CHIEF COMPLAINT: MVA

PRESENT ILLNESS: Mr. [**Known lastname **] (Eu Crit [**Doctor First Name **]) is a 79 yo M with h/o CAD s/p CABG,
HTN, HL who presents after MVC with IVH.The patient was driving
and apparently hit a telephone pole. He remembers driving but
cannot remember any events leading up to the crash, or any
abnormal symptoms. He was brought to OSH ED where head CT showed
IVH. He was transferred to [**Hospital1 18**] where he was hypertensive on
arrival SBP>200. In the ED he received labetalol and phenytoin.
Trauma was consulted. R wrist had laceration, irrigated and will
be monitored only by plastics. FAST showed a question of LUQ
cyst, so CT abdomen was done. Neurosurgery was consulted for
IVH.
The patient is currently denying headache, N/V, vision
changes,numbness, weakness or tingling.

MEDICAL HISTORY: CAD s/p CABG x 4 ~10yrs ago
HTN
HL
?COPD
hernia repair

MEDICATION ON ADMISSION: Lipitor dose unknown
BP meds unknown
Spiriva
Advair
ASA 81 mg

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
Gen: NAD
HEENT: xanthelasma on face, sclera anicteric
CV: RRR, no m/r/g
PULM: CTAB
AB: NT/ND
EXT: well perfused

FAMILY HISTORY: NC

SOCIAL HISTORY: lives with wife who has [**Name (NI) 11964**]. h/o tobacco use.
Intracerebral hemorrhage,Obstructive hydrocephalus,Paralytic ileus,Mobitz (type) II atrioventricular block,Candidiasis of mouth,Malignant neoplasm of lower lobe, bronchus or lung,Open wound of hand except finger(s) alone, without mention of complication,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Other persistent mental disorders due to conditions classified elsewhere,Dysphagia, unspecified,Retention of urine, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Aortocoronary bypass status
Intracerebral hemorrhage,Obstructiv hydrocephalus,Paralytic ileus,Atrioven block-mobitz ii,Thrush,Mal neo lower lobe lung,Open wound of hand,Oth coll stndng obj-driv,Hypertension NOS,Hyperlipidemia NEC/NOS,Chr airway obstruct NEC,Tobacco use disorder,Mental disor NEC oth dis,Dysphagia NOS,Retention urine NOS,Ath ext ntv at w claudct,Aortocoronary bypass
Admission Date:  [**2181-2-15**]              Discharge Date:   [**2181-3-1**]

Date of Birth:  [**2101-12-26**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
MVA

Major Surgical or Invasive Procedure:
[**2181-2-18**]: Placement of right External Ventricular Drain


History of Present Illness:
Mr. [**Known lastname **] (Eu Crit [**Doctor First Name **]) is a 79 yo M with h/o CAD s/p CABG,
HTN, HL who presents after MVC with IVH.The patient was driving
and apparently hit a telephone pole. He remembers driving but
cannot remember any events leading up to the crash, or any
abnormal symptoms. He was brought to OSH ED where head CT showed
IVH. He was transferred to [**Hospital1 18**] where he was hypertensive on
arrival SBP>200. In the ED he received labetalol and phenytoin.
Trauma was consulted. R wrist had laceration, irrigated and will
be monitored only by plastics. FAST showed a question of LUQ
cyst, so CT abdomen was done. Neurosurgery was consulted for
IVH.
The patient is currently denying headache, N/V, vision
changes,numbness, weakness or tingling.

Past Medical History:
CAD s/p CABG x 4 ~10yrs ago
HTN
HL
?COPD
hernia repair

Social History:
lives with wife who has [**Name (NI) 11964**]. h/o tobacco use.

Family History:
NC

Physical Exam:
PHYSICAL EXAM:
Gen: NAD
HEENT: xanthelasma on face, sclera anicteric
CV: RRR, no m/r/g
PULM: CTAB
AB: NT/ND
EXT: well perfused

NEURO:
Alert and oriented x 3. Able to recite days of week backward
easily. Language intact for naming, comprehension, no
dysarthria.
No neglect.
CN I- not tested
II- PERRL 4 to 3mm
III, IV, VI- EOMI without nystagmus
V- facial sensation intact to light touch
VII- facial musculature full strength and symmetric
IX, X, [**Doctor First Name 81**]- palate elevates symmetrically, tongue protrudes in
midline

MOTOR- 5/5 strength at bilateral delt, [**Hospital1 **], tri, finger
ext/flexors, IP, ham, quad, TA and gastroc. Upward drift on
pronator drift on L.

SENSATION- intact to light touch and joint position sense

DTR: 2+ at [**Hospital1 **], brachiorad, tri. 0 at patella, achilles. Toes
downgoing, no clonus.

COORDINATION: intact FNF

Discharge:
Gen: pleasant, awake, NAD
HEENT: incision intact with nylon suture, eyes clear
Neck: supple, no thyromegaly
CV; RR, S1 s2 nl, no murmurs
Pulm: CTAB, no w/c/r
abd: obese, but soft, + BS, incision with steri, mild ecchymosis
Ext: right hand with wrap, no c/c/e
Neuro: AAOX3, PERRL, left droop at nasolabial fold, PERRL, EOM
intact, Strength intact throughout, sensory intact throughout,
coordination intact, gait not tested

Pertinent Results:
CTA Head and neck: [**2-15**]
Intraventricular hemorrhage and ? small left tentorial subdural
hemorrhage.
CTA head and neck: [**2-15**]
Preliminary read 3D recons pending. Occlusion of the R
ICA.Dimminutive flow in the right ACA and MCA; could be
collaterals. No flow in the V1 right vertebral, dimminutive flow
in right V2. Cannot determine chronicty - no prior or history to
compare.

LABS:
PLT 183
INR 1.0
WBC 9.2
H/H 17.6/52.0

CT Head [**2-16**] - Overall stable extent of intraventricular
hemorrhage and probable concurrent subdural hemorrhage along the
tentorium cerebelli. Stable ventricular size. No new hemorrhage

Chest CT [**2-16**] -
1. No acute rib fracture.
2. 6-cm mass-like lesion along the right basilar lateral region,
with
heterogeneous attenuation, not acute hematoma, could be neoplasm
or unusual rounded atelectasis.
3. Heterogeneous collection medial to the right middle lobe,
could represent an old hematoma or postinfectious phlegmon.
Recommend correlation with prior history of trauma.
4. Moderate volume loss of right hemithorax with pleural
thickening, of
uncertain chronicity and etiology.
5. Status post CABG, with significant coronary artery
calcifications
involving all three vessels.
6. Simple cholelithiasis without acute cholecystitis.

Ct head [**2-18**] - 1. Interval development of hydrocephalus.
  2. Stable appearance of intracranial hemorrhage with interval
redistribution
of clot

CT head [**2-19**] - 1. Unchanged hydrocephalus with intraventricular
hemorrhage. New right frontal approach ventriculostomy catheter.

2. Small subarachnoid hemorrhage in the right parietal lobe

CT head [**2-20**] - 1. Unchanged hydrocephalus with intraventricular
hemorrhage. New right frontal approach ventriculostomy catheter.

2. Small subarachnoid hemorrhage in the right parietal lobe

CT head [**2-22**] - Mildly decreased ventriculomegaly. See details
above. The tip of the catheter
is in the septum pellucidum close to the left foramen of [**Last Name (un) 2044**],
unchanged

CT head [**2-25**] - Status post removal of ventricular drain with
interval mild
prominence of the ventricles compared to most recent CT head. An
interval
increase in amount of free air in the right frontal and temporal
[**Doctor Last Name 534**] of the ventricle. Similar focus of subarachnoid hemorrhage
along the right occipital and pariteal gyri. Similar
intraventricular hemorrhage.
CT head [**2-26**] - Resolving intraventricular hemorrhage and nearly
resolved right subarachnoid hemorrhage. Persistent air in the
right lateral ventricle status post removal of ventriculostomy
catheter.

CT head [**2-26**] - 1. The new right frontal approach
intraventricular catheter terminates in the left frontal [**Doctor Last Name 534**].
Minimal decrease in the size of the lateral ventricles.
2. Minimal new blood adjacent to the catheter tip.

3. Unchanged residual blood in the right lateral ventricle
atrium and in few right parietal sulci

KUB [**2-28**] - Distended loops of large and small bowel gas-filled
in keeping
with ileus.


Brief Hospital Course:
Mr. [**Known lastname **] was admitted to [**Hospital1 18**] Neurosurgery service after an
IVH caused an MVA. CTA ruled out aneurysm. CT chest was done for
rib pain and this showed multiple lung abnormalities. the family
was informed and they agreed. On [**2-17**], patient was seen to be
neuro intact. On [**2-18**], in am rounds, he was seen to move all
extremities, but non verbal with no eye opening, no commands. A
stat head ct revealed hydrocephalus and an abg showed no CO2
retention. He was then transferred to the ICU and an EVD was
placed and leveled at 10.

On [**2-19**], a repeat head CT shows decreased IVH, but ventricles
were still plump. EVD at 10 with low ICP pressures. His exam was
improved, he was A&Ox3 and full strength throughout, but still
somewhat lethargic. He remained int he ICU for neuro monitoring.
On [**2-20**], patient reported nausea, he was seen to be more
lethargic and  confused, a repeat head CT was done which showed
slight 1mm increase in 3rd ventreicle.

On [**2-21**] his mental status improved and his EVD was raised to 20.
His Aspirin and SQH were started. His ICP's remained low and his
EVD was clamped on the morning on [**2-22**]. CT in the afternoon
showed no increase in ventricular size. The drain remained
clamped. Pulmonology saw the patient for his newly discovered
lung lesions and they recommended a PET CT and CT guided FNA
with outpatient clinic follow up. Overnight, patient's EVD
became disconnected. Exam was unchanged and the drain was
reconnected sterily.

On [**2-23**], patient was alert and oriented x3, follows all commands
and full strength. His EVD remained clamped overnight and
patient's exam remained intact. His EVD was removed and he was
transferred to step down. PT consult was placed.

Over the weekend, patient was seen to have drainage from EVD
site. A dressing was placed and was saturated on Sunday morning.
A repeat head CT showed increase in ventricle size. On [**2-26**],
patient exam worsened, he was more lethargic and difficult to
arouse. He was taken to the OR for VP shunt placement. In OR,
opening pressure was observed to be 38. Shunt was placed with
the assistance of general surgery and no complication were
observed. Post operatively, patient was more alert and ansering
questions appropriately. Head CT was stable and he was
transferred to the floor. On [**2-27**], patient was stable, PT was
consulted and he was being screened for rehab.

[**2-28**] patient developed illeus which was confirmed on KUB. He was
made NPO and an agressive bowel regimen was initiated. On [**3-1**]
he had four bowel movements. He was hypertensive to a systolic
blood pressure in the 190's and norvasc was added.


Medications on Admission:
Lipitor dose unknown
BP meds unknown
Spiriva
Advair
ASA 81 mg


Discharge Medications:
1. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
2. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
[**12-3**] Disk with Devices Inhalation [**Hospital1 **] (2 times a day).
3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
4. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. docusate sodium 50 mg/5 mL Liquid Sig: Two (2)  PO BID (2
times a day).
6. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. labetalol 100 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
8. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
9. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
10. nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed for oral thrush.
11. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
12. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day) as needed for constipation.
13. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
14. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

15. megestrol 40 mg Tablet Sig: One (1) Tablet PO QID (4 times a
day).
16. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
17. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: [**12-3**]  Inhalation Q4H (every 4 hours) as needed
for wheeze/SOB.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 **] Hospital

Discharge Diagnosis:
Intraventricular hemorrhage
Hydrocephalus
Subarachnoid hemorrhage
Dysphagia
Type II AtrioVentricular block- Wenckebach
Right Lower lobe mass
Ileus
Incontinence
Hypertension
Oral thrush


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
General Instructions

??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, or
Ibuprofen etc.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion, lethargy or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	New onset of the loss of function, or decrease of function on
one whole side of your body.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) 739**], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.

Pulmonary follow up:
You will need a PET CT of your chest. This will be done in
Nuclear medicine on Thursday [**2181-3-1**] at 11:45am. This is located
on [**Location (un) **] of the [**Hospital Ward Name 23**] building on the [**Hospital Ward Name **] of [**Hospital1 **]. A
preparation list and directions should be picked up before this
appointment.

You have an appointment with a pulmonologist: Dr. [**Last Name (STitle) **] in
the pulmonary clinic ([**Telephone/Fax (1) 612**]) on [**3-8**], at 9:00am. you
need to arrive at 8:30 for pulmonary function testing. this
location is [**Hospital Ward Name 23**] Building, [**Hospital Ward Name 516**], [**Location (un) 436**].


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2181-3-1**]

Name:  [**Known lastname **],[**Known firstname 389**]                    Unit No:   [**Numeric Identifier 5338**]

Admission Date:  [**2181-2-15**]              Discharge Date:   [**2181-3-1**]

Date of Birth:  [**2101-12-26**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1698**]
Addendum:
PET CT scan to be done prior to rehab today.

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 **] Hospital

                             [**Name6 (MD) **] [**Name8 (MD) 1041**] MD [**MD Number(2) 1709**]

Completed by:[**2181-3-1**]
{'Intracerebral hemorrhage,Obstructive hydrocephalus,Paralytic ileus,Mobitz (type) II atrioventricular block,Candidiasis of mouth,Malignant neoplasm of lower lobe, bronchus or lung,Open wound of hand except finger(s) alone, without mention of complication,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Other persistent mental disorders due to conditions classified elsewhere,Dysphagia, unspecified,Retention of urine, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Aortocoronary bypass status'}


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: MVA

PRESENT ILLNESS: Mr. [**Known lastname **] (Eu Crit [**Doctor First Name **]) is a 79 yo M with h/o CAD s/p CABG,
HTN, HL who presents after MVC with IVH.The patient was driving
and apparently hit a telephone pole. He remembers driving but
cannot remember any events leading up to the crash, or any
abnormal symptoms. He was brought to OSH ED where head CT showed
IVH. He was transferred to [**Hospital1 18**] where he was hypertensive on
arrival SBP>200. In the ED he received labetalol and phenytoin.
Trauma was consulted. R wrist had laceration, irrigated and will
be monitored only by plastics. FAST showed a question of LUQ
cyst, so CT abdomen was done. Neurosurgery was consulted for
IVH.
The patient is currently denying headache, N/V, vision
changes,numbness, weakness or tingling.

MEDICAL HISTORY: CAD s/p CABG x 4 ~10yrs ago
HTN
HL
?COPD
hernia repair

MEDICATION ON ADMISSION: Lipitor dose unknown
BP meds unknown
Spiriva
Advair
ASA 81 mg

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
Gen: NAD
HEENT: xanthelasma on face, sclera anicteric
CV: RRR, no m/r/g
PULM: CTAB
AB: NT/ND
EXT: well perfused

FAMILY HISTORY: NC

SOCIAL HISTORY: lives with wife who has [**Name (NI) 11964**]. h/o tobacco use. 

### Response:
{'Intracerebral hemorrhage,Obstructive hydrocephalus,Paralytic ileus,Mobitz (type) II atrioventricular block,Candidiasis of mouth,Malignant neoplasm of lower lobe, bronchus or lung,Open wound of hand except finger(s) alone, without mention of complication,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Other persistent mental disorders due to conditions classified elsewhere,Dysphagia, unspecified,Retention of urine, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Aortocoronary bypass status'}
