CHIEF COMPLAINT: s/p fall

PRESENT ILLNESS: 77 yo male on Coumadin for DVT who fell at CVS with LOC and
unresponsive on [**12-23**]. Initially brought to [**Hospital1 **] with GCS
of 5 and intubated. Was given Vit K 10mg, hypertonic saline ,
Dilantin 1gm, Propofol @ 10mcg. He was transferred to [**Hospital1 18**] ER
where Neurosurgery was consulted. Upon arrival INR 3.0. FFP
started, and emergent [**Last Name (un) **] bolt placed.

MEDICAL HISTORY: DVT

MEDICATION ON ADMISSION: Coumadin

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: On Admission:
O: T: 97  BP: 128/68     HR: 59   R 16      O2Sats 98 /
intubated
Gen: Intubated and sedated; Right facial and periorbital
ecchymosis./ c-collar in place/
Neuro:
Upon arrival, pt was intubated and sedated on Propofol. No eye
opening to sternal rub. No movement of extremities to noxious
stimulation. Pupils were 2 to 1.5 bilaterally. Trace corneal
reflex with trace pupillary response. GCS=3T on sedation.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married, resides at home with wife.
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Acute respiratory failure,Unspecified fall,Atrial fibrillation,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants
Cl skl base fx-deep coma,Acute respiratry failure,Fall NOS,Atrial fibrillation,Hx-ven thrombosis/embols,Long-term use anticoagul
Admission Date:  [**2105-12-23**]              Discharge Date:   [**2105-12-26**]

Date of Birth:  [**2032-6-4**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 3227**]
Chief Complaint:
s/p fall

Major Surgical or Invasive Procedure:
[**2105-12-23**]: Bedside Bolt ICP monitor placement


History of Present Illness:
77 yo male on Coumadin for DVT who fell at CVS with LOC and
unresponsive on [**12-23**]. Initially brought to [**Hospital1 **] with GCS
of 5 and intubated. Was given Vit K 10mg, hypertonic saline ,
Dilantin 1gm, Propofol @ 10mcg. He was transferred to [**Hospital1 18**] ER
where Neurosurgery was consulted. Upon arrival INR 3.0. FFP
started, and emergent [**Last Name (un) **] bolt placed.


Past Medical History:
DVT

Social History:
Married, resides at home with wife.

Family History:
Non-contributory

Physical Exam:
On Admission:
O: T: 97  BP: 128/68     HR: 59   R 16      O2Sats 98 /
intubated
Gen: Intubated and sedated; Right facial and periorbital
ecchymosis./ c-collar in place/
Neuro:
Upon arrival, pt was intubated and sedated on Propofol. No eye
opening to sternal rub. No movement of extremities to noxious
stimulation. Pupils were 2 to 1.5 bilaterally. Trace corneal
reflex with trace pupillary response. GCS=3T on sedation.

Neuro exam repeated after pt returned from CT scan.  Note: while
in scanner, pt had some spontaneous upper ext. movement.
On exam: Pt without eye opening to voice or noxious stim. ?
follow commands ->moved feet x 2 to request of wiggle toes.
Pt localizes briskly with RUE, Extensor postures with LUE, w/d's
b/l LE's  to noxious, no clonus. Pt lightly chewing on ETT. GCS=
E=1, M=5, V=1T = 7T
HEENT: + Raccoon's sign, Neg battles sign, negative
hemotympanum,
negative CSF rhinorrhea/otorrhea.
Neck: In collar.
Lungs: clear / ? R lower lobe rhonchi
Cardiac: s1 s2 RRR
Abd: Soft
Extrem: Warm and well-perfused / no edema.


Pertinent Results:
Imaging:
Head CT [**12-23**]:
IMPRESSION:
1. Extensive intraparenchymal hemorrhage in the right frontal
and temporal
lobes and, to lesser extent, left frontal lobe. Small bilateral
acute
subdural hematomas and parafalcine subdural hematoma. Moderate
bilateral
acute subarachnoid hemorrhage, as above. Peri-hemorrhagic edema
with partial effacement of the right lateral ventricle,
effacement of the right cerebral sulci, and minimal leftward
shift of normally midline structures.
2. Left temporal bone and superolateral orbital wall fractures,
incompletely assessed. Small foci of air in the right superior
orbit and bifrontal intracranial space, concerning for
additional facial bone fractures.

Head CT [**12-24**]:
IMPRESSION:
1. Stable appearance of bilateral frontal and right temporal
lobe hemorrhage, bilateral subdural hematomas and subarachnoid
hemorrhage. Increasing hypodensity surrounding hemorrhage,
consistent with edema, but no change in mass effect.
2. Increase in fluid levels of the paranasal sinuses with
high-density fluid noted in the right sphenoid sinus, consistent
with blood.


Brief Hospital Course:
Patient is a 73M admitted to [**Hospital1 18**] for neurosurgical management
following a mechanical fall with resulting significant right
frontoparietal contusion and traumatic subarachnoid hemorrhage.
Upon arrival to [**Hospital1 18**], [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] bolt was placed for ICP
monitoring. Mannitol and Hypertonic therapies were intitiated.
ICPs remained persistantly elevated despite aggressive medical
managment. Surgical managment was deferred due to family request
and expected prognosis. To assist with further decision making,
and coping, a social work consult was obtained. Dr.
[**Last Name (STitle) 739**] spoke to family memebr son [**2105-12-26**]. They still
requested further time to discuss code status amongst
themselves. On [**12-26**] the family made the patient CMO and he
passed away on [**2105-12-26**].

Medications on Admission:
Coumadin

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Right Frontoparietal Contusion, Traumatic SAH
Respiratory Failure


Discharge Condition:
Expired

Discharge Instructions:
N/A

Followup Instructions:
N/A


Completed by:[**2105-12-28**]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Acute respiratory failure,Unspecified fall,Atrial fibrillation,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}


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

PRESENT ILLNESS: 77 yo male on Coumadin for DVT who fell at CVS with LOC and
unresponsive on [**12-23**]. Initially brought to [**Hospital1 **] with GCS
of 5 and intubated. Was given Vit K 10mg, hypertonic saline ,
Dilantin 1gm, Propofol @ 10mcg. He was transferred to [**Hospital1 18**] ER
where Neurosurgery was consulted. Upon arrival INR 3.0. FFP
started, and emergent [**Last Name (un) **] bolt placed.

MEDICAL HISTORY: DVT

MEDICATION ON ADMISSION: Coumadin

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: On Admission:
O: T: 97  BP: 128/68     HR: 59   R 16      O2Sats 98 /
intubated
Gen: Intubated and sedated; Right facial and periorbital
ecchymosis./ c-collar in place/
Neuro:
Upon arrival, pt was intubated and sedated on Propofol. No eye
opening to sternal rub. No movement of extremities to noxious
stimulation. Pupils were 2 to 1.5 bilaterally. Trace corneal
reflex with trace pupillary response. GCS=3T on sedation.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married, resides at home with wife. 

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Acute respiratory failure,Unspecified fall,Atrial fibrillation,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}
