CHIEF COMPLAINT: fall

PRESENT ILLNESS: 82 y.o. female nursing home resident who fell during transfer
from bed to wheelchair on [**2158-9-9**]. The patient landed on her
knees bilaterally and struck her nose on the bed. After this
event, she complained of bilaterally leg pain. On [**2158-9-10**] X-rays
were taken at the nursing home, showing bilateral femur
fractures. She was then transferred to [**Hospital1 18**] for treatment.

MEDICAL HISTORY: A fib
HTN
Depression
Non-insulin dependent DM
Chronic venous stasis w/ hx of foot ulcers
Bilateral hip fractures s/p bilateral hip replacement
Osteoporosis
Arthritis
Degenerative joint disease
Chronic UTI

MEDICATION ON ADMISSION: 1. Bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO QD (once a
day).
Disp:*60 Tablet(s)* Refills:*2*
2. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
3. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO at bedtime.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Effexor 37.5 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*2*
7. Isordil Titradose 40 mg Tablet Sig: 1.5 Tablets PO once a
day.
Disp:*45 Tablet(s)* Refills:*2*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*2*

ALLERGIES: Coumadin / Sulfa (Sulfonamides) / Penicillins

PHYSICAL EXAM: on arrival to the ED

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives at [**Location 58139**] [**First Name9 (NamePattern2) 58140**] [**Doctor First Name 533**] center for extended care
has two goddaughters who both have POA: [**Name (NI) 58141**] [**Name (NI) 58142**] and
[**Last Name (un) **] [**Name (NI) 58143**]
Closed fracture of epiphysis, lower (separation) of femur,Atrial fibrillation,Pyelonephritis, unspecified,Calculus of ureter,Hydronephrosis,Acute posthemorrhagic anemia,Closed Colles' fracture,Accidental fall from bed
Fx low femur epiphy-clos,Atrial fibrillation,Pyelonephritis NOS,Calculus of ureter,Hydronephrosis,Ac posthemorrhag anemia,Colles' fracture-closed,Fall from bed
Admission Date:  [**2158-9-11**]              Discharge Date:   [**2158-9-15**]


Service: [**Last Name (un) **]

Allergies:
Coumadin / Sulfa (Sulfonamides) / Penicillins

Attending:[**First Name3 (LF) 5880**]
Chief Complaint:
fall

Major Surgical or Invasive Procedure:
1. Casting of Left forearm for Colles fracture
2. Hinge casting of bilateral lower extremities for spiral
fracture of the right distal femoral diaphysis extending to the
supracondylar region and oblique fracture of the distal left
femur metaphysis
3. Placement of percutaneous left nephrostomy tube
4. Transfusion of 2U PRBC

History of Present Illness:
82 y.o. female nursing home resident who fell during transfer
from bed to wheelchair on [**2158-9-9**]. The patient landed on her
knees bilaterally and struck her nose on the bed. After this
event, she complained of bilaterally leg pain. On [**2158-9-10**] X-rays
were taken at the nursing home, showing bilateral femur
fractures. She was then transferred to [**Hospital1 18**] for treatment.

Past Medical History:
A fib
HTN
Depression
Non-insulin dependent DM
Chronic venous stasis w/ hx of foot ulcers
Bilateral hip fractures s/p bilateral hip replacement
Osteoporosis
Arthritis
Degenerative joint disease
Chronic UTI

Social History:
lives at [**Location 58139**] [**First Name9 (NamePattern2) 58140**] [**Doctor First Name 533**] center for extended care
has two goddaughters who both have POA: [**Name (NI) 58141**] [**Name (NI) 58142**] and
[**Last Name (un) **] [**Name (NI) 58143**]

Family History:
non-contributory

Physical Exam:
on arrival to the ED

vitals: Temp 101.6 rectal HR 138 BP 153/52 RR 23 Sats 100% on
NRB FSBG 280
GEN: awake, alert, able to answer yes and no to questions,
follows commands NAD
HEENT: PERRL, EOMI, right perorbital ecchymosis, midface stable,
no oral pharyngeal trauma
NECK: c-collar in place, trachea midline
CHEST: equal BS bilaterally
CV: irregularly irregular, no M/R/G
ABD: SNTND
PELVIS: stable to AP and lateral compression
RECTAL: normal tone, no gross blood, heme neg
BACK: no palpable step-offs, no visible abrasions
EXT: left wrist swelling and ecchymosis, Right leg in flexion,
no grossly apparent deformities of bilateral LE
Skin: warm, dry, intact
NEURO: CN II-XII intact, able to move all 4 ext, no apparent
motor or sensory deficits

Pertinent Results:
[**2158-9-10**] 10:11 PM CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST
IMPRESSION:
1) No evidence of acute traumatic intraabdominal injury.
2) 9 mm obstructing stone in the proximal left ureter with
moderate hydronephrosis. CT evidence of bilateral pyelonephritis

[**2158-9-10**] 10:11 PM CT C-SPINE W/O CONTRAST; CT
RECONSTRUCTIONIMPRESSION: Severe degenerative changes and
demineralization. No definite acute fracture seen.

[**2158-9-10**] 10:10 PM CT HEAD W/O CONTRAST IMPRESSION: Likely remote
right MCA distribution infarct. Subacute to chronic right PCA
distribution infarct, but exact timing is indeterminate without
a prior study. MRI could be performed for further evaluation, if
the patient is a candidate for MRI

[**2158-9-10**] 9:36 PM ELBOW (AP, LAT & OBLIQUE) LEFT; WRIST(3 +
VIEWS) LEFTIMPRESSION:
1. Suspicion for fracture of the radial head.
2. Colles' fracture.

[**2158-9-11**] 3:57 PM L-SPINE (AP & LAT); T-SPINE IMPRESSION:
1. Loss of height in multiple midthoracic vertebral bodies and
in the L1 vertebral body. These are of uncertain chronicity.
2. Grade I anterolisthesis of L4 on L5.
3. Diffuse demineralization. No acute fracture can be
identified, noting that evaluation is limited in the presence of
diffuse demineralization.

[**2158-9-11**] 12:52 AM FEMUR (AP & LAT) BILAT
There is a spiral fracture of the right distal femoral diaphysis
extending to the supracondylar region. There is an oblique
fracture of the distal left femur metaphysis. Neither of these
fractures appear to extend intraarticularly. There is posterior
displacement of the distal fracture fragments bilaterally. There
is diffuse demineralization. Degenerative changes are seen in
both knees. There is a dynamic compression screw in the proximal
right femur with extensive foreshortening of the femoral neck
region and associated heterotopic bone formation. A bipolar left
hip prosthesis is present without evidence of fracture.

[**2158-9-10**] 09:10PM BLOOD WBC-21.3* RBC-3.16* Hgb-9.9* Hct-29.0*
MCV-92 MCH-31.5 MCHC-34.3 RDW-13.9 Plt Ct-360
[**2158-9-11**] 08:50AM BLOOD WBC-17.6* RBC-2.44* Hgb-7.7* Hct-23.4*
MCV-96 MCH-31.7 MCHC-33.1 RDW-13.7 Plt Ct-329
[**2158-9-11**] 10:35PM BLOOD Hct-27.6*
[**2158-9-12**] 01:59AM BLOOD WBC-15.6* RBC-3.24*# Hgb-10.2*# Hct-29.4*
MCV-91 MCH-31.4 MCHC-34.5 RDW-15.3 Plt Ct-270
[**2158-9-12**] 03:47PM BLOOD WBC-14.0* RBC-3.22* Hgb-10.3* Hct-28.5*
MCV-89 MCH-32.1* MCHC-36.3* RDW-15.6* Plt Ct-250
[**2158-9-13**] 05:27AM BLOOD WBC-11.7* RBC-3.21* Hgb-10.3* Hct-28.9*
MCV-90 MCH-32.0 MCHC-35.5* RDW-15.2 Plt Ct-267

Brief Hospital Course:
[**2158-9-10**]: X-ray studies revealed bilateral femur fx and left
Colles' fx. CT of Abd/Pelvis also revealed obstructing 9mm
ureteral stone on left with bilateral hydronephrosis. The pt was
empirically started on Levofloxacin for treatment of presumed
pyelonephritis. The pt was initially admitted to the TSICU
because she was requiring Diltiazem IV for management of her
rapid a fib. Vascular and Ortho services were also consulted for
evaluation of the pt's injuries. Based on clinical exam, the
pt's fractures did not compromise blood flow to the lower
extremities. A confirmatory angiogram was deferred secondary to
the risks of the procedures and the [**Hospital **] medical comorbidities.
Close neurovascular surveillence of the pt's LE was continued
throughout her hospital course and no changes were noted.
Orthopedics performed a closed reduction of the pt's left
Colles' fracture with good success. Her left forearm was then
placed in a hard cast. Urology was also consulted for the pt's
obstructing ureteral stone. Their decision to place a diverting
percutaneous nephrostomy tube would be determined based on the
pt's urine culture.
[**2158-9-11**] to [**2158-9-15**]: The pt's C-spine was cleared after flex-ex
films were obtained. T/L spine films revealed old compression
fx. The pt's HCT dropped to 23 and she was transfused 2U PRBC.
After clearance of the pt's C-spine, she was switched to PO meds
and transferred to the hospital floor. Options for treatment of
the pt's bilateral femur fx were discussed and the POA's decided
on non-surgical management with casting under fluoroscopy. This
was performed by orthopedics and the pt tolerated the procedure
well. The pt's initial urine ctx came back with diffuse
contamination. Urology decided to place a percutaneous
nephrostomy tube due to the high likelihood of infxn. This was
performed by interventional radiology on [**2158-9-14**]. After the
procedure, the pt's foley remained in place and will be removed
at the nursing care facility at the request of the pt's health
care POA. She had no difficulty urinating and clear urine was
draining from the tube. She was tolerating PO without difficulty
and placed back on all of her home meds. The bilateral hinged
casts on her LE fit well with no evidence of pain, swelling, or
erythema of the skin or her toes. Physical therapy worked with
the pt in house to facilitate her rehab. On [**2158-9-15**] the pt was
discharged home to her previous rehab facility. She will be
continued on PO antibiotics for five days after discharge.

Medications on Admission:
1. Bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO QD (once a
day).
Disp:*60 Tablet(s)* Refills:*2*
2. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
3. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO at bedtime.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Effexor 37.5 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*2*
7. Isordil Titradose 40 mg Tablet Sig: 1.5 Tablets PO once a
day.
Disp:*45 Tablet(s)* Refills:*2*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*2*

Discharge Medications:
1. Bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO QD (once a
day).
Disp:*60 Tablet(s)* Refills:*2*
2. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
3. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO at bedtime.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Effexor 37.5 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*2*
7. Isordil Titradose 40 mg Tablet Sig: 1.5 Tablets PO once a
day.
Disp:*45 Tablet(s)* Refills:*2*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*2*
9. Enoxaparin Sodium 40 mg/0.4mL Syringe Sig: One (1) injection
Subcutaneous QD (once a day) for 6 weeks.
Disp:*30 injection* Refills:*2*
10. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
11. Acetaminophen-Codeine 300-30 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed.
Disp:*90 Tablet(s)* Refills:*0*
12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 533**] [**Last Name (NamePattern1) **] for Extended Care - [**Location 1268**]

Discharge Diagnosis:
1. Pyelonephritis
2. A fib
3. GERD
4. Degenerative joint disease
5. Bilateral hip replacement
6. Left Colles' fracture requiring reduction and casting
7. Spiral fracture of the right distal femoral diaphysis
requiring reduction and casting
8. Oblique fracture of the distal left femur metaphysis
requiring reduction and casting
9. HTN
10. Depression
11. Non-insulin dependent DM
12. Chronic venous stasis w/ hx of foot ulcers
13. Osteoporosis
14. Blood loss anemia requiring transfusion 2U PRBC
15. Obstructive nephrolithiasis requiring placement of
percutaneous nephrostomy tube in the left ureter

Discharge Condition:
Stable

Discharge Instructions:
You may resume your regular diet. Continue physical therapy as
tolerated to help improve your movement with the leg casts. Your
weight bearing status is: non-weight bearing on bilateral lower
extremities and non-weight bearing on left upper extremity. You
will be on the Lovenox injections for anticoagulation for a
total of six weeks. Please leave the foley catheter in place
until arrival at the health care facility, then it may be
removed.

Followup Instructions:
You should follow up with Dr. [**Last Name (STitle) **] in the [**Hospital **] clinic
located in the [**Hospital Ward Name 23**] building on the [**Location (un) 1773**]. An
appointment has been scheduled for you on [**10-20**] @ 9:10
AM. Please call ([**Telephone/Fax (1) 58144**] if you have any questions or need
to change the appointment. Prior to this appointment, please
obtain AP and Lateral x-rays of bilateral femurs and an x-ray of
the pt's left wrist. Please have these transported with the pt
on the day of the clinic appointment so Dr. [**Last Name (STitle) **] may see the
films.



Follow up with Dr. [**Last Name (STitle) 770**] of Urology in 4 weeks. Call ([**Telephone/Fax (1) 58145**] to schedule an appt. The clinic is located in the
[**Hospital Ward Name 23**] building. If possible, you may want to schedule the appt
for the same day as your orthopedic visit.
{"Closed fracture of epiphysis, lower (separation) of femur,Atrial fibrillation,Pyelonephritis, unspecified,Calculus of ureter,Hydronephrosis,Acute posthemorrhagic anemia,Closed Colles' fracture,Accidental fall from bed"}


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

PRESENT ILLNESS: 82 y.o. female nursing home resident who fell during transfer
from bed to wheelchair on [**2158-9-9**]. The patient landed on her
knees bilaterally and struck her nose on the bed. After this
event, she complained of bilaterally leg pain. On [**2158-9-10**] X-rays
were taken at the nursing home, showing bilateral femur
fractures. She was then transferred to [**Hospital1 18**] for treatment.

MEDICAL HISTORY: A fib
HTN
Depression
Non-insulin dependent DM
Chronic venous stasis w/ hx of foot ulcers
Bilateral hip fractures s/p bilateral hip replacement
Osteoporosis
Arthritis
Degenerative joint disease
Chronic UTI

MEDICATION ON ADMISSION: 1. Bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO QD (once a
day).
Disp:*60 Tablet(s)* Refills:*2*
2. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
3. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO at bedtime.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Effexor 37.5 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*2*
7. Isordil Titradose 40 mg Tablet Sig: 1.5 Tablets PO once a
day.
Disp:*45 Tablet(s)* Refills:*2*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*2*

ALLERGIES: Coumadin / Sulfa (Sulfonamides) / Penicillins

PHYSICAL EXAM: on arrival to the ED

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives at [**Location 58139**] [**First Name9 (NamePattern2) 58140**] [**Doctor First Name 533**] center for extended care
has two goddaughters who both have POA: [**Name (NI) 58141**] [**Name (NI) 58142**] and
[**Last Name (un) **] [**Name (NI) 58143**] 

### Response:
{"Closed fracture of epiphysis, lower (separation) of femur,Atrial fibrillation,Pyelonephritis, unspecified,Calculus of ureter,Hydronephrosis,Acute posthemorrhagic anemia,Closed Colles' fracture,Accidental fall from bed"}
