CHIEF COMPLAINT: s/p fall down stairs

PRESENT ILLNESS: 66F transfer from outside hospital after patient found down
in front of her staircase. Patient had multiple signs of trauma
including subarachnoid hemorrhage and orbital blowout fracture.
Patient had alcohol onboard with alcohol level in the 200s.
Patient was transferred for further care.

MEDICAL HISTORY: PMH: breast CA
PSH: CCY [**2112**], lumpectomy [**2133**]

MEDICATION ON ADMISSION: Anastrozole 1mg QD, Armidex 1 mg QD, Fluoxetine 20mg QD,
Citalopram 40mg QD, Campral 333mg 2 tabs QD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On arrival to [**Hospital1 18**]:

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: 1ppd smoker almost 50 years, alcoholism 14-15 shots per day with
recent detox, lives at home
Closed fracture of mandible, symphysis of body,Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Acute respiratory failure following trauma and surgery,Ventilator associated pneumonia,Acidosis,Delirium due to conditions classified elsewhere,Accidental fall on or from other stairs or steps,Open wound of tooth (broken) (fractured) (due to trauma), without mention of complication,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Thrombocytopenia, unspecified,Other specified periodontal diseases,Personal history of malignant neoplasm of breast,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Fx symphy mandib body-cl,Traum subarachnoid hem,Ac resp flr fol trma/srg,Ventltr assoc pneumonia,Acidosis,Delirium d/t other cond,Fall on stair/step NEC,Broken tooth-uncomplic,Alcoh dep NEC/NOS-contin,Tobacco use disorder,Thrombocytopenia NOS,Periodontal disease NEC,Hx of breast malignancy,Abn react-procedure NEC
Admission Date:  [**2139-10-5**]              Discharge Date:   [**2139-10-16**]

Date of Birth:  [**2073-8-5**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
s/p fall down stairs

Major Surgical or Invasive Procedure:
[**2139-10-9**]
1. Open reduction internal fixation of left parasymphysis
    fracture of the mandible.
2. Extraction of teeth numbers 4, 5, 11, 12, 13, 14, and
    23.
3. Alveoplasty of upper right quadrant and upper left
    quadrant.


History of Present Illness:
66F transfer from outside hospital after patient found down
in front of her staircase. Patient had multiple signs of trauma
including subarachnoid hemorrhage and orbital blowout fracture.
Patient had alcohol onboard with alcohol level in the 200s.
Patient was transferred for further care.

Fall was unwitnessed, ?LOC.  But responsive at the scene.  GCS
reportedly 15 at the scene.  Intubated in the ED for airway
protection 2/2 blood in the airway.


Past Medical History:
PMH: breast CA
PSH: CCY [**2112**], lumpectomy [**2133**]


Social History:
1ppd smoker almost 50 years, alcoholism 14-15 shots per day with
recent detox, lives at home


Family History:
noncontributory

Physical Exam:
On arrival to [**Hospital1 18**]:

Constitutional: Somnolent
HEENT: Left facial bruising and ecchymosis
Multiple dental fractures as well as intraoral laceration
Chest: Clear to auscultation
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Nontender, Soft
GU/Flank: No costovertebral angle tenderness
Extr/Back: No cyanosis, clubbing or edema
Skin: Warm and dry
Neuro: Speech fluent, moving all 4 extremities


Pertinent Results:
[**10-5**] CT OSH:  Comminuted Rt ramus and left parasymphyseal
mandible fractures   Rt ant and med maxillary wall fx with
alveolar ridge
Left tetrapod type fracture with ant/med/lat wall fractures of
maxillary sinus, L zygoma fracture, and L orbital floor
non-displaced fx. L orbital rim fx. Comminuted nasal bone fx
with minimal displacement. No c-spine injury per radiology.

MR SPine [**10-6**] IMPRESSION:
1. At least partial tear of the cervical nuchal ligament with
small amount of surrounding fluid/edema. No evidence of deeper
posterior ligamentous or
multicolumn injury, as associated with cervical instability.

2. Significant multilevel cervical degenerative disease, as
described, but no cord signal abnormality.

3. No MR evidence of acute lumbar spine injury.

4. Multilevel lumbar degenerative disease, most marked at the
L5-S1 level,
with facet arthrosis and synovial effusion, and gap measuring up
to 3.5 mm, which may be associated with instability.


[**2139-10-5**] WBC-11.2* Hct-38.6 Plt Ct-137*
[**2139-10-7**] WBC-4.5 Hct-25.1* Plt Ct-90*
[**2139-10-9**] WBC-4.2 Hct-23.4* Plt Ct-91*
[**2139-10-10**] WBC-3.4* Hct-22.7* Plt Ct-123*
[**2139-10-11**] WBC-4.1 Hct-20.5* Plt Ct-162
[**2139-10-11**] Hct-24.0*
[**2139-10-11**] Hct-23.6*
[**2139-10-12**] WBC-4.6 Hct-24.3* Plt Ct-257#

[**2139-10-5**] Creat-0.5 Na-142 K-4.0
[**2139-10-12**] Creat-0.4 Na-145 K-4.0

Brief Hospital Course:
66 F s/p fall down stairs in the setting of EtOH. She suffered
multiple injuries including a small R SAH, Bil mandible fx, Bil
ant/med maxillary wall fx, L zygoma, L orbital floor/rim fxs and
a nasal bone fracture.  She was intubated in the trauma bay as
she was not protecting her airway and subsequently admitted to
the TSICU. The patient was evaluated by neurosurgery upon
admission who reccomended seizure prophylaxis with dilantin for
seven days. Her course is now completed. She was seen by plastic
surgery for her facial fractures who deferred care to the OMFS
team. She was taken to the OR on [**10-9**] for open reduction
internal fixation of left parasymphysis fracture of the
mandible; extraction of teeth numbers 4, 5, 11, 12, 13, 14, and
23; and alveoplasty of upper right quadrant and upper left
quadrant.  Initially she had symptoms of alcohol withdrawl and
required hourly ativan. An MRI of the C/L spine was preformed
and showed no evidence of fracture or injury. While in the ICU
she spiked mulitple fevers and was diagnosed with a LLL
pneumonia. Bronchoscopy showed purulent thick secretions, and
culture grew SERRATIA LIQUEFACIENS >100,000 ORGANISMS/ML and
ENTEROBACTER CLOACAE ~4000/ML. She was started on a 10 day
course of antibiotics for this. When she returned from the OR
with OMFS she was extubated but rapidly re-intubated given
desaturations. Much of this was thought to be secondary to
edema. Upon resolution of the edema she was easily extubated but
failed speech and swallow so was initiated on tube feeds. Foley
catheter was discontinued but replaced shortly thereafter due to
urinary retention. She was started on flomax. Mrs. [**Known lastname **]
remained hemodynamically stable and mentation continued to
improve so she was transferred to the floor.

On [**2139-10-14**] she was transferred to the surgical floor where she
continued to remain hemodynamically stable without respiratory
compromise. Her mental status continued to improve and she was
alert and oriented x 3 at the time of discharge. Prior to
discharge, occupational therapy evaluated her cognitive status
given the TBI and follow up with cognitive neurology was
recommended. She remained afebrile and incentive spirometry and
pulmonary toileting were continually encouraged. At the time of
discharge, her O2 saturation was stable on room air and her IV
ceftriaxone for VAP was transitioned to PO ciprofloxacin, course
to be completed on [**10-19**]. Her WBC count remained within normal
limits. She was evaluated by speech and swallow therapy, who
said she was okay to take both thin and thick liquids; therefore
PO's were encouraged and her tube feeds were discontinued. Her
foley was removed after starting on flomax and she was able to
void without difficulty there after, with no further evidence of
urinary retention. Physical therapy also evaluated her her
recommended discharge to an extended care facility for continued
acute PT.

Social work was also consulted at the time of her admission and
continued to follow the patient and provide support for her
family given the trauma and history of alcohol use.

Medications on Admission:
Anastrozole 1mg QD, Armidex 1 mg QD, Fluoxetine 20mg QD,
Citalopram 40mg QD, Campral 333mg 2 tabs QD

Discharge Medications:
1. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
2. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for Constipation.
3. docusate sodium 50 mg/5 mL Liquid Sig: Ten (10) mL PO BID (2
times a day).
4. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

5. fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
6. anastrozole 1 mg Tablet Sig: One (1) Tablet PO QD ().
7. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) inj
Injection TID (3 times a day).
10. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO DAILY (Daily).
11. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed
for GERD.
13. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
14. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
15. Cipro 500 mg Tablet Sig: One (1) Tablet PO every twelve (12)
hours for 3 days.
16. bacitracin 500 unit/g Ointment Sig: One (1) application
Topical twice a day: Please apply to left submental incision .


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
Primary:
s/p fall

Injuries:
Small Right SAH
Bilateral mandible fracture
Bilateral ant/med maxillary wall fracture
L zygoma, L orbital floor/rim fractures
Nasal bone fracture

Secondary:
Ventilator associated pneumonia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted to the hospital after suffering a fall down
stairs. You sustained multiple injuries including multiple
facial fractures and a traumatic injury to your brain. You
developed pneumonia while you were intubated, for which you are
receiving antibiotics. You are now being discharged to an
extended care facility to continue rehabilitation from your
accident.

Please follow up as instructed below. It is important that you
keep all of your follow up appointments.

Continue to take a liquid diet. It is important that you take
the supplements recommended by nutrition as you will be on a
liquid diet for 6 weeks.

You are being given a prescription for narcotic pain medication.
Take the medication as needed. Do not drink alcohol or drive
while taking narcotics. Narcotics can cause constipation so
continue to take an over the counter stool softener such as
colace while taking narcotics, and increase your fluid and fiber
intake if possible.

Followup Instructions:
Department: Oral and Maxillary Facial Surgery
Notes: Please call the office number to make a hospital follow
up appointment for 4-8 days after your hospital discharge.
[**Hospital6 **]
[**Location (un) 24902**] Yawkey Building [**Location (un) **]
[**Location (un) 86**], [**Numeric Identifier 13108**]
Phone: [**Telephone/Fax (1) 91002**]

Department: GENERAL SURGERY/[**Hospital Unit Name 2193**]
When: TUESDAY [**2139-11-3**] at 3:00 PM
With: ACUTE CARE CLINIC [**Telephone/Fax (1) 600**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: COGNITIVE NEUROLOGY UNIT
When: MONDAY [**2139-11-9**] at 3:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6403**], MD [**Telephone/Fax (1) 1690**]
Building: Ks [**Hospital Ward Name 860**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage

Department: [**Hospital3 1935**] CENTER
When: TUESDAY [**2139-11-10**] at 10:45 AM
With: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. [**Telephone/Fax (1) 253**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2139-10-16**]
{'Closed fracture of mandible, symphysis of body,Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Acute respiratory failure following trauma and surgery,Ventilator associated pneumonia,Acidosis,Delirium due to conditions classified elsewhere,Accidental fall on or from other stairs or steps,Open wound of tooth (broken) (fractured) (due to trauma), without mention of complication,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Thrombocytopenia, unspecified,Other specified periodontal diseases,Personal history of malignant neoplasm of breast,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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 down stairs

PRESENT ILLNESS: 66F transfer from outside hospital after patient found down
in front of her staircase. Patient had multiple signs of trauma
including subarachnoid hemorrhage and orbital blowout fracture.
Patient had alcohol onboard with alcohol level in the 200s.
Patient was transferred for further care.

MEDICAL HISTORY: PMH: breast CA
PSH: CCY [**2112**], lumpectomy [**2133**]

MEDICATION ON ADMISSION: Anastrozole 1mg QD, Armidex 1 mg QD, Fluoxetine 20mg QD,
Citalopram 40mg QD, Campral 333mg 2 tabs QD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On arrival to [**Hospital1 18**]:

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: 1ppd smoker almost 50 years, alcoholism 14-15 shots per day with
recent detox, lives at home 

### Response:
{'Closed fracture of mandible, symphysis of body,Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Acute respiratory failure following trauma and surgery,Ventilator associated pneumonia,Acidosis,Delirium due to conditions classified elsewhere,Accidental fall on or from other stairs or steps,Open wound of tooth (broken) (fractured) (due to trauma), without mention of complication,Other and unspecified alcohol dependence, continuous,Tobacco use disorder,Thrombocytopenia, unspecified,Other specified periodontal diseases,Personal history of malignant neoplasm of breast,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
