CHIEF COMPLAINT: 

PRESENT ILLNESS: 

MEDICAL HISTORY: 1.  HIV positive with CD4 count on [**2112-1-30**] of 96. The
patient known to be medically non-compliant but previously on
Nelfinavir.
2.  HCV positive.
3.  History of endocarditis related to cocaine approximately
17 years ago.
4.  History of seizures felt secondary to benzodiazepine
withdraw.
5.  Polysubstance abuse times 18 years including IV heroin,
cocaine, alcohol and Klonopin.
6.  History of right deltoid abscess secondary to IM illicit
drug infection.
7.  Depression with history of suicidal ideation.
8.  Recent otitis media treated with Augmentin on admission.
9.  Cognitive impairment at baseline.

MEDICATION ON ADMISSION: 1.  Tylenol.
2.  Klonopin prn.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for alcohol abuse in father.

SOCIAL HISTORY: Mr. [**Known lastname 8071**] is homeless and lives at [**Location 8072**]
House in [**Location (un) 86**] for now.
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Closed fracture of other facial bones,Other accidental fall from one level to another,Pneumonitis due to inhalation of food or vomitus,Other convulsions,Asymptomatic human immunodeficiency virus [HIV] infection status,Other, mixed, or unspecified drug abuse, unspecified,Other chronic sinusitis
Cl skul base fx-coma NOS,Fx facial bone NEC-close,Fall-1 level to oth NEC,Food/vomit pneumonitis,Convulsions NEC,Asymp hiv infectn status,Drug abuse NEC-unspec,Chronic sinusitis NEC
Admission Date:  [**2112-1-26**]     Discharge Date: [**2112-2-8**]

Date of Birth:   [**2064-6-17**]     Sex:  M

Service: Medicine
DISCHARGE ADDENDUM:  This is a 47 year-old Caucasian male with
history of HIV, hepatitis C, depression with suicidal ideation,
polysubstance abuse including alcohol, Klonopin and cocaine who
presents to the ED after being found beside a two foot wall in
[**Hospital1 8**], [**State 350**]. The patient apparently fell from the
wall and became unresponsive and was brought to the ED.  He was
noted to have at that time a generalized tonic, clonic seizure.
The patient was treated with 14 milligrams of Ativan, Vecuronium,
Ceftriaxone and Dilantin.  He was intubated also for airway
protection.

Head CT scan at that time demonstrated small left frontal and
lateral temporal subdural hematoma with left sylvian fissures,
subarachnoid hemorrhage as well as multiple facial fractures. The
patient was loaded on Dilantin, treated with Mannitol for
associated edema.  At that time he was started on Neo-Synephrine
for transient post intubation hypertensive and admitted to the
ICU.

The patient was maintained on Ativan drip, Morphine drip,
Mannitol, and Dilantin. He was noted to be febrile and was
initiated on Levofloxacin and Flagyl for presumed aspiration
pneumonia on [**2112-1-27**].

The patient was seen by ophthalmology and plastic surgery for
orbital fractures and noted to have unequal pupils.  Neurosurgery
had been consulted. There were no new changes on head CT scan.
The patient remained tachypneic, alkalotic on CPAP and he was
extubated with success on [**2112-1-29**].

The patient continued to have persistent fevers and
Infectious Disease consult was obtained.

PAST MEDICAL HISTORY:
1.  HIV positive with CD4 count on [**2112-1-30**] of 96. The
patient known to be medically non-compliant but previously on
Nelfinavir.
2.  HCV positive.
3.  History of endocarditis related to cocaine approximately
17 years ago.
4.  History of seizures felt secondary to benzodiazepine
withdraw.
5.  Polysubstance abuse times 18 years including IV heroin,
cocaine, alcohol and Klonopin.
6.  History of right deltoid abscess secondary to IM illicit
drug infection.
7.  Depression with history of suicidal ideation.
8.  Recent otitis media treated with Augmentin on admission.
9.  Cognitive impairment at baseline.

MEDICATIONS ON ADMISSION:
1.  Tylenol.
2.  Klonopin prn.

SOCIAL HISTORY:   Mr. [**Known lastname 8071**] is homeless and lives at [**Location 8072**]
House in [**Location (un) 86**] for now.

FAMILY HISTORY:  Significant for alcohol abuse in father.

Differential diagnoses include drug seizure, alcohol
withdraw, myositis, sinusitis, meningitis, otitis media.  The
patient also noted to be somnolent with impaired communication
status post extubation.  Dilantin was temporarily discontinued on
[**2112-1-31**] for possible drug fever but on the following day the
patient had transient right sided arm and leg twitching
consistent with transient seizures.  Dilantin was restarted per
neurology and neurology consult was obtained.

The patient continued to require high flow oxygen to maintain
saturations in the upper 90s and frequent suctioning for
respiratory secretions.  At that time he was transferred to
the MICU service for persistent mental status changes, seizures
and oxygen requirement.

MICU course significant for LP on [**2112-2-2**] which showed the
following: Tube 1 had 700 red blood cells with 19 white blood
cells. Tube 4 with 550 red blood cells, 22 white blood cells,
protein was 57 with glucose 45. Gram stain fluid was negative
for organisms and crypto antigen was negative. Cultures following
were negative as well. It is unlikely that the LP findings were
more typical for possible subarachnoid hemorrhage rather than
acute meningitis.

Infectious Disease - Mr. [**Known lastname 8071**] continued to spike fevers up
to 102 degrees. On [**2112-1-27**] sputum grew the following sparse
grow of staphylococcus aureus coag positive which was resistant
only to penicillin.  Cultures [**2112-2-2**] continued to grow
staphylococcus aureus and he was started on IV Oxicillin for
further gram positive coverage.  Infectious Disease consult at
that time recommended Unasyn which was started on [**2112-2-6**] for
further broad range coverage.

On [**2112-2-7**] Mr. [**Known lastname 8071**]' BAL culture from his previous began to
grow methicillin resistant staphylococcus aureus.  Oxicillin was
discontinued and Vancomycin was started at that time.

Respiratory - Mr. [**Known lastname 8071**] required high flow oxygen as stated
before.  On [**2112-2-6**] he had acute hypoxic episode and was
emergently re-intubated.  On [**2112-2-7**] oxygen saturation had
improved and he was extubated successfully. Overnight he has
required minimal suctioning.

Neurology - Neuro consult had the following:  After seizures
that were present on day of admission with repeated seizures
on [**2112-1-31**] shortly after phenytoin was weaned secondary to
the possible drug fever.

On [**2112-2-5**] Mr. [**Known lastname 8071**] suffered another seizure which was
thought secondary to low Dilantin levels. Dilantin was reloaded
and serum levels of Dilantin have been followed since then.

Orthopedics / Plastics - Mr. [**Known lastname 8071**] is known to have several
facial fractures including right zygomatic, right interior
temporal, low lateral wall orbit and greater pterygoid [**Doctor First Name 362**]
fractures.  Plastics has been following and is deferring further
surgeries at present.  Mr. [**Known lastname 8071**] also wears a hard collar
secondary to inability to clinically clear his neck since
admission.  MRI was not done for ligamentous injury within
the first three days of admission and thus he will require six
weeks of C-spine stabilization.

Access -  A PIC line was placed on [**2112-2-2**].  At this time
he will be transferred to [**Location (un) 2655**] Medicine Firm for further
management of his multiple problems.




                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4446**]

Dictated By:[**Name8 (MD) 8073**]

MEDQUIST36

D:  [**2112-2-8**]  14:09
T:  [**2112-2-10**]  10:11
JOB#:  [**Job Number 8074**]


Admission Date:  [**2112-1-26**]       Discharge Date:  [**2112-2-18**]

Date of Birth:   [**2064-6-17**]       Sex:  M

Service:  [**Hospital1 212**]
NOTE:  This is a discharge addendum from [**2112-2-8**] to [**2112-2-18**].

As a brief review, this is a 47-year-old Caucasian male with
a history of human immunodeficiency virus, hepatitis C,
depression with suicidal ideation, polysubstance abuse who was
found down at the side of a 2 foot wall with non responsiveness.
He was in the Medical Intensive Care Unit for approximately two
weeks, at which time he was transferred on [**2112-2-8**] to CC7 for
further management.

HOSPITAL COURSE:

1.  INFECTIOUS DISEASE:  Mr. [**Known lastname 8071**] continues treatment with
Staphylococcus aureus pneumonia as well as sinusitis in human
immunodeficiency virus setting.  The Vancomycin was started
on [**2112-2-7**] and it will be continued for two weeks.  The
Unasyn was started two days prior to that and will need to be
continued for 21 days.  In the interim, Mr. [**Known lastname 8071**] continues
to spike fevers up to 102.8??????.  All blood, urine, fungal
isolators have been negative.  CT of the head was repeated x2
which showed mild resolution of the sinusitis.  LP was
attempted on [**2112-2-16**], but no fluid was able to be procured.
His fevers have been attributed to possible Dilantin drug
fever and he was thus changed to Trileptal for his seizures.
However, he continues to spike fevers every two to three days.
Other sources of fever include his subdural hemorrhage which is
like the current source.  His fever could also be because of
subdural hematoma, Methicillin resistant Staphylococcus aureus
pneumonia or sinusitis which are the likely the sources at this
time.

2.  NEUROLOGIC:  As stated above, Mr. [**Known lastname 8071**] was weaned off
Dilantin and changed to Trileptal for seizure prophylaxis.  He
has had no further seizures.  His neurologic exam has remained
unchanged with the exception of occasional purposeful movement.
He remains talkative, but it seems that his language is
complicated with some degree of dysarthria.  Mr. [**Known lastname 8071**]' speech
is garbled and incoherent.

3.  RESPIRATORY:  Mr. [**Known lastname 8071**] continues to be unable to protect
his airway against his secretions.  He continues to have no gag
reflex.  He does occasional desaturate on room air and on oxygen
secondary to mucous plugging, but improved significantly with
deep suction.  Chest x-ray on [**2112-2-15**] showed marked improvement
of his Methicillin resistant Staphylococcus aureus pneumonia.
There was interval involvement of the costophrenic angles with
new possible bilateral pleural effusions.  Decubitus chest x-rays
were done which showed no layering of the fluid and thus
thoracentesis was not attempted.  He is currently saturating 97%
on room air.

4.  FLUIDS, ELECTROLYTES AND NUTRITION:  Mr. [**Known lastname 8071**] has
nasogastric tube for tube feeds.  He may need PEG placement at
some point in the setting of his sinusitis.  However, this has
been deferred secondary to the lack of guardianship.

DISPOSITION:  Mr. [**Known lastname 8071**] is full code.  He is undergoing
application for a medical guardianship.  The first hearing will
be on [**2112-2-19**].

DISCHARGE MEDICATIONS:
1.  Scopolamine patch 1.5 mg TP q 72 hours
2.  Colace 100 mg po bid
3.  Trileptal 900 mg po bid
4.  Unasyn 3 gm intravenous q6h until at least [**2112-2-27**]
5.  Vancomycin 1 gm q 12 hours until [**2112-2-20**]
6.  Respalor 55 cc per hour every hour for 24 hours a day
7.  Albuterol nebulizers q 2 to 4 hours prn
8.  Atrovent nebulizers q 2 to 4 hours prn
9.  Haldol 1 to 2 mg intravenous q 6 to 8 hours prn
10. Tylenol 325 to 650 mg po q 4 to 6 hours prn
11. Ativan 0.5 to 1 mg intravenous/po q 4 to 6 hours prn
12. Nystatin swish and swallow 10 cc po qid

DISCHARGE DIAGNOSES:
1.  Subdural hematoma
2.  Subarachnoid hematoma
3.  Human immunodeficiency virus positive
4.  HCV positive
5.  History of endocarditis
6.  History of seizures
7.  Polysubstance abuse
8.  History of right deltoid abscess
9.  History of depression with suicidal ideation
10. Altered mental status




                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4446**]

Dictated By:[**Name8 (MD) 8073**]
MEDQUIST36

D:  [**2112-2-18**]  11:52
T:  [**2112-2-18**]  12:40
JOB#:  [**Job Number 8075**]


Name:  [**Known lastname 1028**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 1029**]

Admission Date:  [**2112-1-26**]     Discharge Date:  [**2112-3-1**]

Date of Birth:   [**2064-6-17**]     Sex:  M

Service:

ADDENDUM:  Over the weekend of [**2-27**] and [**2-28**],
Mr. [**Known lastname **] continued to have altered mental status but was
otherwise stable.

On [**Last Name (LF) 228**], [**2-29**], he went to the Endoscopy Suite where a
percutaneous endoscopic gastrostomy feeding tube was placed.
During the evening of [**2-29**] the feeding tube was used for
medications without incident.

On the morning of [**3-1**], the Gastrointestinal team advised
that the tube was okay for feeding.  Mr. [**Known lastname **] was now
stable for discharge to a nursing facility.

DISCHARGE STATUS:  To nursing facility.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

MEDICATIONS ON DISCHARGE:  (As detailed in previous Discharge
Summary).




                          [**First Name4 (NamePattern1) 168**] [**Last Name (NamePattern1) 1030**], MD  [**MD Number(1) 1031**]

Dictated By:[**Last Name (NamePattern1) 1032**]

MEDQUIST36

D:  [**2112-3-1**]  23:39
T:  [**2112-3-1**]  16:17
JOB#:  [**Job Number 1033**]


Name:  [**Known lastname 1028**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 1029**]

Admission Date:  [**2112-1-26**]     Discharge Date: [**2112-3-1**]

Date of Birth:   [**2064-6-17**]     Sex:  M

Service:  Medicine
DISCHARGE SUMMARY ADDENDUM: The patient will not be discharged
for at least a few more days. This is a discharge addendum from
previous discharge summary completed one week prior. In the
intervening week Mr. [**Known lastname **] has remained stable.

REVIEW:  This is a 47 year-old Caucasian male with HIV who was
found down near a wall and found to have subdural and
subarachnoid hemorrhages present. The patient seized in the ED
and since has had an eventful ICU course. The patient was called
out to the medical service in early [**Month (only) 880**] and has remained on
this service for the past three weeks.

1.  INFECTIOUS DISEASE  - Mr. [**Known lastname **] has been afebrile since the
Dilantin has been discontinued.  His fever was likely secondary
to drug fever rather than infectious etiology.  However other
sources of fever have included his subdural / subarachnoid
hemorrhage, sinusitis and MRSA pneumonia.  He has completed a two
week course of Vancomycin for MRSA pneumonia and a three week
course of Unasyn for sinusitis.

2.  NEUROLOGIC - Mr. [**Known lastname **] continues to have altered mental
status which waxes and wanes. He is occasionally increasingly
agitated which requires Ativan, Haldol and occasional Trazodone.
His altered mental status is likely secondary to his intracranial
bleed with closed head injury, seizures, recent infection, and
possibly HIV encephalopathy.

3. PULMONARY - Mr. [**Known lastname **] has been treated for a MRSA
pneumonia.  He is currently stable on room air.

4.  GASTROINTESTINAL - Mr. [**Known lastname **] will require PEG tube
placement by GI.  He failed swallow study on [**2112-2-25**] and was
noted to frankly aspirate without coughing.  He currently has NG
tube and gets tube feeds at goal - 55 cc an hour.

DISPOSITION:  Mr. [**Known lastname **] had a guardianship hearing on
[**2112-2-26**] and a guardian was appointed.  This guardian will need
to be contact[**Name (NI) **] for further procedures such as PEG tube
placement.  At this time he will need to undergo a screening for
nursing home placement.  He is currently full code.



                          [**Name6 (MD) 1034**] [**Name8 (MD) 1035**], M.D.  [**MD Number(1) 1036**]

Dictated By:[**Name8 (MD) 1037**]

MEDQUIST36

D:  [**2112-2-27**]  14:54
T:  [**2112-2-29**]  09:42
JOB#:  [**Job Number 1038**]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Closed fracture of other facial bones,Other accidental fall from one level to another,Pneumonitis due to inhalation of food or vomitus,Other convulsions,Asymptomatic human immunodeficiency virus [HIV] infection status,Other, mixed, or unspecified drug abuse, unspecified,Other chronic sinusitis'}


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: 

PRESENT ILLNESS: 

MEDICAL HISTORY: 1.  HIV positive with CD4 count on [**2112-1-30**] of 96. The
patient known to be medically non-compliant but previously on
Nelfinavir.
2.  HCV positive.
3.  History of endocarditis related to cocaine approximately
17 years ago.
4.  History of seizures felt secondary to benzodiazepine
withdraw.
5.  Polysubstance abuse times 18 years including IV heroin,
cocaine, alcohol and Klonopin.
6.  History of right deltoid abscess secondary to IM illicit
drug infection.
7.  Depression with history of suicidal ideation.
8.  Recent otitis media treated with Augmentin on admission.
9.  Cognitive impairment at baseline.

MEDICATION ON ADMISSION: 1.  Tylenol.
2.  Klonopin prn.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for alcohol abuse in father.

SOCIAL HISTORY: Mr. [**Known lastname 8071**] is homeless and lives at [**Location 8072**]
House in [**Location (un) 86**] for now. 

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Closed fracture of other facial bones,Other accidental fall from one level to another,Pneumonitis due to inhalation of food or vomitus,Other convulsions,Asymptomatic human immunodeficiency virus [HIV] infection status,Other, mixed, or unspecified drug abuse, unspecified,Other chronic sinusitis'}
