CHIEF COMPLAINT: Unwitnessed fall

PRESENT ILLNESS: This is a 67 yo M transferred from OSH s/p fall with dislocation
of L hip. The patient was down for an unknown amount of time and
was found to have a CK of [**Numeric Identifier 389**] at the OSH with a K of 7 and
increased Scr. He was also found to have a mottled RUE and RLE.
On arrival to [**Hospital1 18**] the patient was also complaining of
abdominal pain, mainly in his LLQ. He then became progressively
hypotensive and ultimately unresponsive and was intubated by the
ED staff. A the time of examination the patient is sedated but
responds to pain and exhibits guarding on his abdominal exam.
History is obtained from the ED staff and OSH records. His next
of [**Doctor First Name **] is his wife who is currently hospitalized at an OSH for
rhabdo following a fall and is a poor historian.

MEDICAL HISTORY: DM, otherwise unknown

MEDICATION ON ADMISSION: Insulin, albuterol, fluticasone-salmeterol, clonazepam

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Vitals: 98.7 116 114/81 22 100 CMV 40% 500 X22 5
GEN: Intubated, sedated
HEENT: No scleral icterus, mucus membranes moist
CV: tachycardic
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, mildly distended, TTP diffusely with guarding
Ext: Cyanosis RUE distal phalanges, dopplerable radial pulse.
Cyanosis of RLE distal phalanges, dopplerable PT/DP

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Unknown
Unspecified septicemia,Acute respiratory failure,Acute and subacute necrosis of liver,Acute vascular insufficiency of intestine,Closed dislocation of hip, unspecified site,Acute kidney failure, unspecified,Rhabdomyolysis,Traumatic compartment syndrome of upper extremity,Hyperpotassemia,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Gout, unspecified,Bipolar disorder, unspecified,Other acquired absence of organ,Personal history of malignant neoplasm of prostate,Unspecified fall
Septicemia NOS,Acute respiratry failure,Acute necrosis of liver,Ac vasc insuff intestine,Dislocat hip NOS-closed,Acute kidney failure NOS,Rhabdomyolysis,Trauma comp synd up ext,Hyperpotassemia,Severe sepsis,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Gout NOS,Bipolar disorder NOS,Acq absence of organ NEC,Hx-prostatic malignancy,Fall NOS
Admission Date:  [**2125-4-17**]              Discharge Date:   [**2125-4-17**]

Date of Birth:  [**2058-3-23**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
Unwitnessed fall

Major Surgical or Invasive Procedure:
[**2125-4-17**]: Exploratory laparotomy

History of Present Illness:
This is a 67 yo M transferred from OSH s/p fall with dislocation
of L hip. The patient was down for an unknown amount of time and
was found to have a CK of [**Numeric Identifier 389**] at the OSH with a K of 7 and
increased Scr. He was also found to have a mottled RUE and RLE.
On arrival to [**Hospital1 18**] the patient was also complaining of
abdominal pain, mainly in his LLQ. He then became progressively
hypotensive and ultimately unresponsive and was intubated by the
ED staff. A the time of examination the patient is sedated but
responds to pain and exhibits guarding on his abdominal exam.
History is obtained from the ED staff and OSH records. His next
of [**Doctor First Name **] is his wife who is currently hospitalized at an OSH for
rhabdo following a fall and is a poor historian.

Past Medical History:
DM, otherwise unknown

Past Surgical History:
? open appendectomy, otherwise unknown

Social History:
Unknown

Family History:
Unknown

Physical Exam:
On admission:
Vitals: 98.7 116 114/81 22 100 CMV 40% 500 X22 5
GEN: Intubated, sedated
HEENT: No scleral icterus, mucus membranes moist
CV: tachycardic
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, mildly distended, TTP diffusely with guarding
Ext: Cyanosis RUE distal phalanges, dopplerable radial pulse.
Cyanosis of RLE distal phalanges, dopplerable PT/DP

Pertinent Results:
[**2125-4-17**] 12:23AM BLOOD WBC-18.3* RBC-5.07 Hgb-13.5* Hct-45.2
MCV-89 MCH-26.7* MCHC-29.9* RDW-14.2 Plt Ct-233
[**2125-4-17**] 12:23AM BLOOD PT-16.7* PTT-32.6 INR(PT)-1.6*
[**2125-4-17**] 12:23AM BLOOD Glucose-444* UreaN-96* Creat-4.8* Na-14
2 K-6.0* Cl-103 HCO3-13* AnGap-32*
[**2125-4-17**] 12:23AM BLOOD ALT-1686* AST-2809* CK(CPK)-[**Numeric Identifier 15841**]*
AlkPhos-137* TotBili-1.3
[**2125-4-17**] 12:59AM BLOOD Type-ART Temp-39.2 Rates-/18 Tidal V-500
PEEP-5 FiO2-100 pO2-524* pCO2-45 pH-7.17* calTCO2-17* Base
XS--11 AADO2-154 REQ O2-35 Intubat-INTUBATED

OSH Pelvix XRAY: Dislocation of the left hip

CT abdomen/pelvis:
1.  Malplaced central venous catheter with its tip likely
interarterial at the aortic arch.  This finding was urgently
discussed with Dr. [**Last Name (STitle) **] in person upon discovery at 2:10
a.m.
2.  Extensive ischemic bowel affecting the majority of the
ileum, and probably also of the distal jejunum with associated
portal venous gas.
3.  Heterogeneous appearance of the liver likely reflects
ischemia.
4.  Delayed renal excretion of contrast, consistent with acute
kidney injury.

Brief Hospital Course:
Patient was emergently evaluated by Acute Care Surgery, Hand
Surgery, and Vascular Surgery in the operating room. He was
profoundly dehydrated with a CK of 85,000 on admission
consistent with rhabomyolysis from having collapsed at home and
unable to move for approximately 24 hours. Patient was also
profoundly acidemic with severe renal failure. CT revealed
significant bowel ischemia and patient was taken to the OR
emergently for exploration. Upon laparotomy, the entire small
bowel and colon appeared necrosed and dead. There was no viable
tissue to preserve. The abdomen was closed. The patient's wife
was called and informed of the unfortunate outcome and that this
finding was incompatible with life and irreversible. She elected
to redirect care toward comfort measures. Patient was started on
a fentanyl drip and brought to the ICU. He was extubated at
10:15 am and expired at 10:40 am.

Medications on Admission:
Insulin, albuterol, fluticasone-salmeterol, clonazepam

Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
Left hip dislocation
Rhabdomyolysis
Acute Renal Failure
Small bowel necrosis
Colon necrosis
Respiratory failure
Sepsis

Discharge Condition:
Death

Discharge Instructions:
NA

Followup Instructions:
NA


Completed by:[**2125-4-17**]
{'Unspecified septicemia,Acute respiratory failure,Acute and subacute necrosis of liver,Acute vascular insufficiency of intestine,Closed dislocation of hip, unspecified site,Acute kidney failure, unspecified,Rhabdomyolysis,Traumatic compartment syndrome of upper extremity,Hyperpotassemia,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Gout, unspecified,Bipolar disorder, unspecified,Other acquired absence of organ,Personal history of malignant neoplasm of prostate,Unspecified 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: Unwitnessed fall

PRESENT ILLNESS: This is a 67 yo M transferred from OSH s/p fall with dislocation
of L hip. The patient was down for an unknown amount of time and
was found to have a CK of [**Numeric Identifier 389**] at the OSH with a K of 7 and
increased Scr. He was also found to have a mottled RUE and RLE.
On arrival to [**Hospital1 18**] the patient was also complaining of
abdominal pain, mainly in his LLQ. He then became progressively
hypotensive and ultimately unresponsive and was intubated by the
ED staff. A the time of examination the patient is sedated but
responds to pain and exhibits guarding on his abdominal exam.
History is obtained from the ED staff and OSH records. His next
of [**Doctor First Name **] is his wife who is currently hospitalized at an OSH for
rhabdo following a fall and is a poor historian.

MEDICAL HISTORY: DM, otherwise unknown

MEDICATION ON ADMISSION: Insulin, albuterol, fluticasone-salmeterol, clonazepam

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Vitals: 98.7 116 114/81 22 100 CMV 40% 500 X22 5
GEN: Intubated, sedated
HEENT: No scleral icterus, mucus membranes moist
CV: tachycardic
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, mildly distended, TTP diffusely with guarding
Ext: Cyanosis RUE distal phalanges, dopplerable radial pulse.
Cyanosis of RLE distal phalanges, dopplerable PT/DP

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Unknown 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Acute and subacute necrosis of liver,Acute vascular insufficiency of intestine,Closed dislocation of hip, unspecified site,Acute kidney failure, unspecified,Rhabdomyolysis,Traumatic compartment syndrome of upper extremity,Hyperpotassemia,Severe sepsis,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Gout, unspecified,Bipolar disorder, unspecified,Other acquired absence of organ,Personal history of malignant neoplasm of prostate,Unspecified fall'}
