CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: [**Age over 90 **] y/o female w/ h/o of A fib, COPD, vertigo who was transfered
from OSH after sustaining a fall w/ trauma to the head.  She
fell while trying to answer the doorbell with no preceeding
symptoms reported and no LOC.  Head CT demonstrated a small SDH
and SAH.  She has had recent difficulty w/ falls reporting 4
falls over the past 4 months.

MEDICAL HISTORY: A fib
COPD
Vertigo
B cataracts
Cholecystectomy
Hysterectomy

MEDICATION ON ADMISSION: Digoxin
Hydroxyzine
Antivert
Accuvite
Vitamin E

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 84   154/p   RR 20   100% RA

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone, has HHA for assistance w/ ADL; daughters live
nearby; ambulates w/ cane
Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified fall,Unspecified essential hypertension
Traum subarachnoid hem,Chr airway obstruct NEC,Atrial fibrillation,Fall NOS,Hypertension NOS
Admission Date:  [**2162-8-18**]              Discharge Date:   [**2162-8-24**]


Service: [**Last Name (un) **]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
none

History of Present Illness:
[**Age over 90 **] y/o female w/ h/o of A fib, COPD, vertigo who was transfered
from OSH after sustaining a fall w/ trauma to the head.  She
fell while trying to answer the doorbell with no preceeding
symptoms reported and no LOC.  Head CT demonstrated a small SDH
and SAH.  She has had recent difficulty w/ falls reporting 4
falls over the past 4 months.

Past Medical History:
A fib
COPD
Vertigo
B cataracts
Cholecystectomy
Hysterectomy

Social History:
lives alone, has HHA for assistance w/ ADL; daughters live
nearby; ambulates w/ cane

Family History:
non-contributory

Physical Exam:
HR 84   154/p   RR 20   100% RA

Gen: GCS 15, AOx1
HEENT: NC/AT, PERRL
Neck: non-tender
Pulm: CTAB
CV: RRR
Abd: soft, flat, non-tender
Back: non-tender, no step offs
Rectal: ? decreased tone, guiac neg
Ext: no injuries, warm

Pertinent Results:
CT Head [**8-18**] Small right sided acute frontal subdural hematoma
and small right frontal subarachnoid hemorrhage, with no
associated mass effect or midline shift. No
fracture detected.

CT Head [**8-19**]: Stable small right subdural hemorrhage and right
frontal subarachnoid
hemorrhage.

Carotid duplex [**8-19**]: FINDINGS: Scattered areas of plaque
involving both carotid systems. However, the peak systolic
velocities bilaterally are normal as are the ICA/CCA ratios.
There is normal antegrade flow in both vertebral arteries.

CT Cspine: No fracture identified. Diffuse degenerative disease
at multiple levels.

Echo results:
LEFT ATRIUM: The left atrium is normal in size.
RIGHT ATRIUM/INTERATRIAL SEPTUM: The right atrium is normal in
size. No atrial septal defect is seen by 2D or color Doppler.
LEFT VENTRICLE: Left ventricular wall thicknesses are normal.
The left ventricular cavity is unusually small. Regional left
ventricular wall motion is normal. Left ventricular systolic
function is hyperdynamic (EF>75%). There is no resting left
ventricular outflow tract obstruction.
RIGHT VENTRICLE: Right ventricular chamber size and free wall
motion are normal.
AORTA: The aortic root is normal in diameter. The abdominal
aorta is markedly dilated.
AORTIC VALVE: The aortic valve leaflets (3) are mildly
thickened. There is no aortic valve stenosis. Trace aortic
regurgitation is seen.
MITRAL VALVE: The mitral valve leaflets are mildly thickened.
There is mild mitral annular calcification. Trivial mitral
regurgitation is seen. The transmitral E-wave decelleration time
is prolonged (>250 ms). The left ventricular inflow pattern
suggests impaired relaxation.
TRICUSPID VALVE: The tricuspid valve leaflets are mildly
thickened. Moderate [2+] tricuspid regurgitation is seen. There
is mild pulmonary artery systolic hypertension.
PERICARDIUM: There is an anterior space which most likely
represents a fat pad, though a loculated anterior pericardial
effusion cannot be excluded.
GENERAL COMMENTS: Based on [**2154**] AHA endocarditis prophylaxis
recommendations, the echo findings indicate a moderate risk
(prophylaxis recommended). Clinical decisions regarding the need
for prophylaxis should be based on clinical and
echocardiographic data.
Conclusions
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thicknesses
are normal. The left ventricular cavity is unusually small.
Regional left ventricular wall motion is normal. Left
ventricular systolic function is hyperdynamic (EF 70-80%). Right
ventricular chamber size and free wall motion are normal. The
abdominal aorta is markedly dilated. The aortic valve leaflets
(3) are mildly thickened. There is no aortic valve stenosis.
Trace aortic regurgitation is seen. The mitral valve leaflets
are mildly thickened. Trivial mitral regurgitation is seen. The
left ventricular inflow pattern suggests impaired relaxation.
The tricuspid valve leaflets are mildly thickened. Moderate [2+]
tricuspid regurgitation is seen. There is mild pulmonary artery
systolic hypertension. There is an anterior space which most
likely represents a fat pad, though a loculated anterior
pericardial effusion cannot be excluded.
The abdominal aorta is markedly dilated.
IMPRESSION: small hyperdynamic left ventricle; diastolic
dysfuncton of the left ventricle; dilated abdominal aorta


Brief Hospital Course:
[**Age over 90 **] y/o s/p fall w/o any preceding symptoms who was noted to have
a small subdural and subarachnoid bleed.  Other studies were
negative for evidence of injury.  The patient was evaluated by
neurosurgery and initiated on dilantin and labetolol PRN to
maintain SBP < 150.  A repeat head CT on HD 2 was unchanged from
the previous day.  A geriatric consult was obtained - they
recommended discontinuing her outpatient hydroxyzine &
famotidine (due to disorienting anticholinergic effects). Head
CT results were as reported. On the floor, she had occasional
episodes of agitation, which improved by HD6. For the remainder
of her hospital stay, she was normotensive, without evidence of
seizure.
She was evaluated by PT/OT, who agreeded with placement plans.
She was discharged to home with nursing assistance and 24 hour
supervision by her family members.
Of note, an incidental finding of a 4.8cm x 4.9cm abdominal
aortic aneurysm was found on cardiac echo - this should be
followed by serial exams as an outpatient.

Medications on Admission:
Digoxin
Hydroxyzine
Antivert
Accuvite
Vitamin E

Discharge Medications:
Phenytoin 100mg PO TID
Digoxin 0.125mg PO QD


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Fall
Subdural hematoma, subarachnoid hematoma


Discharge Condition:
Fair

Discharge Instructions:
You should have someone with you at home 24-hours a day.
You should return to the hospital or Emergency Department or
call your doctor if you have any worse dizziness or difficulty
walking or nausea or vomiting.
You should return to the hospital or Emergency Department or
call your doctor if you develop any seizure activity (shaking of
your arms or legs, or loss of consciousness).
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified fall,Unspecified essential hypertension'}


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

PRESENT ILLNESS: [**Age over 90 **] y/o female w/ h/o of A fib, COPD, vertigo who was transfered
from OSH after sustaining a fall w/ trauma to the head.  She
fell while trying to answer the doorbell with no preceeding
symptoms reported and no LOC.  Head CT demonstrated a small SDH
and SAH.  She has had recent difficulty w/ falls reporting 4
falls over the past 4 months.

MEDICAL HISTORY: A fib
COPD
Vertigo
B cataracts
Cholecystectomy
Hysterectomy

MEDICATION ON ADMISSION: Digoxin
Hydroxyzine
Antivert
Accuvite
Vitamin E

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 84   154/p   RR 20   100% RA

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone, has HHA for assistance w/ ADL; daughters live
nearby; ambulates w/ cane 

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified fall,Unspecified essential hypertension'}
