CHIEF COMPLAINT: s/p fall- SAH, L acetabular fx, L2+L3 transverse process
fractures, question of T and L spine compression fractures

PRESENT ILLNESS: 80 year-old man with history of CAD s/p IMI, afib s/p pacemaker
on coumadin, COPD, laryngeal CA, who was admitted to the TICU
with SAH after a fall, and is now transferred to the MICU for
management of respiratory failure. Briefly, he had a mechanical
fall on [**2134-8-12**] and subsequently sustained a SAH, transverse
process fracture at L2/L3, a compression fracture of
T3/T12/L1/L4, and a left acetabular fracture. His SAH and
fractures were thought to be non-operable per neurosurgery and
ortho, respectively. His course in the TICU was also remarkable
for respiratory distress and ?new hypoxia on the day after
admission (he was 98%2L on the day of admission per review of
the notes), for which he was placed on a face mask, started on
solumedrol, nebs, and azithromycin empirically for a presumed
COPD exacerbation. This was weaned down to 2L NC on the day
prior to transfer and he was satting 98%ra on the morning of
transfer with a plan to go to rehab today.
.
Per report, later this morning around 11 a.m., he was found to
be dyspneic, lethargic and breathing at a rate of 40. He was
placed on a nonrebreather and had O2 satts in the 70s, HR 100s
(afib), SBP 110. ABG was 7.37/47/98/28. He was thought to have
aspirated vs flash pulmonary edema and given lasix 40 mg IV x 1
with good UOP. Of note, his family has been updated and he
agrees to BiPAP but would want to be comfortable if this fails
(after many conversations with patient and family).
.
His hospital course has also been remarkable for delerium
thought to be secondary to sundowning and narcotics, with
geriatrics consulted.

MEDICAL HISTORY: AAA repair 4 years earlier
Thyroidectomy 3 years earlier
Advanced COPD
AFib treated with coumadin
CAD and pacemaker placement

MEDICATION ON ADMISSION: Nitropatch 0.2 mg per hour
folic acid 1 mg per day
Toprol-XL 12.5 mg per day
Protonix 40 mg per day
Coumadin 2mg per day
Mirtazapine
Levoxyl 50 mcg per day
Testosterone
Vytorin 20/10,
Albuterol inhaler
Combivent inhaler
Fluticasone inhaler
Calcium/vit B-12

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: BP: P: R: 18 O2:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives at home with son.  [**Name (NI) **] current alcohol or tobacco use.
Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Acute kidney failure, unspecified,Closed fracture of acetabulum,Obstructive chronic bronchitis with (acute) exacerbation,Drug-induced delirium,Closed fracture of lumbar vertebra without mention of spinal cord injury,Hypovolemia,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Old myocardial infarction,Personal history of malignant neoplasm of larynx,Encounter for palliative care,Cardiac pacemaker in situ,Accidental fall on or from other stairs or steps,Other specified analgesics and antipyretics causing adverse effects in therapeutic use
Traum subarachnoid hem,Acute kidney failure NOS,Fracture acetabulum-clos,Obs chr bronc w(ac) exac,Drug-induced delirium,Fx lumbar vertebra-close,Hypovolemia,Atrial fibrillation,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Old myocardial infarct,Hx-laryngeal malignancy,Encountr palliative care,Status cardiac pacemaker,Fall on stair/step NEC,Adv eff analgesics NEC
Admission Date:  [**2134-8-12**]              Discharge Date:   [**2134-8-19**]

Date of Birth:  [**2053-11-6**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
s/p fall- SAH, L acetabular fx, L2+L3 transverse process
fractures, question of T and L spine compression fractures

Major Surgical or Invasive Procedure:
None


History of Present Illness:
80 year-old man with history of CAD s/p IMI, afib s/p pacemaker
on coumadin, COPD, laryngeal CA, who was admitted to the TICU
with SAH after a fall, and is now transferred to the MICU for
management of respiratory failure. Briefly, he had a mechanical
fall on [**2134-8-12**] and subsequently sustained a SAH, transverse
process fracture at L2/L3, a compression fracture of
T3/T12/L1/L4, and a left acetabular fracture. His SAH and
fractures were thought to be non-operable per neurosurgery and
ortho, respectively. His course in the TICU was also remarkable
for respiratory distress and ?new hypoxia on the day after
admission (he was 98%2L on the day of admission per review of
the notes), for which he was placed on a face mask, started on
solumedrol, nebs, and azithromycin empirically for a presumed
COPD exacerbation. This was weaned down to 2L NC on the day
prior to transfer and he was satting 98%ra on the morning of
transfer with a plan to go to rehab today.
.
Per report, later this morning around 11 a.m., he was found to
be dyspneic, lethargic and breathing at a rate of 40. He was
placed on a nonrebreather and had O2 satts in the 70s, HR 100s
(afib), SBP 110. ABG was 7.37/47/98/28. He was thought to have
aspirated vs flash pulmonary edema and given lasix 40 mg IV x 1
with good UOP. Of note, his family has been updated and he
agrees to BiPAP but would want to be comfortable if this fails
(after many conversations with patient and family).
.
His hospital course has also been remarkable for delerium
thought to be secondary to sundowning and narcotics, with
geriatrics consulted.

Past Medical History:
AAA repair 4 years earlier
Thyroidectomy 3 years earlier
Advanced COPD
AFib treated with coumadin
CAD and pacemaker placement

Social History:
Lives at home with son.  [**Name (NI) **] current alcohol or tobacco use.

Family History:
Unknown

Physical Exam:
Vitals: T: BP: P: R: 18 O2:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
ADMISSION LABS:
.
[**2134-8-12**] 06:05AM BLOOD WBC-17.9*# RBC-5.01# Hgb-14.6# Hct-44.8#
MCV-89 MCH-29.1 MCHC-32.6 RDW-14.1 Plt Ct-200
[**2134-8-12**] 06:05AM BLOOD Neuts-93.8* Lymphs-3.5* Monos-2.5 Eos-0.1
Baso-0.1
[**2134-8-12**] 06:05AM BLOOD PT-32.5* PTT-35.3* INR(PT)-3.3*
[**2134-8-12**] 06:05AM BLOOD Glucose-150* UreaN-24* Creat-1.8* Na-137
K-4.8 Cl-102 HCO3-25 AnGap-15
[**2134-8-12**] 06:05AM BLOOD CK(CPK)-88
[**2134-8-12**] 06:05AM BLOOD CK-MB-NotDone
[**2134-8-12**] 06:05AM BLOOD cTropnT-<0.01
[**2134-8-12**] 09:01AM BLOOD Calcium-8.9 Phos-3.5 Mg-2.0
[**2134-8-12**] 06:05AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2134-8-12**] 04:14PM BLOOD Type-ART pO2-43* pCO2-35 pH-7.44
calTCO2-25 Base XS-0
[**2134-8-12**] 06:17AM BLOOD Lactate-1.6
[**2134-8-12**] 04:14PM BLOOD freeCa-1.12
.
.
PERTINENT STUDIES:
.
CT Chest ([**8-12**]):1. Multiple thoracolumbar compression deformities
as described above.  2. Right transverse process fracture of L3
and L4.  3. Emphysema and multiple pulmonary nodules, one of
which is not included in the field of view of the prior
examination, measuring 4 mm. Given risk
factors, a 12-month followup is recommended.  4. Multiple
hepatic cysts.  5. Bilateral renal cysts

CT Head ([**8-12**]):There is asymmetric dense appearance of the right
side of the tentorium and
lateral to it indicating a possible suddural hemorrhage
associated.  Close f/u to assess the stability of the above
findings is recommended.

CT C-Spine ([**8-12**]):There is asymmetry in the size of the disc
space at C4/5, wider anteriorly.
(series 400b, im 19). Though this can relate to DJD and disc
bulge, ligamentous injury needs to be excluded given the history
of trauma and no prior studies. MR c spine can be performed for
the same.

LENI ([**8-18**]):  LLE: partially occluded clot in greater saphenous,
unchanged from prior; superficial femoral vein proximal
thrombus. Possible thrombus . RLE: interval development of
partially occlusive clot in greater saphenous at junction of
common femoral.

CT Head ([**8-18**]):  1. No evidence of new hemorrhage  2. Stable
appearance of bilateral subdural hemorrhage layering along the
tentorium cerebelli. Interval resolution of subarachnoid
hemorrhage seen in the interpeduncular cistern.  3. Chronic
small vessel ischemic changes.
4. Prominent ventricles and sulci, unchanged.

TTE ([**8-18**]):  Mild symmetric left ventricular hypertrophy with
preserved global and regional biventricular systolic function.
Moderate pulmonary hypertension.


Brief Hospital Course:
Patient was admitted to T/SICU from ER for management of his
injuries s/p mechanical fall, which included SAH, L acetabular
fracture, L2L3 transverse process fractures, and thoracolumbar
compression injuries.  Orthopaedics and Neurosurgery were
consulted for these injuries.  Orthopaedics recommended
non-operative management of L hip fracture. Patient was to be
touch-down weight-bearing for 6 weeks and to follow-up in the
[**Hospital 13308**] clinic after this course of time.  Neurosurgery
recommended normalization of his INR and repeat imaging of his
head in 6hours and 24 hours.  No intervention was recommended
for vertebral fractures.  His repeat head CTs revealed no
change.

Patient had unstable respiratory status while in the ICU, which
was felt to be d/t COPD flair.  He was treated with steroids,
CPAP or BiPAP, and Azithromycin.   He experienced some delirium
and sundowning in the unit and geriatrics was consulted and
recommended afternoon haldol rather than standing doses and
tylenol with breakthrough oxycodone rather than morphine
standing.

On HD4 patient had discussion with team regaring desire to be
DNR/DNI and desire for care not to be escalated.  Patient was
weaned to 2L NC and transferred to floor.  Physical therapy and
occupational therapy evaluated the patient and hospice care was
consulted.  Patient had a speech and swallow consult.  1:1
supervision with crushed/pureed foods was recommended.

On HD5 patient became increasingly tachypneic and was
transferred back to the T/SICU for BiPAP.  The decision was made
to transfer patient from surgical intensive care unit to medical
intensive care unit.

During his MICU stay, the patient was placed on Bipap for
hypoxic respiratory failure.  He was placed empirically on
antibiotics and was given IV steroids for a possible COPD
exacerbation.  He remained dyspneic with labored work of
breathing while on Bipap. LENIs were performed, which showed a
new DVT in his lower extremity.  He was thus placed on a heparin
drip.  He went into AFib with RVR and was started on a diltiazem
drip.  He developed increased work of breathing in the setting
of AFib with RVR and eventually expired from cardiopulmonary
arrest.


Medications on Admission:
Nitropatch 0.2 mg per hour
folic acid 1 mg per day
Toprol-XL 12.5 mg per day
Protonix 40 mg per day
Coumadin 2mg per day
Mirtazapine
Levoxyl 50 mcg per day
Testosterone
Vytorin 20/10,
Albuterol inhaler
Combivent inhaler
Fluticasone inhaler
Calcium/vit B-12

Discharge Medications:
1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: [**1-8**] Tablet,
Sublinguals Sublingual PRN (as needed) as needed for chest pain.

2. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
3. Azithromycin 250 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours) for 1 days.
Disp:*2 Tablet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) ML's
PO twice a day as needed for constipation.
6. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every [**4-12**]
hours as needed for pain.
8. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime as
needed for constipation.


Discharge Disposition:
Expired

Discharge Diagnosis:
s/p Fall
Subarachnoid hemorrhage
Transverse process fractures L2,3
Compression fracture T3,12; L1,4
Left acetabular fracture


Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired


Completed by:[**2134-11-29**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Acute kidney failure, unspecified,Closed fracture of acetabulum,Obstructive chronic bronchitis with (acute) exacerbation,Drug-induced delirium,Closed fracture of lumbar vertebra without mention of spinal cord injury,Hypovolemia,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Old myocardial infarction,Personal history of malignant neoplasm of larynx,Encounter for palliative care,Cardiac pacemaker in situ,Accidental fall on or from other stairs or steps,Other specified analgesics and antipyretics causing adverse effects in therapeutic use'}


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- SAH, L acetabular fx, L2+L3 transverse process
fractures, question of T and L spine compression fractures

PRESENT ILLNESS: 80 year-old man with history of CAD s/p IMI, afib s/p pacemaker
on coumadin, COPD, laryngeal CA, who was admitted to the TICU
with SAH after a fall, and is now transferred to the MICU for
management of respiratory failure. Briefly, he had a mechanical
fall on [**2134-8-12**] and subsequently sustained a SAH, transverse
process fracture at L2/L3, a compression fracture of
T3/T12/L1/L4, and a left acetabular fracture. His SAH and
fractures were thought to be non-operable per neurosurgery and
ortho, respectively. His course in the TICU was also remarkable
for respiratory distress and ?new hypoxia on the day after
admission (he was 98%2L on the day of admission per review of
the notes), for which he was placed on a face mask, started on
solumedrol, nebs, and azithromycin empirically for a presumed
COPD exacerbation. This was weaned down to 2L NC on the day
prior to transfer and he was satting 98%ra on the morning of
transfer with a plan to go to rehab today.
.
Per report, later this morning around 11 a.m., he was found to
be dyspneic, lethargic and breathing at a rate of 40. He was
placed on a nonrebreather and had O2 satts in the 70s, HR 100s
(afib), SBP 110. ABG was 7.37/47/98/28. He was thought to have
aspirated vs flash pulmonary edema and given lasix 40 mg IV x 1
with good UOP. Of note, his family has been updated and he
agrees to BiPAP but would want to be comfortable if this fails
(after many conversations with patient and family).
.
His hospital course has also been remarkable for delerium
thought to be secondary to sundowning and narcotics, with
geriatrics consulted.

MEDICAL HISTORY: AAA repair 4 years earlier
Thyroidectomy 3 years earlier
Advanced COPD
AFib treated with coumadin
CAD and pacemaker placement

MEDICATION ON ADMISSION: Nitropatch 0.2 mg per hour
folic acid 1 mg per day
Toprol-XL 12.5 mg per day
Protonix 40 mg per day
Coumadin 2mg per day
Mirtazapine
Levoxyl 50 mcg per day
Testosterone
Vytorin 20/10,
Albuterol inhaler
Combivent inhaler
Fluticasone inhaler
Calcium/vit B-12

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: BP: P: R: 18 O2:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives at home with son.  [**Name (NI) **] current alcohol or tobacco use. 

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Acute kidney failure, unspecified,Closed fracture of acetabulum,Obstructive chronic bronchitis with (acute) exacerbation,Drug-induced delirium,Closed fracture of lumbar vertebra without mention of spinal cord injury,Hypovolemia,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Old myocardial infarction,Personal history of malignant neoplasm of larynx,Encounter for palliative care,Cardiac pacemaker in situ,Accidental fall on or from other stairs or steps,Other specified analgesics and antipyretics causing adverse effects in therapeutic use'}
