CHIEF COMPLAINT: 

PRESENT ILLNESS: Mrs. [**Known lastname 4135**] is an 88 year old
female with a past medical history of chronic obstructive
pulmonary disease, hypertension, insulin dependent diabetes
mellitus, history of lung carcinoma, status post lobectomy
who presented to the [**Hospital6 256**] at
approximately 6:30 in the morning on [**2164-3-9**] after
suffering an unwitnessed fall from standing and being found
on the kitchen floor in her home.  She had activated a
Medical Bracelet Life Alert and was seen by the emergency
medical services in her home in Southborn [**State 350**].  Her
initial [**Location (un) 2611**] coma scale was 15.  She was complaining of
some mild headache and was transported by ambulance to the
[**Hospital6 256**] Emergency Department
with stable vital signs and an intact neurologic event.  She
had had an obvious left supraorbital laceration which had
minimal bleeding.  After she was initially transported there
was no evidence of hypoxia or hypotension noted.  She was
seen by the Neurosurgical Service and thereafter a trauma
consultation was called.

MEDICAL HISTORY: The patient's past medical history is
notable for coronary artery disease, history of hypertension,
history of hypercholesterolemia, history of peripheral
vascular disease, history of Type 2 diabetes, history of
gastroesophageal reflux disease, chronic renal insufficiency
chronic obstructive pulmonary disease, history of
adenocarcinoma of the lung, history of diverticulosis and
history of a small infrarenal stable 3.5 cm abdominal aortic
aneurysm.

MEDICATION ON ADMISSION: Albuterol, Beclomethasone,
Moexipril 15 mg b.i.d., Quinine sulfate 250 mg a day,
Fexofenadine 50 mg a day, Ambien, Cilostazol 200 mg p.o.
q.i.d., Zantac 150 mg q. day, Thiamine, Vitamin C, a full
Aspirin, Colace 100 mg p.o. b.i.d., Norvasc 5 mg p.o. q. day,
Neurontin 100 mg p.o. q.h.s. and Dextromethorphan.

ALLERGIES: Penicillin, Phenobarbital and Ibuprofen.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subdural hemorrhage,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Bacteremia,Open wound of face, unspecified site, without mention of complication,Unspecified fall,Home accidents
Subdural hemorrhage,Chr airway obstruct NEC,Acidosis,Acute respiratry failure,Meth sus pneum d/t Staph,Bacteremia,Open wound of face NOS,Fall NOS,Accident in home
Admission Date:  [**2164-3-9**]       Discharge Date:  [**2164-3-15**]


Service:  Trauma

HISTORY OF PRESENT ILLNESS:  Mrs. [**Known lastname 4135**] is an 88 year old
female with a past medical history of chronic obstructive
pulmonary disease, hypertension, insulin dependent diabetes
mellitus, history of lung carcinoma, status post lobectomy
who presented to the [**Hospital6 256**] at
approximately 6:30 in the morning on [**2164-3-9**] after
suffering an unwitnessed fall from standing and being found
on the kitchen floor in her home.  She had activated a
Medical Bracelet Life Alert and was seen by the emergency
medical services in her home in Southborn [**State 350**].  Her
initial [**Location (un) 2611**] coma scale was 15.  She was complaining of
some mild headache and was transported by ambulance to the
[**Hospital6 256**] Emergency Department
with stable vital signs and an intact neurologic event.  She
had had an obvious left supraorbital laceration which had
minimal bleeding.  After she was initially transported there
was no evidence of hypoxia or hypotension noted.  She was
seen by the Neurosurgical Service and thereafter a trauma
consultation was called.

PAST MEDICAL HISTORY:  The patient's past medical history is
notable for coronary artery disease, history of hypertension,
history of hypercholesterolemia, history of peripheral
vascular disease, history of Type 2 diabetes, history of
gastroesophageal reflux disease, chronic renal insufficiency
chronic obstructive pulmonary disease, history of
adenocarcinoma of the lung, history of diverticulosis and
history of a small infrarenal stable 3.5 cm abdominal aortic
aneurysm.

PAST SURGICAL HISTORY:  Notable for total abdominal
hysterectomy and bilateral salpingo-oophorectomy, history of
prior left lobectomy for adenocarcinoma of the lung in [**2153**].
It is unknown as to whether or not the patient continues to
drink.  She had a history of previous tobacco use, greater
than 65 years of one to two packs per day, however, she has
quit since her lung surgery in [**2153**].  She has not imbibed in
any recreational drugs.

ALLERGIES:  Penicillin, Phenobarbital and Ibuprofen.

MEDICATIONS ON ADMISSION:  Albuterol, Beclomethasone,
Moexipril 15 mg b.i.d., Quinine sulfate 250 mg a day,
Fexofenadine 50 mg a day, Ambien, Cilostazol 200 mg p.o.
q.i.d., Zantac 150 mg q. day, Thiamine, Vitamin C, a full
Aspirin, Colace 100 mg p.o. b.i.d., Norvasc 5 mg p.o. q. day,
Neurontin 100 mg p.o. q.h.s. and Dextromethorphan.

PHYSICAL EXAMINATION:  Her admission vital signs on
examination were significant for a temperature of 97.4
rectally, a blood pressure of 148/72 with a heart rate of 70,
respiratory rate 18 and she was sating 96% on 2 liters of
nasal cannula.  Her initial examination was notable for [**Initials (NamePattern4) **]
[**Last Name (NamePattern4) 2611**] coma scale of 15.  She had an obvious 2 cm left
supraorbital laceration with associated ecchymosis.  There
was no active bleeding.  Her pupils were equal, round and
reactive to light and accommodation, they were 4 to 2 and
brisk bilaterally.  Her extraocular movements were intact.
Her tympanic membranes were clear.  Her oropharynx was
negative.  Her trachea was midline.  She had an old
well-healed left neck incision from prior carotid surgery.
Her heart was regular, lungs clear but decreased throughout.
Her chest had no deformities or tenderness.  Her abdomen was
soft, nontender, nondistended.  There was no pulsatile mass,
no bruit.  She had an old lower midline scar that was noted
without any evidence of hernia.  Her pelvis was stable.  Her
flanks were without any deformity.  No costovertebral angle
tenderness.  There was no ecchymosis.  Her back showed no
deformities, tenderness or stepoff along her thoracolumbar
spine.  Her extremities had palpable popliteals and femoral
pulses bilaterally, they were monophasic dorsalis pedis and
posterior tibial pulses on both feet.  There were no obvious
skin ulcers.

LABORATORY DATA:  Her admission laboratory data were notable
for a white count of 11,000, hematocrit 41, platelet count
303.  Chemistries notable for a sodium of 137, potassium 5.2,
chloride 105, bicarbonate 22, BUN and creatinine 56 and 1.1
with a glucose of 194.  Her coagulase panel was normal.  She
had a urinalysis that was negative.  Her toxicology screen,
urine and serum were otherwise unremarkable.  Her lactate was
unremarkable.  She had a Foley catheter placed by the
Emergency Department Services.  She had had a chest x-ray
that was within normal limits.  Pelvis film was normal.  Her
computerized tomography scan of the cervical spine showed old
degenerative changes, no acute fracture or tissue edema.  She
had a fast ultrasound examination within the Emergency
Department that was also normal.  She had no evidence of free
fluid in the abdomen.  She had had a computerized tomography
scan of the head performed which showed a small right
subdural hematoma, right frontal contusion as well as a left
frontal subarachnoid blood and question of left temporal
region, subarachnoid blood.  There was no midline shift and
no collapse of the ventricles.  She had had a TLS series
which showed no evidence of thoracolumbar or sacral spinous
process fracture or vertebral body fractures.  She was
complaining of left wrist pain, however, the previous failed
to reveal any obvious injury.  Bilateral knee films were
performed because of small scraps and cuts over the knees
which showed no evidence of fracture or dislocation.

After Trauma Consultation was called, three hours into her
hospital course in the Emergency Department, evaluation by
the Trauma Service found that her [**Location (un) 2611**] coma scale had
deteriorated 12.  She was obviously confused and agitated.
Due to this she required an emergent repeat head computerized
tomography scan which showed no evidence of increased
bleeding or shift of midline structures.  Thereafter she was
intubated for airway control.  It became immediately obvious
that the patient was going to do somewhat poorly given her
age and multiple comorbidities and traumatic mechanism with a
head bleed.

HOSPITAL COURSE:  She was admitted to the Trauma SICU Service
for further management and care.  Over the ensuing 24 to 36
hours, the patient required minimal ventilatory support.  She
was somewhat awake and following simple commands.  She did
have a gag reflex and after approximately 24 hours on the
ventilator and after being evaluated by the Neurosurgical
Service and having had two follow up head computerized
tomography scans showing no significant changes, she was able
to be weaned and extubated without event.  However, 24 hours
after her extubation she had increased work of breathing,
tachypnea a high degree of secretions that were somewhat tan
and purulent in nature.  She was having a low-grade
temperature and ultimately required reintubation because of
respiratory failure.  Over the ensuing three to four days she
required full ventilatory support.  She did spike a
temperature intermittently as high as 102.6 and was
pancultured accordingly.  She did have sputum that was
growing Staphylococcus aureus confirming likely that she did
have a Staphylococcus pneumonia.  It should be noted that the
patient had previously been in a rehabilitation facility for
approximately two to three months during her recovery phase
of the previously treated pneumonia.  She was not responding
much to commands.  She had been loaded with Dilantin on her
admission and had no evidence of seizure activity.  She was
being followed by the Neurosurgical Service who had evaluated
the patient's likelihood of functional recovery which was
minimal.

After prolonged discussions and multiple family meeting with
the health care proxy who is the son as well as the daughter
and two other sons, it was fully understood and decided that
the patient had made strong wishes that she did not want to
be supported on a ventilator.  She had actually had a
pre-existing Do-Not-Resuscitate, Do-Not-Intubate order and as
a consequence the family opted to remove her from the
ventilator and to make her comfort-measures-only, knowing
that this was in keeping with the patient's prior known
wishes and legal wishes as in a prior Do-Not-Resuscitate,
Do-Not-Intubate order, as well as knowing that she would not
have a very good functional recovery and would likely acquire
at minimum prolonged ventilatory support with tracheostomy
and enteral feedings through a percutaneous ventral
gastrostomy tube.  This was not in standing or compatible
with the patient's previous known wishes and the family was
quite accepting and expecting this for removal of care.
Thereafter, after several family discussions it was
determined that the patient would be removed from the
ventilator and be comfort-measures-only.  This was done in
the afternoon of [**2164-3-15**].  She expired at 3:30 PM.
There was no evidence of cardiac or pulmonary activity, no
brain stem reflexes were noted.  Her pupils were fixed and
dilated and she was pronounced dead.  The medical examiner
did accept this case after hearing that she did have a
traumatic mechanism, so please refer to the final autopsy
results and publication per the medical examiner for further
details to elucidate whether there was any undue harm placed
on this patient or any other mechanism that lead to her
deterioration.  The family was present at the bedside and was
quite aware of the outcome.


                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D.  [**MD Number(1) 2214**]

Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2164-3-15**]  16:35
T:  [**2164-3-15**]  16:54
JOB#:  [**Job Number 104118**]
{'Subdural hemorrhage,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Bacteremia,Open wound of face, unspecified site, without mention of complication,Unspecified fall,Home accidents'}


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: 

PRESENT ILLNESS: Mrs. [**Known lastname 4135**] is an 88 year old
female with a past medical history of chronic obstructive
pulmonary disease, hypertension, insulin dependent diabetes
mellitus, history of lung carcinoma, status post lobectomy
who presented to the [**Hospital6 256**] at
approximately 6:30 in the morning on [**2164-3-9**] after
suffering an unwitnessed fall from standing and being found
on the kitchen floor in her home.  She had activated a
Medical Bracelet Life Alert and was seen by the emergency
medical services in her home in Southborn [**State 350**].  Her
initial [**Location (un) 2611**] coma scale was 15.  She was complaining of
some mild headache and was transported by ambulance to the
[**Hospital6 256**] Emergency Department
with stable vital signs and an intact neurologic event.  She
had had an obvious left supraorbital laceration which had
minimal bleeding.  After she was initially transported there
was no evidence of hypoxia or hypotension noted.  She was
seen by the Neurosurgical Service and thereafter a trauma
consultation was called.

MEDICAL HISTORY: The patient's past medical history is
notable for coronary artery disease, history of hypertension,
history of hypercholesterolemia, history of peripheral
vascular disease, history of Type 2 diabetes, history of
gastroesophageal reflux disease, chronic renal insufficiency
chronic obstructive pulmonary disease, history of
adenocarcinoma of the lung, history of diverticulosis and
history of a small infrarenal stable 3.5 cm abdominal aortic
aneurysm.

MEDICATION ON ADMISSION: Albuterol, Beclomethasone,
Moexipril 15 mg b.i.d., Quinine sulfate 250 mg a day,
Fexofenadine 50 mg a day, Ambien, Cilostazol 200 mg p.o.
q.i.d., Zantac 150 mg q. day, Thiamine, Vitamin C, a full
Aspirin, Colace 100 mg p.o. b.i.d., Norvasc 5 mg p.o. q. day,
Neurontin 100 mg p.o. q.h.s. and Dextromethorphan.

ALLERGIES: Penicillin, Phenobarbital and Ibuprofen.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subdural hemorrhage,Chronic airway obstruction, not elsewhere classified,Acidosis,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Bacteremia,Open wound of face, unspecified site, without mention of complication,Unspecified fall,Home accidents'}
