CHIEF COMPLAINT: Submersion injury

PRESENT ILLNESS: Mr. [**Known lastname 44505**] is a 22 year-old male with a history of seizure
disorder who presents after having a seizure in a hot tub and
ingesting a large amount of water.
.
At six PM on the day of admission, patient was swimming in a
pool and then went to a hot tub. The patient does not recall
what happened next but in speaking with the father, it seems
that bystanders noticed that the patient was under water for a
long period of time (unclear how long; minutes?). He was pulled
out and EMS was called. No CPR was performed on the scene and
the patient was brought to an OSH for evaluation.
.
Initially presented to an OSH with O2 sats in the 80s on room
air and 95% on 10 liters. Ceftriaxone and flagyl were given. CT
of the the chest showed patchy opacities of the lower lobes. He
was transferred to [**Hospital1 18**] for futher care.
.
In the ED, patient was afebrile with a HR of 78, BP 111/65.
Initially RR 29 with O2 99% on NRB. O2 improved to 100% on 4
liters NC. Was given Tegretol 800mg, Lamictal 200mg, Strattera
60mg.
.
Currently the patient is tired but awake and interactive. He
complains of chest pain with deep inspiration but is otherwise
well. The father reports that he was agitated and in his typical
"post seizure state" until around midnight (six hours before
admission) when his mental status began to clear.

MEDICAL HISTORY: 1. Seizure disorder. Most recent seizure two months prior.
2. Traumatic brain injury with subsequent short-term memory
issues.

MEDICATION ON ADMISSION: 1. Tegretol 800mg [**Hospital1 **]
2. Lamictal 200mg [**Hospital1 **]
3. Strattera 60mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals - Afebrile, BP 116/61, HR 70. O2 sat 93-95% on room air
and 99% on 4L
gen - Tired but alert. Lying in bed in no distress, breathing
comfortably.
heent - Anicteric and without palor.
cv - Regular. II/VI systolic murmur best heard at aortic site.
No radiation.
pulm - Poor inspiratory effort. Mild crackles heard at bases.
abd - Warm and without edema.
ext - Alert. Oriented to person, "[**Hospital **] Hospital" and
"Saturday [**October 2128**]". Knows who father is. Otherwise non-focal
exam.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Currently a studnet at [**Hospital1 3597**] State. Does not smoke, drink or use
recreational drugs. Manages his own medications which is
sometimes an issues given his short-term memory issues.
Pneumonitis due to inhalation of food or vomitus,Epilepsy, unspecified, without mention of intractable epilepsy
Food/vomit pneumonitis,Epilep NOS w/o intr epil
Admission Date:  [**2128-11-13**]              Discharge Date:   [**2128-11-13**]

Date of Birth:  [**2105-11-18**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 330**]
Chief Complaint:
Submersion injury

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Mr. [**Known lastname 44505**] is a 22 year-old male with a history of seizure
disorder who presents after having a seizure in a hot tub and
ingesting a large amount of water.
.
At six PM on the day of admission, patient was swimming in a
pool and then went to a hot tub. The patient does not recall
what happened next but in speaking with the father, it seems
that bystanders noticed that the patient was under water for a
long period of time (unclear how long; minutes?). He was pulled
out and EMS was called. No CPR was performed on the scene and
the patient was brought to an OSH for evaluation.
.
Initially presented to an OSH with O2 sats in the 80s on room
air and 95% on 10 liters. Ceftriaxone and flagyl were given. CT
of the the chest showed patchy opacities of the lower lobes. He
was transferred to [**Hospital1 18**] for futher care.
.
In the ED, patient was afebrile with a HR of 78, BP 111/65.
Initially RR 29 with O2 99% on NRB. O2 improved to 100% on 4
liters NC. Was given Tegretol 800mg, Lamictal 200mg, Strattera
60mg.
.
Currently the patient is tired but awake and interactive. He
complains of chest pain with deep inspiration but is otherwise
well. The father reports that he was agitated and in his typical
"post seizure state" until around midnight (six hours before
admission) when his mental status began to clear.


Past Medical History:
1. Seizure disorder. Most recent seizure two months prior.
2. Traumatic brain injury with subsequent short-term memory
issues.


Social History:
Currently a studnet at [**Hospital1 3597**] State. Does not smoke, drink or use
recreational drugs. Manages his own medications which is
sometimes an issues given his short-term memory issues.

Family History:
Non-contributory.

Physical Exam:
vitals - Afebrile, BP 116/61, HR 70. O2 sat 93-95% on room air
and 99% on 4L
gen - Tired but alert. Lying in bed in no distress, breathing
comfortably.
heent - Anicteric and without palor.
cv - Regular. II/VI systolic murmur best heard at aortic site.
No radiation.
pulm - Poor inspiratory effort. Mild crackles heard at bases.
abd - Warm and without edema.
ext - Alert. Oriented to person, "[**Hospital **] Hospital" and
"Saturday [**October 2128**]". Knows who father is. Otherwise non-focal
exam.


Pertinent Results:
138 99 20
----------- 132
4.1 27 1.1
.
Ca: 9.6 Mg: 2.1
Carbamaz: 2.4
.
WBC: 11.5
PLT: 161
HCT: 44.8
Lactate:1.9
Trop-T: <0.01
.
EKG: NSR at 81. ST-elevations V2-V3, consistent with J-point
elevations.
.
CT CHEST (OSH): Patchy opacities of the lower lobes.
.
CT Head (OSH): No acute intracranial abnormalities. Chronic
abnormalities ifentified within R frontal/temporal/parietal lobe
and L frontal lobe likely related to prior brain injury.
Acute or chronic L facial fractures with air/fluid levels noted
within multiple sinuses.
.
Urine tox screen (OSH): Positive for benzodiazepines. Negative
for alcohol, amphetamines, barbit, cocain, methadone, opiates,
oxycodone, propoxyphene, cannabinoids

Brief Hospital Course:
22 year-old male with seizure disorder and history of traumatic
brain injury who presents with submersion injury after probable
seizure.
.
1. Submersion injury: Initially hypoxic at [**Hospital **] hospital,
however, O2 requirement quickly resolved upon transfer to [**Hospital1 18**].
 He was initially started on 4L O2 NC which was soon titrated
off.  He was encouraged to use an incentive spirometer which he
was able to reach maximum volume easily. Antibiotics were not
continued as the patient was afebrile and had no further
respiratory symptoms, however he was instructed upon discharge
to call his PCP if he had new fever, chills, cough or difficulty
breathing.
.
2. Seizure disorder: Upon admission the patient was mildly
disoriented but quickly cleared.  He does have a history of
short term memory loss as a result of a traumatic brain injury.
He had no seizure-like activity while in the hospital.  Outside
hospital records were obtained and CT head showed no acute
intracranial abnormalities as well as evidence of facial fracure
(acute vs/ chronic) which was consistent with past injury.  He
also had a urine toxicology screen which was positive only for
benzodiazepines. A Tegretol level was low on admission and he
received a loading dose of this in the emergency room, then
continued on his regular dose of Tegretol and lamotrigine.  The
patient admitted to being forgetful about taking these
medications, and in particular did miss [**First Name (Titles) 44509**] [**Last Name (Titles) 4319**] recently.
His outpatient neurologist's office was contact[**Name (NI) **] (Dr.
[**Last Name (STitle) **] and communicated with covering physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 13972**].
Based on the information surrounding his admission, and given
that he no longer had any seizure activity she felt that it
would be safe to discharge him home with close supervision. Dr.
[**Last Name (STitle) **] was informed of his hospitalization and he is to
follow-up with her on the week after discharge.

Medications on Admission:
1. Tegretol 800mg [**Hospital1 **]
2. Lamictal 200mg [**Hospital1 **]
3. Strattera 60mg daily


Discharge Medications:
1. Carbamazepine 400 mg Tablet Sustained Release 12 hr Sig: Two
(2) Tablet Sustained Release 12 hr PO twice a day.
2. Lamotrigine 200 mg Tablet Sig: One (1) Tablet PO twice a day.

3. Strattera 60 mg Capsule Sig: One (1) Capsule PO daily ().


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
1.) Aspiration pneumonitis secondary to submersion in water
2.) Seizure


Discharge Condition:
afebrile, displaying normal vital signs, satting >95% on room
air, tolerating po.


Discharge Instructions:
You were admitted to the hospital after having a seizure while
swimming.  While you had some minor lung injury as a result of
being underwater you quickly regained your lung function, and
you do not need to take any antibiotics upon discharge.
When you were admitted to the hospital your blood level of
Tegretol (one of the medications you take to control your
seizures) was very low which is likely the reason why you had
the seizure.  The most likely reason for this low level is
forgetting to take this medication regularly.  As you know it is
very important that you take all of your medications regularly
as instructed to prevent further seizures.
Also, because of this event, it is very important that you don't
drive or go swimming because of the risk of injury to yourself
and others if you have another seizure.
Your neurologist Dr. [**Last Name (STitle) **] was contact[**Name (NI) **] regarding your
hospitalization and you should follow up with her next week.
.
Please take all medications as prescribed and continue to keep
all health care appointments.  No changes were made to your
current medications.
.
As discussed, if you have new cough, fever, chills, or
difficulty breathing, or if you have headache, new seizure
activity, muscle weakness or numbness, or if your condition
worsens in any way seek immediate medical attention.

Followup Instructions:
Please follow up with your neurologist Dr. [**Last Name (STitle) **] at ([**Telephone/Fax (1) 44510**] within one week of discharge from the hospital.
{'Pneumonitis due to inhalation of food or vomitus,Epilepsy, unspecified, without mention of intractable epilepsy'}


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: Submersion injury

PRESENT ILLNESS: Mr. [**Known lastname 44505**] is a 22 year-old male with a history of seizure
disorder who presents after having a seizure in a hot tub and
ingesting a large amount of water.
.
At six PM on the day of admission, patient was swimming in a
pool and then went to a hot tub. The patient does not recall
what happened next but in speaking with the father, it seems
that bystanders noticed that the patient was under water for a
long period of time (unclear how long; minutes?). He was pulled
out and EMS was called. No CPR was performed on the scene and
the patient was brought to an OSH for evaluation.
.
Initially presented to an OSH with O2 sats in the 80s on room
air and 95% on 10 liters. Ceftriaxone and flagyl were given. CT
of the the chest showed patchy opacities of the lower lobes. He
was transferred to [**Hospital1 18**] for futher care.
.
In the ED, patient was afebrile with a HR of 78, BP 111/65.
Initially RR 29 with O2 99% on NRB. O2 improved to 100% on 4
liters NC. Was given Tegretol 800mg, Lamictal 200mg, Strattera
60mg.
.
Currently the patient is tired but awake and interactive. He
complains of chest pain with deep inspiration but is otherwise
well. The father reports that he was agitated and in his typical
"post seizure state" until around midnight (six hours before
admission) when his mental status began to clear.

MEDICAL HISTORY: 1. Seizure disorder. Most recent seizure two months prior.
2. Traumatic brain injury with subsequent short-term memory
issues.

MEDICATION ON ADMISSION: 1. Tegretol 800mg [**Hospital1 **]
2. Lamictal 200mg [**Hospital1 **]
3. Strattera 60mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals - Afebrile, BP 116/61, HR 70. O2 sat 93-95% on room air
and 99% on 4L
gen - Tired but alert. Lying in bed in no distress, breathing
comfortably.
heent - Anicteric and without palor.
cv - Regular. II/VI systolic murmur best heard at aortic site.
No radiation.
pulm - Poor inspiratory effort. Mild crackles heard at bases.
abd - Warm and without edema.
ext - Alert. Oriented to person, "[**Hospital **] Hospital" and
"Saturday [**October 2128**]". Knows who father is. Otherwise non-focal
exam.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Currently a studnet at [**Hospital1 3597**] State. Does not smoke, drink or use
recreational drugs. Manages his own medications which is
sometimes an issues given his short-term memory issues. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Epilepsy, unspecified, without mention of intractable epilepsy'}
