CHIEF COMPLAINT: fall with loss of consciousness

PRESENT ILLNESS: This is a 65M with h/o CHF (LVEF 20-25%) s/p ICD, CAD s/p MI x3,
HTN, IDDM, COPD, AFlutter who fell down 10 steps at home,
unobserved. +LOC. Pt was d/c home from [**Hospital **] Hospital on [**9-4**]
for CHF and a COPD exacerbation. He went home w/ his family, no
c/o dizziness or weakness. Woke up around 1am on the day of
admission, and fell down a flight of 10 stairs. Pt was found
down at the bottom of the stairs w/ his face in a pool of blood,
confused. EMS unable to intubate him in the field. Taken to
[**Hospital **] Hospital where ENT performed primary repair of tongue
laceration. After repair, anesthesia intubated pt w/ a
glidescope for airway protection. Pt found to have C2 fracture -
was transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: PMH: COPD, CHF LVEF 20-25% s/p ICD placement, CAD s/p MI x 3,
HTN, IDDM, Lung CA, Aflutter, cholelithiasis, h/o lung cancer
s/p right lobectomy, GERD
PSH: right lobectomy via thoracotomy for lung cancer [**2093**], s/p
lumbar laminectomy, L renal surgery (unknown), left knee surgery
(unknown), appendectomy, s/p ICD placement [**2107**], PCI (unknown)

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Insulin 42u IM'',Lispro sliding, Amiodarone 300mg', ASA
325mg',Coreg 12.5mg'',plavix 75mg',digoxin 0.125mg', lasix
80mg', imdur 60mg', lisinopril 20mg'',predisone 10mg''(on second
day of 2day course), ativan 1mg prn, potassium 20meq', metformin
1000mg'', lovastatin 40mg'

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Discharge:
AVSS
GEN: NAD, AOx3
CNII-XII intact
C [**Name (NI) 8658**] in place.
CV: - irregular rythm but normal rate
Lungs: CTAB
ABD: Soft, NT/ND
EXT: 1+ b/l edema

FAMILY HISTORY: NC

SOCIAL HISTORY: married, lives w/ wife and daughter in [**Name (NI) **], MA; long
smoking hx, no EtOH, occ MJ
Closed fracture of mandible, ramus, unspecified,Closed fracture of second cervical vertebra,Acidosis,Pneumonia, organism unspecified,Contusion of lung without mention of open wound into thorax,Congestive heart failure, unspecified,Atrial fibrillation,Closed fracture of two ribs,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Chronic airway obstruction, not elsewhere classified,Accidental fall on or from other stairs or steps,Personal history of malignant neoplasm of bronchus and lung,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Fitting and adjustment of automatic implantable cardiac defibrillator
Fx ramus NOS-closed,Fx c2 vertebra-closed,Acidosis,Pneumonia, organism NOS,Lung contusion-closed,CHF NOS,Atrial fibrillation,Fracture two ribs-closed,Old myocardial infarct,Hypertension NOS,DMII wo cmp nt st uncntr,Long-term use of insulin,Chr airway obstruct NEC,Fall on stair/step NEC,Hx-bronchogenic malignan,Open wnd knee/leg/ankle,Ftng autmtc dfibrillator
Admission Date:  [**2113-9-5**]              Discharge Date:   [**2113-9-15**]

Date of Birth:  [**2048-5-12**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
fall with loss of consciousness

Major Surgical or Invasive Procedure:
Open reduction and internal fixation of left mandible body, open
reduction internal fixation of right angle ramus fracture.
Tracheostomy

History of Present Illness:
This is a 65M with h/o CHF (LVEF 20-25%) s/p ICD, CAD s/p MI x3,
HTN, IDDM, COPD, AFlutter who fell down 10 steps at home,
unobserved. +LOC. Pt was d/c home from [**Hospital **] Hospital on [**9-4**]
for CHF and a COPD exacerbation. He went home w/ his family, no
c/o dizziness or weakness. Woke up around 1am on the day of
admission, and fell down a flight of 10 stairs. Pt was found
down at the bottom of the stairs w/ his face in a pool of blood,
confused. EMS unable to intubate him in the field. Taken to
[**Hospital **] Hospital where ENT performed primary repair of tongue
laceration. After repair, anesthesia intubated pt w/ a
glidescope for airway protection. Pt found to have C2 fracture -
was transferred to [**Hospital1 18**] for further care.


Past Medical History:
PMH: COPD, CHF LVEF 20-25% s/p ICD placement, CAD s/p MI x 3,
HTN, IDDM, Lung CA, Aflutter, cholelithiasis, h/o lung cancer
s/p right lobectomy, GERD
PSH: right lobectomy via thoracotomy for lung cancer [**2093**], s/p
lumbar laminectomy, L renal surgery (unknown), left knee surgery
(unknown), appendectomy, s/p ICD placement [**2107**], PCI (unknown)


Social History:
married, lives w/ wife and daughter in [**Name (NI) **], MA; long
smoking hx, no EtOH, occ MJ

Family History:
NC

Physical Exam:
On Discharge:
AVSS
GEN: NAD, AOx3
CNII-XII intact
C [**Name (NI) 8658**] in place.
CV: - irregular rythm but normal rate
Lungs: CTAB
ABD: Soft, NT/ND
EXT: 1+ b/l edema

Pertinent Results:
[**2113-9-5**] - cspine: 1. Non-displaced fracture of the left lateral
mass of C2 with close approximation to the transverse foramen.

[**2113-9-5**] - face CT: 1. Comminuted fracture of the right proximal
ramus and angle of the mandible with associated soft tissue
swelling and hematoma of the right jaw. Complete transecting
fracture of the left body of the mandible with lateral
displacement of the left ramus relative to the body of the
mandible. There is no associated dislocation of the mandibular
condyles.
2. No other fractures are identified. The orbits and sinuses
appear intact.

[**2113-9-15**] 04:46AM BLOOD WBC-8.2 RBC-3.71* Hgb-11.4* Hct-34.3*
MCV-92 MCH-30.6 MCHC-33.1 RDW-16.7* Plt Ct-315
[**2113-9-15**] 11:54AM BLOOD PT-15.5* PTT-32.9 INR(PT)-1.4*
[**2113-9-15**] 04:46AM BLOOD Glucose-65* UreaN-19 Creat-0.9 Na-140
K-3.6 Cl-106 HCO3-25 AnGap-13
[**2113-9-15**] 04:46AM BLOOD CK-MB-3 cTropnT-<0.01
[**2113-9-15**] 04:46AM BLOOD Calcium-10.4* Phos-2.5* Mg-2.1

Brief Hospital Course:
The patient was admitted on [**2113-9-5**] after sustaining an
unwitnessed fall with loss of consciousness. His injuries were:
C2 Hangman's fracture, bilateral comminuted displaced mandibular
fracture, tongue laceration, left 3rd and 6th rib fracture,
laceration over left tibia, w/ bone exposed, 2cm lac over left
knee. Received immediate care at [**Hospital **] Hospital where his
tongule laceration was repaired and he was intubated for airway
protection. He was then transferred to [**Hospital1 18**] for further care.

Neuro: Ortho spine was consulted regarding his C2 fracture and
recommended [**Location (un) 2848**] J [**Location (un) 8658**] for 6 weeks. The patient was sedated
while intubated, but after extubation, patient's pain was well
controlled with IV medications. After tolerating po intake,
patient was transitioned to po pain medications.

HEENT: The patient was taken to the operating [**Last Name (un) **] by OMFS on
HD4 for repair of his mandibular fractures. Please see operative
report for further details. Patient tolerated the procedure
well.

CVS: The patient has a history of CHF and A-fib. Troponins were
trended and remained stable at 0.02. He was continued on his
cardiac home medications. Patient required IV lopressor while in
the hospital due to episodes of rapid afib into the 140s. He was
transferred to the floor on [**9-14**], but was transferred back to
the ICU on [**9-15**] for rapid heart rate. The patient's po lopressor
dose was titrated up, and heartrate normalized. Patient remained
hemodynamically stable during all of these episodes with normal
blood pressures. Cardiology was consulted and recommend
titrating up metroprolol, and maintaining patient on amiodarone,
digoxin, and amlodopine. At time of discharge, the patient was
in normal sinus rhythm with normal rate.

Pulm: The patient was initially managed on mechanical
ventilation. A tracheostomy was performed on HD4 due to
excessive swelling in the face from the initial accident. He was
administered prednisone to complete a course previously started
at OSH. Tracheostomy was removed on [**2113-9-14**], and the patient
tolerated this well. His O2 sats were normal at room air at the
time of discharge.

GI/FEN: The patient was kept NPO with a OGT in place, once
extubated, patient's diet was advanced. He was kept on full
liquid diet per OMFS recommendations. He will stay on full
liquid diet for several weeks per OMFS.

GU: A foley catheter was placed for UOP monitoring. Fluids and
diuretics were administered judiciously based on fluid status.
Foley was removed [**2113-9-14**], and patient has been incontinent of
urine since.

Heme: The patient's complete blood count was examined routinely;
no transfusions were required.

ID: The patient was administered Unasyn for his open mandibular
fracture, but this was discontinued several days prior to
discharge.

Endo: The patient's blood sugar was monitored throughout his
stay; insulin dosing was adjusted accordingly.

Prophylaxis: The patient received subcutaneous heparin and
venodyne boots were used during this stay; he received
famotidine for stress ulcer prophylaxis. He was started on a
heparin gtt on [**9-13**] for persistent afib, and patient was started
on coumadin. heparing gtt will continue until patient is
therapeutic, then he will be transitioned to coumadin only.


Medications on Admission:
[**Last Name (un) 1724**]: Insulin 42u IM'',Lispro sliding, Amiodarone 300mg', ASA
325mg',Coreg 12.5mg'',plavix 75mg',digoxin 0.125mg', lasix
80mg', imdur 60mg', lisinopril 20mg'',predisone 10mg''(on second
day of 2day course), ativan 1mg prn, potassium 20meq', metformin
1000mg'', lovastatin 40mg'

Discharge Medications:
1. docusate sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
2. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day).

3. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. isosorbide dinitrate 20 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
7. hydrocodone-acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
8. lisinopril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
10. heparin (porcine) in D5W 25,000 unit/250 mL Parenteral
Solution Sig: 1700 (1700) units Intravenous ASDIR (AS DIRECTED):
titrate to goal 60-80 PTT until INR [**1-12**], then stop.
11. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
12. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
13. digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. warfarin 2 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for
1 doses: Please give at 4pm today, then titrate to INR goal [**1-12**].

15. insulin glargine 100 unit/mL Cartridge Sig: Forty Two (42)
units Subcutaneous twice a day.
16. quetiapine 25 mg Tablet Sig: half Tablet PO at bedtime as
needed for agitation.
17. heparin, porcine (PF) 10 unit/mL Syringe Sig: Ten (10) ML
Intravenous PRN (as needed) as needed for line flush.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital for Continuing Medical Care - [**Location (un) 1121**]
([**Hospital3 1122**] Center)

Discharge Diagnosis:
s/p fall with C2 fracture, bilateral comminuted mandibular fx
and RLE laceration


Discharge Condition:
Mental Status: Clear and coherent.
Activity Status: Out of Bed with assistance to chair or
wheelchair.
Level of Consciousness: Alert and interactive.


Discharge Instructions:
Please call your doctor or go to the ED if you develop worsening
pain, fevers, chills, nausea, vomiting, poor oral intake,
redness, swelling, or drainage from your wounds, or any other
concerns that you have.

You will be discharged on your home medications, please take all
of this as scheduled. You should remain on full liquid diet,
until instructed by your doctor. [**First Name (Titles) **] [**Last Name (Titles) 8658**] in place at all
times.

Followup Instructions:
Please call [**Hospital 2536**] clinic to schedule follow up in 2 wks. Acute
Care Surgery Clinic, call ([**Telephone/Fax (1) 2537**] to schedule appt.

Call to schedule a follow up 1-2 wks with [**Hospital 40530**] clinic. [**Hospital 40530**]
Clinic: [**Last Name (NamePattern1) **], [**Location (un) 86**], [**Numeric Identifier 13108**]; [**Hospital1 2177**], Yawkey Bldg;
[**Location (un) 89056**]; [**Telephone/Fax (1) 68463**]) Dr. [**First Name (STitle) **]. ([**Telephone/Fax (1) 90845**])

Please call to make follow up with Spine surgery in 6 wks.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Office Phone: ([**Telephone/Fax (1) 2007**]



Completed by:[**2113-9-15**]
{'Closed fracture of mandible, ramus, unspecified,Closed fracture of second cervical vertebra,Acidosis,Pneumonia, organism unspecified,Contusion of lung without mention of open wound into thorax,Congestive heart failure, unspecified,Atrial fibrillation,Closed fracture of two ribs,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Chronic airway obstruction, not elsewhere classified,Accidental fall on or from other stairs or steps,Personal history of malignant neoplasm of bronchus and lung,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Fitting and adjustment of automatic implantable cardiac defibrillator'}


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: fall with loss of consciousness

PRESENT ILLNESS: This is a 65M with h/o CHF (LVEF 20-25%) s/p ICD, CAD s/p MI x3,
HTN, IDDM, COPD, AFlutter who fell down 10 steps at home,
unobserved. +LOC. Pt was d/c home from [**Hospital **] Hospital on [**9-4**]
for CHF and a COPD exacerbation. He went home w/ his family, no
c/o dizziness or weakness. Woke up around 1am on the day of
admission, and fell down a flight of 10 stairs. Pt was found
down at the bottom of the stairs w/ his face in a pool of blood,
confused. EMS unable to intubate him in the field. Taken to
[**Hospital **] Hospital where ENT performed primary repair of tongue
laceration. After repair, anesthesia intubated pt w/ a
glidescope for airway protection. Pt found to have C2 fracture -
was transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: PMH: COPD, CHF LVEF 20-25% s/p ICD placement, CAD s/p MI x 3,
HTN, IDDM, Lung CA, Aflutter, cholelithiasis, h/o lung cancer
s/p right lobectomy, GERD
PSH: right lobectomy via thoracotomy for lung cancer [**2093**], s/p
lumbar laminectomy, L renal surgery (unknown), left knee surgery
(unknown), appendectomy, s/p ICD placement [**2107**], PCI (unknown)

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Insulin 42u IM'',Lispro sliding, Amiodarone 300mg', ASA
325mg',Coreg 12.5mg'',plavix 75mg',digoxin 0.125mg', lasix
80mg', imdur 60mg', lisinopril 20mg'',predisone 10mg''(on second
day of 2day course), ativan 1mg prn, potassium 20meq', metformin
1000mg'', lovastatin 40mg'

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Discharge:
AVSS
GEN: NAD, AOx3
CNII-XII intact
C [**Name (NI) 8658**] in place.
CV: - irregular rythm but normal rate
Lungs: CTAB
ABD: Soft, NT/ND
EXT: 1+ b/l edema

FAMILY HISTORY: NC

SOCIAL HISTORY: married, lives w/ wife and daughter in [**Name (NI) **], MA; long
smoking hx, no EtOH, occ MJ 

### Response:
{'Closed fracture of mandible, ramus, unspecified,Closed fracture of second cervical vertebra,Acidosis,Pneumonia, organism unspecified,Contusion of lung without mention of open wound into thorax,Congestive heart failure, unspecified,Atrial fibrillation,Closed fracture of two ribs,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Chronic airway obstruction, not elsewhere classified,Accidental fall on or from other stairs or steps,Personal history of malignant neoplasm of bronchus and lung,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Fitting and adjustment of automatic implantable cardiac defibrillator'}
