CHIEF COMPLAINT: L SDH

PRESENT ILLNESS: [**Known lastname 63347**] is a 86 yo man with baseline dementia, CAD, TIAs,
s/p endovascular repair of AAA. His baseline functional status
is
not well known.

MEDICAL HISTORY: 1. Dementia
2. CAD
3. TIAs
4. s/p endovascular repair of AAA.

MEDICATION ON ADMISSION: 1. Nitro paste
2. Lisinopril 20mg daily
3. Zofran 4mg PRN
4. Protonix 40mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:         EOMs
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro: Opens eyes to voice. Cannot reliably follow simple
commands. Mumbles incomprehensibly with some dysarthria. Pupils
2
to 1mm. face symmetric. Moving all extremities anti-gravity with
perhaps some mild R arm weakness.

FAMILY HISTORY: Mother with stroke

SOCIAL HISTORY: Lives at home. No Tob, EtOH use
Subdural hemorrhage,Other persistent mental disorders due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Facial weakness,Other and unspecified hyperlipidemia,Do not resuscitate status,Dysarthria,Hypopotassemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Peripheral vascular disease, unspecified,Arthropathy, unspecified, site unspecified,History of fall
Subdural hemorrhage,Mental disor NEC oth dis,Crnry athrscl natve vssl,Hx TIA/stroke w/o resid,Facial weakness,Hyperlipidemia NEC/NOS,Do not resusctate status,Dysarthria,Hypopotassemia,BPH w/o urinary obs/LUTS,Periph vascular dis NOS,Arthropathy NOS-unspec,Personal history of fall
Admission Date:  [**2193-6-10**]              Discharge Date:   [**2193-6-18**]

Date of Birth:  [**2107-5-18**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
L SDH


Major Surgical or Invasive Procedure:
Left Sided Craniotomy for Subdural Hematoma Evacuation


History of Present Illness:
[**Known lastname 63347**] is a 86 yo man with baseline dementia, CAD, TIAs,
s/p endovascular repair of AAA. His baseline functional status
is
not well known.

He presents from [**Hospital3 26615**] hospital after being admitted there
on [**6-9**] with worsening confusion and walking difficulty. There,
a
CT showed a left parietal SDH, approx 1cm in depth. At first,
family wanted supportive care for this, however, they later
changed their mind and opted for transfer to a tertiary care
facility so pt was transferred here.


Past Medical History:
1. Dementia
2. CAD
3. TIAs
4. s/p endovascular repair of AAA.


Social History:
Lives at home. No Tob, EtOH use

Family History:
Mother with stroke


Physical Exam:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:         EOMs
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro: Opens eyes to voice. Cannot reliably follow simple
commands. Mumbles incomprehensibly with some dysarthria. Pupils
2
to 1mm. face symmetric. Moving all extremities anti-gravity with
perhaps some mild R arm weakness.


Pertinent Results:
CT Head [**2193-6-10**] 9:20 PM
IMPRESSION: Unchanged moderate left subdural hematoma with acute
and
non-acute blood products. Associated mass effect on the brain is
relatively mild due to extensive cerebral atrophy, but mild
rightward shift of normally midline structures is present.

CT Head [**2193-6-11**] 8:33 AM
IMPRESSION: Unchanged moderate left subdural hematoma with acute
and nonacute blood products. Unchanged associated mass effect.

CT Head Post-OP [**6-13**]
The study is slightly limited secondary to patient motion. The
patient is status post left parietal craniotomy. There is a
large volume of subcutaneous gas along the left side of the
cranium and a small amount of pneumocephalus with gas seen
subjacent to the craniotomy site as well as anteriorly
bilaterally. The left subdural hematoma has been evacuated and
now there is only a trace amount of subdural blood and fluid
remaining. There is no new intracranial hemorrhage or vascular
territorial infarction. The degree of mass effect of the left
subdural fluid is also decreased as expected.  Ventricles and
sulci are enlarged, reflecting parenchymal volume loss. Note is
made of periventricular white matter hypodensity indicating
chronic microvascular infarction. Punctate calcifications in the
basal ganglia are bilateral. Note is made of dense
atherosclerotic vascular calcification.


Brief Hospital Course:
86 y/o M with baseline dementia and on anticoagulation presents
s/p multiple falls with Left SDH. He was transferred from OSH
for further neurosurgical intervention. Patient was admitted to
ICU for monitoring. Serial Head CTs were stable and patient was
transferred to the step down unit with a plan His mental status
improved greatly over 2 days and in the morning on [**6-12**] he was
alert, attentive and following commands.  He went to the
operating room on the afternoon of [**6-13**] for evacuation of his
SDH. He toelrated the procedure wellm, was extuabted in the OR
and trasnferred to the PACU for further monitoring. His post-op
Head CT should expected changes and on the morning of 5.20 he
was downgraded to floor status and stayed in the PACU overnight
and then trasnferred to SICU in stable condition.  He had an
uncomplicated ICU course.  He was transferred to floor in stable
condition.  He was found to have a low dilantin level and was
re-bolused.  His most recent phenytoin level was 9.9.
PT/OT/speech and nutrition were consulted.  He was started on
calorie counts.  His mental status although sporadic remained
stable during his floor course.

Now DOD, he is afebrile, VSS, and neurologically stable.  He is
tolerating an oral diet although marginal PO intake and voiding
spontaneously.  His incision is clean, dry and intact.  He is
set for discharge to rehab in stable condition and will
follow-up with Dr. [**Last Name (STitle) **] accordingly.


Medications on Admission:
1. Nitro paste
2. Lisinopril 20mg daily
3. Zofran 4mg PRN
4. Protonix 40mg daily


Discharge Medications:
1. phenytoin sodium extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
2. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
4. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. nitroglycerin 2 % Ointment Sig: One (1)  Transdermal Q6H
(every 6 hours) as needed for chest pain.
8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
9. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
11. paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
14. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

15. diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
16. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
17. memantine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
18. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 979**] - [**Location (un) 246**]

Discharge Diagnosis:
Left SDH
hypokalemia
dysarthria


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge 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 wash your hair only after sutures and/or staples have
been removed. If your wound closure uses dissolvable sutures,
you must keep that area dry for 10 days.
??????	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.
??????	If you were on a medication such as Coumadin (Warfarin), or
Plavix (clopidogrel), or Aspirin, prior to your injury, you may
safely resume taking this on until follow-up with Dr. [**Last Name (STitle) **]
??????	If you have been prescribed Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.

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 Appointment Instructions

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.



Completed by:[**2193-6-18**]
{'Subdural hemorrhage,Other persistent mental disorders due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Facial weakness,Other and unspecified hyperlipidemia,Do not resuscitate status,Dysarthria,Hypopotassemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Peripheral vascular disease, unspecified,Arthropathy, unspecified, site unspecified,History of fall'}


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: L SDH

PRESENT ILLNESS: [**Known lastname 63347**] is a 86 yo man with baseline dementia, CAD, TIAs,
s/p endovascular repair of AAA. His baseline functional status
is
not well known.

MEDICAL HISTORY: 1. Dementia
2. CAD
3. TIAs
4. s/p endovascular repair of AAA.

MEDICATION ON ADMISSION: 1. Nitro paste
2. Lisinopril 20mg daily
3. Zofran 4mg PRN
4. Protonix 40mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:         EOMs
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro: Opens eyes to voice. Cannot reliably follow simple
commands. Mumbles incomprehensibly with some dysarthria. Pupils
2
to 1mm. face symmetric. Moving all extremities anti-gravity with
perhaps some mild R arm weakness.

FAMILY HISTORY: Mother with stroke

SOCIAL HISTORY: Lives at home. No Tob, EtOH use 

### Response:
{'Subdural hemorrhage,Other persistent mental disorders due to conditions classified elsewhere,Coronary atherosclerosis of native coronary artery,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Facial weakness,Other and unspecified hyperlipidemia,Do not resuscitate status,Dysarthria,Hypopotassemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Peripheral vascular disease, unspecified,Arthropathy, unspecified, site unspecified,History of fall'}
