CHIEF COMPLAINT: Found unresponsive

PRESENT ILLNESS: Mr [**Known lastname 116**] is a 55 year old male, current smoker who is
wheelchair-bound due a motorcycle accident 21 years ago which
resulted in R AKA and R arm injury who was transferred to [**Hospital1 18**]
today for evaluation of intracranial hemorrhage.
This history was obtained from the patient's records and his
ex-wife since the patient is currently intubated and sedated.
He was apparently in his usual state of health and was last seen
well by his ex-wife at 12:15PM today.  At that time, he was
preparing to go fishing with a friend and he "seemed fine" to
his ex-wife.  She said that he was moving around in his
weelchair well and did not complain of headache.  Around 1:30PM,
his friend arrived to pick him up for their fishing trip and
found him unresponsive on the floor next to his wheelchair.  He
was lying on his back, foam was coming from his mouth and he did
not move or respond to his friend.  The friend called 911.  EMS
arrived to
find pt unresponsive.  Vitals:  HR 101 BP 178/90 O2Sat initially
98%, but dropped to 90% en route.  He was given Narcan without
response.  They tried to intubate him, but could not because his
jaw was clenched shut.

MEDICAL HISTORY: 1.  s/p motorcycle accident - AKA and right arm injury
2. Polio (in childhood)

MEDICATION ON ADMISSION: Tylenol PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: TAfeb  BP119-148/73-99 RR24-27 O2 Sat 95%
Gen: Thin male, intubated and sedated
HEENT: small laceration above left orbit, otherwise no evidence
of trauma
Neck: supple, no thyromegaly, no bruit
CV: RRR, S1/S2
Lung: Course breath sounds anteriorly
aBd: +BS slightly distended, soft, nontender
ext: Right AKA, Right arm flaccid and atrophied, left leg
atrophied.  No edema

FAMILY HISTORY: Pt was adopted; nothing is known about his biological family

SOCIAL HISTORY: Smokes [**2-4**] [**2-5**] ppd.  Smokes marijuana frequently.  Rare EtOH
abuse. No other drug use.  Lives with a friend.
Anomalies of cerebrovascular system,Other convulsions,Tobacco use disorder,Above knee amputation status
Cerebrovascular anomaly,Convulsions NEC,Tobacco use disorder,Status amput above knee
Admission Date:  [**2141-6-4**]              Discharge Date:   [**2141-6-7**]

Date of Birth:  [**2085-7-26**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
Found unresponsive

Major Surgical or Invasive Procedure:
cerebral angiography


History of Present Illness:
Mr [**Known lastname 116**] is a 55 year old male, current smoker who is
wheelchair-bound due a motorcycle accident 21 years ago which
resulted in R AKA and R arm injury who was transferred to [**Hospital1 18**]
today for evaluation of intracranial hemorrhage.
This history was obtained from the patient's records and his
ex-wife since the patient is currently intubated and sedated.
He was apparently in his usual state of health and was last seen
well by his ex-wife at 12:15PM today.  At that time, he was
preparing to go fishing with a friend and he "seemed fine" to
his ex-wife.  She said that he was moving around in his
weelchair well and did not complain of headache.  Around 1:30PM,
his friend arrived to pick him up for their fishing trip and
found him unresponsive on the floor next to his wheelchair.  He
was lying on his back, foam was coming from his mouth and he did
not move or respond to his friend.  The friend called 911.  EMS
arrived to
find pt unresponsive.  Vitals:  HR 101 BP 178/90 O2Sat initially
98%, but dropped to 90% en route.  He was given Narcan without
response.  They tried to intubate him, but could not because his
jaw was clenched shut.

On arrival to [**Hospital 1474**] Hospital, he had a witnessed GTC seizure.
He was given Ativan 2mg.  He was loaded with dilantin 1g IV.  He
was intubated and sedated.  He last received paralytic agents at
15:15.  In our emergency room, he was given Versed and started
on propofol.


Past Medical History:
1.  s/p motorcycle accident - AKA and right arm injury
2. Polio (in childhood)

Social History:
Smokes [**2-4**] [**2-5**] ppd.  Smokes marijuana frequently.  Rare EtOH
abuse. No other drug use.  Lives with a friend.


Family History:
Pt was adopted; nothing is known about his biological family

Physical Exam:
TAfeb  BP119-148/73-99 RR24-27 O2 Sat 95%
Gen: Thin male, intubated and sedated
HEENT: small laceration above left orbit, otherwise no evidence
of trauma
Neck: supple, no thyromegaly, no bruit
CV: RRR, S1/S2
Lung: Course breath sounds anteriorly
aBd: +BS slightly distended, soft, nontender
ext: Right AKA, Right arm flaccid and atrophied, left leg
atrophied.  No edema

Neurologic examination: (on propofol)
Mental status: Sedated on propofol, unresposive to voice, not
following commands, grimaces and moves left>right in respose to
sternal rub, but does not open eyes. +frequent coughing and
biting ETT.

Cranial Nerves:
Pupils equally round and reactive to light, 2mm bilaterally. No
blink to threat.  Eyes conjugate/midline, no nystagmus.   No
doll's. +corneals bilaterally.  Grimaces to nasal tickle.  No
facial asymmetry, though ETT obstructs view of lower face.
+gag.

Motor:
Decreased bulk in right hand.  Decreased tone on right arm.
Withdraws left arm and leg briskly to noxious stimuli.  Right
arm
does not withdraw to painful stim.

Sensation: Grimaces to noxious stimuli in all 3 limbs.

Reflexes:
      B T  Br  Pa Ach
Right 1 1  1   X   X
Left  1 1  1   0   4
Clonus (>10 beats) in left ankle

Toes upgoing on left

Coordination/Gait: Unable to assess


Pertinent Results:
[**2141-6-6**] 03:36AM BLOOD WBC-11.3* RBC-3.96* Hgb-12.5* Hct-36.5*
MCV-92 MCH-31.7 MCHC-34.3 RDW-14.1 Plt Ct-210
[**2141-6-4**] 04:40PM BLOOD WBC-22.4* RBC-4.71 Hgb-14.6 Hct-44.3
MCV-94 MCH-31.1 MCHC-33.0 RDW-13.8 Plt Ct-219
[**2141-6-6**] 03:36AM BLOOD Plt Ct-210
[**2141-6-5**] 04:00AM BLOOD Plt Ct-197
[**2141-6-5**] 04:00AM BLOOD PT-12.7 PTT-27.8 INR(PT)-1.1
[**2141-6-4**] 04:40PM BLOOD Glucose-77 UreaN-13 Creat-0.9 Na-142
K-4.7 Cl-111* HCO3-20* AnGap-16
[**2141-6-6**] 03:36AM BLOOD Glucose-91 UreaN-5* Creat-0.5 Na-139
K-3.2* Cl-107 HCO3-24 AnGap-11
[**2141-6-6**] 03:36AM BLOOD Phenyto-15.3
[**2141-6-4**] 04:40PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-8.2
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2141-6-5**] 02:18PM BLOOD Type-ART pO2-73* pCO2-33* pH-7.44
calHCO3-23 Base XS-0

CTA (head):1) No evidence of an arteriovenous malformation or
other vascular abnormality in the region of the evolving
hemorrhagic infarct of the right parietal lobe.2) An angiogram
is recommended to exclude a possible arteriovenous malformation
just anterior to the above-described infarct. This [**Known lastname **] very well
be an incidental finding representing a developmental venous
anomaly.


Brief Hospital Course:
55 year old male who was found unresponsive at home, taken to OH
where he had a GTC and was found to have a right
parieto-occipital hemorrhage.   It is unclear whether he fell
due to a seizure/bleed or whether the bleed was traumatic from
the fall
itself.

1.  Neuro:  Intraparenchymal hemorrhage-area of surrounding
edema on CT concerning for underlying mass, infarct or AVM.  He
underwent a MRI with gado and MRA which showed prominance of the
veins near the area of hemorrhage-there was no enhancing mass
visualized.  He was admitted to the Neuro ICU and continued on
dilantin for seizure prevention.  Repeat head CT showed no
change in hemorrhage.  CTA was done to look for AVM and showed
an area of abnormality anterior to the right parietal hemorrage
(unrelated to it) which was thought to represent an AVM or
venous malformation.  Cerebral angiogram was done to clarify
this question and showed no evidence for AVM, but suggested an
underlying venous anomaly in the internal cerebral veins. He was
continued on dilantin for sz prevention-level was 13.

2.  CV:  EKG shows no evidence of ischemia or arrhythmia
-Rule out MI with serial CE
-telemetry
-Keep SBP 120-150

3.  Pulm:  Pt was brought to the ER intubated for airway
protection.  He was extubated on HD2 after mental status
improved.  He tolerated extubation well.

4. GI:
-Pt remained on GI ppx throughout this admission

5. ID:  Increased WBC- UA negative, initial CXR negative, but
rpt showed LLL atelectasis.

Medications on Admission:
Tylenol PRN

Discharge Medications:
1. Phenytoin Sodium Extended 100 mg Capsule Sig: Three (3)
Capsule PO once a day.
Disp:*90 Capsule(s)* Refills:*6*


Discharge Disposition:
Home

Discharge Diagnosis:
Seizure
Right parietal venous anomaly


Discharge Condition:
Improved

Discharge Instructions:
You have been started on a new medication called dilantin to
prevent seizures.  Please continue to take this medication.  You
should have your dilantin level checked next week.
If you have any further seziures, headache, vision changes, new
numbness, weakness, incoordination or dizziness-please call Dr.
[**Last Name (STitle) **] or Dr. [**Last Name (STitle) 7994**] [**Telephone/Fax (1) 8717**] or come directly to the
emergency room.

Followup Instructions:
1. [**Hospital 18**] [**Hospital 4038**] Clinic in 2 months- Dr. [**Last Name (STitle) **]; please call
[**Telephone/Fax (1) 1694**] for an appointment

2. Call your primary care provider for an appointment within [**2-5**]
weeks.


                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]
{'Anomalies of cerebrovascular system,Other convulsions,Tobacco use disorder,Above knee amputation 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: Found unresponsive

PRESENT ILLNESS: Mr [**Known lastname 116**] is a 55 year old male, current smoker who is
wheelchair-bound due a motorcycle accident 21 years ago which
resulted in R AKA and R arm injury who was transferred to [**Hospital1 18**]
today for evaluation of intracranial hemorrhage.
This history was obtained from the patient's records and his
ex-wife since the patient is currently intubated and sedated.
He was apparently in his usual state of health and was last seen
well by his ex-wife at 12:15PM today.  At that time, he was
preparing to go fishing with a friend and he "seemed fine" to
his ex-wife.  She said that he was moving around in his
weelchair well and did not complain of headache.  Around 1:30PM,
his friend arrived to pick him up for their fishing trip and
found him unresponsive on the floor next to his wheelchair.  He
was lying on his back, foam was coming from his mouth and he did
not move or respond to his friend.  The friend called 911.  EMS
arrived to
find pt unresponsive.  Vitals:  HR 101 BP 178/90 O2Sat initially
98%, but dropped to 90% en route.  He was given Narcan without
response.  They tried to intubate him, but could not because his
jaw was clenched shut.

MEDICAL HISTORY: 1.  s/p motorcycle accident - AKA and right arm injury
2. Polio (in childhood)

MEDICATION ON ADMISSION: Tylenol PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: TAfeb  BP119-148/73-99 RR24-27 O2 Sat 95%
Gen: Thin male, intubated and sedated
HEENT: small laceration above left orbit, otherwise no evidence
of trauma
Neck: supple, no thyromegaly, no bruit
CV: RRR, S1/S2
Lung: Course breath sounds anteriorly
aBd: +BS slightly distended, soft, nontender
ext: Right AKA, Right arm flaccid and atrophied, left leg
atrophied.  No edema

FAMILY HISTORY: Pt was adopted; nothing is known about his biological family

SOCIAL HISTORY: Smokes [**2-4**] [**2-5**] ppd.  Smokes marijuana frequently.  Rare EtOH
abuse. No other drug use.  Lives with a friend. 

### Response:
{'Anomalies of cerebrovascular system,Other convulsions,Tobacco use disorder,Above knee amputation status'}
