CHIEF COMPLAINT: Fall down stairs

PRESENT ILLNESS: 53-year-old male who fell down 15 steps by report while
intoxicated. He was brought to an area hospital and subsequently
transferred to the [**Hospital1 1444**] for full trauma evaluation.
On his arrival he was found to exhibit flaccid paralysis of
bilateral upper extremities, but demonstrated some sacral
sensory sparing and distal lower extremity strength 3/5 in
the gastrocnemius soleus complex, [**Last Name (un) 938**], tibialis anterior. He
underwent imaging including fine-cut CT and MRI of his entire
spine.  This identified an undisplaced fracture of the C2
pars into the body, involving the foramen transversarium
without vertebral injury as well as a C3 spinous process
fracture, evidence of previous C4 and C5 spinal process
fractures, severe subaxial spondylosis with ligamentum flavum
buckling causing severe central as well as foraminal subaxial
stenosis and a non-displaced C4 injury with increased STIR
signal. Thoracic imaging identified T3 spinous process fracture
with posterior ligamentous complex disruption, a T4 burst
fracture with retropulsion, and a minimally displaced T7
compression fracture with increased STIR signal.

MEDICAL HISTORY: HTN
Back surgery

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:
98.4, 63, 136/57, 16, 100% on FIO2 0.35.
              TV 700, PEEP 5, PS 10.
GENERAL APPEARANCE:  The patient is a thin man, intubated and
sedated.
NECK:  A cervical spinal collar is in place.
LUNGS:  Clear to auscultation bilaterally anteriorly.
HEART:  S1, S2, regular, without murmurs.
ABDOMEN:  Soft, without palpable masses or splenomegaly.
EXTREMITIES:  No peripheral edema.
NEUROLOGIC:  The patient is sedated and does not respond to
voice
or withdraw to pain.  He has hyperreflexia of upper extremities
and 2+ patellar reflexes.
SKIN: There are no petechiae or ecchymoses and no visible oozing
from IV lines.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: +EtOH
Supportive family
Closed fracture of C1-C4 level with unspecified spinal cord injury,Pneumonia, organism unspecified,Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Traumatic spondylopathy,Other and unspecified coagulation defects,Dependence on respirator, status,Other and unspecified alcohol dependence, unspecified,Accidental fall on or from other stairs or steps,Alcoholic cirrhosis of liver,Unspecified essential hypertension,Contusion of thigh,Abrasion or friction burn of face, neck, and scalp except eye, without mention of infection,Other specified cardiac dysrhythmias,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other abnormal glucose
C1-c4 fx-cl/cord inj NOS,Pneumonia, organism NOS,Clos skull base fracture,Traumatic spondylopathy,Coagulat defect NEC/NOS,Respirator depend status,Alcoh dep NEC/NOS-unspec,Fall on stair/step NEC,Alcohol cirrhosis liver,Hypertension NOS,Contusion of thigh,Abrasion head,Cardiac dysrhythmias NEC,Abn react-artif implant,Abnormal glucose NEC
Admission Date:  [**2164-4-14**]              Discharge Date:   [**2164-4-25**]

Date of Birth:  [**2110-5-11**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
Fall down stairs

Major Surgical or Invasive Procedure:
On [**2164-4-15**]: posterior cervical laminectomy C4-C7.
2. Posterior thoracic laminectomy T4-T5.
3. Posterior cervico-thoracic arthrodesis C3-T9.
4. Posterior cervico-thoracic instrumentation C3-T9.
5. Application of local autograft.
6. Cortical cancellous allograft.


History of Present Illness:
53-year-old male who fell down 15 steps by report while
intoxicated. He was brought to an area hospital and subsequently
transferred to the [**Hospital1 1444**] for full trauma evaluation.
On his arrival he was found to exhibit flaccid paralysis of
bilateral upper extremities, but demonstrated some sacral
sensory sparing and distal lower extremity strength 3/5 in
the gastrocnemius soleus complex, [**Last Name (un) 938**], tibialis anterior. He
underwent imaging including fine-cut CT and MRI of his entire
spine.  This identified an undisplaced fracture of the C2
pars into the body, involving the foramen transversarium
without vertebral injury as well as a C3 spinous process
fracture, evidence of previous C4 and C5 spinal process
fractures, severe subaxial spondylosis with ligamentum flavum
buckling causing severe central as well as foraminal subaxial
stenosis and a non-displaced C4 injury with increased STIR
signal. Thoracic imaging identified T3 spinous process fracture
with posterior ligamentous complex disruption, a T4 burst
fracture with retropulsion, and a minimally displaced T7
compression fracture with increased STIR signal.



Past Medical History:
HTN
Back surgery

Social History:
+EtOH
Supportive family

Family History:
Noncontributory

Physical Exam:
Upon admission:
98.4, 63, 136/57, 16, 100% on FIO2 0.35.
              TV 700, PEEP 5, PS 10.
GENERAL APPEARANCE:  The patient is a thin man, intubated and
sedated.
NECK:  A cervical spinal collar is in place.
LUNGS:  Clear to auscultation bilaterally anteriorly.
HEART:  S1, S2, regular, without murmurs.
ABDOMEN:  Soft, without palpable masses or splenomegaly.
EXTREMITIES:  No peripheral edema.
NEUROLOGIC:  The patient is sedated and does not respond to
voice
or withdraw to pain.  He has hyperreflexia of upper extremities
and 2+ patellar reflexes.
SKIN: There are no petechiae or ecchymoses and no visible oozing
from IV lines.



Pertinent Results:
Upon admission:

[**2164-4-14**] 09:32PM   GLUCOSE-107* UREA N-14 CREAT-0.7 SODIUM-143
POTASSIUM-4.3 CHLORIDE-116* TOTAL CO2-18* ANION GAP-13
[**2164-4-14**] 09:32PM   CALCIUM-7.8* PHOSPHATE-4.1 MAGNESIUM-2.6
[**2164-4-14**] 09:32PM   WBC-4.4 RBC-2.85* HGB-9.5* HCT-29.3* MCV-103*
MCH-33.2* MCHC-32.3 RDW-15.4
[**2164-4-14**] 09:32PM   PLT COUNT-32*
[**2164-4-14**] 09:32PM   PT-17.5* PTT-34.9 INR(PT)-1.6*
[**2164-4-14**] 09:32PM   FIBRINOGE-112*
[**2164-4-14**] 03:49PM   TYPE-ART PO2-242* PCO2-35 PH-7.32* TOTAL
CO2-19* BASE XS--7
[**2164-4-14**] 04:30AM   ASA-NEG ETHANOL-310* ACETMNPHN-5.0
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2164-4-14**] 04:43AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG

CHEST (PORTABLE AP)  [**2164-4-24**] 4:02 AM

CHEST (PORTABLE AP)

Reason: eval for interval changes

[**Hospital 93**] MEDICAL CONDITION:
53 year old man with recent trach/PEG placement s/p multilevel
spinal fractures
REASON FOR THIS EXAMINATION:
eval for interval changes
HISTORY: Multilevel spinal fractures, to assess for
cardiopulmonary disease.

FINDINGS: In comparison with the study of [**4-23**], there is
improvement in the diffuse bilateral pulmonary changes extending
outward from the hilum, consistent with decreasing pulmonary
venous pressure. The cardiac size remains within normal limits.
The costophrenic angles are now more sharply seen. Metallic
devices and support monitoring devices remain in place. The IVC
filter is again noted.

IMPRESSION: Improving pulmonary vascular status.

CT HEAD W/O CONTRAST  [**2164-4-21**] 9:16 AM

CT HEAD W/O CONTRAST

Reason: Acute intracranial process?

[**Hospital 93**] MEDICAL CONDITION:
53 year old man with hypertension breaking through
supratherapeutic doses of benzodiazepines and opioids
REASON FOR THIS EXAMINATION:
Acute intracranial process?
CONTRAINDICATIONS for IV CONTRAST: None.

HEAD CT WITHOUT CONTRAST.

INDICATION: 53-year-old man with hypertension, breaking-through
supratherapeutic doses of benzodiazepines and opioids. Rule out
acute intracranial process.

COMPARISON: [**2164-4-14**].

CT HEAD WITHOUT INTRAVENOUS CONTRAST: There is no acute
intracranial hemorrhage, edema, shift of normally midline
structures, or hydrocephalus. The density values of the brain
parenchyma are within normal limits.

Since prior examination, there has been development of extensive
mucosal thickening involving the imaged maxillary sinuses, right
greater than left, as well as air-fluid levels of sphenoid sinus
and opacification of mastoid air cells. Nondisplaced right
occipital condyle flap fracture is incompletely imaged.

IMPRESSION:

1. No evidence of acute hemorrhage or edema.

2. Interval development of sinus disease.

CT CHEST W/CONTRAST  [**2164-4-14**] 5:08 AM

CT CHEST W/CONTRAST; CT ABDOMEN W/CONTRAST

Reason: ? INJURY
Field of view: 36

[**Hospital 93**] MEDICAL CONDITION:
53 year old man with s/p fall 15stairs +loc +etoh
REASON FOR THIS EXAMINATION:
please eval for acute injury
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: 53-year-old male after fall while intoxicated with
concern for traumatic injury of the torso.

COMPARISON: No prior.

TECHNIQUE: MDCT axial images of the chest, abdomen, and pelvis
after Optiray IV contrast with multiplanar reformats.

CT OF THE CHEST WITH IV CONTRAST: The heart and great vessels of
the chest opacify well. There is no evidence of mediastinal
hematoma. There is no pericardial fluid. Circumferential
atherosclerotic calcification is noted throughout the aorta.
Dependent opacity is noted of both lower lobes which may simply
represent atelectasis but is concerning for aspiration. There is
no pleural fluid or pneumothorax.

CT OF THE ABDOMEN WITH IV CONTRAST: In the peripheral right
hepatic lobe is noted a 3.4 x 2.7 cm triangular-shaped area of
relative low attenuation of the hepatic parenchyma. There is a
suggestion of a tiny amount of adjacent subcapsular fluid. A
small round subcentimeter hypodense focus of the left hepatic
lobe is too small to characterize. The background hepatic
attenuation is somewhat heterogeneous suggesting underlying
chronic liver disease. There is mild gallbladder wall thickening
possibly due to liver disease, but no adjacent fluid or stones.
The spleen, adrenal glands, kidneys, stomach, and
intra-abdominal large and small bowel are unremarkable.
Incidental note is made of pancreas divisum. There is no free
intraperitoneal gas or fluid. Several mildly enlarged
retroperitoneal lymph nodes are noted measuring up to 11-mm on
short axis.

Atherosclerotic calcification is noted at the origins of the
celiac, SMA, and [**Female First Name (un) 899**].

CT OF THE PELVIS WITH IV CONTRAST: The rectum, prostate, seminal
vesicles, and pelvic loops of bowel and bladder are
unremarkable. There is a Foley catheter within the urinary
bladder.

BONE WINDOWS: An acute wedge compression fracture is noted of T4
with retropulsion of bone causing moderate central canal
stenosis. Also noted is a minimally displaced fracture through
the spinous process of T3 which extends into the bilateral
transverse processes.

IMPRESSION:

1. Acute wedge compression fracture of T4 with retropulsion of
bone causing moderate central canal stenosis. Minimally
displaced fracture involving the transverse and spinous
processes of T3.

2. 3.4 cm hypodense region of the peripheral right hepatic lobe
with suggestion of tiny amount of adjacent subcapsular fluid is
suspicious for laceration in a patient s/p trauma. Subcentimeter
low density focus of the left hepatic lobe not fully
characterized and relation to trauma uncertain.

3. Dependent consolidation of the lower lobes. This may
represent atelectasis but is concerning for possible aspiration.

4. Heterogenous attenuation of the background hepatic parenchyma
suggests underlying liver disease.

5. Several mildly enlarged retroperitoneal lymph nodes of
uncertain significance.

6. Pancreas divisum.


Brief Hospital Course:
He was admitted to the Trauma Service. Orthopedic Spine Surgery
was consulted given his multiple spine injuries. Because of
pancytopenia a Hematology consult was urgently placed; it was
recommended that he be given a platelet transfusion and it was
they felt that surgery should not be delayed. His most recent
CBC as of [**4-25**] as follows:
WBC RBC   Hgb HCT   MCV MCH MCHC RDW   PLT Ct
7.7 2.93* 9.1* 28.0* 96 31.0 32.4 19.0* 89*
Once this clearance was given he was taken to the operating room
for posterior cervical laminectomy C4-C7, posterior thoracic
laminectomy T4-T5, posterior cervico-thoracic arthrodesis C3-T9,
posterior cervico-thoracic instrumentation C3-, application of
local autograft, and cortical cancellous allograft. His JP
drains were eventually removed. There were no intraoperative
complications. He was later fitted with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 36323**] brace
(cervical & TLSO) which is to be worn at all times.

Postoperatively he was taken to the Trauma ICU where he was
followed closely. He remained intubated and sedated. He was
placed on Ativan per CIWA protocol. Nutrition consult was
obtained and tube feedigns were initiated early. The decision
was made after team/family discuassions for a tracheostomy and
PEG placment in preparation for rehabilitation. An IVC filter
was also placed given his high risk for PE. His sedation was
weaned and although he did open his eyes he has been not
interactive. He does grimace to painful stimuli and withdraws
from the stimulus bilateral upper extrmemties, response is quite
weak.

His pain is being controlled with a Clonidine patch prn
Oxycodone. He was placed on a bowel regimine as well.

Physical and Occupational therapy were consulted and have
continued to work with him. Social work was also closely
involved; providing emotional support to patient and family.

He will follow up with Dr. [**Last Name (STitle) 1007**], Orthopedic Spine Surgery, in
the next 3-4 weeks.


Discharge Medications:
1. Senna 8.8 mg/5 mL Syrup Sig: Five (5) ML's PO BID (2 times a
day) as needed for constipation.
2. Docusate Sodium 50 mg/5 mL Liquid Sig: Ten (10) ML's PO BID
(2 times a day).
3. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
EVERY OTHER DAY (Every Other Day).
4. Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QSUN (every Sunday).
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15) ML
Mucous membrane [**Hospital1 **] (2 times a day).
7. Oxycodone 5 mg/5 mL Solution Sig: [**5-19**] ML's PO Q3H (every 3
hours) as needed for pain.
8. Acetaminophen 160 mg/5 mL Solution Sig: Twenty (20) ML's PO
every 4-6 hours as needed for fever or pain.
9. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical three
times a day: Appy to scrotal/peri rectal area as needed.
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day): hold fro HR <60; SBP <110.
11. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Dose
Injection four times a day as needed for per sliding scale: See
attached sliding scale.
12. Heparin Flush CVL  (100 units/ml) 1 ml IV DAILY:PRN
10ml NS followed by 1ml of 100 units/ml heparin (100 units
heparin) each lumen QD and PRN.  Inspect site every shift
13. Levofloxacin in D5W 750 mg/150 mL Piggyback Sig: Seven
[**Age over 90 1230**]y (750) MG Intravenous DAILY (Daily) for 2 weeks.
14. Nafcillin 2 gram Piggyback Sig: Two (2) GM's Intravenous
every six (6) hours for 2 weeks.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 5503**] [**Hospital **] Hospital

Discharge Diagnosis:
s/p Fall
Right occipital condyle fracture, nondisplaced
C2 Fracture right lateral mass
C3 Spinous fracture
T3 Spinous process fracture
T4 Compresson fracture w/ mild retropulsion/canal narrowing
Respiratory failure
Pancytopenia


Discharge Condition:
Good


Discharge Instructions:
You must continue to wear the [**Location (un) 36323**] brace at all times.

Followup Instructions:
Follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1007**], Spine Surgery, in [**3-13**] weeks.
Call [**Telephone/Fax (1) 1228**] for an appointment.



Completed by:[**2164-8-31**]
{'Closed fracture of C1-C4 level with unspecified spinal cord injury,Pneumonia, organism unspecified,Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Traumatic spondylopathy,Other and unspecified coagulation defects,Dependence on respirator, status,Other and unspecified alcohol dependence, unspecified,Accidental fall on or from other stairs or steps,Alcoholic cirrhosis of liver,Unspecified essential hypertension,Contusion of thigh,Abrasion or friction burn of face, neck, and scalp except eye, without mention of infection,Other specified cardiac dysrhythmias,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other abnormal glucose'}


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 down stairs

PRESENT ILLNESS: 53-year-old male who fell down 15 steps by report while
intoxicated. He was brought to an area hospital and subsequently
transferred to the [**Hospital1 1444**] for full trauma evaluation.
On his arrival he was found to exhibit flaccid paralysis of
bilateral upper extremities, but demonstrated some sacral
sensory sparing and distal lower extremity strength 3/5 in
the gastrocnemius soleus complex, [**Last Name (un) 938**], tibialis anterior. He
underwent imaging including fine-cut CT and MRI of his entire
spine.  This identified an undisplaced fracture of the C2
pars into the body, involving the foramen transversarium
without vertebral injury as well as a C3 spinous process
fracture, evidence of previous C4 and C5 spinal process
fractures, severe subaxial spondylosis with ligamentum flavum
buckling causing severe central as well as foraminal subaxial
stenosis and a non-displaced C4 injury with increased STIR
signal. Thoracic imaging identified T3 spinous process fracture
with posterior ligamentous complex disruption, a T4 burst
fracture with retropulsion, and a minimally displaced T7
compression fracture with increased STIR signal.

MEDICAL HISTORY: HTN
Back surgery

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:
98.4, 63, 136/57, 16, 100% on FIO2 0.35.
              TV 700, PEEP 5, PS 10.
GENERAL APPEARANCE:  The patient is a thin man, intubated and
sedated.
NECK:  A cervical spinal collar is in place.
LUNGS:  Clear to auscultation bilaterally anteriorly.
HEART:  S1, S2, regular, without murmurs.
ABDOMEN:  Soft, without palpable masses or splenomegaly.
EXTREMITIES:  No peripheral edema.
NEUROLOGIC:  The patient is sedated and does not respond to
voice
or withdraw to pain.  He has hyperreflexia of upper extremities
and 2+ patellar reflexes.
SKIN: There are no petechiae or ecchymoses and no visible oozing
from IV lines.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: +EtOH
Supportive family 

### Response:
{'Closed fracture of C1-C4 level with unspecified spinal cord injury,Pneumonia, organism unspecified,Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Traumatic spondylopathy,Other and unspecified coagulation defects,Dependence on respirator, status,Other and unspecified alcohol dependence, unspecified,Accidental fall on or from other stairs or steps,Alcoholic cirrhosis of liver,Unspecified essential hypertension,Contusion of thigh,Abrasion or friction burn of face, neck, and scalp except eye, without mention of infection,Other specified cardiac dysrhythmias,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Other abnormal glucose'}
