CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 88 year old
man who fell down 15 steps on stairs at home witnessed by his
wife.  [**Name (NI) **] was found down the steps unresponsive, bleeding
profusely from nose as well as his right eye.  He was cold.
He was found to be GCS of 3 in field.  He was intubated,
brought into Emergency Room.

MEDICAL HISTORY: Parkinson's disease.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Accidental fall on or from other stairs or steps,Paralysis agitans,Cardiac pacemaker in situ
Cl skl base fx-deep coma,Fall on stair/step NEC,Paralysis agitans,Status cardiac pacemaker
Admission Date: [**2156-8-7**]        Discharge Date: [**2156-8-7**]


Service:  MED


HISTORY OF PRESENT ILLNESS:  The patient is an 88 year old
man who fell down 15 steps on stairs at home witnessed by his
wife.  [**Name (NI) **] was found down the steps unresponsive, bleeding
profusely from nose as well as his right eye.  He was cold.
He was found to be GCS of 3 in field.  He was intubated,
brought into Emergency Room.

PAST MEDICAL HISTORY:  Parkinson's disease.

Urinary incontinence.

Pacemaker.

History of meningioma resection.

Dementia.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Not available.

PHYSICAL EXAMINATION:  Upon presentation to the Emergency
Room, the patient is intubated, sedated with pulse of 92 and
blood pressure of 158/96, oxygen saturations 100 percent.
HEENT:  His pupils were fixed and dilated bilaterally. He had
a large hematoma and bleeding from his right eye socket as
well as profuse bleeding from both nostrils. His neck was in
C-collar.
CHEST:  Clear to auscultation bilaterally.
ABDOMEN:  Soft and nondistended.
RECTAL:  Guaiac negative with decreased tone
EXTREMITIES:  Well perfused with no deformities.
NEUROLOGICAL:  She was unresponsive with extension to a pain
stimuli.

LABORATORY DATA:  CBC - white blood cell count of 10,
hematocrit of 38.3, platelets of 165, PT 16.1, PTT 81, INR
1.6, differential 83.  Sodium 143, potassium 4.0, chloride
104, bicarb 27, creatinine 0.9, amylase 75, lipase of 37.  He
was positive for blood. CT of head showed missing bone on the
right parietal region replaced with a mesh. Large
subarachnoid hemorrhage and subdural hematoma with partially
obliterated lateral ventricle.  Sphenoid bone fracture with
sphenoid and ethmoid sinuses filled with blood. ? Occipital
fracture.  C-spine was negative.  CT chest negative. CT
abdomen - evidence of previous surgery. ? Partial colectomy.
No acute process.

HOSPITAL COURSE:  The patient was evaluated by ophthalmology
service who felt that this time although the patient had
retrobulbar hematoma, he did not need any surgical
intervention.  The neurosurgical service evaluated the
patient and concluded that his chance for any kind of
meaningful recovery are minimal and his chance of overall any
kind of recovery is very minimal as well given his injury.
The patient was brought to Intensive Care Unit but his
coagulopathy was  FFP cryoprecipitate.  His eye was examined
by ophthalmology service and covered with the gauze. His
nasal bleed was controlled with Foley which was placed and
the balloon injected on the pharynx as well as hemostatic
gauze.  He had peripheral intravenous placed at the same
time.  A discussion was undertaken with the family by senior
surgical resident and neurosurgical service and given the
patient's extensive injuries as well as what the family
stated were the patient's wishes that the patient was made
DNR, DNI, and later made comfort measures only.  Fluid
replacement was stopped and the patient expired in a matter
of hours.

DISPOSITION:  The case was phoned in to the medical examiner
who accepted the case.




                        [**First Name11 (Name Pattern1) 518**] [**Last Name (NamePattern4) **], [**MD Number(1) 17554**]

Dictated By:[**Doctor Last Name 5186**]
MEDQUIST36
D:  [**2156-8-7**] 21:25:14
T:  [**2156-8-7**] 22:57:45
Job#:  [**Job Number **]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Accidental fall on or from other stairs or steps,Paralysis agitans,Cardiac pacemaker in situ'}


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 88 year old
man who fell down 15 steps on stairs at home witnessed by his
wife.  [**Name (NI) **] was found down the steps unresponsive, bleeding
profusely from nose as well as his right eye.  He was cold.
He was found to be GCS of 3 in field.  He was intubated,
brought into Emergency Room.

MEDICAL HISTORY: Parkinson's disease.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Accidental fall on or from other stairs or steps,Paralysis agitans,Cardiac pacemaker in situ'}
