CHIEF COMPLAINT: [**First Name3 (LF) 8751**]

PRESENT ILLNESS: This is a [**Age over 90 **] year old female who was transferred from an outside
hospital after an [**Age over 90 8751**]. Per report, the patient was the
unrestrained passenger in a vehicle that was traveling
approximately 15mph, the car did sustain significant
front end damage. She was found to be in a crumpled position
underneath the dash board. LOC is unknown. She was amnestic to
the event.

MEDICAL HISTORY: dementia
hypothyroid ds
Hyperlipidemia

MEDICATION ON ADMISSION: ASA

ALLERGIES: Penicillins

PHYSICAL EXAM: On Admssion:
O: T:97.7  BP: 130/93         HR: 103   R 21      O2Sats
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: R [**2-5**], L unable to examine        EOMs R intact
Neck: collar
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: She is married and her husband was involved in the same [**Name (NI) 8751**].
Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of nasal bones,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Street and highway accidents
Traumatic subdural hem,Nasal bone fx-closed,Mv collision NOS-driver,Accid on street/highway
Admission Date:  [**2166-1-29**]              Discharge Date:   [**2166-1-31**]


Service: NEUROSURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
[**First Name3 (LF) 8751**]

Major Surgical or Invasive Procedure:
None


History of Present Illness:
This is a [**Age over 90 **] year old female who was transferred from an outside
hospital after an [**Age over 90 8751**]. Per report, the patient was the
unrestrained passenger in a vehicle that was traveling
approximately 15mph, the car did sustain significant
front end damage. She was found to be in a crumpled position
underneath the dash board. LOC is unknown. She was amnestic to
the event.

Past Medical History:
dementia
hypothyroid ds
Hyperlipidemia


Social History:
She is married and her husband was involved in the same [**Name (NI) 8751**].

Family History:
NC

Physical Exam:
On Admssion:
O: T:97.7  BP: 130/93         HR: 103   R 21      O2Sats
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: R [**2-5**], L unable to examine        EOMs R intact
Neck: collar
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, to
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power 4+ right UE; BLE limited due to
pain. No pronator drift
Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.
Reflexes: Normal bilat
Toes downgoing bilaterally

At discharge:
Alert to self and hospital
PERRL
EOMs intact, R periorbital ecchymosis
Face symmetrical
No pronator drift
MAE with good strength


Pertinent Results:
[**2166-1-30**] CT C-spine
No acute cervical spine fractures. Normal alignment.

[**2166-1-30**] CT head
1. There is an 8-mm extra-axial hemorrhage overlying the right
frontoparietal lobe with a biconvex appearance most suggestive
of an epidural hematoma. 2. Extensive left frontal subgaleal
hematoma with supraorbital and infraorbital components.
3. Tiny hyperdense focus visualized in a sulcus in the right
temporal lobe is suggestive of a tiny focus of subarachnoid
hemorrhage versus partial volume averaging.

L hip X-rays [**2166-1-30**]
1. No definite acute fracture or dislocation. If there is
continued clinical concern for left hip fracture, consider
correlation with hip MRI.
2. Tricompartmental mild-to-moderate osteoarthritic changes of
the left knee secondary to chondrocalcinosis.

L Femur X-rays [**2166-1-30**]
1. No definite acute fracture or dislocation. If there is
continued clinical concern for left hip fracture, consider
correlation with hip MRI.
2. Tricompartmental mild-to-moderate osteoarthritic changes of
the left knee secondary to chondrocalcinosis

CT head [**2166-1-30**]
1. Stable appearance of right frontoparietal epidural hematoma.
2. No other apparent foci of hemorrhage.
3. Stable large left orbital subgaleal hematoma.




Brief Hospital Course:
Ms. [**Known lastname **] was admitted to the TSICU under the care of Dr.
[**First Name (STitle) **] for Q1 hr neuro checks for EDH. She remained stable with
some disorientation  to time that was consistent with her
basline status due to dementia. Repeat CT head was stable.
Imaging of the left leg was negative for fracture. She was seen
by the medicine service and there were no acute issues and they
would not take over her care. She was transfered to the floor.
Her collar was cleared by the TSICU as she had no fracture or
pain. PT and OT were consulted and they felt that she was safe
to go home with 24hr supervision. The daughter will be home with
her over the weekend and a home VNA will be assisting on Monday.

Medications on Admission:
ASA

Discharge Medications:
Patient may take tylenol for pain

Discharge Disposition:
Home

Discharge Diagnosis:
EDH


Discharge Condition:
Neurologically stable


Discharge Instructions:
Instructions for  Follow up for Subdural, Epidural or
Subarachnoid Hemorrhages
Non-Surgical

??????	You may take tylenol for pain. You do not need to take it if
you do not have pain.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	DO not take any anti-inflammatory medicines such as Motrin,
Aspirin, Advil, or Ibuprofen etc. until follow up.
??????*****	If you were on Aspirin prior to your injury, you may
safely resume taking this on [**2166-2-4**].******

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion, lethargy or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	New onset of the loss of function, or decrease of function on
one whole side of your body.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please call ([**Telephone/Fax (1) 4676**] to schedule an appointment with Dr.
[**First Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.
??????We recommend you see Dr [**First Name (STitle) **] in the Traumatic Brain Injury
(TBI) clinic the phone number is [**Telephone/Fax (1) 6335**]. If you have any
problems booking this appointment please ask for [**First Name8 (NamePattern2) 16367**] [**Last Name (NamePattern1) 16368**].



Completed by:[**2166-1-31**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of nasal bones,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Street and highway 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: [**First Name3 (LF) 8751**]

PRESENT ILLNESS: This is a [**Age over 90 **] year old female who was transferred from an outside
hospital after an [**Age over 90 8751**]. Per report, the patient was the
unrestrained passenger in a vehicle that was traveling
approximately 15mph, the car did sustain significant
front end damage. She was found to be in a crumpled position
underneath the dash board. LOC is unknown. She was amnestic to
the event.

MEDICAL HISTORY: dementia
hypothyroid ds
Hyperlipidemia

MEDICATION ON ADMISSION: ASA

ALLERGIES: Penicillins

PHYSICAL EXAM: On Admssion:
O: T:97.7  BP: 130/93         HR: 103   R 21      O2Sats
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: R [**2-5**], L unable to examine        EOMs R intact
Neck: collar
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: She is married and her husband was involved in the same [**Name (NI) 8751**]. 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of nasal bones,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Street and highway accidents'}
