CHIEF COMPLAINT: 89M h/o EtOH found at bottom of stairs

PRESENT ILLNESS: 89M h/o EtOH found at bottom of stairs, initial GCS 8, diffuse
SAH, R frontotemporal SDH, no hydrocephalus or MLS Thicken
duodenoum.  Intubated at OSH and medflighted to [**Hospital1 18**]

MEDICAL HISTORY: unknown

MEDICATION ON ADMISSION: ?

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: At arrival to trauma bay:
Vitals p80 bp 194/palp rr16 (bagged) spo2 99%, intubated,
sedated.
Heent: bilateral ecchymosis/racoon eyes, bilaterally 3mm
minimally reactive pupils TM clear, minor oral bleeding,
multiple facial lacs and abrasions
Pulm: CTA [**Hospital1 **]
Card: RRR cs1/s2
Abd: Soft
Ext: 2+ pulses x4ext

FAMILY HISTORY: unknown

SOCIAL HISTORY: apparent chronic etoh abuse
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,Accidental fall on or from other stairs or steps,Closed fracture of nasal bones,Open wound of scalp, without mention of complication
Cl skl base fx-deep coma,Fall on stair/step NEC,Nasal bone fx-closed,Open wound of scalp
Admission Date:  [**2144-11-1**]              Discharge Date:   [**2144-11-3**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
89M h/o EtOH found at bottom of stairs

Major Surgical or Invasive Procedure:
none


History of Present Illness:
89M h/o EtOH found at bottom of stairs, initial GCS 8, diffuse
SAH, R frontotemporal SDH, no hydrocephalus or MLS Thicken
duodenoum.  Intubated at OSH and medflighted to [**Hospital1 18**]


Past Medical History:
unknown

Social History:
apparent chronic etoh abuse

Family History:
unknown

Physical Exam:
At arrival to trauma bay:
Vitals p80 bp 194/palp rr16 (bagged) spo2 99%, intubated,
sedated.
Heent: bilateral ecchymosis/racoon eyes, bilaterally 3mm
minimally reactive pupils TM clear, minor oral bleeding,
multiple facial lacs and abrasions
Pulm: CTA [**Hospital1 **]
Card: RRR cs1/s2
Abd: Soft
Ext: 2+ pulses x4ext


Pertinent Results:
[**2144-11-1**] 04:50AM BLOOD WBC-13.1* RBC-3.71* Hgb-12.2* Hct-33.6*
MCV-91 MCH-33.0* MCHC-36.4* RDW-13.8 Plt Ct-246
[**2144-11-2**] 02:02AM BLOOD WBC-11.4* RBC-3.27* Hgb-10.9* Hct-30.8*
MCV-94 MCH-33.5* MCHC-35.6* RDW-13.8 Plt Ct-325
[**2144-11-2**] 02:02AM BLOOD WBC-11.4* RBC-3.27* Hgb-10.9* Hct-30.8*
MCV-94 MCH-33.5* MCHC-35.6* RDW-13.8 Plt Ct-325
[**2144-11-1**] 04:50AM BLOOD PT-12.9 PTT-25.3 INR(PT)-1.1
[**2144-11-2**] 02:02AM BLOOD Plt Ct-325
[**2144-11-2**] 02:02AM BLOOD Glucose-162* UreaN-12 Creat-0.9 Na-140
K-3.4 Cl-109* HCO3-23 AnGap-11
[**2144-11-1**] 06:08PM BLOOD CK-MB-12* cTropnT-0.04*
[**2144-11-2**] 02:02AM BLOOD CK-MB-7 cTropnT-0.02*
[**2144-11-2**] 02:02AM BLOOD Calcium-7.6* Phos-2.2* Mg-1.6
[**2144-11-1**] 08:42AM BLOOD Type-ART pO2-364* pCO2-46* pH-7.35
calTCO2-26 Base XS-0 Intubat-INTUBATED
[**2144-11-1**] 04:58AM BLOOD Glucose-109* Lactate-1.3 Na-142 K-2.6*
Cl-113* calHCO3-22

CT CHEST W/CONTRAST; CT ABDOMEN W/CONTRAST

Reason: ?trauma
Field of view: 39 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
89 year old man with fall down stairs, ?down 2 hours, GCS 8 at
scene, intubated at OSH
REASON FOR THIS EXAMINATION:
?trauma
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: Fall down stairs. GCS of 8.

No prior comparisons are available.

TECHNIQUE: MDCT-acquired axial images were obtained through the
chest, abdomen, and pelvis with intravenous contrast only for CT
trauma protocol. Coronal and sagittal reformations are
evaluated.

CT OF THE CHEST WITH INTRAVENOUS CONTRAST. The heart and great
vessels appear unremarkable. Moderate calcifications noted
within the left main and LAD circulation. No pathologically
enlarged lymph nodes are identified. Lungs are clear with no
evidence of pneumothorax and minimal bilateral dependent
atelectasis. A small benign calcified granuloma is noted within
the right lower lobe. Airways are patent to the subsegmental
level. There is no pleural or pericardial effusion. An
orogastric tube tip terminates just within the gastric fundus.
Intubation device terminates above the thoracic inlet as noted
on scout radiograph. There is mild prominence of both main
pulmonary arteries bilaterally measuring greater than 3 cm.

CT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST: There is marked
irregular mucosal enhancement predominantly involving the first
and second portions of the duodenum with surrounding hyperdense
fluid/wall thickening. The remainder of the small bowel appears
unremarkable and the liver, gallbladder, adrenals, pancreas, and
kidneys are normal. Multiple hypoattenuating lesions are noted
within the splenic parenchyma, incompletely characterized but
likely benign. Atherosclerotic disease noted within the
intrathoracic aorta, which appears otherwise unremarkable. No
free air is noted within the abdominal cavity. No pathologically
enlarged lymph nodes are present.

CT OF THE PELVIS WITH INTRAVENOUS CONTRAST: Air is noted within
a Foley containing urinary bladder, which contains a small
anterior bladder diverticulum with a 10 mm neck. There is mild
bladder wall thickening, which may be partly related to
underdistension. Mild symmetrical rectal wall thickening is also
likely related to underdistension with the intrapelvic bowel
appearing otherwise unremarkable. No free fluid is noted within
the pelvic cavity. No pathologically enlarged lymph nodes are
present. There are bilateral fat-containing inguinal hernias.

BONE WINDOWS: No malignant-appearing osseous lesions or acute
fractures are identified. There are multilevel degenerative
changes within the thoracic and lumbar spine, which appear
otherwise unremarkable.

IMPRESSION:

1. Irregular internal mucosal enhancement involving the first
and second portions of the duodenum with surrounding wall
thickening or hyperdense fluid. Traumatic injury to the duodenum
is within the differential diagnosis (although felt less likely)
as is focal duodenitis/duodenal ulceration. Correlation with
endoscopy or barium swallow is recommended.

2. Incidental note of anterior bladder wall diverticulum with
mild bladder wall thickening, which may be partly related to
underdistension.

3. Prominence to the main pulmonary artery bilaterally may
suggest underlying pulmonary arterial hypertension.

CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST  [**2144-11-1**] 4:57 AM

CT SINUS/MANDIBLE/MAXILLOFACIA

Reason: ?frx

[**Hospital 93**] MEDICAL CONDITION:
89 year old man with fall down stairs, ?down 2 hours, GCS 8 at
scene, intubated at OSH
REASON FOR THIS EXAMINATION:
?frx
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: Fall down stairs with GCS of 8.

No prior comparison exams are available.

TECHNIQUE: MDCT acquired axial images were obtained through the
facial bones. Axial soft tissue and bone algorithms and coronal
reformations were evaluated.

CT OF THE FACIAL BONES: There are minimally displaced fractures
involving the lamina papyracea/medial walls of the orbits
bilaterally with patchy opacification of the majority of the
ethmoid air cells. Additionally, there is a mildly displaced
fracture involving the lateral wall of the right orbit with
adjacent subcutaneous emphysema and minimally displaced
fractures involving the nasal bone and lateral wall of the right
sphenoid sinus. The sphenoid sinuses are also largely opacified.
No definite displaced inferior orbital wall fractures are
identified and there is symmetric mucosal thickening involving
the maxillary sinuses, likely related to chronic sinusitis. The
rami and zygomatic arches appear intact, as do the globes. No
definite extraocular muscle involvement is identified by CT. A
small probable osteiod osteoma is noted within the left frontal
sinus, and the frontal sinuses display mild mucosal thickening.

IMPRESSION:
1. Bilateral medial orbital wall fractures and right lateral
orbital wall fracture with adjacent extraconal air pockets. No
definite extraocular muscle involvement but please correlate
clinically.

2. Minimally displaced nasal bone fracture and fracture through
the lateral wall of the right sphenoid sinus.

3. Symmetrical mucosal thickening involving the maxillary
sinuses bilaterally could relate to chronic sinusitis. Minimal
mucosal thickening in the frontal sinuses.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
DR. [**First Name8 (NamePattern2) 11136**] [**Last Name (NamePattern1) 11137**]

CT HEAD W/O CONTRAST  [**2144-11-1**] 4:56 AM

CT HEAD W/O CONTRAST

Reason: ?trauma

[**Hospital 93**] MEDICAL CONDITION:
89 year old man with fall down stairs, ?down 2 hours, GCS 8 at
scene, intubated at OSH
REASON FOR THIS EXAMINATION:
?trauma
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: Fall down stairs, GCS 8. Seen, intubated, outside
hospital.

No prior comparison exams are available.

NON-CONTRAST CT

FINDINGS: There are multiple areas of subarachnoid hemorrhage
within the frontal and parietal lobes bilaterally and left
greater than right temporal lobes. Additionally, a small left
extra-axial subdural hematoma is noted measuring at greatest
distance 6 mm off the inner table adjacent to the frontal lobe.
There is mild adjacent effacement of the cortical sulci. No
intraventricular hemorrhage, frank intraparenchymal hemorrhage,
or significant midline shift is identified. There may be 1 to 2
mm of rightward subfalcine herniation. There is no evidence of
hydrocephalus or acute major vascular territorial infarct. The
globes are intact. There is a large soft tissue laceration
adjacent to the right frontal calvarium with associated
subgaleal hematoma. The globes appear intact. No calvarial skull
fractures are identified. There is diffuse opacification of the
paranasal sinuses. The mastoid air cells are well aerated. There
are secretions within the oro- and [**Last Name (un) **]-pharynx consistent with
patient's intubation.

IMPRESSION:

1. Extensive areas of subarachnoid hemorrhage bilaterally within
the frontal, parietal, and temporal lobes. Small left
extra-axial subdural hematoma causing mild effacement of the
adjacent sulci. Minimal subfalcine herniation with no
intraventricular hemorrhage is identified.

2. Extensive right frontal soft tissue laceration that extends
to the skull with adjacent subgaleal hematoma.

3. Near-complete opacification of the majority of the paranasal
sinuses. Please refer to dedicated CT facial bones for a better
description of osseous findings.

Findings discussed with trauma team in person shortly after exam
acquisition.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
DR. [**First Name8 (NamePattern2) 11136**] [**Last Name (NamePattern1) 11137**]

CT HEAD W/O CONTRAST  [**2144-11-2**] 4:37 AM

CT HEAD W/O CONTRAST

Reason: for [**11-2**] 04:00 - please eval for interval change

[**Hospital 93**] MEDICAL CONDITION:
89 year old man with traumatic SAH and SDH on [**11-1**]
REASON FOR THIS EXAMINATION:
for [**11-2**] 04:00 - please eval for interval change
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: Traumatic subarachnoid and subdural hemorrhage.
Evaluate for interval change.

Comparison is made to [**2144-11-1**], examination.

NON-CONTRAST HEAD CT

FINDINGS: The majority of multiple areas of subarachnoid
hemorrhage within the bilateral frontal, parietal and temporal
lobes is not significantly changed. However, there does appear
to be a probable new area of hemorrhage within the right
parietal temporal region (series 2B, image 29) even given slight
differences in image acquisition. Additionally, there appears to
be slightly increased density to areas of subarachnoid
hemorrhage within the superior frontal lobes bilaterally
compared to initial examination. Trace new blood is also noted
within the occipital horns bilaterally with no evidence of
hydrocephalus. Left cerebral convexity subdural hematoma is
stable in size and appearance. Right subgaleal hematoma appears
slightly redistributed and there has been interval closure of a
large right-sided soft tissue laceration noted on admission
imaging. There is increased aerosolization of secretions within
the right maxillary sinus, worrisome for developing sinusitis.
Stable appearance to mucosal thickening within the left
maxillary sinus and near complete opacification of the ethmoid
air cells and sphenoid sinuses. 3-4 mm of rightward subfalcine
herniation may be slightly progressed from prior examination.

IMPRESSION:
1. Probable new areas of increased density to subarachnoid
hemorrhage within the right parietotemporal region with new
intraventricular hemorrhage within the occipital horns
bilaterally. No evidence of hydrocephalus.
2. No significant interval change to the majority of other areas
of previously described subarachnoid hemorrhage and left
subdural hematoma.
3. 3-4 mm of rightward subfalcine herniation .
4. Increased aerosolization of secretions within the right
maxillary sinus, worrisome for developing sinusitis in this
intubated patient. Please correlate clinically.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
DR. [**First Name (STitle) **] [**Name (STitle) 12563**]

4. Recommend advancement of the orogastric tube and endotracheal
tube; the ETT is at the thoracic inlet and likely 10 cm from the
carina.

Findings discussed with Dr. [**Last Name (STitle) 33863**] on date of exam at 6:30 a.m.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
DR. [**First Name (STitle) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]


Brief Hospital Course:
Patient was stabilized in the trauma bay and diagnostic
radiology was conducted as above.  After the findings of
substantial cranial trauma neurosurgery was emergently
contact[**Name (NI) **].  Following their evaluation no neurosurgical
intervention was indicated, and the patient was loaded with 1gm
IV dilantin.  A repeat CT in 24hr indicated no interval
improvement.  The patient was weaned off the vent and frequent
neuro checks were continued.  The facial lacerations were
repaired. After extensive discussions with the patient's family
and his health care proxy it was decided to make the patient
CMO, considering his previously stated wishes to not be
maintained artificially if he could not make a full recover.
The patient expired at 1640 on [**11-3**].

Medications on Admission:
?

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
s/p fall with head trauma, Subarachnoid hemmorhage, subdural
hemmorhage, multiple facial/skull fractures.


Discharge Condition:
deceased


Discharge Instructions:
none

Followup Instructions:
none
{'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,Accidental fall on or from other stairs or steps,Closed fracture of nasal bones,Open wound of scalp, without mention of complication'}


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: 89M h/o EtOH found at bottom of stairs

PRESENT ILLNESS: 89M h/o EtOH found at bottom of stairs, initial GCS 8, diffuse
SAH, R frontotemporal SDH, no hydrocephalus or MLS Thicken
duodenoum.  Intubated at OSH and medflighted to [**Hospital1 18**]

MEDICAL HISTORY: unknown

MEDICATION ON ADMISSION: ?

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: At arrival to trauma bay:
Vitals p80 bp 194/palp rr16 (bagged) spo2 99%, intubated,
sedated.
Heent: bilateral ecchymosis/racoon eyes, bilaterally 3mm
minimally reactive pupils TM clear, minor oral bleeding,
multiple facial lacs and abrasions
Pulm: CTA [**Hospital1 **]
Card: RRR cs1/s2
Abd: Soft
Ext: 2+ pulses x4ext

FAMILY HISTORY: unknown

SOCIAL HISTORY: apparent chronic etoh abuse 

### 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,Accidental fall on or from other stairs or steps,Closed fracture of nasal bones,Open wound of scalp, without mention of complication'}
