CHIEF COMPLAINT: Subdural hemorrhage

PRESENT ILLNESS: Pt with progressive dementia starting about one year ago which
has accelerated with multiple falls recently.  One the day of
admissiona nd one the day before.

MEDICAL HISTORY: HTN
Dementia
Mitral valve replacement ([**Last Name (un) 3843**]-[**Doctor Last Name **] valve per [**Hospital1 2177**])

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]:  Coumadin 4', Protonix 40', Amiodarone 200', Namenda 5",
Lopressor 25", Quinine 5g HS, Aricept 10'

ALLERGIES: Keflex

PHYSICAL EXAM: Confused, difficulty following questions and commands
AAOx1 - difficulty following questions though
NAD
RRR
CTAB
CNII-XII intact
Motor 5+
Coordination intact (finger to nose)
Sensorium intact
No pronator drift

FAMILY HISTORY: nc

SOCIAL HISTORY: 30 PY smoker (30 x 1), etOH - cocktail/night
Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Retention of urine, unspecified,Unspecified fall,Heart valve replaced by other means,Unspecified essential hypertension,Senile dementia with delirium
Traumatic subdural hem,Retention urine NOS,Fall NOS,Heart valve replac NEC,Hypertension NOS,Senile delirium
Admission Date:  [**2151-3-11**]              Discharge Date:   [**2151-3-15**]

Date of Birth:  [**2074-9-25**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Keflex

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

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Pt with progressive dementia starting about one year ago which
has accelerated with multiple falls recently.  One the day of
admissiona nd one the day before.

Past Medical History:
HTN
Dementia
Mitral valve replacement ([**Last Name (un) 3843**]-[**Doctor Last Name **] valve per [**Hospital1 2177**])

Social History:
30 PY smoker (30 x 1), etOH - cocktail/night

Family History:
nc

Physical Exam:
Confused, difficulty following questions and commands
AAOx1 - difficulty following questions though
NAD
RRR
CTAB
CNII-XII intact
Motor 5+
Coordination intact (finger to nose)
Sensorium intact
No pronator drift

Pertinent Results:
[**2151-3-15**] 07:35AM BLOOD WBC-7.3 RBC-3.66* Hgb-11.6* Hct-34.0*
MCV-93 MCH-31.5 MCHC-34.0 RDW-14.1 Plt Ct-179
[**2151-3-14**] 05:39AM BLOOD WBC-6.5 RBC-3.49* Hgb-10.9* Hct-32.1*
MCV-92 MCH-31.3 MCHC-34.1 RDW-14.2 Plt Ct-174
[**2151-3-13**] 09:28AM BLOOD WBC-7.2 RBC-3.71* Hgb-11.7* Hct-34.4*
MCV-93 MCH-31.5 MCHC-34.0 RDW-14.2 Plt Ct-145*
[**2151-3-12**] 05:27AM BLOOD WBC-6.0 RBC-3.47* Hgb-10.8* Hct-31.9*
MCV-92 MCH-31.1 MCHC-33.8 RDW-14.4 Plt Ct-128*
[**2151-3-11**] 12:30PM BLOOD WBC-7.5 RBC-3.50* Hgb-11.4* Hct-32.1*
MCV-92 MCH-32.6* MCHC-35.6* RDW-14.3 Plt Ct-135*
[**2151-3-11**] 12:30PM BLOOD Neuts-83.3* Lymphs-13.3* Monos-2.9
Eos-0.3 Baso-0.3
[**2151-3-14**] 05:39AM BLOOD PT-12.7 PTT-24.1 INR(PT)-1.1
[**2151-3-13**] 09:28AM BLOOD PT-13.1 PTT-24.3 INR(PT)-1.1
[**2151-3-12**] 05:27AM BLOOD PT-12.8 PTT-26.5 INR(PT)-1.1
[**2151-3-15**] 07:35AM BLOOD Glucose-88 UreaN-15 Creat-1.3* Na-138
K-4.6 Cl-101 HCO3-27 AnGap-15
[**2151-3-14**] 05:39AM BLOOD Glucose-105 UreaN-14 Creat-1.3* Na-135
K-4.1 Cl-101 HCO3-23 AnGap-15
[**2151-3-13**] 09:28AM BLOOD Glucose-119* UreaN-12 Creat-1.0 Na-135
K-4.1 Cl-97 HCO3-28 AnGap-14
[**2151-3-11**] 12:30PM BLOOD CK(CPK)-182*
[**2151-3-15**] 07:35AM BLOOD Calcium-8.9 Phos-3.3
[**2151-3-14**] 05:39AM BLOOD Calcium-8.3* Phos-2.3* Mg-2.5
[**2151-3-15**] 07:35AM BLOOD Phenyto-17.7
[**2151-3-13**] 09:28AM BLOOD Phenyto-17.6

CT [**3-11**]:
Interval development of large mixed density left cerebral
convexity subdural hemorrhage

XR [**3-11**]:
Unremarkable radiographs of the pelvis and bilateral femora. No
acute fracture.

CT [**3-13**]:
Improved, decreased maximal diameter

CT [**3-15**]:
Unchanged

Brief Hospital Course:
Pt was admitted on [**3-11**] to the ICU o/n.  Her mental status
remained at her [**Hospital 111098**] [**Hospital 111099**] hospital course.  On HD #2
she moved to the stepdown unit and on HD #4 she moved to the
floor.  O/N she routinely had to be restrained due to
aggitation.  On HD#4 she slid down her chair without trauma.
Repeat CT's were improved on [**3-13**] and unchaged on [**3-15**].  She was
in good condition for discharge to a skilled nurising fascility
on [**3-15**].  Here she needs to be seen and worked up by a physician
for her falls and she needs to be reevaluated for her long term
coumadin use.  Geriatrics was consulted and sgrees with this
plan.

Medications on Admission:
[**Last Name (un) 1724**]:  Coumadin 4', Protonix 40', Amiodarone 200', Namenda 5",
Lopressor 25", Quinine 5g HS, Aricept 10'

Discharge Medications:
1. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

5. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO DAILY
(Daily).
6. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
7. Memantine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO DAILY (Daily).
9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
10. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
11. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 599**] of [**Location (un) 55**]

Discharge Diagnosis:
Subdural hemorrhage


Discharge Condition:
Improved


Discharge Instructions:
Please call or retun if you have worsening mental status or
confusion, if you fall, have any head trauma, or anything else
that causes you concern.
Please follow up with PCP [**Name Initial (PRE) **] [**Name10 (NameIs) 72215**] Dr. [**First Name (STitle) **] or new PCP at
nursing facility regarding a work up for why you are falling.
Also please follow-up regarding the need for coumadin.  We
recommend you stay off of it for 3-4 weeks and you need to be
re-evaluated about whther it is necessary to restart it for long
term use.

Followup Instructions:
Call Dr. [**Last Name (STitle) 739**] for a follow-up ([**Telephone/Fax (1) 88**] to be seen
in 2 weeks with a Head CT/non contrast
Follow up with your PCP regarding need for fall work up and need
for long term anticoagulation (blood thinning)


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Retention of urine, unspecified,Unspecified fall,Heart valve replaced by other means,Unspecified essential hypertension,Senile dementia with delirium'}


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: Subdural hemorrhage

PRESENT ILLNESS: Pt with progressive dementia starting about one year ago which
has accelerated with multiple falls recently.  One the day of
admissiona nd one the day before.

MEDICAL HISTORY: HTN
Dementia
Mitral valve replacement ([**Last Name (un) 3843**]-[**Doctor Last Name **] valve per [**Hospital1 2177**])

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]:  Coumadin 4', Protonix 40', Amiodarone 200', Namenda 5",
Lopressor 25", Quinine 5g HS, Aricept 10'

ALLERGIES: Keflex

PHYSICAL EXAM: Confused, difficulty following questions and commands
AAOx1 - difficulty following questions though
NAD
RRR
CTAB
CNII-XII intact
Motor 5+
Coordination intact (finger to nose)
Sensorium intact
No pronator drift

FAMILY HISTORY: nc

SOCIAL HISTORY: 30 PY smoker (30 x 1), etOH - cocktail/night 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Retention of urine, unspecified,Unspecified fall,Heart valve replaced by other means,Unspecified essential hypertension,Senile dementia with delirium'}
