospital 93**] MEDICAL CONDITION:
   55 year old man with fever spike to 102
REASON FOR THIS EXAMINATION:
   pna?



Wet Read: PXDb SUN [**2108-8-5**] 8:32 PM
Increasing opacity in bilateral lower lobes, R>L, may reflect
ateletectasis,
superimposed on mild volume overload with cephalization and
blurring of
perihilar vasculature. ([**First Name8 (NamePattern2) 30217**] [**Doctor Last Name **] [**Numeric Identifier 83113**])


Final Report
AP CHEST 7:06 P.M. ON [**2108-8-5**]

HISTORY: New fever spike, question pneumonia.

IMPRESSION: AP chest compared to [**8-4**]:

Interval increase in caliber of mediastinal vasculature suggests
that some of
the new interstitial abnormality in the left lower lung is
asymmetric edema,
but there is more consolidation at the left lung base and was
present
previously, concerning for new pneumonia. Heart size is normal.
No pleural
effusion or pneumothorax. Tracheostomy tube and left subclavian
line are in
standard placements.

The study and the report were reviewed by the staff radiologist.




[**Known lastname 971**],[**Known firstname **] [**Medical Record Number 83111**] M  55  [**2053-1-11**]

Radiology Report UNILAT UP EXT VEINS US LEFT Study Date of
[**2108-8-6**] 9:12 AM


[**Last Name (LF) **],[**First Name3 (LF) 742**] NSURG FA11 [**2108-8-6**] 9:12 AM
UNILAT UP EXT VEINS US LEFT   Clip # [**Clip Number (Radiology) 83114**]
Reason: 55 year old man with LUE swelling. Eval for DVT. PLEASE
PE



[**Hospital 93**] MEDICAL CONDITION:
   55 year old man with LUE swelling. Eval for DVT. PLEASE
PERFORM MORNING OF
   [**8-6**]
REASON FOR THIS EXAMINATION:
   55 year old man with LUE swelling. Eval for DVT. PLEASE
PERFORM MORNING OF
   [**8-6**]



Provisional Findings Impression: JRCi [**Name2 (NI) **] [**2108-8-6**] 10:34 AM
PFI: Near complete occlusive thrombus within the left cephalic
vein.


Final Report
STUDY: Left unilateral upper extremity veins ultrasound.

INDICATION: Left upper extremity swelling.

COMPARISONS: None available at the time of dictation.

FINDINGS: Grayscale, color, and pulsed Doppler son[**Name (NI) 867**] was
performed on
the left internal jugular, subclavian, axillary, brachial,
basilic, and
cephalic veins. Near complete occlusive thrombus is demonstrated
within the left cephalic vein with a small amount of flow
demonstrated. The remaining named veins are patent with normal
compression and waveforms. Note is made of a left subclavian
central venous catheter without clot demonstrated surrounding
the catheter.

IMPRESSION: Near complete occlusive clot within the left
cephalic vein.


  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2108-8-8**] 04:58AM    10.5 2.96* 9.1* 27.1* 92 30.8 33.7 12.9
409
Source: Line-L CVL
DIFFERENTIAL Neuts Bands Lymphs Monos Eos Baso Atyps Metas
Myelos
[**2108-7-28**] 08:20PM    77* 11* 8* 3 0 0 0 1* 0
RED CELL MORPHOLOGY Hypochr Anisocy Poiklo Macrocy Microcy
Polychr
[**2108-7-28**] 08:20PM    NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL

  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Smr Plt Ct
INR(PT)
[**2108-8-8**] 04:58AM          409
Source: Line-L CVL
[**2108-8-8**] 04:58AM    12.3 26.2     1.0
Source: Line-L CVL

Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2108-8-8**] 04:58AM    146* 18 0.8 135 3.6 101 26 12
Source: Line-L CVL





































Brief Hospital Course:
This is a 55 year old male found down after a fall from a bike
He was taken to outside hospital were was conscious, and
reported several hours of right sided headache prior to biking,
he had a seizure and left sided weakness.  His Head CT showed
large IPH right deep basal ganglia.  He was intubated and
transferred to [**Hospital1 18**] for further care and received
phosphenytoin.  He was admitted to the ICU for close
neurological monitoring.  On [**7-29**], his Head CT revealed no
progression of right basal ganglia hematoma with preexisting 6
mm left midline shift and new small subarachnoid hemorrhage in a
left paramedian frontal sulcus.He unserwent an angiogram which
was negative. His cervbical spine was cleared. On [**7-30**], he
followed commands on the right with no movement on the left
side. On [**7-31**], He went to the OR for a Decompressive right
hemi-craniectomy for his intracranial hemorrhage,
post-operatively he was given Mannitol 25 mg q 8 hours, his
post-operative Head CT was consistent with improvement in
leftward midline shift and decreased dilation of the left
lateral ventricle. On [**8-1**], the patients Head Ct was consistent
with no significant change since the prior examination,
persistent midline shift with approximately 5 mm of deviation
towards the left, stable intracranial and intraventricular
hemorrhage and unchanged edema surrounding the area of
intraparenchymal hemorrhage.  The patient mannitol dosing was
weaned and his helmut for his craniectomy was ordered.  On [**8-2**],
he experienced fevers was started on antibiotics for pneumonia,
the patient was pancultured for other possible sources of
infection. On [**8-3**], the patient ws following simple commands on
the right, his helmut was fitted, and he had a tracheostomy and
PEG placement.  He spiked a temperature of 102.3.  On [**8-4**] he
was out of bed to the chair with his helmut on and began trach
collar trials off the ventilator. Bilateral Lower Extremity
venous ultrasound was performed with no evidence of DVT in
either lower extremity. On [**8-5**], he was on the trach collar, off
the ventilator for over 24 hours and is awaiting a bed in the
Step-down unit.

On [**8-6**], overnight pt spike a temperature of 102.3 and was
pancultured and a chest x-ray revealed increased opacities in
the lower lobes r>l. A sputum culture was obtained and sent for
culture.  They have all been "poor quality to date", No formal
BAL was performed.  The patient was started on ciprofloxacin to
emperically to treat a pneumonia on [**2108-8-5**]. He was started on
broad spectrum abx upon discharge to provide more complete
coverage.  If the patient re-spikes a fever would consider ID
consult at your facility and obtain appropriate specimens.
Urine cx was negative.

Formal video swallow was not performed as of this time. Passy
Muir valve challenge passed.



Medications on Admission:
ASA, fluoxetine, lipitor


Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever/pain.
3. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): insulain sliding scale coverage.

4. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
5. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for fever/pain.
6. Labetalol 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
7. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
11. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
12. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
14. Labetalol 10 mg IV Q4H:PRN SBP > 120
15. HydrALAzine 10-20 mg IV Q6H:PRN SBP > 140
16. Ondansetron 4 mg IV Q8H:PRN nausea/emesis
17. Sodium Chloride 0.9%  Flush 10 mL IV PRN line flush
Temporary Central Access-ICU: Flush with 10mL Normal Saline
daily and PRN.
18. Sodium Chloride 0.9%  Flush 3 mL IV Q8H:PRN line flush
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.
19. Heparin Flush (10 units/ml) 1 mL IV PRN line flush
Temporary Central Access-Floor:    Flush with 10 mL Normal
Saline followed by Heparin as above daily and PRN.
20. Vancomycin 1000 mg IV Q 12H Duration: 8 Days
please obtain trough level in between third and fourth doses
pls.
21. CefePIME 2 g IV Q12H Duration: 8 Days
22. Ciprofloxacin 400 mg IV Q12H Duration: 8 Days


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Right Basal ganglia/intraparenchymal hemorrhage
seizure
respiratory failure
Uncal herniation
left hemiparesis
dysphagia
protein / calorie malnutrition
fever
aspiration pneumonia
dysartrhia
left partially thrombosed cephalic vein




Discharge Condition:
Neurologically 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.

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.
[**Last Name (STitle) 26803**], 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.


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2108-8-8**]
{'Intracerebral hemorrhage,Cerebral edema,Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hemiplegia, unspecified, affecting unspecified side,Unspecified protein-calorie malnutrition,Subarachnoid hemorrhage,Other convulsions,Dysphagia, unspecified,Atrial fibrillation,Other and unspecified hyperlipidemia,Acute myocardial infarction of other inferior wall, episode of care unspecified,Pedal cycle accident injuring pedal cyclist,Street and highway accidents'}


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: Intraparenchymal hemorrhage

PRESENT ILLNESS: Patient is a 55M found down after fall from bike; he was taken
to OSH were he was initially conscious. He then complained of
several hours of right sided headache, had a seizure and
developed subsequent left sided weakness. CT scan of the head
was performed and a large IPH was identified. He was intubated
for airway protection and transferred to [**Hospital1 18**] for definitive
neurosurgical care.

MEDICAL HISTORY: dyslipidemia

MEDICATION ON ADMISSION: ASA, fluoxetine, lipitor

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission-PHYSICAL EXAM:
125/73  82  12  100
Intubated; minimally sedated;
Grimaces to stim but not opening his eyes; follows simple
command
on Rt;
PERLA; Face symetric
Moves appropriately Rt side; withdraws Rt LE; almost posturing
Rt
UE
Toes: equivocal on Rt, upgoing on Lt; downgoing bilaterally

FAMILY HISTORY: non contributory

SOCIAL HISTORY: non contributory 

### Response:
{'Intracerebral hemorrhage,Cerebral edema,Cerebral artery occlusion, unspecified with cerebral infarction,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hemiplegia, unspecified, affecting unspecified side,Unspecified protein-calorie malnutrition,Subarachnoid hemorrhage,Other convulsions,Dysphagia, unspecified,Atrial fibrillation,Other and unspecified hyperlipidemia,Acute myocardial infarction of other inferior wall, episode of care unspecified,Pedal cycle accident injuring pedal cyclist,Street and highway accidents'}
