CHIEF COMPLAINT: 50 y/o female transferred from an outside hospital intubated
with a subdural hematoma.

PRESENT ILLNESS: Ms. [**Known lastname 12101**] was transferred from the referring institution to
the [**Hospital1 18**] ER on [**2147-6-17**].  On arrival she was intubated.  Per
report the patient was found the morning of [**2147-6-17**] unresponsive
in bed.  She was brought to the referring institution where she
was intubated and a head CT was obtained which showed a large
subdural hematoma with shift.

MEDICAL HISTORY: Unknown

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Acetaminophen / Sertraline / Sulfa (Sulfonamides) / Tegaserod /
Venlafaxine

PHYSICAL EXAM: Gen: critically ill, intubated.
HEENT: Pupils: fixed 4mm bilaterally, unreactive to light or
threat, no corneal reflexes biilaterally
Lungs: rhoncorus bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft
Extrem: multiple subacute contusions on upper and lower
extremities. Warm, well-perfused.
Mental status: Unresponsive voice or to noxious central
stimulation.
Cranial Nerves: pupils fixed, no corneal response, + soft gag.
Motor: Decorticate extensor posturing with bilateral upper
extremity extension. No spontaneous movements. Flaccid tone in
all 4 extrem.
Sensation: no response to noxious stimulation x4 extrem
Toes briskly upgoing bilaterally

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: History of EtOH abuse
Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Alcohol abuse, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Unspecified fall,Unspecified essential hypertension
Traumatic subdural hem,Alcohol abuse-unspec,Crbl art ocl NOS w infrc,Fall NOS,Hypertension NOS
Admission Date:  [**2147-6-17**]              Discharge Date:   [**2147-6-19**]

Date of Birth:  [**2097-4-20**]             Sex:   F

Service: SURGERY

Allergies:
Acetaminophen / Sertraline / Sulfa (Sulfonamides) / Tegaserod /
Venlafaxine

Attending:[**First Name3 (LF) 5880**]
Chief Complaint:
50 y/o female transferred from an outside hospital intubated
with a subdural hematoma.

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Ms. [**Known lastname 12101**] was transferred from the referring institution to
the [**Hospital1 18**] ER on [**2147-6-17**].  On arrival she was intubated.  Per
report the patient was found the morning of [**2147-6-17**] unresponsive
in bed.  She was brought to the referring institution where she
was intubated and a head CT was obtained which showed a large
subdural hematoma with shift.

Past Medical History:
Unknown

Social History:
History of EtOH abuse

Family History:
Non-contributory

Physical Exam:
Gen: critically ill, intubated.
HEENT: Pupils: fixed 4mm bilaterally, unreactive to light or
threat, no corneal reflexes biilaterally
Lungs: rhoncorus bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft
Extrem: multiple subacute contusions on upper and lower
extremities. Warm, well-perfused.
Mental status: Unresponsive voice or to noxious central
stimulation.
Cranial Nerves: pupils fixed, no corneal response, + soft gag.
Motor: Decorticate extensor posturing with bilateral upper
extremity extension. No spontaneous movements. Flaccid tone in
all 4 extrem.
Sensation: no response to noxious stimulation x4 extrem
Toes briskly upgoing bilaterally


Pertinent Results:
[**2147-6-17**] 08:35AM   PT-13.3* PTT-22.7 INR(PT)-1.2*
[**2147-6-17**] 08:35AM   WBC-11.7* RBC-3.65* HGB-11.2* HCT-33.2*
MCV-91 MCH-30.6 MCHC-33.7 RDW-18.4*
[**2147-6-17**] 08:35AM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2147-6-17**] 08:35AM   ASA-7 ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG
barbitrt-NEG tricyclic-NEG
[**2147-6-17**] 08:35AM   GLUCOSE-162* UREA N-22* CREAT-1.2* SODIUM-139
POTASSIUM-4.0 CHLORIDE-103 TOTAL CO2-22 ANION GAP-18

CT CHEST W/CONTRAST  [**2147-6-17**] 11:50 AM
IMPRESSION:
1. Subcutaneous stranding in the anterior chest wall superior to
the left breast prosthesis, likely post traumatic in nature.
2. Diffuse fatty infiltration of the liver.
3. Upper pole cortical parenchymal deficits within the right
kidney consistent with prior inflammatory change.

CT HEAD W/O CONTRAST  [**2147-6-17**] 8:38 AM
IMPRESSION:
1. Large mixed density left subdural collection hematoma. There
is significant mass effect on the subjacent cortex with 1.5 cm
of subfalcine herniation and findings worrisome for
transtentorial herniation.
2. Air-fluid levels within bilateral maxillary sinuses without
definite fracture identified. If clinical situation supports
facial fractures a facial CT series may be obtained.

CT HEAD W/O CONTRAST  [**2147-6-19**] 6:10 AM
COMPARISON STUDY: [**2147-6-17**] CT scan reported by Dr. [**Last Name (STitle) **]
revealing "large mixed density left subdural collection. There
is significant mass effect on the cortex with 1.5 cm of
subfalcine herniation and findings worrisome for transtentorial
herniation. Air-fluid levels within bilateral maxillary sinuses
without definite fracture identified."
FINDINGS: The very large left cerebral convexity acute subdural
hemorrhage has not diminished in size. There is continued
evidence for a pronounced rightward subfalcine herniation and
the evolution of bilateral anterior cerebral artery territory
infarcts. There is also low density within the brainstem,
particularly the pons with some involvement of the right-sided
cerebellar hemisphere superiorly, suggesting additional infarcts
likely due to transtentorial herniation. There has been no
interval change in ventricular size. There continues to be
moderate-sized air-fluid levels within the maxillary sinuses,
now also seen in the sphenoid sinus, with opacification of both
ethmoid sinuses by soft tissue density, probably a mixture of
fluid and/or mucosal thickening. At least some of these findings
may relate to the intubated status of the patient.
CONCLUSION: Persistent large left cerebral convexity acute
subdural hemorrhage, with secondary infarcts in multiple locales
as noted above. We discussed these findings today by telephone.


Brief Hospital Course:
The patient was transferred to the emergency room from NH
intubated and in a C-collar. On arrival her pupils were fixed
and dilated and she was not responsive to painful stimuli.  A
neurosurgery consult was obtained and they determined that due
to the large subdural hematoma and infarction in the middle
cerebral artery territory there was no indication for
neurosurgical intervention.  From the ER she was admitted to the
Trauma Surgical Intensive Care Unit.  Her neurological
examination did not improve during her admission.  A repeat CT
of the head was obtained on [**2147-6-19**] which showed no improvement
in her subdural hematoma. On [**2147-6-19**] a family meeting was held
with the patient's sister, husband, and husband's sister.  The
condition of the patient and the poor prognosis was reviewed
with the family and the decision was made to make patient
comfort measures only the evening of [**2147-6-19**].  On the evening of
[**2147-6-19**] the patient's pain was controlled with narcotics and she
was palliatively extubated.  She expired approximately an hour
and half after extubation.  A death certificate was completed,
the medical examiner was contact[**Name (NI) **] and the body was transferred
to pathology for autopsy.


Medications on Admission:
Unknown

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Subdural hematoma

Discharge Condition:
Dead

Discharge Instructions:
None

Followup Instructions:
None
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Alcohol abuse, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Unspecified fall,Unspecified essential hypertension'}


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: 50 y/o female transferred from an outside hospital intubated
with a subdural hematoma.

PRESENT ILLNESS: Ms. [**Known lastname 12101**] was transferred from the referring institution to
the [**Hospital1 18**] ER on [**2147-6-17**].  On arrival she was intubated.  Per
report the patient was found the morning of [**2147-6-17**] unresponsive
in bed.  She was brought to the referring institution where she
was intubated and a head CT was obtained which showed a large
subdural hematoma with shift.

MEDICAL HISTORY: Unknown

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Acetaminophen / Sertraline / Sulfa (Sulfonamides) / Tegaserod /
Venlafaxine

PHYSICAL EXAM: Gen: critically ill, intubated.
HEENT: Pupils: fixed 4mm bilaterally, unreactive to light or
threat, no corneal reflexes biilaterally
Lungs: rhoncorus bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft
Extrem: multiple subacute contusions on upper and lower
extremities. Warm, well-perfused.
Mental status: Unresponsive voice or to noxious central
stimulation.
Cranial Nerves: pupils fixed, no corneal response, + soft gag.
Motor: Decorticate extensor posturing with bilateral upper
extremity extension. No spontaneous movements. Flaccid tone in
all 4 extrem.
Sensation: no response to noxious stimulation x4 extrem
Toes briskly upgoing bilaterally

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: History of EtOH abuse 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Alcohol abuse, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Unspecified fall,Unspecified essential hypertension'}
