CHIEF COMPLAINT: s/p fall out of wheelchair

PRESENT ILLNESS: 74M w/h/o Afib, HTN, COPD, DM, PVD, CVA, s/p fall w/ SAH.  Until
two days prior, when he presented to OSH for routine arterial
studies of RLE for PVD. Following studies, pt was brought to
entrance of clinic in wheelchair, and subsequently found to have
fallen out of wheelchair with abrasions to right frontal area of
head, as well as R arm. Taken there directly to OSH ED.
.
At OSH, initial labs INR 2.3, PTT 38, Hct 29.7, Plt 264. CT head
revealed bilat SAH, no midline shift. Pt was given two units
PRBCs and two units FFP. Received 1g fosphenytoin load, vitk 5mg
SC. Transferred to [**Hospital1 18**] for further evaluation.
.
At [**Hospital1 18**] ED, given 2units of Proplex, when INR on arrival was
1.9, Hct down to 25.2 from reported 29.7. Initially guaiac
negative in ED.
.
Since arrival, CT head again confirmed bilat SAH. Pt was started
on nimodipine to prevent cerebral vasospasm, all anticoagulation
held.
.
per wife: + DOE for the last year, only walk 20 ft, but no
CP/shoulder pain/neck pain/no palpitations/ n/v/diaphoresis. No
PND/orthopnea, syncope or presyncope. + bilateral claudication
+LE edema:R>L.  Denies f/c/sweats, weight changes, abd pain,
melena, hematochezia, dysuria, urinary frequency,
arthralgia/myalgia or rashes. + cough and wheeze, but generally
well-controlled with inhalers, and not currently worse from
baseline.

MEDICAL HISTORY: HTN
NIDDM
Hypercholesterolemia
R rotator cuff injury s/p surgical repair
R knee surgery
R CEA
h/o polyps, nonmalignant
COPD (last PFTs this year, but unk results)
Atrial Fibrillation (on warfarin)
CVA w/ residual facial weakness 1/05
R CEA [**1-17**]
PVD s/p R Fem-[**Doctor Last Name **] bypass
R knee surgery
Last colonoscopy ?5 yrs ago, (+) polyps
BPH

MEDICATION ON ADMISSION: Diltiazem 240 mg QD
Zocor 40 mg QD
Combivent 8x/day
Advair 500/50 [**Hospital1 **]
Atenolol 100 QD
Lasix 80 QD
Metformin 500 QID
Prevacid 30 QD
Cozaar 50 [**Hospital1 **]
Allopurinol 300 QD
Coumadin 5 mg Q sunday, 2.5 mg Mon-Sat
Plavix 75 mg QD
ASA 81 mg QD
Lisinopril 40 mg QD
Tramodol 50 mg QID PRN
Terazosin 2 mg QID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T- 98.3 BP- 143/76 HR- 109 RR- 16 O2Sat 97% on RA
Gen: Lying in bed, NAD, in C collar
HEENT: NC/AT, moist oral mucosa
CV: irregular, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Lives with wife in [**Name (NI) **].
Tobacco: 2PPD X 52yrs, quit 10yrs ago.
Alcohol: 2drinks/day
Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Acute posthemorrhagic anemia,Atrial fibrillation,Obstructive chronic bronchitis without exacerbation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Accidental fall from wheelchair,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with intermittent claudication,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Subarachnoid hem-no coma,Ac posthemorrhag anemia,Atrial fibrillation,Obst chr bronc w/o exac,Acute kidney failure NOS,Chronic kidney dis NOS,Fall from wheelchair,Hypertension NOS,DMII wo cmp nt st uncntr,Ath ext ntv at w claudct,BPH w/o urinary obs/LUTS
Name:  [**Last Name (LF) 11798**],[**Known firstname **] M                  Unit No:   [**Numeric Identifier 11799**]

Admission Date:  [**2132-9-11**]              Discharge Date:   [**2132-9-18**]

Date of Birth:  [**2057-9-22**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1305**]
Addendum:
Explained to pt which of the meds he should no longer take that
he was taking pre-admission. Also, explained which meds are new.
Wife verbally agrees to understanding.

Discharge Medications:
1. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**1-14**]
Puffs Inhalation Q6H (every 6 hours) as needed.
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
5. Terazosin 1 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
7. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours) for 2 weeks.
Disp:*168 Capsule(s)* Refills:*0*
8. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
10. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
11. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Hydralazine 25 mg Tablet Sig: 1.5 Tablets PO TID (3 times a
day).
Disp:*135 Tablet(s)* Refills:*2*
13. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
14. Isosorbide Dinitrate 20 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
15. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 328**] VNA

                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1307**]

Completed by:[**2132-9-18**]

Admission Date:  [**2132-9-11**]              Discharge Date:   [**2132-9-18**]

Date of Birth:  [**2057-9-22**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
s/p fall out of wheelchair

Major Surgical or Invasive Procedure:
None


History of Present Illness:
74M w/h/o Afib, HTN, COPD, DM, PVD, CVA, s/p fall w/ SAH.  Until
two days prior, when he presented to OSH for routine arterial
studies of RLE for PVD. Following studies, pt was brought to
entrance of clinic in wheelchair, and subsequently found to have
fallen out of wheelchair with abrasions to right frontal area of
head, as well as R arm. Taken there directly to OSH ED.
.
At OSH, initial labs INR 2.3, PTT 38, Hct 29.7, Plt 264. CT head
revealed bilat SAH, no midline shift. Pt was given two units
PRBCs and two units FFP. Received 1g fosphenytoin load, vitk 5mg
SC. Transferred to [**Hospital1 18**] for further evaluation.
.
At [**Hospital1 18**] ED, given 2units of Proplex, when INR on arrival was
1.9, Hct down to 25.2 from reported 29.7. Initially guaiac
negative in ED.
.
Since arrival, CT head again confirmed bilat SAH. Pt was started
on nimodipine to prevent cerebral vasospasm, all anticoagulation
held.
.
per wife: + DOE for the last year, only walk 20 ft, but no
CP/shoulder pain/neck pain/no palpitations/ n/v/diaphoresis. No
PND/orthopnea, syncope or presyncope. + bilateral claudication
+LE edema:R>L.  Denies f/c/sweats, weight changes, abd pain,
melena, hematochezia, dysuria, urinary frequency,
arthralgia/myalgia or rashes. + cough and wheeze, but generally
well-controlled with inhalers, and not currently worse from
baseline.

Past Medical History:
HTN
NIDDM
Hypercholesterolemia
R rotator cuff injury s/p surgical repair
R knee surgery
R CEA
h/o polyps, nonmalignant
COPD (last PFTs this year, but unk results)
Atrial Fibrillation (on warfarin)
CVA w/ residual facial weakness 1/05
R CEA [**1-17**]
PVD s/p R Fem-[**Doctor Last Name **] bypass
R knee surgery
Last colonoscopy ?5 yrs ago, (+) polyps
BPH

Social History:
Lives with wife in [**Name (NI) **].
Tobacco: 2PPD X 52yrs, quit 10yrs ago.
Alcohol: 2drinks/day

Family History:
Noncontributory

Physical Exam:
T- 98.3 BP- 143/76 HR- 109 RR- 16 O2Sat 97% on RA
Gen: Lying in bed, NAD, in C collar
HEENT: NC/AT, moist oral mucosa
CV: irregular, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
Mental status: Awake and alert, cooperative with exam, normal
affect. Oriented to person, place, and date. Attentive. Speech
is fluent with normal comprehension. No dysarthria.

Cranial Nerves:
Pupils equally round and reactive to light, 3 to 2 mm
bilaterally. Visual fields are full to confrontation.
Extraocular
movements intact bilaterally, no nystagmus. Sensation intact V1-

V3. Mild R facial droop. Hearing intact to finger rub
bilaterally. Palate elevation symmetrical. Sternocleidomastoid
and trapezius normal bilaterally. Tongue midline, movements
intact

Motor:
Normal bulk bilaterally. Tone normal. No observed myoclonus or
tremor
No pronator drift
[**Doctor First Name **] Tri [**Hospital1 **] WF WE FE FF IP H Q DF PF TE TF
R 4+ 5 5 5 5 5 5 5 5 5 5 5 5 5
L 5 5 5 5 5 5 5 5 5 5 5 5 5 5

(pt. reports R delt weakness 2/2 rotator cuff injury)

Sensation: Intact to light touch throughout.

Reflexes:
+2 and symmetric throughout, except absent in R patella (site of

R knee surgery)
Toes downgoing bilaterally

Coordination: finger-nose-finger normal



Pertinent Results:
[**2132-9-11**] 06:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2132-9-11**] 06:00PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.007
[**2132-9-11**] 06:00PM   PLT COUNT-237
[**2132-9-11**] 06:00PM   ANISOCYT-1+ MACROCYT-1+
[**2132-9-11**] 06:00PM   NEUTS-76.9* LYMPHS-17.2* MONOS-4.2 EOS-1.3
BASOS-0.5
[**2132-9-11**] 06:00PM   WBC-7.6 RBC-2.69* HGB-8.6* HCT-25.2* MCV-94
MCH-31.9 MCHC-34.0 RDW-16.3*
[**2132-9-11**] 06:00PM URINE  HOURS-RANDOM
EKG: AFib 80, borderline inf axis, nonspecific TW flattening in
III, avF.
.
CTA Head:
Wet read: No aneurysm seen although reconstructions are pending.
Absent right vertebral artery.
.
CT Head:
IMPRESSION: Subarachnoid hemorrhage, greatest in the areas of
the sylvian fissures bilaterally. Though the etiology is likely
traumatic, an underlying aneurysm is not excluded.
The extensive nature of the hemorrhage, and the apparent
spherical area of high density in the left sylvian fissure
(seires 2 image 15) raise a concern of aneurysmal bleeding.
Recommend CTA, MRA, or catheter arteriography for further
evaluation.
.
CT Abd/Pelvis [**2132-9-11**]
1. No definite acute traumatic injury identified. There is very
mild wedging of the anterior portion of the T11 vertebral body,
of undetermined age.
2. Indeterminate left adrenal lesion. This may represent an
adenoma, but further evaluation with CT or MR is recommended.
3. Small bilateral pleural effusions.
4. Atherosclerosis of the abdominal aorta, with mild dilation of
the
infrarenal portion to 2.8 cm.
5. Enlarged prostate.
.
TTE [**2132-9-16**]: left and right atriums moderately dilated; mild
symmetric left ventricular hypertrophy; left ventricular
systolic function is normal (LVEF 70%); increased left
ventricular filling pressure (PCWP>18mmHg). No masses or thrombi
are seen in the left ventricle. Mild to moderate mitral
regurgitation is seen- the severity
of mitral regurgitation may be significantly UNDERestimated;
borderline pulmonary artery systolic hypertension; no
pericardial effusion.
.
CXR [**2132-9-16**]:persistence of small bilateral pleural effusions,
with minimal congestive heart failure/volume overload, mild
improvement from [**2132-9-13**].
.

[**2132-9-18**] 07:00AM BLOOD WBC-7.9 RBC-3.23* Hgb-9.9* Hct-28.7*
MCV-89 MCH-30.5 MCHC-34.3 RDW-19.5* Plt Ct-258
[**2132-9-16**] 06:35AM BLOOD Glucose-111* UreaN-62* Creat-3.3* Na-138
K-3.9 Cl-102 HCO3-22 AnGap-18
[**2132-9-17**] 07:00AM BLOOD Glucose-163* UreaN-54* Creat-2.6* Na-140
K-3.8 Cl-102 HCO3-23 AnGap-19
[**2132-9-18**] 07:00AM BLOOD Glucose-126* UreaN-47* Creat-2.1* Na-142
K-3.8 Cl-105 HCO3-23 AnGap-18
[**2132-9-17**] 07:00AM BLOOD WBC-7.7 RBC-3.37* Hgb-9.7* Hct-28.8*
MCV-86 MCH-28.8 MCHC-33.6 RDW-20.0* Plt Ct-256
[**2132-9-16**] 06:35AM BLOOD WBC-7.9 RBC-2.75* Hgb-8.4* Hct-24.3*
MCV-88 MCH-30.7 MCHC-34.7 RDW-17.6* Plt Ct-221
[**2132-9-15**] 06:05AM BLOOD calTIBC-211* TRF-162*
[**2132-9-14**] 09:47PM BLOOD Hapto-237* Ferritn-373
[**2132-9-13**] 09:00PM BLOOD VitB12-178* Folate-GREATER TH Ferritn-209
[**2132-9-16**] 06:35AM BLOOD PTH-81*
[**2132-9-14**] 05:15PM BLOOD Type-ART pO2-82* pCO2-33* pH-7.44
calTCO2-23 Base XS-0

Brief Hospital Course:
A/P: 74yoM w/ h/o DM, HTN, PVD, COPD, here s/p fall w/ SAH now
w/ SOB and ARF.
.
# Cards- Vasculopath, longstanding h/o HTN now w/SOB and pleural
effusion, cardiomegaly on CXR
- Pump- echo shows EF 70%
-- Hold on standing lasix
- Rate/Rhythm- A. Fib; rate controlled
-- continue Atenolol, Diltiazem
-- anticoagulation held [**2-14**] falls (was on ASA, plavix, coumadin
when fell)
- Coronaries
-- Plan for outpt w/u w/exercise stress when stable.
- HTN
-- d/c Atenolol, start Metoprolol, start hydralazine/isosorbide
dinitrate; Plan to restart ACE [**Last Name (LF) **], [**First Name3 (LF) **] d/c hydral/isosorbide
at that time.
.
# Renal- ARF on CRI(baseline Cr unknown), initiall oliguric, now
autodiuresing
-- Cr on admission 1.7, discharge creatinine 2.1 Pt w/ recent
h/o contrast studies [**2132-9-11**], [**2132-9-12**]; FENA 0.2- Prerenal/ATN.
- transfusion of 1 unit overnight followed by Diuril 500 mg IV
and IV Lasix 120 mg with improvement in UO
- Urine Alb/Cr ratio 0.7 likely secondary to long standing DM
and Hypertension
- Plan to restart ACE [**Month/Day/Year **] as above.
.
# Pulm- SOB, 92% on 6L, 80's on RA; ABG: 7.44/33/82
- Pleural effusions- most likely [**2-14**] CHF
-- continue to diurese
-- renal consulted, recommending fluid challenge followed by
diuresis.
-- f/u CXR showing resolution of effusions,
-- [**2132-9-17**] 97% on RA
- COPD
-- continue inhalers, nebs prn
-- continue O2 to maintain Sat>92%
.
# Neuro- new subarachnoid hemorrhage, h/o CVA- stable
- Subarachnoid Hemorrhage
-- Neurosurg following recs:
-- Plan to restart Plavix [**2132-9-18**], Plan to restart coumadin
[**2132-10-12**]
-- continue Nimodipine/Dilantin for 3 wk course
- h/o CVA- stable hemiparesis R side
-- continue ASA
.
# Heme
- Anemia- ?[**2-14**] SC absorption from numerous ecchymoses- iron
studies reveal anemia of chronic inflammation
-- pretreat w/ Tylenol, Benadryl for a ? transfusion reaction
with no evidence of hemolysis
-- Transfused with clinical improvmement.
- Continue to hold Plavix, warfarin for now
.
# [**Name (NI) **] pt w/ h/o chronic bronchitis
- Treated with Azithromycin, Ceftriaxone for possible PNA;
?retrocardiac opacity
.
# GI- unlikely to be GI source given Guaiac negative stools.
- continue PPI.
- bowel regimen.
.
# Endocrine- DM2- SSI
.
#  FEN.- regular diet, replete lytes.
.
#  PPX.  SC heparin, PPI, bowel regimen
.
#  Code: Full
.
# Communication:  Primary Care Physician: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20561**] MD
[**Telephone/Fax (1) 26190**],  [**Name (NI) 1094**] Wife: [**Telephone/Fax (1) 69044**] (cell)
.
# Dispo: d/c home when stable; f/u w/ Dr. [**Last Name (STitle) 548**] 6 wks
[**Telephone/Fax (1) 1669**]; fax d/c summary to Dr. [**Last Name (STitle) 20561**] on D/c office
ph:[**Telephone/Fax (1) 26190**]

Medications on Admission:
Diltiazem 240 mg QD
Zocor 40 mg QD
Combivent 8x/day
Advair 500/50 [**Hospital1 **]
Atenolol 100 QD
Lasix 80 QD
Metformin 500 QID
Prevacid 30 QD
Cozaar 50 [**Hospital1 **]
Allopurinol 300 QD
Coumadin 5 mg Q sunday, 2.5 mg Mon-Sat
Plavix 75 mg QD
ASA 81 mg QD
Lisinopril 40 mg QD
Tramodol 50 mg QID PRN
Terazosin 2 mg QID


Discharge Medications:
1. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**1-14**]
Puffs Inhalation Q6H (every 6 hours) as needed.
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
5. Terazosin 1 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
7. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours) for 2 weeks.
Disp:*168 Capsule(s)* Refills:*0*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
11. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
12. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Hydralazine 25 mg Tablet Sig: 1.5 Tablets PO TID (3 times a
day).
Disp:*135 Tablet(s)* Refills:*2*
14. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
15. Isosorbide Dinitrate 20 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
16. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Traumatic subarachnoid hemorrhage
ARF
hypoxia


Discharge Condition:
stable


Discharge Instructions:
Return to ER or call Dr.[**Name (NI) 2845**] office if you develop sudden
worsening headaches or any neurologic changes
[**Month (only) 116**] restart coumadin [**2132-10-12**].
Return to ER or call Dr.[**Name (NI) 2845**] office if you develop sudden
worsening headaches or any neurologic changes
[**Month (only) 116**] restart coumadin in 1 month.
Please follow up with Dr. [**Last Name (STitle) 20561**] in the next 2 weeks.
Please take your medications as directed.
Please recheck your labs including creatinine outpatient with
your primary care physician; if your creatinine is below 2.0,
please stop taking hydralazine/isosorbide dinitrate and restart
your Cozaar per your primary care physician.

Followup Instructions:
You have the following appointments:
Follow up with Dr. [**Last Name (STitle) 548**] on [**2132-10-15**]- head CT at 11:45 AM please
do not eat for 4 hours before CT, 1 PM appointment with Dr.
[**Last Name (STitle) 548**], call [**Telephone/Fax (1) 2992**] if you have questions.
Follow up with Dr. [**Last Name (STitle) 20561**], please call for appointment.
Please recheck your labs including creatinine outpatient with
your primary care physician; if your creatinine is below 2.0,
please stop taking hydralazine/isosorbide dinitrate and restart
your cozaar per your primary care physician.
[**Name10 (NameIs) 357**] schedule follow up colonoscopy.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Acute posthemorrhagic anemia,Atrial fibrillation,Obstructive chronic bronchitis without exacerbation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Accidental fall from wheelchair,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with intermittent claudication,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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: s/p fall out of wheelchair

PRESENT ILLNESS: 74M w/h/o Afib, HTN, COPD, DM, PVD, CVA, s/p fall w/ SAH.  Until
two days prior, when he presented to OSH for routine arterial
studies of RLE for PVD. Following studies, pt was brought to
entrance of clinic in wheelchair, and subsequently found to have
fallen out of wheelchair with abrasions to right frontal area of
head, as well as R arm. Taken there directly to OSH ED.
.
At OSH, initial labs INR 2.3, PTT 38, Hct 29.7, Plt 264. CT head
revealed bilat SAH, no midline shift. Pt was given two units
PRBCs and two units FFP. Received 1g fosphenytoin load, vitk 5mg
SC. Transferred to [**Hospital1 18**] for further evaluation.
.
At [**Hospital1 18**] ED, given 2units of Proplex, when INR on arrival was
1.9, Hct down to 25.2 from reported 29.7. Initially guaiac
negative in ED.
.
Since arrival, CT head again confirmed bilat SAH. Pt was started
on nimodipine to prevent cerebral vasospasm, all anticoagulation
held.
.
per wife: + DOE for the last year, only walk 20 ft, but no
CP/shoulder pain/neck pain/no palpitations/ n/v/diaphoresis. No
PND/orthopnea, syncope or presyncope. + bilateral claudication
+LE edema:R>L.  Denies f/c/sweats, weight changes, abd pain,
melena, hematochezia, dysuria, urinary frequency,
arthralgia/myalgia or rashes. + cough and wheeze, but generally
well-controlled with inhalers, and not currently worse from
baseline.

MEDICAL HISTORY: HTN
NIDDM
Hypercholesterolemia
R rotator cuff injury s/p surgical repair
R knee surgery
R CEA
h/o polyps, nonmalignant
COPD (last PFTs this year, but unk results)
Atrial Fibrillation (on warfarin)
CVA w/ residual facial weakness 1/05
R CEA [**1-17**]
PVD s/p R Fem-[**Doctor Last Name **] bypass
R knee surgery
Last colonoscopy ?5 yrs ago, (+) polyps
BPH

MEDICATION ON ADMISSION: Diltiazem 240 mg QD
Zocor 40 mg QD
Combivent 8x/day
Advair 500/50 [**Hospital1 **]
Atenolol 100 QD
Lasix 80 QD
Metformin 500 QID
Prevacid 30 QD
Cozaar 50 [**Hospital1 **]
Allopurinol 300 QD
Coumadin 5 mg Q sunday, 2.5 mg Mon-Sat
Plavix 75 mg QD
ASA 81 mg QD
Lisinopril 40 mg QD
Tramodol 50 mg QID PRN
Terazosin 2 mg QID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T- 98.3 BP- 143/76 HR- 109 RR- 16 O2Sat 97% on RA
Gen: Lying in bed, NAD, in C collar
HEENT: NC/AT, moist oral mucosa
CV: irregular, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Lives with wife in [**Name (NI) **].
Tobacco: 2PPD X 52yrs, quit 10yrs ago.
Alcohol: 2drinks/day 

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Acute posthemorrhagic anemia,Atrial fibrillation,Obstructive chronic bronchitis without exacerbation,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Accidental fall from wheelchair,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with intermittent claudication,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
