CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 56 year-old
gentleman with a history of seizures who was transferred from
[**Hospital3 **] with a C spine injury, which occurred
earlier in the day.  The patient was found in a 50 degree
unkept house with no windows or internal heating.  The
patient arrived in a state of very poor hygiene.  Apparently
the patient was found lying in blood with multiple abrasions.
According to the report a roommate living in the same
location stated that the patient had multiple falls.  There
was a question of loss of consciousness as well as leg
weakness.  The patient at the time of arrival denied
headache, shortness of breath, chest pain, nausea or
vomiting.

MEDICAL HISTORY: Seizures, epilepsy for multiple years.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Condemned house.

SOCIAL HISTORY: 
Closed fracture of C1-C4 level with unspecified spinal cord injury,Unspecified fall,Epilepsy, unspecified, without mention of intractable epilepsy,Cervical spondylosis without myelopathy,Abnormal coagulation profile,Hydantoin derivatives causing adverse effects in therapeutic use
C1-c4 fx-cl/cord inj NOS,Fall NOS,Epilep NOS w/o intr epil,Cervical spondylosis,Abnrml coagultion prfile,Adv eff hydantoin deriv
Admission Date:  [**2141-2-17**]     Discharge Date:  [**2141-2-21**]

Date of Birth:   [**2084-9-2**]     Sex:  M

Service:  TRAUMA

HISTORY OF PRESENT ILLNESS:  The patient is a 56 year-old
gentleman with a history of seizures who was transferred from
[**Hospital3 **] with a C spine injury, which occurred
earlier in the day.  The patient was found in a 50 degree
unkept house with no windows or internal heating.  The
patient arrived in a state of very poor hygiene.  Apparently
the patient was found lying in blood with multiple abrasions.
According to the report a roommate living in the same
location stated that the patient had multiple falls.  There
was a question of loss of consciousness as well as leg
weakness.  The patient at the time of arrival denied
headache, shortness of breath, chest pain, nausea or
vomiting.

PAST MEDICAL HISTORY:  Seizures, epilepsy for multiple years.

PAST SURGICAL HISTORY:  None.

MEDICATIONS:
1.  Dilantin.
2.  Phenobarbitol.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY/FAMILY HISTORY:  Condemned house.

PHYSICAL EXAMINATION:  On arrival vital signs temperature
98.1.  Blood pressure 171/100.  Heart rate 94.  Respiratory
rate 15.  Pulse ox 100%.  General, normocephalic, atraumatic.
No acute distress.  Agitated.  HEENT pupils are equal, round
and reactive to light and accommodation.  Chest clear to
auscultation bilaterally.  Cardiac regular rate and rhythm.
No murmurs, rubs or gallops.  Abdomen positive bowel sounds,
soft, nontender, nondistended.  Multiple abrasions on all
extremities.  Neurological GCS 15.  Nonfocal.  Reflexes,
sensation and motor all grossly intact.

INITIAL LABORATORIES:  White blood cell count 17.1,
hematocrit 48.1 and platelets of 315, sodium 139, potassium
3.6, chloride 96, bicarb 24, BUN 21, creatinine 1.1, glucose
135.  Electrocardiogram showed nonspecific ST and T changes,
shaky baseline.  Urine showed 11 to 20 red blood cells, 100
protein and 15 ketones.  CK was 8200.  Troponin was pending
at the time.  Serum barb was positive.  Urine barb was
positive.  Otherwise negative.  Phenobarbitol was 34.2,
Phenytoin was 34.2 as well.  Chest x-ray was negative.
Pelvis x-ray was negative.  TLS was negative.  Cervical MRI
was positive for a C3 C4 fracture.

HOSPITAL COURSE:  The patient was placed in a cervical hard
collar and transferred to the Surgical Intensive Care Unit
for q two hour neurological checks and additional
observation.  The patient was evaluated by the neurological
CICU team who decided no halo was necessary at that point.  A
Solu-Medrol drip was started at the outside hospital was then
stopped.  The ortho spine team felt that at this point no
surgical intervention was necessary, commenting that the C
collar must remain on for a significant period of time.
After initial stabilization and three days in the Intensive
Care Unit the patient was then transferred to the floor.  Due
to the patient's history of epilepsy and the supratherapeutic
levels of his Phenytoin, neurology was consulted to see the
patient. The neurology service recommended current doses of
his antiseizure medication and agreed to follow the patient.
The patient's levels of Phenytoin remained supratherapeutic
throughout his stay and on his final day was down to the
upper limits of normal at 20.  Ultimately neurology agreed
that the patient should restart medications once his level
returned to near 20.  After three days on the floor the
patient was evaluated by physical therapy and occupational
therapy who felt he was safe to go home.  Due to the fact
that the patient's home was condemned by the state the
patient will be discharged to the care of a friend.  The
patient has follow up with a new primary care physician this
[**Name9 (PRE) 2974**].  The patient also has a neurology follow up this
Friday.  The initial plan for this patient is to leave the
hospital today and return to the Emergency Room in two days
for a blood draw of his Dilantin level.  If this is close to
the normal range or in the normal range the patient will then
follow up the following day with is neurology appointment at
8:30 a.m.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSIS:
Fracture C3-C4.

FOLLOW UP PLANS:  The patient has follow up plans with
neurosurgery in one to two weeks.  The patient has follow up
with neurology this Friday at 8:30 a.m.  The patient has a
new primary care physician appointment at 2:30 p.m. this
Friday.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D.  [**MD Number(1) 2214**]

Dictated By:[**Last Name (NamePattern1) 7170**]

MEDQUIST36

D:  [**2141-2-21**]  04:17
T:  [**2141-2-22**]  06:14
JOB#:  [**Job Number 53112**]
{'Closed fracture of C1-C4 level with unspecified spinal cord injury,Unspecified fall,Epilepsy, unspecified, without mention of intractable epilepsy,Cervical spondylosis without myelopathy,Abnormal coagulation profile,Hydantoin derivatives causing adverse effects in therapeutic use'}


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: The patient is a 56 year-old
gentleman with a history of seizures who was transferred from
[**Hospital3 **] with a C spine injury, which occurred
earlier in the day.  The patient was found in a 50 degree
unkept house with no windows or internal heating.  The
patient arrived in a state of very poor hygiene.  Apparently
the patient was found lying in blood with multiple abrasions.
According to the report a roommate living in the same
location stated that the patient had multiple falls.  There
was a question of loss of consciousness as well as leg
weakness.  The patient at the time of arrival denied
headache, shortness of breath, chest pain, nausea or
vomiting.

MEDICAL HISTORY: Seizures, epilepsy for multiple years.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Condemned house.

SOCIAL HISTORY:  

### Response:
{'Closed fracture of C1-C4 level with unspecified spinal cord injury,Unspecified fall,Epilepsy, unspecified, without mention of intractable epilepsy,Cervical spondylosis without myelopathy,Abnormal coagulation profile,Hydantoin derivatives causing adverse effects in therapeutic use'}
