CHIEF COMPLAINT: Status post fall.

PRESENT ILLNESS: The patient is an 84-year-old
gentleman status post an unwitnessed fall down a flight of
stairs.  Positive amnesia to the event.

MEDICAL HISTORY: 1.  Bioprosthetic valve replacement.
2.  Insulin-dependent diabetes mellitus.

MEDICATION ON ADMISSION: Lopressor, Imdur, aspirin,
potassium, and Detrol.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Methicillin susceptible pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Heart valve replaced by transplant,Bacteremia,Accidental fall on or from other stairs or steps,Other late effects of cerebrovascular disease, dysphagia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Subarach hem-brief coma,Meth sus pneum d/t Staph,Urin tract infection NOS,Heart valve transplant,Bacteremia,Fall on stair/step NEC,Late ef CV dis dysphagia,DMII wo cmp nt st uncntr
Admission Date:  [**2110-3-9**]       Discharge Date:  [**2110-3-22**]


Service:  Trauma Surgery

CHIEF COMPLAINT:  Status post fall.

HISTORY OF PRESENT ILLNESS:  The patient is an 84-year-old
gentleman status post an unwitnessed fall down a flight of
stairs.  Positive amnesia to the event.

The patient was transferred to an outside hospital with
confusion.  A computed tomography scan revealed a
subarachnoid hematoma.

The patient was transferred to the [**Hospital1 190**] for further management of his head injury.
The patient denied chest pain and abdominal pain.

PAST MEDICAL HISTORY:
1.  Bioprosthetic valve replacement.
2.  Insulin-dependent diabetes mellitus.

MEDICATIONS ON ADMISSION:  Lopressor, Imdur, aspirin,
potassium, and Detrol.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION ON PRESENTATION:  Initial physical
examination revealed his pulse was 80, his blood pressure was
138/palp, his respiratory rate was 16, and his oxygen
saturation was 97% on room air.  [**Location (un) 2611**] Coma Scale was 15.
The pupils were equal and reactive bilaterally.  The
extraocular muscles were intact.  The transcranial magnetic
stimulation were clear bilaterally.  Midface had no
deformities.  There was a 3-cm laceration above the left eye.
The patient's trachea was midline.  The patient was in a
regular rate and rhythm.  His breath sounds were clear
bilaterally.  There was no stepoff of deformities of the
back.  The pelvis was stable.  Rectal examination was
nasogastric with good rectal tone.  Extremities revealed no
deformities or tenderness.  There were palpable pulses
bilaterally.

BRIEF SUMMARY OF HOSPITAL COURSE:   The patient was admitted
to the Trauma Intensive Care Unit for every 1-hour neurologic
checks.  The patient was seen by Neurosurgery who concluded
that the patient was stable and would need a head computed
tomography in the morning on hospital day two.

The patient was admitted to the Trauma Intensive Care Unit.
An arterial line was placed without any complications.  The
patient's blood pressure was controlled without the need of
pressors or nitroglycerin.  The 3-cm head laceration was
washed out and sutured with interrupted nylon sutures.
Neurosurgery's recommendations were to continue the PCO2
between 35 and 40.  They also wanted a magnetic resonance
imaging of the cervical spine due to the patient's
tenderness.

Early on [**3-10**], the patient was noted to have stridor and
decreasing oxygen saturations.  The patient was intubated
without difficulty.

During the patient's hospitalization stay, he was extubated
twice.  Due to failure to clear secretions and failure of a
gag reflex, he was reintubated.  It was decided after the
patient's third intubation that he would require a
tracheostomy and an open gastrojejunostomy tube placement.  A
discussion took place between the Trauma team and the
patient's family.  The patient's son agreed that a
tracheostomy and a percutaneous endoscopic gastrostomy tube
would be in his father's best interest.  During that time,
Neurosurgery deemed the patient stable.  They recommended
follow up with Dr. [**First Name (STitle) **] in two weeks after discharge and to
continue to the cervical collar until discharge.

During that time, the patient had sputum cultures which grew
methicillin-susceptible Staphylococcus aureus and had a urine
culture which grew Escherichia coli which was sensitive to
Levaquin.

On [**3-14**], the patient had a left subclavian triple lumen
placed for access and an arterial line placed.

On [**3-17**], the patient was brought to the operating room
with a preoperative diagnosis of respiratory failure due to
the inability to clear secretions and loss of the gag reflex.
The patient had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] gastrostomy and open tracheostomy by
Dr. [**Last Name (STitle) **], Dr. [**Last Name (STitle) **], and Dr. [**Last Name (STitle) **].  The patient
tolerated the procedure well with minimal blood loss.  The
patient was transferred to the Trauma Intensive Care Unit in
stable condition.

On postoperative day one, the patient's tube feeds were
advanced to goal.  On postoperative day two, the patient
attempted a tracheostomy trial.  During the night on
postoperative day two, he was placed back on the ventilator
for support due to tachypnea.

On [**3-20**], it was decided that the patient was well enough
to be discharged to a rehabilitation services with ventilator
support.

Discharge physical examination revealed his temperature
maximum 100.8/99.8, his blood pressure was 152/47, his heart
rate was 68, his respiratory rate was 27, and 100% on a
tracheostomy 50% mask.  The patient's total ins for the day
included 2500 cc of fluid and total outs of 1900 cc of fluid.
The patient's white blood cell count was 9.6 and his
hematocrit was 28.9.  He was alert and oriented.  He followed
commands and moved all extremities.  His pupils were equal
and reactive.  His extraocular muscles were intact.  Heart
was regular in rate.  His breath sounds were coarse
bilaterally.  His abdomen was soft, nontender, and
nondistended.  His incision was healing well.  The patient
had no peripheral edema.

DISCHARGE DIAGNOSES:
1.  Status post fall with subarachnoid hemorrhage.
2.  Loss of pharyngeal muscle control and gag reflex.
3.  Respiratory failure.
4.  Pneumonia.
5.  Urinary tract infection.

DISCHARGE DISPOSITION:  The patient was to be discharged to
rehabilitation services.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient should continue on Levaquin for an additional
seven days after discharge.
2.  The patient should continue with aggressive chest
physical therapy and suctioning.
3.  The patient should continue with tracheostomy and
gastrojejunostomy tube.
4.  The patient may need ventilator assistance depending on
his tachypnea.
5.  The patient was instructed to follow up with Neurosurgery
in two weeks with Dr. [**First Name (STitle) **] (telephone number [**Telephone/Fax (1) 2992**]).
6.  The patient was also instructed to follow up with Trauma
Surgery in one to two weeks (telephone number [**Telephone/Fax (1) 2756**]).

MAJOR SURGICAL/INVASIVE PROCEDURES PERFORMED:
1.  Status post tracheostomy.
2.  Status post open gastrojejunostomy tube placement.

CONDITION AT DISCHARGE:  The patient was discharged in stable
condition.

DISCHARGE STATUS:  The patient was to be discharged to
rehabilitation services.

MEDICATIONS ON DISCHARGE:
1.  Heparin 5000 units subcutaneously twice per day.
2.  Lopressor 75 mg by mouth twice per day.
3.  Tylenol one to two weeks by mouth q.4-6h.
4.  Dulcolax suppositories once per day as needed.
5.  Levaquin 250-mg tablets three tablets for a total of 750
mg by mouth once per day (times seven days).
6.  Regular insulin sliding-scale (per the attached sheet).
7.  Roxicet as needed.





                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9325**], M.D.  [**MD Number(1) 10637**]

Dictated By:[**Last Name (NamePattern4) 959**]
MEDQUIST36

D:  [**2110-3-21**]  22:25
T:  [**2110-3-22**]  07:34
JOB#:  [**Job Number 55245**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Methicillin susceptible pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Heart valve replaced by transplant,Bacteremia,Accidental fall on or from other stairs or steps,Other late effects of cerebrovascular disease, dysphagia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Status post fall.

PRESENT ILLNESS: The patient is an 84-year-old
gentleman status post an unwitnessed fall down a flight of
stairs.  Positive amnesia to the event.

MEDICAL HISTORY: 1.  Bioprosthetic valve replacement.
2.  Insulin-dependent diabetes mellitus.

MEDICATION ON ADMISSION: Lopressor, Imdur, aspirin,
potassium, and Detrol.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Methicillin susceptible pneumonia due to Staphylococcus aureus,Urinary tract infection, site not specified,Heart valve replaced by transplant,Bacteremia,Accidental fall on or from other stairs or steps,Other late effects of cerebrovascular disease, dysphagia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
