CHIEF COMPLAINT: 

PRESENT ILLNESS: An 82-year-old male with history
of atrial fibrillation on [**Hospital 197**] transferred from outside
hospital status post unwitnessed fall, presumably from
standing position at approximately 10 a.m. on day of
admission.  Patient was reportedly conscious at the scene,
oriented x2 without recollection of event.  Patient had
progressive deterioration of mental status at the outside
hospital with vomiting (bright read hematemesis).  INR was
5.2 at the outside hospital; patient received 2 units of FFP.
Patient was intubated for airway protection and transferred
to [**Hospital1 69**].

MEDICAL HISTORY: 1. CVA and TIA at unknown times.
2. COPD.
3. CAD status post a bypass in [**2080**].
4. Anemia.
5. Chronic renal insufficiency.
6. Atrial fibrillation.

MEDICATION ON ADMISSION: 1. Coumadin 2.5 mg p.o. q.d.
2. Zestril.
3. Vitamin E.
4. Digoxin 0.125 mg p.o. q.d.
5. Vitamin B12.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subdural hemorrhage following injury without mention of open intracranial wound, with prolonged [more than 24 hours] loss of consciousness without return to pre-existing conscious level,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Long-term (current) use of anticoagulants,Peripheral vascular disease, unspecified
Subdural hem-deep coma,Gastrointest hemorr NOS,Atrial fibrillation,Acute respiratry failure,Chr airway obstruct NEC,Fall NOS,Long-term use anticoagul,Periph vascular dis NOS
Admission Date:  [**2101-7-31**]     Discharge Date:  [**2101-7-31**]


Service:  [**Location (un) **] MICU

HISTORY OF PRESENT ILLNESS:  An 82-year-old male with history
of atrial fibrillation on [**Hospital 197**] transferred from outside
hospital status post unwitnessed fall, presumably from
standing position at approximately 10 a.m. on day of
admission.  Patient was reportedly conscious at the scene,
oriented x2 without recollection of event.  Patient had
progressive deterioration of mental status at the outside
hospital with vomiting (bright read hematemesis).  INR was
5.2 at the outside hospital; patient received 2 units of FFP.
Patient was intubated for airway protection and transferred
to [**Hospital1 69**].

CT there showed a 2.8 cm left subdural hematoma, several
intraparenchymal hemorrhages in the frontal lobes, pontine
hemorrhage with hypodensity of brain stem.  Midline shift
with ablation of left lateral ventricle and entrapment of the
right lateral ventricle, tonsillar herniation were noted.

Patient was evaluated by Trauma, Neurosurgery, and Neurology
services.  The extent of the neurologic injury was felt to
preclude surgical intervention at this time.  Patient had
bright red blood on nasogastric lavage in the Emergency
Department.

PAST MEDICAL HISTORY:
1. CVA and TIA at unknown times.
2. COPD.
3. CAD status post a bypass in [**2080**].
4. Anemia.
5. Chronic renal insufficiency.
6. Atrial fibrillation.

MEDICATIONS ON ADMISSION:
1. Coumadin 2.5 mg p.o. q.d.
2. Zestril.
3. Vitamin E.
4. Digoxin 0.125 mg p.o. q.d.
5. Vitamin B12.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAM ON ADMISSION:  Vital signs:  Temperature 96.4,
pulse 82, blood pressure 167/72, respirations 20.  Patient
was on FIMV with pressure support, tidal volume of 600, rate
14, pressure support 5, PEEP 5, FIO2 100.  General:  Patient
intubated, unresponsive.  HEENT:  Left periauricular
hematoma, head laceration with overlying gauze, blood soaked.
Pupils at 7 mm, equal, nonreactive to light.  No corneal
reflex noted.  Neck brace in place.  No lymphadenopathy.
Cardiac:  Regular, rate, and rhythm, normal S1, S2, with a
2/6 systolic murmur at the apex.  Pulmonary:  Coarse breath
sounds bilaterally with no wheezes, rubs, or crackles noted.
Abdomen:  Normoactive bowel sounds, concave, soft, no masses.
Extremities:  Cool with no cyanosis and no edema.
Neurologic:  No response to voice.  No response to sternal
rub or pain in upper extremities bilaterally.  Pupils 7 mm,
equal, and fixed, with no reaction to light.  No gag
elicited.  No spontaneous movement.  Trouble flexion of legs
bilaterally and response to stimulation of legs.  Toes are
upgoing bilaterally.

LABORATORY STUDIES ON ADMISSION:  White blood cell count
25.5, polys 91.8, bands 0, lymphocytes 4.3, monocytes 3.7,
eosinophils 0.1, basos 0.1, hematocrit 25.3.  Platelets 267.
Sodium 140, potassium 3.0, chloride 108, bicarbonate 21, BUN
22, creatinine 0.9, glucose 285.  Alkaline phosphatase 129,
calcium 7.1, phosphorus 3.5, magnesium 1.8.  CK 85 with a
troponin of less than 0.01.  PT 17.7, INR 2.0, PTT 34.6.

Chest x-ray:  Nasogastric tube at the GE junction, ET in good
position.  No focal consolidations, CHF, or fractures noted.

AP pelvis:  Degenerative changes in the lower lumbar spine
with osteopenic osseous structures.

EKG:  Normal sinus rhythm at 71 beats per minute with normal
axis.  QRS 0.13 seconds, P-R 0.142 seconds, QTc 0.443,
sloping [**Street Address(2) 4793**] depressions in II, III, and aVF, and T-wave
inversions in V1 through V3, and [**Street Address(2) 4793**] depressions in V4
through V6.

SUMMARY OF HOSPITAL COURSE:  As this male had evidence of
intracranial hemorrhage with herniation status post fall, his
health care proxy was [**Name (NI) 653**].  She requested that he
receive comfort oriented care until the family arrived from
[**State 531**] City.  She stated that she wanted no pressors,
cardiac resuscitation, or invasive procedures.  She
understood that the patient might not survive until she
arrived.

The patient was continued on the ventilator at the settings
given above until the family arrived from [**State 531**] City.
Shortly after arrival, the [**Hospital 228**] health care proxy along
with the rest of her family decided to withdrawal ventilatory
support.  Approximately 15 minutes after extubation, patient
went into asystole.  His pupils remained fixed at 7 mm and
nonreactive, he was unresponsive to sternal rub.  There was
no spontaneous ventilation and no heart sounds were heard
while auscultating for five minutes.

Time of death:  11:45 p.m. [**2101-7-31**].  Case was reported to
the medical examiner's office, who accepted the case.  Family
was present at time of death and was informed regarding the
forthcoming medical examiner's autopsy.



                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3795**]

Dictated By:[**Last Name (NamePattern1) 14605**]

MEDQUIST36

D:  [**2101-10-12**]  13:53
T:  [**2101-10-13**]  07:45
JOB#:  [**Job Number 50844**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with prolonged [more than 24 hours] loss of consciousness without return to pre-existing conscious level,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Long-term (current) use of anticoagulants,Peripheral vascular disease, unspecified'}


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: 

PRESENT ILLNESS: An 82-year-old male with history
of atrial fibrillation on [**Hospital 197**] transferred from outside
hospital status post unwitnessed fall, presumably from
standing position at approximately 10 a.m. on day of
admission.  Patient was reportedly conscious at the scene,
oriented x2 without recollection of event.  Patient had
progressive deterioration of mental status at the outside
hospital with vomiting (bright read hematemesis).  INR was
5.2 at the outside hospital; patient received 2 units of FFP.
Patient was intubated for airway protection and transferred
to [**Hospital1 69**].

MEDICAL HISTORY: 1. CVA and TIA at unknown times.
2. COPD.
3. CAD status post a bypass in [**2080**].
4. Anemia.
5. Chronic renal insufficiency.
6. Atrial fibrillation.

MEDICATION ON ADMISSION: 1. Coumadin 2.5 mg p.o. q.d.
2. Zestril.
3. Vitamin E.
4. Digoxin 0.125 mg p.o. q.d.
5. Vitamin B12.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with prolonged [more than 24 hours] loss of consciousness without return to pre-existing conscious level,Hemorrhage of gastrointestinal tract, unspecified,Atrial fibrillation,Acute respiratory failure,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Long-term (current) use of anticoagulants,Peripheral vascular disease, unspecified'}
