CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 83 year old
woman transferred from [**Hospital **] Hospital with bilateral acute
subdural hematomas.  The patient apparently was seated on the
side of her bed at home the night before admission and leaned
forward to remove her shoes and fell forward off the bed and
onto the floor.  Unclear if there was any loss of
consciousness.  The patient refused to seek medical attention
at that time but subsequently at the urging of the patient's
daughter she ambulated into [**Name (NI) **] Emergency Department for
medical attention.  Head CT there showed the above bilateral
acute subdural hematomas with no evidence of skull fracture
and the patient was transferred to [**Hospital1 190**] in stable condition for further management.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: 1. Potassium.
2. Norvasc.
3. Lasix.
4. Iron.
5. Aspirin.

ALLERGIES: The patient has an allergy to Sulfa.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: 
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Acute respiratory failure,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Unspecified fall,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status
Subdural hem w/o coma,Acute respiratry failure,Pneumonia, organism NOS,CHF NOS,Fall NOS,Hypertension NOS,Cor ath unsp vsl ntv/gft,Status-post ptca
Admission Date: [**2161-9-24**]        Discharge Date: [**2161-10-16**]


Service:  NSU


HISTORY OF PRESENT ILLNESS:  The patient is an 83 year old
woman transferred from [**Hospital **] Hospital with bilateral acute
subdural hematomas.  The patient apparently was seated on the
side of her bed at home the night before admission and leaned
forward to remove her shoes and fell forward off the bed and
onto the floor.  Unclear if there was any loss of
consciousness.  The patient refused to seek medical attention
at that time but subsequently at the urging of the patient's
daughter she ambulated into [**Name (NI) **] Emergency Department for
medical attention.  Head CT there showed the above bilateral
acute subdural hematomas with no evidence of skull fracture
and the patient was transferred to [**Hospital1 190**] in stable condition for further management.

PAST MEDICAL HISTORY:  Hypertension

Coronary artery disease.

PAST SURGICAL HISTORY:  Coronary angioplasty and stent.

MEDICATIONS ON ADMISSION:
1. Potassium.
2. Norvasc.
3. Lasix.
4. Iron.
5. Aspirin.


ALLERGIES:  The patient has an allergy to Sulfa.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION:  Her temperature was 98.8, heart rate
65, blood pressure 182/76, respiratory rate 20, oxygen
saturation 100 percent in room air.  The patient was awake,
alert and oriented times three and in no acute distress,
neurologically moving all four extremities, no focal
deficits.  GCS was 15.  Head, eyes, ears, nose and throat -
The pupils are equal, round and reactive to light and
accommodation, four down to three millimeters.  She had
bilateral raccoon eyes.  She had oromaxillofacial injuries.
She had no hemotympanum.  Neck - Cervical collar was intact.
No spinous tenderness.  Back - No step-off.  No tenderness in
the thoracolumbosacral spine.

HOSPITAL COURSE:  The patient was seen by neurosurgery,
recommended admitting the patient to the Intensive Care Unit
for close neurologic observation and repeating a head CT the
following day.  The patient was assessed by Dr. [**First Name (STitle) **] the
following day and Dr. [**First Name (STitle) **] recommended close neurologic
monitoring and no surgical intervention at that time.  Repeat
head CT remained stable with no midline shift or mass effect
from the subdural hematomas and the patient's cervical spine
was cleared.


DICTATION ENDED




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 8632**]

Dictated By:[**Last Name (NamePattern1) 6583**]
MEDQUIST36
D:  [**2161-10-15**] 16:24:26
T:  [**2161-10-15**] 16:43:39
Job#:  [**Job Number 14045**]


Name:  [**Known lastname **], [**Known firstname 460**]           Unit No:  [**Numeric Identifier 2184**]

Admission Date: [**2161-9-24**]        Discharge Date: [**2161-10-22**]

Date of Birth:  [**2078-7-20**]        Sex:  F

Service:  NSU


Repeat head CT remains stable with no midline shift or mass
effect from the subdural hematomas and the cervical spine was
cleared. The patient had a repeat head CT on [**2161-9-26**] which
again was stable. She had a PICC line placed for IV access
and the patient was transferred to the Regular Floor on
[**2161-9-26**]. On transfer, she responded when her name was
called, but did not follow commands. She was not oriented.
Her pupils were equal, round and reacted to light. She moved
all four extremities spontaneously. She had a nonfocal exam.
She had a repeat head CT again on the 4th which again showed
no change. She remained on the Trauma Service.  On [**9-29**], she
was more somnolent, but was alert and oriented times three
when awake. She had a repeat head CT which again was stable.
She had a bedside swallow that was done which they
recommended advancing to ground solids and nectar-thick
liquids. However, on [**2161-9-30**], she became minimally
responsive to painful stimulation only. She had a head CT
which was unchanged. She also had a chest x-ray which showed
left lower lobe pneumonia and a Dilantin level came back at
22. She had a sodium of 151 and enlarged pupil.  On [**10-1**],
the patient became acutely worse with a nonreactive pupil on
the right side. The left pupil was sluggish to react. The
patient was taken emergently to the OR on [**10-1**] for
evacuation of the subdural hematoma. Essentially, the patient
herniated just prior to surgery. Postop, the patient was in
the Recovery Room. On physical examination postop, the
patient's pupils were equal and reacted. The right was
slightly more sluggish than the left. The right was 4 down to
3.3 mm. The left was 4 down to 2. The patient had a positive
gag and cough. Her chest was clear on auscultation. Her
abdomen was soft and nontender. Extremities - she had some
bruising noted. She withdraw to noxious stimulation in all
extremities.  On [**10-2**], on exam, she was awake, alert and
localizing but not following commands. Her pupils were equal
and reacted to light. She had a repeat head CT which showed
pneumocephalus and she was put on 100 percent oxygen. On
[**2161-10-3**], on exam, she was following commands in both lower
extremities. Her pupils were 3.5 down to 3. She was more
sluggish to react on the right than the left. Her sensation
was intact. She localized in all extremities. She was
transfused with one unit of packed red blood cells for some
anemia. She was started on Lopressor 50 [**Hospital1 **] and subcutaneous
heparin for DVT prophylaxis. She remained stable. The patient
was started on Levaquin for the left lower lobe pneumonia. ID
was following the patient and recommended to discontinue the
levofloxacin and start her on Zosyn for empiric coverage of
aspiration and nosocomial pneumonia. Her condition remained
stable. A family meeting was held on [**10-9**] and the patient
was made a DNR. However, she may be reintubated and trach and
PEG if she fails extubation. She was extubated and did
tolerate that. She had a PEG placed and was transferred to
the regular floor on [**2161-10-14**]. She has remained
neurologically stable, moving all extremities, intermittently
following commands and has had episodes of congestive heart
failure, receiving IV Lasix. She also had a filter placed. On
[**10-16**], the patient had an episode of respiratory distress.
The family was consulted and they did not want the patient
intubated. She was therefore transferred to the MICU
overnight and was put on BiPAP. This episode did resolve and
the patient was transferred back to the regular floor the
following day. She has remained neurologically stable and
respiratory-wise has been stable, receiving daily doses of
Lasix. She has also had difficulty with hypertension and has
been treated with hydralazine, Lopressor and lisinopril for
blood pressure control. She was afebrile up until the 25th
when she did spike a temperature. Her UA came back positive
for Enterococcus which was sensitive to ampicillin and she
was started on ampicillin for that. She is also currently on
levofloxacin for her left lower lobe pneumonia. Her condition
remained stable.

Her medications at the time of discharge include Dilantin 100
mg po tid, metoprolol 75 mg po bid, hold for heart rate less
than 60 and SBP less than 120, lisinopril 10 mg po daily,
hydralazine 10 mg IV q4 prn, hold for SBP less than 120,
ampicillin 500 mg po q6 for three days which was started on
the 27th, levofloxacin 250 mg po q24h which was started on
the 24th for a total of seven days for pneumonia,
multivitamins 5 ml po daily, isosorbide 30 mg po tid, insulin
sliding scale, ferrous sulfate 300 mg po bid, folic acid 1 mg
po daily, heparin 5000 subcutaneous q12h, lansoprazole 30 mg
per NG daily.

Her condition was stable at the time of discharge. She will
follow up with Dr. [**First Name (STitle) 24**] in one month with repeat head CT.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 2185**]

Dictated By:[**Last Name (NamePattern1) 2186**]
MEDQUIST36
D:  [**2161-10-22**] 11:14:26
T:  [**2161-10-22**] 12:07:59
Job#:  [**Job Number 2187**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Acute respiratory failure,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Unspecified fall,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty 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: 

PRESENT ILLNESS: The patient is an 83 year old
woman transferred from [**Hospital **] Hospital with bilateral acute
subdural hematomas.  The patient apparently was seated on the
side of her bed at home the night before admission and leaned
forward to remove her shoes and fell forward off the bed and
onto the floor.  Unclear if there was any loss of
consciousness.  The patient refused to seek medical attention
at that time but subsequently at the urging of the patient's
daughter she ambulated into [**Name (NI) **] Emergency Department for
medical attention.  Head CT there showed the above bilateral
acute subdural hematomas with no evidence of skull fracture
and the patient was transferred to [**Hospital1 190**] in stable condition for further management.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: 1. Potassium.
2. Norvasc.
3. Lasix.
4. Iron.
5. Aspirin.

ALLERGIES: The patient has an allergy to Sulfa.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY:  

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Acute respiratory failure,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Unspecified fall,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status'}
