CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 34-year-old
Brazilian male, who was transferred from the [**Hospital **]
Hospital in [**Location (un) 47**], MA on the day of admission having
experienced nausea and vomiting over several hours during the
middle of the day.  He then went to the emergency room at
[**Hospital6 1109**], where he complained of headache and
revealed subarachnoid hemorrhage with interparenchymal and
intraventricular blood and he underwent placement of two
ventricular drains immediately at that time at the outside
hospital prior to being transferred to the [**Hospital1 346**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subarachnoid hemorrhage,Urinary tract infection, site not specified,Pneumonia due to Pseudomonas,Acute respiratory failure,Coma
Subarachnoid hemorrhage,Urin tract infection NOS,Pseudomonal pneumonia,Acute respiratry failure,Coma
Admission Date:  [**2140-8-12**]       Discharge Date:  [**2140-10-13**]

Date of Birth: [**2106-6-11**]         Sex: M

Service:

Discharge summary was originally done on [**2140-9-20**].

MEDICATIONS ON DISCHARGE:  Ciprofloxacin 500 mg PO q.12h.
Ciprofloxacin should be continued for a total of 10 days.  It
was started on [**2140-10-13**].  It may be discontinued on
[**2140-10-14**].

Other medications include the following:  Diltiazem 30 mg PO
q.i.d.; Hydrochlorothiazide 12.5 mg PO q.d.; Nystatin oral
suspension 5 cc PO q.i.d. p.r.n.; free water 250 cc per PEG
q.6h. for sodium of 147 or greater; Metoprolol 150 mg PO
t.i.d.; Clonidine patch, one patch to the skin, change
q.Thursday; Epogen alfa 40,000 units subcutaneously q.week;
Colace 100 mg PO b.i.d.; Ibuprofen 400 mg NG q.6h.p.r.n.;
Lacrilube one application OU p.r.n.; Artificial Tears one to
two drops OU p.r.n.; heparin 5000 units subcutaneously q.12h.

The patient did spike a temperature on [**2140-10-3**].  The
patient was fully cultured and grew out pseudomonas in the
urine and the lungs.  Therefore, the patient is now being
treated with Ciprofloxacin, which will finish on [**2140-10-14**].
He has, otherwise, been in stable condition.  Neurologically,
he opens his eyes.  He does not blink to threat.  He moves
all extremities.  Withdraws to pain.  He does not follow
commands.  He has a PEG tube in place.  The site is clean,
dry, and intact.  He is on a tracheostomy collar for missed
oxygen.  Vital signs have been stable and he is ready for
transfer.


                    DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 14-133



Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2140-10-13**]  09:39
T:  [**2140-10-13**]  09:58
JOB#:  [**Job Number 44514**]


Name: [**Known lastname 8136**],[**Known firstname 7661**]            Unit No:  [**Numeric Identifier 8137**]

Admission Date:  [**2140-8-12**]     Discharge Date: [**2140-9-20**]

Date of Birth:   [**2106-6-11**]     Sex:  M

Service:

The patient's medications at the time of discharge are 250 cc
of free water via his PEG q6 hours, metoprolol 150 mg/PEG
tid, clonidine patch one patch q day to the skin q Thursday,
Epoetin alpha 40,000 units subQ q week, ibuprofen 400 mg
nasogastric q6 hours prn, Colace 100 mg per PEG [**Hospital1 **],
Artificial Tears 1-2 drops OU prn, acetaminophen 650 PR q6
hours prn, Heparin 5,000 units subQ q12 hours, lansoprazole
oral solution 30 mg per nasogastric q day.

Patient's prognosis is unknown at this point, though patient
is going to need six months to a year of [**Hospital 2754**]
rehabilitation in order to improve his condition.  He is a
young gentleman without any medical history aside from this
subarachnoid hemorrhage and will require at least six months
to a year of therapy to determine his final outcome.

His condition right now is stable.  He neurologically opens
his eyes.  He withdraws his extremities to pain.  He blinks
to threat.  He does not tend to the examiner nor does he
follow commands.  His vital signs have been stable.  He is in
stable condition and ready for transfer to [**Country 8138**].






                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 5862**]

Dictated By:[**Last Name (NamePattern1) 366**]

MEDQUIST36

D:  [**2140-9-20**]  09:16
T:  [**2140-9-20**]  09:26
JOB#:  [**Job Number 8139**]


Name: [**Known lastname 8136**],[**Known firstname 7661**]            Unit No: [**Unit Number 8137**]

Admission Date:  [**2140-8-12**]     Discharge Date: [**2140-10-13**]

Date of Birth:   [**2106-6-11**]     Sex:  M

Service:

The patient's medications at the time of discharge are 250 cc
of free water via his PEG q6 hours, metoprolol 150 mg/PEG
tid, clonidine patch one patch q day to the skin q Thursday,
Epoetin alpha 40,000 units subQ q week, ibuprofen 400 mg
nasogastric q6 hours prn, Colace 100 mg per PEG [**Hospital1 **],
Artificial Tears 1-2 drops OU prn, acetaminophen 650 PR q6
hours prn, Heparin 5,000 units subQ q12 hours, lansoprazole
oral solution 30 mg per nasogastric q day.

Patient's prognosis is unknown at this point, though patient
is going to need six months to a year of [**Hospital 2754**]
rehabilitation in order to improve his condition.  He is a
young gentleman without any medical history aside from this
subarachnoid hemorrhage and will require at least six months
to a year of therapy to determine his final outcome.

His condition right now is stable.  He neurologically opens
his eyes.  He withdraws his extremities to pain.  He blinks
to threat.  He does not tend to the examiner nor does he
follow commands.  His vital signs have been stable.  He is in
stable condition and ready for transfer to [**Country 8138**].






                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 5862**]

Dictated By:[**Last Name (NamePattern1) 366**]

MEDQUIST36

D:  [**2140-9-20**]  09:16
T:  [**2140-9-20**]  09:26
JOB#:  [**Job Number 8139**]


Admission Date:  [**2140-8-12**]    Discharge Date: [**2140-10-13**]

Date of Birth:                    Sex:

Service: NEUROSURGERY
DISCHARGE DATE:  Undetermined.

DISCHARGE PLAN:  The patient is to be transferred back to his
home country of [**Country 4194**] at some time in the near future.  The
dictation of this discharge summary is done in preparation

HISTORY OF THE PRESENT ILLNESS:  This is a 34-year-old
Brazilian male, who was transferred from the [**Hospital **]
Hospital in [**Location (un) 47**], MA on the day of admission having
experienced nausea and vomiting over several hours during the
middle of the day.  He then went to the emergency room at
[**Hospital6 1109**], where he complained of headache and
revealed subarachnoid hemorrhage with interparenchymal and
intraventricular blood and he underwent placement of two
ventricular drains immediately at that time at the outside
hospital prior to being transferred to the [**Hospital1 346**].

Repeat head CT scan, upon arrival, at the [**Hospital1 346**], showed findings consistent with
massive interparenchymal hemorrhage, as well as
intraventricular hemorrhage and massive subarachnoid
hemorrhage.  In the patient's physical examination, he was
grade 5, unresponsive, pupils nonreactive and entirely
unresponsive.  Previous medical history was reportedly
unremarkable although questionable due to absence of family
members for thorough questioning and obtaining of history.
Due to the clinical findings, the patient was taken urgently
to the Neuroangiography Suite for coiling of aneurysm after
angiogram.  The angiogram showed aneurysm in the anterior
communicating artery and nine coils were placed at that time.
The patient tolerated the procedure well.  The patient
remained neurologically unchanged and, therefore, admitted to
the Intensive Care Unit for further treatment.  The in situ
ventricular drains were removed at the time of the angiogram
due to clot formation in the drain tube and new drains were
placed urgently at that time.  The patient was brought to the
ICU with three intraventricular drains, all of the drains,
draining small amounts of thick, bloody fluid at the time of
admission to the ICU.  The patient had positive corneal
reflexes bilaterally and a weak intermittent cough, but,
otherwise, entirely unresponsive.

HOSPITAL COURSE:  On post-op day 1 the patient underwent
instillation of intraventricular tPA for dissolution of
intraventricular  clot and this helped improve drainage from
the drains and resulted in a lower intracranial pressure.  The
patient remained in the Intensive Care Unit for several days.
 On
the 11th, he was noted to show pupils 2.5 mm bilaterally and
minimally to nonreactive, neurologically unchanged.  The vent
drains were showing high intraventricular correction and
intracerebral pressures of 8 to 31 cm water.  The patient was
maintained on sedation at that time.  Later on the 12th, the
patient was taken to the operating room for treatment of [**Last Name (un) **]
ve
brain edema, at which time a left frontotemporal parietal
craniectomy was performed by Dr. [**Last Name (STitle) 1132**] with the bone flap plac
ed
into the abdominal subcutaneous adipose tissue for preservatio
n.
The patient tolerated the procedure well.  The patient went to
the recovery room stable.  The above procedure was done due to
persistent elevated intracranial pressures.  During the
postoperative course, the intracranial pressure came down
slightly and the patient remained in the Intensive Care Unit
for an additional several days at which time on the [**9-17**] the sputum culture showed positive growth and
Staphylococcus aureus.  The patient was placed on Oxicillin.
He remained in the Intensive Care Unit again for several
days.  On the 17th, he spiked a fever to 103.5 and he was
resulted.  All cultures came back negative with the exception
of the sputum.  Pupils remained 2.0 mm and nonreactive on the
right and 2 to 1.5 sluggishly reactive on the left.  He had
positive doll's eyes.  He began to open his eyes on occasion
inconsistently to sternal rub.  However, he remained,
otherwise, decerebrate in the left upper extremity.  He did
not localize.  He showed mild withdrawal of the right upper
extremity.  He triple flexed the bilateral lower extremities.
He was considered to be neurologically without change and in
grave condition, status post the grade 5 subarachnoid
hemorrhage.  However, the family felt they wanted to continue
aggressive therapy and this was continued.  The patient
remained in the ICU until the [**2140-9-2**], at which
time bronchoscopy and placement of trach was done.
Subsequently to this, in early [**Month (only) **] a PEG tube was
placed for feeding.  The patient tolerated these procedure
quite well.  The patient was maintained in the Intensive Care
Unit and remained essentially neurologically without change.
The patient was periodically cultured.  He was also seen in
consultation by the Stroke Service for further evaluation.
However, due to the clinical findings and the presence of
ventricular drains, no further interventions were felt to be
appropriate.  Decision was made for the patient to undergo
removal of the drains and placement of a ventricular
peritoneal shunt.  He was, therefore, taken back to the
operating room on the afternoon of the [**2140-9-9**], where he underwent removal of the ventricular drains
and placement of a right frontal ventriculoperitoneal shunt
and also had replacement of the bone flap with a small
incision made in the left abdominal wall for removal of the
bone flap and replacement of the bone flap onto the left
frontotemporoparietal area.  The patient tolerated all
procedures well.  The patient returned to the Intensive Care
Unit and remained essentially unchanged neurologically with
occasions when the patient's eyes were opened and he would
appear to be awake or minimally response if at all to light
sternal rub and deep painful stimulation.  However, he never
attended the examiner.  He does not blink to threat.  He
minimally withdraws to painful stimulation and he remained,
otherwise, neurologically unchanged.  Therefore, toward the
end of the first week of [**Month (only) **], discussion was made with
the family, who indicated the desire to maintain current
aggressive therapy with plans for the patient to be
transferred to [**Country 4194**] to his home country when arrangements
could be made.

CONDITION ON DISCHARGE:  Neurologically minimally responsive
male who remains severely comatose with grade 5 subarachnoid
hemorrhage status post multiple procedures.

MEDICATIONS ON DISCHARGE:  Medications will be dictated in an
addendum note.




                            [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Name8 (MD) 22907**]
MEDQUIST36

D:  [**2140-9-12**]  18:29
T:  [**2140-9-14**]  15:49
JOB#:  [**Job Number **]
{'Subarachnoid hemorrhage,Urinary tract infection, site not specified,Pneumonia due to Pseudomonas,Acute respiratory failure,Coma'}


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: This is a 34-year-old
Brazilian male, who was transferred from the [**Hospital **]
Hospital in [**Location (un) 47**], MA on the day of admission having
experienced nausea and vomiting over several hours during the
middle of the day.  He then went to the emergency room at
[**Hospital6 1109**], where he complained of headache and
revealed subarachnoid hemorrhage with interparenchymal and
intraventricular blood and he underwent placement of two
ventricular drains immediately at that time at the outside
hospital prior to being transferred to the [**Hospital1 346**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subarachnoid hemorrhage,Urinary tract infection, site not specified,Pneumonia due to Pseudomonas,Acute respiratory failure,Coma'}
