CHIEF COMPLAINT: Right sided IPH

PRESENT ILLNESS: 63 yo RHF with PMH of Afib, HTN, on coumadin was found
somnolent and lying on floor at about 1-1.30 pm this afternoon
by
her neighbour. She was last seen at her usual state of health
around 12 noon. When her neighbour went in, she was found lying
on the floor, she was apparently talking but felt weak on Left
leg, and hence was unable to get up. Apparently there is no h/o
seizures or trauma but the fall is unwitnessed and the exact
details are not known. At OSH, head CT showed significant ICH an

MEDICAL HISTORY: HTN, afib, ACS 3 years ago with angioplasty

MEDICATION ON ADMISSION: Avapro 300 mg QDay
Plavix 75 mg QDay
Nexium 40 mg QDay
HCTZ 12.5 mg
Stool softener
Lipitor 80 mg QDay
Toprol XL 100 mg QDay
Digoxin 125 mcg
Coumadin 5 mg Q & Sat, rest of the days 2.5 mg
Lorazepam 0.5 mg QDay, prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T: afeb BP: 96 / 66 HR: 120- 140 R 22 O2Sats 98
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: left 3mm sluggishly reactive, right 1mm sluggish
reactive EOMs - could not be tested , opens eyes
occasionally to commands
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: Irrg Irrg, in Afib. no m/r/g.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

FAMILY HISTORY: strokes in various family members

SOCIAL HISTORY: lives with husband, 1 [**Doctor Last Name 6654**] per day, smoking- [**3-9**]
packs per day for 20-30 years, quit 3 years ago.
Intracerebral hemorrhage,Acute respiratory failure,Urinary tract infection, site not specified,Ventilator associated pneumonia,Compression of brain,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Benign essential hypertension,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of tobacco use,Family history of stroke (cerebrovascular),Percutaneous transluminal coronary angioplasty status,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Intracerebral hemorrhage,Acute respiratry failure,Urin tract infection NOS,Ventltr assoc pneumonia,Compression of brain,Mth sus Stph aur els/NOS,Benign hypertension,Crnry athrscl natve vssl,Atrial fibrillation,Long-term use anticoagul,History of tobacco use,Family hx-stroke,Status-post ptca,Abn react-procedure NEC
Admission Date:  [**2190-11-18**]              Discharge Date:   [**2190-12-1**]

Date of Birth:  [**2127-2-1**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Right sided IPH

Major Surgical or Invasive Procedure:
Right Hemicraniectomy
PEG
Trach


History of Present Illness:
63 yo RHF with PMH of Afib, HTN, on coumadin was found
somnolent and lying on floor at about 1-1.30 pm this afternoon
by
her neighbour. She was last seen at her usual state of health
around 12 noon. When her neighbour went in, she was found lying
on the floor, she was apparently talking but felt weak on Left
leg, and hence was unable to get up. Apparently there is no h/o
seizures or trauma but the fall is unwitnessed and the exact
details are not known. At OSH, head CT showed significant ICH an

Right lobar area with midline shift of about 8mm hence was refd
to [**Hospital1 18**]. She was intubated during our initial exam.

Past Medical History:
HTN, afib, ACS 3 years ago with angioplasty

Social History:
lives with husband, 1 [**Doctor Last Name 6654**] per day, smoking- [**3-9**]
packs per day for 20-30 years, quit 3 years ago.


Family History:
 strokes in various family members


Physical Exam:
O: T: afeb BP: 96 / 66 HR: 120- 140 R 22 O2Sats 98
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: left 3mm sluggishly reactive, right 1mm sluggish
reactive EOMs - could not be tested , opens eyes
occasionally to commands
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: Irrg Irrg, in Afib. no m/r/g.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

Neuro:
Mental status: somnolent and intubated, sedated, groans on
painful stimuli, follows some coomands like moving right leg.,
but does not follow commands like move your eyes.

Cranial nerves
Pupils: left 3mm sluggishly reactive, right 1mm sluggish
reactive

No facial asymmetry, gag reflex present.

Motor:
actively moving right side of her body, some movement of left
LL,
miniaml movement of left UL

Reflexes: B T Br Pa Ac
Right 1 1 1 1 -
Left 1 1 1 1 -


Toes upgoing on left side, withdrawal on right

Physical Exam on Discharge:
Opens eyes to voice
PERRL
Follows commands on R side
Withdraws L lower extremity
No movement of L upper extremity to noxious stimuli




Pertinent Results:
[**2190-11-30**] 03:16AM BLOOD WBC-10.2 RBC-2.95* Hgb-7.9* Hct-24.6*
MCV-83 MCH-26.7* MCHC-31.9 RDW-17.3* Plt Ct-317
[**2190-11-30**] 03:16AM BLOOD Plt Ct-317
[**2190-11-18**] 04:25PM BLOOD Neuts-90.6* Lymphs-5.5* Monos-3.1 Eos-0.6
Baso-0.1
[**2190-11-30**] 03:16AM BLOOD Glucose-161* UreaN-23* Creat-0.5 Na-143
K-3.6 Cl-105 HCO3-28 AnGap-14
[**2190-11-22**] 09:17AM BLOOD ALT-8 AST-17 AlkPhos-176* Amylase-20
TotBili-1.2
[**2190-11-22**] 09:17AM BLOOD Lipase-33
[**2190-11-19**] 10:17AM BLOOD CK-MB-NotDone
[**2190-11-30**] 03:16AM BLOOD Calcium-8.4 Phos-2.6* Mg-2.2
[**2190-11-22**] 09:17AM BLOOD Triglyc-126
[**2190-11-30**] 03:36AM BLOOD Type-ART pO2-107* pCO2-42 pH-7.45
calTCO2-30 Base XS-4
[**2190-11-19**] 09:46PM BLOOD Hgb-9.9* calcHCT-30
[**2190-11-30**] 03:36AM BLOOD freeCa-1.15


Brief Hospital Course:
Ms [**Known lastname **] was admitted to the neurosurgery service directly to the
ICU her INR was corrected. She was then taken to the operating
room and went under a right sided hemicraniectomy due to mass
effect of the large frontal IPH the patient had been on
coumadin. She was monitored closely in the ICU with Q 1
neurochecks, she was started on Mannitol to reduce swelling
baseline triponin was negative for MI. The patient was extubated
[**11-23**] but had developed respiratory distress on [**11-26**] requiring
re-intubation and placement of trach and PEG. She was diagnosed
with ventilator associated pneumomia on [**11-29**] and started on
triple antibiotics. Follow up CTs showed decreasing size of
hemorrhage with continued brain herniation through craniectomy
defect. Neurologically the patient would follow commands on the
right side, she is plegic on her left side arm but follow
command on right foot. On exam on [**12-1**], patient was observed to
have left upper extremity edema, an upper extremity utrasound
was ordered to rule out DVT and was read as negative by
radiology.

Medications on Admission:
Avapro 300 mg QDay
Plavix 75 mg QDay
Nexium 40 mg QDay
HCTZ 12.5 mg
Stool softener
Lipitor 80 mg QDay
Toprol XL 100 mg QDay
Digoxin 125 mcg
Coumadin 5 mg Q & Sat, rest of the days 2.5 mg
Lorazepam 0.5 mg QDay, prn


Discharge Medications:
1. Insulin Regular Human 100 unit/mL Solution [**Month/Year (2) **]: One (1)
Injection ASDIR (AS DIRECTED).
2. Bisacodyl 10 mg Suppository [**Month/Year (2) **]: One (1) Suppository Rectal
DAILY (Daily).
3. Heparin (Porcine) 5,000 unit/mL Solution [**Month/Year (2) **]: One (1)
Injection TID (3 times a day).
4. Aspirin 81 mg Tablet, Chewable [**Month/Year (2) **]: One (1) Tablet, Chewable
PO DAILY (Daily).
5. Acetaminophen 650 mg Suppository [**Month/Year (2) **]: One (1) Suppository
Rectal Q6H (every 6 hours) as needed for fever.
6. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
7. Metoprolol Tartrate 50 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO Q6H
(every 6 hours).
8. Irbesartan 300 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Qday ().
9. Chlorhexidine Gluconate 0.12 % Mouthwash [**Last Name (STitle) **]: One (1) ML
Mucous membrane [**Hospital1 **] (2 times a day).
10. Propofol 10 mg/mL Emulsion [**Hospital1 **]: One (1)  Intravenous TITRATE
TO (titrate to desired clinical effect (please specify)).
11. Simvastatin 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
12. Clonidine 0.1 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID (3 times
a day).
13. Digoxin 250 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

14. LeVETiracetam 1000 mg IV BID
15. Sodium Chloride 0.9%  Flush 3 mL IV Q8H:PRN line flush
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.
16. Fentanyl Citrate 25-100 mcg IV Q2H:PRN pain
Please hold for oversedation or RR<8
17. Vancomycin 500 mg Recon Soln [**Hospital1 **]: Three (3) Recon Soln
Intravenous Q 12H (Every 12 Hours): Last dose [**2190-12-13**].
18. Ciprofloxacin in D5W 400 mg/200 mL Piggyback [**Month/Day/Year **]: One (1)
Intravenous Q12H (every 12 hours): Last dose [**2190-12-13**].
19. Cefepime 2 gram Recon Soln [**Month/Day/Year **]: One (1) Recon Soln Injection
Q24H (every 24 hours): Last dose [**2190-12-13**].
20. Metoprolol Tartrate 10 mg IV Q4H:PRN tachycardia
Hold SBP < 110, HR < 60


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] Northeast - [**Location (un) 1110**]

Discharge Diagnosis:
IPH


Discharge Condition:
Neurologically Stable


Discharge Instructions:
General Instructions

??????	Have a friend/family member check your incision daily for
signs of infection.
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	You may shower before this time using a shower cap to cover
your head.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow up with Dr [**First Name8 (NamePattern2) **] [**Name (STitle) **] in 4 weeks with a non-contrast
head CT.



Completed by:[**2190-12-1**]
{'Intracerebral hemorrhage,Acute respiratory failure,Urinary tract infection, site not specified,Ventilator associated pneumonia,Compression of brain,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Benign essential hypertension,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of tobacco use,Family history of stroke (cerebrovascular),Percutaneous transluminal coronary angioplasty status,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: Right sided IPH

PRESENT ILLNESS: 63 yo RHF with PMH of Afib, HTN, on coumadin was found
somnolent and lying on floor at about 1-1.30 pm this afternoon
by
her neighbour. She was last seen at her usual state of health
around 12 noon. When her neighbour went in, she was found lying
on the floor, she was apparently talking but felt weak on Left
leg, and hence was unable to get up. Apparently there is no h/o
seizures or trauma but the fall is unwitnessed and the exact
details are not known. At OSH, head CT showed significant ICH an

MEDICAL HISTORY: HTN, afib, ACS 3 years ago with angioplasty

MEDICATION ON ADMISSION: Avapro 300 mg QDay
Plavix 75 mg QDay
Nexium 40 mg QDay
HCTZ 12.5 mg
Stool softener
Lipitor 80 mg QDay
Toprol XL 100 mg QDay
Digoxin 125 mcg
Coumadin 5 mg Q & Sat, rest of the days 2.5 mg
Lorazepam 0.5 mg QDay, prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T: afeb BP: 96 / 66 HR: 120- 140 R 22 O2Sats 98
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: left 3mm sluggishly reactive, right 1mm sluggish
reactive EOMs - could not be tested , opens eyes
occasionally to commands
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: Irrg Irrg, in Afib. no m/r/g.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

FAMILY HISTORY: strokes in various family members

SOCIAL HISTORY: lives with husband, 1 [**Doctor Last Name 6654**] per day, smoking- [**3-9**]
packs per day for 20-30 years, quit 3 years ago. 

### Response:
{'Intracerebral hemorrhage,Acute respiratory failure,Urinary tract infection, site not specified,Ventilator associated pneumonia,Compression of brain,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Benign essential hypertension,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of tobacco use,Family history of stroke (cerebrovascular),Percutaneous transluminal coronary angioplasty status,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
