CHIEF COMPLAINT: s/p Fall

PRESENT ILLNESS: [**Age over 90 **] F s/p unwitnessed fall on coumadin, found face down in
kitchen by her daughter. Reportedly was prone for several hours.
Per EMS patient was alert and oriented upon their arrival. She
was collared and boarded and transported to an area hospital
where found to have mulitple injuries; she was then transferred
to [**Hospital1 18**] for further care.

MEDICAL HISTORY: HTN, CAD, CHF, RBBB, ^lipid, depression, DJD

MEDICATION ON ADMISSION: metoprolol 25", nifedipine CR 30', warfarin ?, ASA 81',
lisinopril 10'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:
Gen: comfortable, NAD.
HEENT: right eye laceration stitched, bilateral ecchymotic eyes,
ecchymosis over right face. Pupils:3-2 mm perrl   EOMs: grossly
intact
Neck: hard cervical collar in place. point tenderness:none
Neuro:
Mental status: Awake and alert, cooperative with exam but
limited
due to mental status, bilateral upper extremity fractures, and
hearing deficit, normal
affect.
Orientation: Oriented to person, place, and not date.
Recall: unable to assess.
Language: Speech fluent

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Closed fracture of lower end of radius with ulna,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Closed fracture of fifth cervical vertebra,Closed fracture of shaft of humerus,Chronic diastolic heart failure,Closed fracture of other facial bones,Unspecified fall,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Right bundle branch block
Fx low radius w ulna-cl,Cl skul base fx w/o coma,Fx c5 vertebra-closed,Fx humerus shaft-closed,Chr diastolic hrt fail,Fx facial bone NEC-close,Fall NOS,Atrial fibrillation,Long-term use anticoagul,Hx TIA/stroke w/o resid,Mental disor NEC oth dis,Hypertension NOS,Tricuspid valve disease,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Rt bundle branch block
Admission Date:  [**2147-5-29**]              Discharge Date:   [**2147-6-5**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
s/p Fall

Major Surgical or Invasive Procedure:
[**2147-6-2**] External fixation right distal radius fracture

History of Present Illness:
[**Age over 90 **] F s/p unwitnessed fall on coumadin, found face down in
kitchen by her daughter. Reportedly was prone for several hours.
Per EMS patient was alert and oriented upon their arrival. She
was collared and boarded and transported to an area hospital
where found to have mulitple injuries; she was then transferred
to [**Hospital1 18**] for further care.

Past Medical History:
HTN, CAD, CHF, RBBB, ^lipid, depression, DJD



Family History:
Noncontributory

Physical Exam:
Upon admission:
Gen: comfortable, NAD.
HEENT: right eye laceration stitched, bilateral ecchymotic eyes,
ecchymosis over right face. Pupils:3-2 mm perrl   EOMs: grossly
intact
Neck: hard cervical collar in place. point tenderness:none
Neuro:
Mental status: Awake and alert, cooperative with exam but
limited
due to mental status, bilateral upper extremity fractures, and
hearing deficit, normal
affect.
Orientation: Oriented to person, place, and not date.
Recall: unable to assess.
Language: Speech fluent

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to
mm 2.5 bilaterally. Visual fields- pt does not participate in
exam
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength right droop
VIII: Hearing deficit at baseline- pt wears hearing aides which
she does not have with her
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: pt not cooperative.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full
Motor:exam limited due to pt hear of hearing and bilateral upper
extremity fractures

Pronator drift unable to assess

Sensation:unable to assess

Toes downgoing bilaterally

good rectal tone

Coordination: unable to assess


Pertinent Results:
[**2147-5-29**] 01:10PM   GLUCOSE-128* UREA N-38* CREAT-1.0 SODIUM-139
POTASSIUM-4.2 CHLORIDE-99 TOTAL CO2-28 ANION GAP-16
[**2147-5-29**] 01:10PM   CALCIUM-8.4 PHOSPHATE-3.5 MAGNESIUM-2.2
[**2147-5-29**] 01:10PM   PT-15.3* PTT-25.1 INR(PT)-1.3*
[**2147-5-29**] 06:17AM   CK(CPK)-718*
[**2147-5-29**] 06:17AM   CK-MB-12* MB INDX-1.7 cTropnT-<0.01
[**2147-5-29**] 06:17AM   WBC-13.7* RBC-2.97* HGB-8.9* HCT-26.3* MCV-89
MCH-30.1 MCHC-33.9 RDW-13.5
[**2147-5-29**] 06:17AM   PLT COUNT-261

Brief Hospital Course:
She was admitted to the Trauma service. Neurosurgery, Plastics
and Orthopedics were consulted given her multiple injuries. Her
subdural hemorrhage was managed non operatively; serial head CT
scans were done and remained stable. Her Coumadin was placed on
hold and should be withheld 2 weeks from injury date ([**2147-5-29**])
per neurosurgery recommendations. It was cleared by neurosurgery
to initiate Heparin subcutaneously for DVT prophylaxis. Follow
up in 4 weeks with a repeat head CT scan.

Her facial fractures were evaluated by Plastics and were also
non operative. A soft diet was recommended so as to not further
displace the zygomatic fracture. She will follow up in [**Hospital 3595**]
clinic in 1 month.

On [**6-2**] she was taken to the operating room for external fixation
of her distal right radius fracture. Her left comminuted humerus
fracture was managed non operatively, she was placed in a
[**Last Name (un) 8688**] brace. She is non weight bearing on both upper
extremities. Follow up next week in [**Hospital 5498**] clinic.

She was evaluated by Speech and Swallow and because of
dysphagia; a bedside swallow was done where she did show signs
of aspiration. It was recommended that she have 1:1 supervision
at all meals and that an oral diet of nectar thick liquids and
pureed solids be given and pills crushed. Her home medications
were restarted.

Physical and Occupational therapy consults were also placed and
she is being recommended for rehab after her acute hospital
stay.


Medications on Admission:
metoprolol 25", nifedipine CR 30', warfarin ?, ASA 81',
lisinopril 10'


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5,000 Units
Injection [**Hospital1 **] (2 times a day).
2. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) Neb rx Inhalation Q6H (every 6 hours)
as needed for shortness of breath or wheezing.
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
4. Oxycodone 5 mg/5 mL Solution Sig: 2.5 - 5 MG PO Q4H (every 4
hours) as needed for pain.
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO BID (2 times a day).
7. Megestrol 400 mg/10 mL Suspension Sig: Four Hundred (400) MG
PO DAILY (Daily).
8. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Nifedipine 10 mg Capsule Sig: One (1) Capsule PO Q8H (every 8
hours).
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) MG
PO BID (2 times a day).
12. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30)
ML's PO twice a day as needed for constipation.
13. Protonix 40 mg Susp,Delayed Release for Recon Sig: Forty
(40) MG PO once a day.
14. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime):
hold for loose stools.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 25759**] & Rehab Center - [**Location (un) **]

Discharge Diagnosis:
s/p Fall
Subdural hemorrhage
Right orbital fracture
Bilateral maxillary sinus fractures
Right zygomatic fracture
C5 fracture
Left comminuted humerus fracture
Right distal & ulna styloid fracture

Discharge Condition:
Hemodynamically stable, tolerating a regular diet, pain
adequately controlled.

Discharge Instructions:
DO NOT bear any weight on either arm because of your fractures.

The cervical collar will need to be worn for 3 months.

Hold Coumadin for 2 weeks from date of injury ([**2147-5-29**]) because
of your head bleed.


Followup Instructions:
Follow up next Thursday [**2147-6-15**] with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] NP,
Orthopedics for your extremity fractures. Call [**Telephone/Fax (1) 1228**] for
an appointment.

Follow up in 4 weeks with Dr. [**Last Name (STitle) 739**], Neurosurgery for
your subdural hemorrhage. Call [**Telephone/Fax (1) 1669**] for an appointment.
Inform the office that you will need a repeat head CT scan for
this appointment.

Follow up in Plastics [**Hospital **] clinic in 1 month. Call [**Telephone/Fax (1) 4652**]
for an appointment.



Follow up as needed in [**Hospital **] Clinic for your orbital
fracture, call [**Telephone/Fax (1) 253**] for an appointment if one is needed.


Completed by:[**2147-6-13**]
{'Closed fracture of lower end of radius with ulna,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Closed fracture of fifth cervical vertebra,Closed fracture of shaft of humerus,Chronic diastolic heart failure,Closed fracture of other facial bones,Unspecified fall,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Right bundle branch block'}


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: s/p Fall

PRESENT ILLNESS: [**Age over 90 **] F s/p unwitnessed fall on coumadin, found face down in
kitchen by her daughter. Reportedly was prone for several hours.
Per EMS patient was alert and oriented upon their arrival. She
was collared and boarded and transported to an area hospital
where found to have mulitple injuries; she was then transferred
to [**Hospital1 18**] for further care.

MEDICAL HISTORY: HTN, CAD, CHF, RBBB, ^lipid, depression, DJD

MEDICATION ON ADMISSION: metoprolol 25", nifedipine CR 30', warfarin ?, ASA 81',
lisinopril 10'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:
Gen: comfortable, NAD.
HEENT: right eye laceration stitched, bilateral ecchymotic eyes,
ecchymosis over right face. Pupils:3-2 mm perrl   EOMs: grossly
intact
Neck: hard cervical collar in place. point tenderness:none
Neuro:
Mental status: Awake and alert, cooperative with exam but
limited
due to mental status, bilateral upper extremity fractures, and
hearing deficit, normal
affect.
Orientation: Oriented to person, place, and not date.
Recall: unable to assess.
Language: Speech fluent

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Closed fracture of lower end of radius with ulna,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Closed fracture of fifth cervical vertebra,Closed fracture of shaft of humerus,Chronic diastolic heart failure,Closed fracture of other facial bones,Unspecified fall,Atrial fibrillation,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Diseases of tricuspid valve,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Right bundle branch block'}
