CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 24 [**Location 46712**] player who was hit head-on while playing
hockey on [**3-5**].  Reportedly his helmet flew off and he
fell striking his head on the ice with positive loss of
consciousness and reportedly had a seizure. The patient was
taken by EMF to [**Hospital1 69**], was
combative throughout the trip and not following commands but
moving all extremities.  Patient was noted to have a moderate
serosanguinous bleeding from the left ear.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Other convulsions,Striking against or struck accidentally by object in sports with subsequent fall,Cerebral edema
Cl skl base fx-deep coma,Convulsions NEC,Sports acc w sub fall,Cerebral edema
Admission Date:  [**2106-3-5**]       Discharge Date:  [**2106-3-25**]

Date of Birth:   [**2081-12-16**]       Sex:  M

Service:  Neurosurgery

HISTORY OF PRESENT ILLNESS:  The patient is a 24 [**Location 46712**] player who was hit head-on while playing
hockey on [**3-5**].  Reportedly his helmet flew off and he
fell striking his head on the ice with positive loss of
consciousness and reportedly had a seizure. The patient was
taken by EMF to [**Hospital1 69**], was
combative throughout the trip and not following commands but
moving all extremities.  Patient was noted to have a moderate
serosanguinous bleeding from the left ear.

PHYSICAL EXAMINATION:  His blood pressure was 122/90, pulse
88, respiratory rate 18 to 24 to 100 percent.  He was in a
cervical collar.  He was sedated and intubated by Emergency
Room staff shortly after arrival for reported vomiting and in
order to control his combativeness.  When sedation was weaned
patient awoke easily but did not follow commands.  Moving all
extremities strongly and attempting to sit upright, localized
promptly to pain and withdrawal of the lower extremities
briskly.

Head CT showed fracture of the left temporal bone extending
along the floor of the temporal fossa toward the carotid
canal with a few air bubbles near the carotid canal.  Also
traumatic subarachnoid hemorrhage along the anterior right
temporal tip with scattered diffuse traumatic subarachnoid
hemorrhoid along the sulci.  Patient also had no obvious
fracture along the left internal auditory canal or obvious
basilar skull fracture seen but patient did have bright red
blood from the left ear.

Patient was admitted to the neurosurgery service and to the
trauma Surgical Intensive Care Unit.  Patient had a comedo
volt placed for ICP monitoring and was intubated, sedated.
Patient had the angiogram on [**2106-3-6**] to rule out any carotid
dissection which was ruled out. Patient continued to be
monitored in the Surgical Intensive Care Unit.  He awoke
easily when sedation was shut off, attempted to sit up,
moving all extremities spontaneously, does not follow
commands.  Pupils were 6 down to 4 mm and briskly reactive.
He had good distal pulses and no oozing or bruising from his
groin post angiogram.  Repeat head CT shows right temporal
bone fracture and subarachnoid hemorrhage.  Cervical spine
was clear with no fractures.  The patient remained in a hard
collar until ligamentous injury could be ruled out.  On
[**2106-3-7**] patient's ICP was climbing and ventricle were
enlarging.  Patient had a ventriculostomy drain placed
without complication.  Patient continued to be intubated and
sedated and continued to receive Mannitol for high ICPs in
the 20s.  On [**2106-2-7**] patient's ICP climbed into the 30s.  He
had a repeat head CT which just showed increased edema.  He
was started on Mannitol 25 grams intravenous q six hours.
His examination remained stable.  Pupils were symmetric and
reactive briskly.  He continued to move all extremities but
not following commands.  On [**2106-3-9**] patient's pupils were 4
down to 2 mm.  ICP was 12 to 22.  Ventricular drain was
patent. Repeat head CT shows evolving right frontal and
temporal contusion, small right temporal pole subdural
hematoma without mass effect.  No midline shift. Basal
cisterns patent and ventricle were well decompressed.
Patient continued on Mannitol with a repeat head CT.  On [**3-9**]
patient required deep sedation with paralysis.  Patient
remained on paralysis until [**2106-3-10**] when that was
discontinued.  Patient did not require barbiturate coma since
ICP seemed to stabilize by [**2106-3-10**].  Patient's sedation was
slowly weaned off and patient began to wake up.  He had a
head CT on [**3-10**] which showed no significant changes.  His
Mannitol was weaned and his sedation was slowly weaned.  On
[**2106-3-15**] the comedo bulb was discontinued and vent rate was
raised to 15.  Patient was then extubated on [**2106-3-16**].  He
continued to wean off Mannitol.  He continued to be awake,
moving all extremities but not following commands.  On
[**2106-3-16**] patient was following commands.  He was alert,
responsive, answering questions by nodding his head with no
speech at that point.  His drain was raised to 20 cm above
the tragus.  His ICP was running 18.  He had a swallow study
which he failed, had a nasogastric tube in.  He was also seen
by the Ear, Nose and Throat service and was thought to maybe
questionably have problem with [**Name2 (NI) 46713**] but his cervical
spine needed to be cleared.  That was completed after patient
was transferred to the floor.  The patient was transferred to
the floor on [**2106-3-18**].  Hear, Nose and Throat continued to
follow patient.  Cervical spine was cleared and patient was
taken to the operating room for direct visualization under
laryngoscopy on [**2106-4-23**] with movement of his [**Year (4 digits) 46713**].
Patient had repeat swallow study on [**2106-3-24**] which he again
continued to aspirate thin liquids.  Patient was allowed soft
solids with thickened liquids with chin to chest position for
swallowing.  He will need to follow up with his Ear, Nose and
Throat as an outpatient to again visualize the [**Year (4 digits) 46713**].
He did have some movement of his vocal cords although his
voice remains hoarse.  Neurologically he was awake, alert,
attentive, following commands and moving all commands but
impulsive requiring sitters and then placed in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] bed.
His vital signs remained stable throughout his hospital stay.
He was afebrile at the time of discharge with improved
neurologic status and the need for repeat swallow evaluation
in two weeks.

His medications at the time of discharge include Zantac 150
mg p.o. b.i.d., Trazodone 100 mg p.o. q.h.s., Seroquel 25 mg
p.o. b.i.d., Colace 100 mg p.o. b.i.d., heparin 5,000
subcutaneous q 12 hours.

Patient's condition was stable at the time of discharge and
he will follow up with Dr. [**Last Name (STitle) 1327**] in three to four weeks time
with a repeat head CT, also with Ear, Nose and Throat in two
weeks time for repeat swallow evaluation and visualization of
his vocal cords and [**Last Name (STitle) 46713**].  Patient was stable at the
time of discharge.





                            [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D.  [**MD Number(1) 1341**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2106-3-25**]  09:11
T:  [**2106-3-25**]  09:12
JOB#:  [**Job Number 46714**]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Other convulsions,Striking against or struck accidentally by object in sports with subsequent fall,Cerebral edema'}


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: The patient is a 24 [**Location 46712**] player who was hit head-on while playing
hockey on [**3-5**].  Reportedly his helmet flew off and he
fell striking his head on the ice with positive loss of
consciousness and reportedly had a seizure. The patient was
taken by EMF to [**Hospital1 69**], was
combative throughout the trip and not following commands but
moving all extremities.  Patient was noted to have a moderate
serosanguinous bleeding from the left ear.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Other convulsions,Striking against or struck accidentally by object in sports with subsequent fall,Cerebral edema'}
