CHIEF COMPLAINT: Fall of approximately 8 feet from ladder.  Mid throacic pain and
neck pain

PRESENT ILLNESS: Mr. [**Known lastname 75210**] was brought to [**Hospital1 18**] after a fall from
approximately 8 feet off of a ladder.  He reported cervical and
mid back pain.  CT scan showed C1 ring fracture with T3 & T4
fracture.

MEDICAL HISTORY: Coronary artery disease with history of myocardial infarction
Hypertension
Diabetes-Insulin dependent

MEDICATION ON ADMISSION: Asprin 325mg
Atenlol 100mg
Avalide 300/25mg [**Hospital1 **]
Lipitor 20mg
Flomax 0.4mg
Glubmetformin 1.25/250
Verapamil 240mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On physical exam Mr. [**Known lastname 75210**] was awake and in no acute
distress.  His breathing was regular.  Musculoskeletal exam
revealed no obvious bony abnormality or decrease in strength.
Rectal tone was normal, refelxes were equal throughout.  He
showed no neurologic compromise.  He was negative for clonus,
hoffmans sign, saddle anesthesia.

FAMILY HISTORY: 

SOCIAL HISTORY: Per pt he lives in a house with his wife on the Community of
Christ [**Name (NI) 75953**] in [**Location (un) **] MA.  He has 3 children - 2
daughters in [**Name2 (NI) **] ages 41 and 46, one son age 38 who lives in
[**Location 5944**].  He has two grandchildren ages 25 and 27 and two great
grandchildren ages 12 and 8.  He has been an elder at Community
of Christ since age 27.
Closed fracture of C1-C4 level with unspecified spinal cord injury,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of one rib,Delirium due to conditions classified elsewhere,Bacteremia,Alkalosis,Myoglobinuria,Accidental fall from ladder,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of other diseases of digestive system,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms
C1-c4 fx-cl/cord inj NOS,Fx dorsal vertebra-close,Fracture one rib-closed,Delirium d/t other cond,Bacteremia,Alkalosis,Myoglobinuria,Fall from ladder,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Old myocardial infarct,Prsnl hst ot spf dgst ds,Oth gram negatv bacteria
Admission Date:  [**2102-10-24**]              Discharge Date:   [**2102-11-6**]

Date of Birth:  [**2034-1-27**]             Sex:   M

Service: ORTHOPAEDICS

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Doctor Last Name 1350**]
Chief Complaint:
Fall of approximately 8 feet from ladder.  Mid throacic pain and
neck pain

Major Surgical or Invasive Procedure:
1. Posterior instrumented fusion thoracic spine, T1 - T7.
2. Laminectomies of T4 and T5
3. Lamino-foraminotomies C7, T1, T2, T3
3. Closed treatment C1 fracture.
4. HALO application.


History of Present Illness:
Mr. [**Known lastname 75210**] was brought to [**Hospital1 18**] after a fall from
approximately 8 feet off of a ladder.  He reported cervical and
mid back pain.  CT scan showed C1 ring fracture with T3 & T4
fracture.

Past Medical History:
Coronary artery disease with history of myocardial infarction
Hypertension
Diabetes-Insulin dependent

Social History:
Per pt he lives in a house with his wife on the Community of
Christ [**Name (NI) 75953**] in [**Location (un) **] MA.  He has 3 children - 2
daughters in [**Name2 (NI) **] ages 41 and 46, one son age 38 who lives in
[**Location 5944**].  He has two grandchildren ages 25 and 27 and two great
grandchildren ages 12 and 8.  He has been an elder at Community
of Christ since age 27.


Physical Exam:
On physical exam Mr. [**Known lastname 75210**] was awake and in no acute
distress.  His breathing was regular.  Musculoskeletal exam
revealed no obvious bony abnormality or decrease in strength.
Rectal tone was normal, refelxes were equal throughout.  He
showed no neurologic compromise.  He was negative for clonus,
hoffmans sign, saddle anesthesia.

Pertinent Results:
[**2102-10-24**] CT C-spine:
IMPRESSION:
1. Comminuted [**Location (un) 5621**] type C1 fracture through the right and
left anterior arch and lateral masses, as well as right
posterior arch, with floating fragment adjacent to the dens
(C2).

2. Possible C7 spinous process fracture.
[**2102-10-24**] CT Chest:
IMPRESSION:
1. T3 and T4 vertebral body (and T4 transverse process)
fractures with no evidence of retropulsion or listhesis.
2. Bilateral posterior 2nd rib fractures
3. No evidence of soft organ injury.
4. Very small bilateral pleural effusions.
[**2102-10-25**] MRI of Cervical, Thoracic & Lumbar spine:
IMPRESSION:
1. Edema of the T2 and T3 vertebral bodies as well as
intervening disc space with paraspinal edema/hematoma. A
fracture line through the posterior superior corner of the T3
vertebral body is also seen. There may be minimal retropulsion
but without significant canal stenosis.
2. Edema related to the C1 burst fracture with prevertebral
hematoma/edema extending from the skull base to the C6 level.
3. Edema of the posterior cervical soft tissues extending from
the skull base to T1 is noted, and injury to the interspinous
and supraspinous ligaments cannot be excluded.
CT Head [**2102-10-28**]:
IMPRESSION:
1.  Multiple dural-based lesions as described above, of which
the left frontal is definitively a calcified meningioma.
Statistically, the additional two right parafalx lesions
represent meningiomas in varying stages of calcification.
Although the right frontal parafalx lesion could also
theoretically represent a small subdural collection, the
multiplicity of dural-based lesions strongly favors meningiomas.
 Further characterization with MR brain with contrast would
provide further clarification.
2.  Stable very small bifrontal low-density subdural collections
(hygromas
versus chronic subdural hemorrhages versus enlarged CSF spaces).



Brief Hospital Course:
Mr. [**Known lastname 75210**] was brought to [**Hospital1 18**] after 8 foot fall from
ladder.  CT & MRI images showed C1, T3 & T4 fractures with soft
tissue damage from T2-T6.  He was neurologically intact on exam.
 He was placed in a C-collar and placed on log roll precautions.
 He was concented for posterior thoracic stabilization and halo
placement.

1. Spine fractures- Mr. [**Known lastname 75210**] [**Last Name (Titles) 1834**] a T1-T7 posterior
thoracic stabilization with halo placement.  After his surgical
procedure, Mr. [**Known lastname 75210**] was transfered to the PACU.  At that
time he could not tolerated extubation.  He was transfered to
the SICU for monitoring.  After two days in the SICU, he was
transfered to the floor.  The rest of his hospital course was
unremarkable.

2. Mental Status changes- On his third night of admission, Mr.
[**Known lastname 75210**] experienced mental status changes and was hostile
towards the nursing staff.  Psychiatry was consulted and a CT of
his head was ordered to rule out changes.

3. Metabolic alkalosis-Mr. [**Known lastname 75210**] had an episode of alkalosis
on [**2102-11-1**].  His lasix & HCTZ were held and he was given IV
fluids.  Medicine was consulted.  They recomended continued
current care.  His bicarb began to trend down. He showed no
signs of alkalosis during this time.

Medications on Admission:
Asprin 325mg
Atenlol 100mg
Avalide 300/25mg [**Hospital1 **]
Lipitor 20mg
Flomax 0.4mg
Glubmetformin 1.25/250
Verapamil 240mg

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO QID (4 times a day).
4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
6. Atenolol 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
7. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day): may d/c if pt is up and moving.
8. Verapamil 80 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours).
9. Irbesartan 300 mg Tablet Sig: One (1) Tablet PO daily ().
10. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
11. Lisinopril 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
14. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours) as
needed for pain.
15. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for breakthrough pain.
16. Glyburide-Metformin 1.25-250 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
17. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours): d/c on [**2102-11-19**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital of [**Location (un) **] & Islands - [**Location (un) 6251**]

Discharge Diagnosis:
1. C1 fracture.
2. T3 fracture.
3. T4 fracture.
4. T4 and T5 lamina fractures.


Discharge Condition:
Stable to outside facility


Discharge Instructions:
Please keep incision clean and dry.  You may shower in 48 hours,
but please do not soak the incision.  Change the dressing daily
with clean dry gauze.  If you notice drainage or redness around
the incision, or if you have a fever greater than 100.5, please
call the office at [**Telephone/Fax (1) **].  Please resume all home
mediciation as prescribed by your primary care physician.  [**Name10 (NameIs) **]
you have questions concerning activity, please refer to the
activity sheet.

Physical Therapy:
Activity as tolerated by pain.
Treatments Frequency:
Please change dressing daily with dry gauze.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 1007**] at two weeks from the date of
surgery.  You can make that appointment by calling [**Telephone/Fax (1) **]



Completed by:[**2102-11-6**]
{'Closed fracture of C1-C4 level with unspecified spinal cord injury,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of one rib,Delirium due to conditions classified elsewhere,Bacteremia,Alkalosis,Myoglobinuria,Accidental fall from ladder,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of other diseases of digestive system,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms'}


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 of approximately 8 feet from ladder.  Mid throacic pain and
neck pain

PRESENT ILLNESS: Mr. [**Known lastname 75210**] was brought to [**Hospital1 18**] after a fall from
approximately 8 feet off of a ladder.  He reported cervical and
mid back pain.  CT scan showed C1 ring fracture with T3 & T4
fracture.

MEDICAL HISTORY: Coronary artery disease with history of myocardial infarction
Hypertension
Diabetes-Insulin dependent

MEDICATION ON ADMISSION: Asprin 325mg
Atenlol 100mg
Avalide 300/25mg [**Hospital1 **]
Lipitor 20mg
Flomax 0.4mg
Glubmetformin 1.25/250
Verapamil 240mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On physical exam Mr. [**Known lastname 75210**] was awake and in no acute
distress.  His breathing was regular.  Musculoskeletal exam
revealed no obvious bony abnormality or decrease in strength.
Rectal tone was normal, refelxes were equal throughout.  He
showed no neurologic compromise.  He was negative for clonus,
hoffmans sign, saddle anesthesia.

FAMILY HISTORY: 

SOCIAL HISTORY: Per pt he lives in a house with his wife on the Community of
Christ [**Name (NI) 75953**] in [**Location (un) **] MA.  He has 3 children - 2
daughters in [**Name2 (NI) **] ages 41 and 46, one son age 38 who lives in
[**Location 5944**].  He has two grandchildren ages 25 and 27 and two great
grandchildren ages 12 and 8.  He has been an elder at Community
of Christ since age 27. 

### Response:
{'Closed fracture of C1-C4 level with unspecified spinal cord injury,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of one rib,Delirium due to conditions classified elsewhere,Bacteremia,Alkalosis,Myoglobinuria,Accidental fall from ladder,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of other diseases of digestive system,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms'}
