CHIEF COMPLAINT: Fall, ICH

PRESENT ILLNESS: The patient is an 86 yo M transferred from OSH s/p fall from
standing, on ASA/Plavix/Coumadin. At OSH diagnosed with SDH and
L femur fx. On arrival to [**Hospital1 18**], it was noted that the patient
was becoming increaingly less responsive and he was intubated
for airway protection. A repeat head CT demonstrated worsening
SDH with midline shift. The patient received Proplex, FFP,
dilantin, and mannitol.

MEDICAL HISTORY: -Afib
-PNA
-MI
-s/p [**Hospital1 **] to L main and distal L main coronary artery [**3-11**] @
[**University/College **]-Hitchcock
-depression
-COPD on home O2

MEDICATION ON ADMISSION: Plavix, Lisinopril, Zoloft, Detrol, Coumadin, Zocor, Lasix, ASA,
Duoneb

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN: Elderly male, boarded and collared
VS: 117/64  78  18  100% NRB
Initial GCS 13 --> 6
HEENT: PERRL, lac to occiput
NECK: Trachea midline
COR: s1s2 RRR
RESP: CTAB
ABD: soft, NT, ND
EXT: LLE shortened, distal pulses intact but cool skin, ABI=1
NEURO: MAE
SKIN: cool, dry
RECTAL: tone WNL, guaiac +

FAMILY HISTORY: N/C

SOCIAL HISTORY: Lives with wife in [**Location (un) 3844**]
No tobacco/EtOH
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Closed fracture of unspecified part of neck of femur,Pneumonia, organism unspecified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status
Subdural hem w/o coma,Fx neck of femur NOS-cl,Pneumonia, organism NOS,Atrial fibrillation,Chr airway obstruct NEC,Fall NOS,Cor ath unsp vsl ntv/gft,Status-post ptca
Admission Date:  [**2137-5-7**]              Discharge Date:   [**2137-5-29**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
Fall, ICH

Major Surgical or Invasive Procedure:
s/p L burr hole
s/p L hemiarthroplasty


History of Present Illness:
The patient is an 86 yo M transferred from OSH s/p fall from
standing, on ASA/Plavix/Coumadin. At OSH diagnosed with SDH and
L femur fx. On arrival to [**Hospital1 18**], it was noted that the patient
was becoming increaingly less responsive and he was intubated
for airway protection. A repeat head CT demonstrated worsening
SDH with midline shift. The patient received Proplex, FFP,
dilantin, and mannitol.

Neurosurgery was involved immediately and there was discussion
with the patient's wife regarding going to the OR for evacuation
of the SDH; the wife declined surgery and the patient was
admitted to the T-SICU for close observation.


Past Medical History:
-Afib
-PNA
-MI
-s/p [**Hospital1 **] to L main and distal L main coronary artery [**3-11**] @
[**University/College **]-Hitchcock
-depression
-COPD on home O2


Social History:
Lives with wife in [**Location (un) 3844**]
No tobacco/EtOH


Family History:
N/C

Physical Exam:
GEN: Elderly male, boarded and collared
VS: 117/64  78  18  100% NRB
Initial GCS 13 --> 6
HEENT: PERRL, lac to occiput
NECK: Trachea midline
COR: s1s2 RRR
RESP: CTAB
ABD: soft, NT, ND
EXT: LLE shortened, distal pulses intact but cool skin, ABI=1
NEURO: MAE
SKIN: cool, dry
RECTAL: tone WNL, guaiac +


Pertinent Results:
[**2137-5-7**] 11:50PM   TYPE-ART PO2-141* PCO2-39 PH-7.47* TOTAL
CO2-29 BASE XS-5
[**2137-5-7**] 10:00PM   TYPE-ART PO2-72* PCO2-45 PH-7.45 TOTAL
CO2-32* BASE XS-6
[**2137-5-7**] 10:00PM   GLUCOSE-114* LACTATE-1.8
[**2137-5-7**] 08:36PM   GLUCOSE-135* UREA N-31* SODIUM-137
POTASSIUM-3.7 CHLORIDE-98 TOTAL CO2-28 ANION GAP-15
[**2137-5-7**] 08:36PM   CALCIUM-8.3* PHOSPHATE-4.1 MAGNESIUM-1.8
[**2137-5-7**] 08:36PM   OSMOLAL-308
[**2137-5-7**] 08:36PM   WBC-6.2 RBC-3.22* HGB-10.0*# HCT-28.0*#
MCV-87 MCH-31.2 MCHC-35.8* RDW-15.4
[**2137-5-7**] 08:36PM   PLT COUNT-137*
[**2137-5-7**] 08:36PM   PT-13.7* PTT-31.9 INR(PT)-1.2*
[**2137-5-7**] 08:36PM   FIBRINOGE-241
[**2137-5-7**] 08:30PM   TYPE-ART PO2-304* PCO2-47* PH-7.43 TOTAL
CO2-32* BASE XS-6
[**2137-5-7**] 05:06PM   TYPE-ART O2-100 PO2-86 PCO2-38 PH-7.48* TOTAL
CO2-29 BASE XS-4 AADO2-606 REQ O2-97 COMMENTS-NON-REBREA
[**2137-5-7**] 05:04PM   TYPE-[**Last Name (un) **] PO2-27* PCO2-51* PH-7.41 TOTAL
CO2-33* BASE XS-4 COMMENTS-GREEN TOP
[**2137-5-7**] 05:04PM   GLUCOSE-103 LACTATE-1.6 NA+-141 K+-4.1
CL--100
[**2137-5-7**] 05:04PM   HGB-13.8* calcHCT-41 O2 SAT-50 CARBOXYHB-2
MET HGB-0
[**2137-5-7**] 05:04PM   freeCa-1.09*
[**2137-5-7**] 05:00PM   GLUCOSE-105 UREA N-32* CREAT-1.0 SODIUM-139
POTASSIUM-4.1 CHLORIDE-100 TOTAL CO2-28 ANION GAP-15
[**2137-5-7**] 05:00PM   AMYLASE-47
[**2137-5-7**] 05:00PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2137-5-7**] 05:00PM URINE  HOURS-RANDOM
[**2137-5-7**] 05:00PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2137-5-7**] 05:00PM   WBC-9.0 RBC-4.27* HGB-13.8* HCT-38.1* MCV-89
MCH-32.3* MCHC-36.3* RDW-15.2
[**2137-5-7**] 05:00PM   PLT COUNT-101*
[**2137-5-7**] 05:00PM   PT-18.2* PTT-31.4 INR(PT)-1.7*
[**2137-5-7**] 05:00PM   FIBRINOGE-331
[**2137-5-7**] 05:00PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.007
[**2137-5-7**] 05:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0
LEUK-NEG
.
CT torso: 1. Multiple large mediastinal lymph nodes.
2. Evidence of lung fibrosis with interstitial and alveolar
changes, consistent with history of interstitial lung disease.
3. Acute comminuted left femoral neck fracture.
.
CT c-spine: IMPRESSION: No evidence of acute fracture or
spondylolisthesis. Degenerative change is seen within the
cervical spine.
.
CT head: IMPRESSION: Large left subdural hematoma with blood
tracking along the falx and left tentorium. There is mass effect
upon the left lateral ventricles. Rightward shift of normally
midline structures with approximately 9 mm shift of the septum
pellucidum concerning for subfalcine herniation. Although the
ambient cisterns appear patent, they are narrowed and there is
concern for impending uncal herniation.
.


Brief Hospital Course:
The patient was admitted to the T-SICU. His mental status
improved and he was extubated. Repeat CT scans of the head
showed stable SDH and shift. On HD 9 a head CT showed decrease
in attenuation of the frontal aspect of the left subdural
hematoma, but an increase in volume of the collection. The
maximal width of the subdural hematoma had increased and there
was an increase in mass effect on the left brain. He returned to
the T-SICU for closer monitoring and remained stable, with a
waxing and [**Doctor Last Name 688**] mental status. On HD 14 a repeat head CT
showed slight worsening of the shift and the patient was
minimally responsive, not communicative. He was taken to the OR
and a L burr hole was placed for evacuation of hematoma. His
mental status improved from a pre-op GCS of 5 to a post-op GCS
of 10. He should be continued on Dilantin with a goal level of
15 (corrected for albumin).

The day prior to discharge, a head CT revealed: Compared to [**5-21**], [**2137**], there has been removal of the left intracranial
drainage catheter. The left subdural hematoma has largely been
evacuated with a small amount of heterogeneously dense blood
products layering along the left temporal and frontal lobes.
There has been no significant change in left to right subfalcine
shift measuring approximately 4 mm. The appearance of the
ventricles and sulci has not significantly changed and there is
no evidence of hydrocephalus. There remains pneumocephalus
around the burr hole site which has slightly improved. There are
no new areas of hemorrhage and no evidence of infarction. The
[**Doctor Last Name 352**]/white matter differentiation appears preserved and the
basal cisterns patent. The paranasal sinuses are pneumatized and
the orbits are unremarkable. IMPRESSION: Status post removal of
left intracranial drainage catheter. Otherwise, stable
appearance of the head.

Other issues for this hospitalization included:

# Cardiac: The patient was s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) **] 2 to the L main coronary
artery in [**2137-3-6**] at [**Hospital3 27447**] Center;
however, due to the acute intracranial hemorrhage, Plavix was
held initially during his course. It was restarted briefly after
discussion between Neurosurgery and Cardiology, held for
surgery, and will need to be restarted [**2137-5-28**] per Neurosurgery.
He was restarted on ASA 81mg QD post-operatively. He has a
history of atrial fibrillation and was in afib with a slow
ventricular response at the time of transfer. He was
hemodynamically stable, with a systolic blood pressure in the
90s which has been largely his baseline (90s-110s).

# Respiratory: The patient spiked a fever and a CXR was
concerning for PNA. He was started on Levaquin on [**2137-5-16**] (HD
10); sputum cx revealed coag + staph and Vanco was started on
[**2137-5-18**].

# L femur fracture: The patient underwent L hemiarthroplasty and
tolerated the procedure well; he has been cleared by Orthopedics
to be weight-bearing as tolerated when able. He can follow up
with the orthopedic surgeon, Dr. [**Last Name (STitle) **] [**Name (STitle) 7376**], in 6 weeks.

# GI: A PEG was placed on [**5-17**] and tube feeds were started, now
at goal.
.

Medications on Admission:
Plavix, Lisinopril, Zoloft, Detrol, Coumadin, Zocor, Lasix, ASA,
Duoneb


Discharge Medications:
1. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed.
3. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
4. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
7. Morphine 2 mg/mL Syringe Sig: One (1)  Injection Q4H (every 4
hours) as needed.
8. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) gram
Intravenous  Q 12H (Every 12 Hours).
9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
10. Phenytoin 100 mg/4 mL Suspension Sig: 200 mg  PO Q12H (every
12 hours).
11. Insulin Regular Human 100 unit/mL Solution Sig: Sliding
Scale  Injection ASDIR (AS DIRECTED).


Discharge Disposition:
Extended Care

Facility:
[**Hospital 66960**]Healthcare

Discharge Diagnosis:
1. Subdural hematoma
2. Femur fracture
3. Pneumonia
4. Atrial fibrillation
5. CAD
6. COPD


Discharge Condition:
Fair


Discharge Instructions:
As per your wife's request, you are being transferred to
[**Hospital3 27447**] Center for continued care.

Followup Instructions:
* Orthopedics: Dr. [**First Name (STitle) **] [**Name (STitle) 7376**] ([**Telephone/Fax (1) 2007**] in 6 weeks

* Neurosurgery: Dr. [**Last Name (STitle) 739**] ([**Telephone/Fax (1) 88**] in 6 weeks if
desired; otherwise you may follow up in [**Location (un) 3844**] if more
convenient


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Closed fracture of unspecified part of neck of femur,Pneumonia, organism unspecified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status'}


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: Fall, ICH

PRESENT ILLNESS: The patient is an 86 yo M transferred from OSH s/p fall from
standing, on ASA/Plavix/Coumadin. At OSH diagnosed with SDH and
L femur fx. On arrival to [**Hospital1 18**], it was noted that the patient
was becoming increaingly less responsive and he was intubated
for airway protection. A repeat head CT demonstrated worsening
SDH with midline shift. The patient received Proplex, FFP,
dilantin, and mannitol.

MEDICAL HISTORY: -Afib
-PNA
-MI
-s/p [**Hospital1 **] to L main and distal L main coronary artery [**3-11**] @
[**University/College **]-Hitchcock
-depression
-COPD on home O2

MEDICATION ON ADMISSION: Plavix, Lisinopril, Zoloft, Detrol, Coumadin, Zocor, Lasix, ASA,
Duoneb

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN: Elderly male, boarded and collared
VS: 117/64  78  18  100% NRB
Initial GCS 13 --> 6
HEENT: PERRL, lac to occiput
NECK: Trachea midline
COR: s1s2 RRR
RESP: CTAB
ABD: soft, NT, ND
EXT: LLE shortened, distal pulses intact but cool skin, ABI=1
NEURO: MAE
SKIN: cool, dry
RECTAL: tone WNL, guaiac +

FAMILY HISTORY: N/C

SOCIAL HISTORY: Lives with wife in [**Location (un) 3844**]
No tobacco/EtOH 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Closed fracture of unspecified part of neck of femur,Pneumonia, organism unspecified,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Unspecified fall,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status'}
