CHIEF COMPLAINT: Mechanical Fall

PRESENT ILLNESS: Mr [**Known lastname 24110**] is a 76yo man with stable multiple sclerosis with
chronic suprapubic cath, hx prostate ca, left parietal AVM, PAF
who presents s/p mechanical fall.  He insists he caught his
[**Known lastname **] wheel and fell, no syncope or dizziness, no LOC. His wife
heard him call that he was about to fall, and saw him
immediately afterward.  EMS noted him to be bradycardic in
field.

MEDICAL HISTORY: 1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation on [**Month/Year (2) **]
22. Shingles - [**2151**]

MEDICATION ON ADMISSION: 1. BACLOFEN - 20 mg Tablet - 2 Tablet(s) by mouth at bedtime
Patient
is taking variable dose.
2. BRIMONIDINE-TIMOLOL [COMBIGAN] - 0.2 %-0.5 % Drops - 1
drop(s)
both eyes twice a day Dispense 4 bottles
3. CLOPIDOGREL [[**First Name3 (LF) **]] - 75 mg Tablet - 1 Tablet(s) by mouth
daily
- No Substitution
4.DARIFENACIN [ENABLEX] - (Prescribed by Other Provider) - 7.5
mg
Tablet Sustained Release 24 hr - 1 Tablet(s) by mouth daily
5. DORZOLAMIDE - 2 % Drops - 1 drop(s) both eyes three times a
day
Dispense 90 days
6. ENALAPRIL MALEATE [VASOTEC] - (Prescribed by Other Provider)
-
10 mg Tablet - 1 Tablet(s) by mouth daily
7. EXCEDRIN - (Prescribed by Other Provider) - Dosage uncertain

ALLERGIES: Morphine / Coumadin

PHYSICAL EXAM: Vitals: T: 95.4 axillary BP: 108/52 P:43 R:14 O2: 100% RA
General: Alert, oriented, no acute distress, pleasant
HEENT: Laceration above right eye, dressing c/d/i.  Some dried
blood around right eye.  Vision loss, old, in right eye.
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Heart sounds are distant, 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 suprapubic tenderness.
GU: no foley
Ext: warm, well perfused, 2+ pulses throughout, no edema

FAMILY HISTORY: Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia.

SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via
AA. Quit cigars a few years ago. Retired judge (at age 68 due to
fatigue).
Unspecified disorder of autonomic nervous system,Acute kidney failure, unspecified,Open wound of forehead, without mention of complication,Fall from other slipping, tripping, or stumbling,Multiple sclerosis,Neurogenic bladder NOS,Other cystostomy,Personal history of malignant neoplasm of prostate,Atrial fibrillation,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia
Autonomic nerve dis NEC,Acute kidney failure NOS,Open wound of forehead,Fall from slipping NEC,Multiple sclerosis,Neurogenic bladder NOS,Cystostomy status NEC,Hx-prostatic malignancy,Atrial fibrillation,Hypertension NOS,Obstructive sleep apnea,Hyperlipidemia NEC/NOS
Admission Date:  [**2153-8-30**]              Discharge Date:   [**2153-8-31**]

Date of Birth:  [**2077-7-1**]             Sex:   M

Service: MEDICINE

Allergies:
Morphine / Coumadin

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Mechanical Fall

Major Surgical or Invasive Procedure:
Stitches placed for head laceration


History of Present Illness:
Mr [**Known lastname 24110**] is a 76yo man with stable multiple sclerosis with
chronic suprapubic cath, hx prostate ca, left parietal AVM, PAF
who presents s/p mechanical fall.  He insists he caught his
[**Known lastname **] wheel and fell, no syncope or dizziness, no LOC. His wife
heard him call that he was about to fall, and saw him
immediately afterward.  EMS noted him to be bradycardic in
field.

Head lac after he hit his right brow on wall; lac repaired in
ED.

He insists his heart rate is typically in 40s-50s; his
cardiologist has not suggested intervention.  He has not had a
fall in years despite MS, left leg [**Last Name (LF) 36579**], [**First Name3 (LF) **] use.  He
mentions his blood pressure is typically in the 130s but
routinely falls to 110s if he doesn't drink much during the day.
 No chest pain, lightheadedness, change in urine, cough,
dyspnea, fever, night sweats or chills.

He was recently admitted for an acute change in mental status
and bradycardia.

In the ED, HR dipped temporarily to 34, mostly around 50.  SBPs
were in 90s/100s.  He was afebrile w/O2 sat 100% on RA.  CT head
and c-spine were negative.  A U/A showed 30-50WBCs, moderate
bacteria and 0-2 epithelial cells.  He was feeling well and not
pleased he was to be admitted.  He was admitted to the MICU

On the floor, patient was bradycardic (50s), and borderline
hypotensive (in 90's systolic).


Past Medical History:
1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation on [**Month/Year (2) **]
22. Shingles - [**2151**]


Social History:
Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via
AA. Quit cigars a few years ago. Retired judge (at age 68 due to
fatigue).

Family History:
Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia.

Physical Exam:
Vitals: T: 95.4 axillary BP: 108/52 P:43 R:14 O2: 100% RA
General: Alert, oriented, no acute distress, pleasant
HEENT: Laceration above right eye, dressing c/d/i.  Some dried
blood around right eye.  Vision loss, old, in right eye.
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Heart sounds are distant, 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 suprapubic tenderness.
GU: no foley
Ext: warm, well perfused, 2+ pulses throughout, no edema

Pertinent Results:
ADMISSION LABS:
[**2153-8-30**] 07:00PM BLOOD WBC-5.9 RBC-3.52* Hgb-10.6* Hct-31.6*
MCV-90 MCH-30.2 MCHC-33.6 RDW-14.3 Plt Ct-186
[**2153-8-30**] 07:00PM BLOOD Neuts-62.3 Lymphs-25.6 Monos-5.7 Eos-5.6*
Baso-0.8
[**2153-8-30**] 07:00PM BLOOD PT-12.7 PTT-29.4 INR(PT)-1.1
[**2153-8-30**] 07:00PM BLOOD Glucose-122* UreaN-25* Creat-1.3* Na-139
K-4.6 Cl-106 HCO3-27 AnGap-11
[**2153-8-30**] 07:00PM BLOOD cTropnT-<0.01

UA:
[**2153-8-30**] 07:00PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.010
[**2153-8-30**] 07:00PM URINE Blood-NEG Nitrite-NEG Protein-25
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-MOD
[**2153-8-30**] 07:00PM URINE RBC-0 WBC-21-50* Bacteri-MOD Yeast-NONE
Epi-0-2
[**2153-8-30**] 10:41PM URINE Hours-RANDOM UreaN-473 Creat-72 Na-49
K-62 Cl-62
[**2153-8-30**] 10:41PM URINE Osmolal-400

CE trend:
[**2153-8-30**] 07:00PM BLOOD cTropnT-<0.01
[**2153-8-31**] 05:10AM BLOOD CK-MB-3 cTropnT-<0.01

MICRO:
[**8-30**] UCx: pending

IMAGING:
[**8-30**] CT Cspine:
1. No evidence of acute injury to the cervical spine.
2. Left thyroid nodules. Followup with ultrasound is suggested
if previously not evaluated.

[**8-30**] CT head:
No evidence of acute intracranial abnormality. Stable, likely
cavernoma within the left parietal lobe and likely colloid cyst
in the third ventricle. No hydrocephalus.

DISCHARGE LABS:
[**2153-8-31**] 05:10AM BLOOD WBC-6.5 RBC-2.97* Hgb-9.1* Hct-26.9*
MCV-91 MCH-30.7 MCHC-33.9 RDW-14.4 Plt Ct-147*
[**2153-8-31**] 05:10AM BLOOD Glucose-123* UreaN-26* Creat-1.1 Na-144
K-3.8 Cl-111* HCO3-26 AnGap-11
[**2153-8-31**] 05:10AM BLOOD CK-MB-3 cTropnT-<0.01
[**2153-8-31**] 05:10AM BLOOD Calcium-8.4 Phos-3.6 Mg-2.2
[**2153-8-30**] 07:00PM BLOOD TSH-0.91


Brief Hospital Course:
Mr. [**Known lastname 24110**] is a 76 year old male with MS, h/o sinus bradycardia
and recent admission for vasovagal syncope who prsents s/p
mechanical fall, found to be hypotensive and bradycardic.

#. Hypotension/Hypertension - Pt with very labile blood
pressures ranging from SBP 90s-low 200s, likely [**12-19**] to autonomic
dysfunction. Pt admitted with SBP 90s, initially improved with
small bolus of IVF. Prior to discharge, the patient was noted to
be hypertensive (up to SBP 208). He was continued on his home
Enalapril at discharge, but this should be discussed at his
upcoming outpatient appointments with his cardiolgist and
gerontologist, as the episodes of hypotension may be
contributing to his instability and falls.

#Falls - Pt evaluated by PT who determined that from a
mechanical state, the pt is a high risk for falling again.  PT
arranged for home PT sessions.

# Bradycardia - Pt with sinus bradycardia, similar to recent
[**Month/Day (2) 5348**]. EKG with prolonged PR interval. TSH was WNL. Pt has
f/u with cardiology in 3 days.

# ARF: Likely pre-renal, as FENa was <1%. Cr improved with IVF.

# Head Lac - Was sutured in ED with absorbable sutures (no need
to remove), CT of head/Cspine showed no acute process (no
bleed). CT Cspine does note thyroid nodules, which should be
followed up with ultrasound if not previously worked up.
- needs thyroid ultrasound

# Multiple Sclerosis: Walks with a [**Month/Day (2) **] at [**Month/Day (2) 5348**]

# UTI: Likely colonized given chronic suprapubic catheter. No
fever, elevated WBC count, or elevated lactate. Pt received a
dose of Ceftriaxone in the ED, but further antibiotics were
held.
- f/u UCx

#OSA: Bipap while inpatient

#Glaucoma: Continued home eye drops

#Multiple sclerosis: Has been stable for many years.  Ambulates
w/[**Month/Day (2) **]. Evaluted by physical therapy - the patient is quite
unstable and at high risk for further falls. He is not agreeable
to going to rehab at this time.

#HLD: Continued home simvastatin

#Afib: Continued home [**Last Name (LF) 4532**], [**First Name3 (LF) **]


Medications on Admission:
1. BACLOFEN - 20 mg Tablet - 2 Tablet(s) by mouth at bedtime
Patient
is taking variable dose.
2. BRIMONIDINE-TIMOLOL [COMBIGAN] - 0.2 %-0.5 % Drops - 1
drop(s)
both eyes twice a day Dispense 4 bottles
3. CLOPIDOGREL [[**First Name3 (LF) **]] - 75 mg Tablet - 1 Tablet(s) by mouth
daily
- No Substitution
4.DARIFENACIN [ENABLEX] - (Prescribed by Other Provider) - 7.5
mg
Tablet Sustained Release 24 hr - 1 Tablet(s) by mouth daily
5. DORZOLAMIDE - 2 % Drops - 1 drop(s) both eyes three times a
day
Dispense 90 days
6. ENALAPRIL MALEATE [VASOTEC] - (Prescribed by Other Provider)
-
10 mg Tablet - 1 Tablet(s) by mouth daily
7. EXCEDRIN - (Prescribed by Other Provider) - Dosage uncertain

8. LATANOPROST [XALATAN] - 0.005 % Drops - 1 drop(s) both eyes
at
bedtime Dispense 90 days
9. NITROFURANTOIN (MACROCRYST25%) [MACROBID] - 100 mg Capsule -
1
Capsule(s) by mouth daily Taking for one out of three weeks in
antibiotic cycle.
10. OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 2
Capsule(s)
by mouth twice a day
11. SIMVASTATIN [ZOCOR] - 10 mg Tablet - 1 Tablet(s) by mouth at

bedtime
12. Gabapentin 800mg PRN
13. ASPIRIN - (Prescribed by Other Provider) - 325 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth daily
14. CALCIUM 600 + D - 600 mg (1,500 mg)-200 unit Tablet - 1
Tablet(s)
by mouth three time daily Take with meals
15. CASCARA SAGRADA - (Prescribed by Other Provider) - Dosage
uncertain
16. DOCUSATE SODIUM [COLACE] - (OTC) - 100 mg Capsule - 2
Capsule(s)
by mouth once a day
17. MULTIVITAMIN - (Prescribed by Other Provider) - Dosage
uncertain

Discharge Medications:
1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Enablex 7.5 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
3. dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID (3
times a day).
4. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO twice a day.
6. simvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
7. baclofen 20 mg Tablet Sig: Two (2) Tablet PO at bedtime.
8. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
9. Calcium 600 + D(3) 600-200 mg-unit Capsule Sig: One (1)
Capsule PO three times a day: with meals.
10. cascara sagrada 450 mg Capsule Sig: as previously prescribed
Capsule PO as previously prescribed.
11. Colace 100 mg Capsule Sig: Two (2) Capsule PO once a day.
12. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
13. Combigan 0.2-0.5 % Drops Sig: One (1) drop, both eyes
Ophthalmic twice a day.
14. enalapril maleate 10 mg Tablet Sig: One (1) Tablet PO once a
day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary Diagnosis:
Mechanical fall
Head laceration
Acute renal failure
Bradycardia
Hypotension

Secondary Diagnosis:
Atrial fibrillation
Multiple sclerosis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid ([**Hospital **]
or cane).


Discharge Instructions:
Dear Mr. [**Known lastname 24110**],

You were admitted to the hospital after a fall. You had stitches
placed in your forehead for a laceration. These stitches will
resorb on their own and do not need to be removed. Your heart
rate and blood pressure were noted to be low, which improved
with intravenous fluids. You were also noted to have mild renal
failure, which also improved with intravenous fluids. Prior to
discharge, your blood pressure was noted to be quite high while
you were walking with physical therapy. You should continue on
your blood pressure [**Known lastname 4085**] as previously prescribed - but
please ask your doctors about this [**Name5 (PTitle) 4085**] during your
scheduled follow up appointments, as your blood pressure ranged
from systolics of 90s-200s.

No changes were made to your medications.

We recommend that you spend the next few days resting at home.
You just had a fall, and your heart rate and blood pressure were
quite low - concerning enough to be admitted to the intensive
care unit. You will likely improve faster if you stay home and
reduce your physical activity over the next 2-3 days. It will
also be very important for you to work with physical therapy at
home to improve your strength. You are at a very high risk of
falls, which can be very dangerous.

It was a pleasure meeting you and taking part in your care.

Followup Instructions:
Please follow up with the following providers:

Cardiologist: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
Date: Monday [**2153-9-3**]

Gerontology:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name12 (NameIs) 280**]
Phone:[**Telephone/Fax (1) 719**]
Date/Time:[**2153-9-5**] 10:00

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13999**], MD
Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2153-9-12**] 3:30



                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Unspecified disorder of autonomic nervous system,Acute kidney failure, unspecified,Open wound of forehead, without mention of complication,Fall from other slipping, tripping, or stumbling,Multiple sclerosis,Neurogenic bladder NOS,Other cystostomy,Personal history of malignant neoplasm of prostate,Atrial fibrillation,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia'}


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: Mechanical Fall

PRESENT ILLNESS: Mr [**Known lastname 24110**] is a 76yo man with stable multiple sclerosis with
chronic suprapubic cath, hx prostate ca, left parietal AVM, PAF
who presents s/p mechanical fall.  He insists he caught his
[**Known lastname **] wheel and fell, no syncope or dizziness, no LOC. His wife
heard him call that he was about to fall, and saw him
immediately afterward.  EMS noted him to be bradycardic in
field.

MEDICAL HISTORY: 1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation on [**Month/Year (2) **]
22. Shingles - [**2151**]

MEDICATION ON ADMISSION: 1. BACLOFEN - 20 mg Tablet - 2 Tablet(s) by mouth at bedtime
Patient
is taking variable dose.
2. BRIMONIDINE-TIMOLOL [COMBIGAN] - 0.2 %-0.5 % Drops - 1
drop(s)
both eyes twice a day Dispense 4 bottles
3. CLOPIDOGREL [[**First Name3 (LF) **]] - 75 mg Tablet - 1 Tablet(s) by mouth
daily
- No Substitution
4.DARIFENACIN [ENABLEX] - (Prescribed by Other Provider) - 7.5
mg
Tablet Sustained Release 24 hr - 1 Tablet(s) by mouth daily
5. DORZOLAMIDE - 2 % Drops - 1 drop(s) both eyes three times a
day
Dispense 90 days
6. ENALAPRIL MALEATE [VASOTEC] - (Prescribed by Other Provider)
-
10 mg Tablet - 1 Tablet(s) by mouth daily
7. EXCEDRIN - (Prescribed by Other Provider) - Dosage uncertain

ALLERGIES: Morphine / Coumadin

PHYSICAL EXAM: Vitals: T: 95.4 axillary BP: 108/52 P:43 R:14 O2: 100% RA
General: Alert, oriented, no acute distress, pleasant
HEENT: Laceration above right eye, dressing c/d/i.  Some dried
blood around right eye.  Vision loss, old, in right eye.
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Heart sounds are distant, 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 suprapubic tenderness.
GU: no foley
Ext: warm, well perfused, 2+ pulses throughout, no edema

FAMILY HISTORY: Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia.

SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via
AA. Quit cigars a few years ago. Retired judge (at age 68 due to
fatigue). 

### Response:
{'Unspecified disorder of autonomic nervous system,Acute kidney failure, unspecified,Open wound of forehead, without mention of complication,Fall from other slipping, tripping, or stumbling,Multiple sclerosis,Neurogenic bladder NOS,Other cystostomy,Personal history of malignant neoplasm of prostate,Atrial fibrillation,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia'}
