CHIEF COMPLAINT: left hip pain and headache

PRESENT ILLNESS: This is a 61 year old gentleman who was riding his bicycle at
0815 this morning on his usual 25 mile route with friends when
he
lost balance and fell off his bicycle.  There was loss of
consciousness and the patient is amnestic to the event.  The
patient wife is present at the bedside but she was not present
during the accident.

MEDICAL HISTORY: PMH: none
PSH: ? L leg fx as a child

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Temp 97.3 BP 122/84   HR 66    R 18    O2Sats:100%
Constitutional: Comfortable
HEENT: Extraocular muscles intact, Pupils equal, round and
reactive to light left hemotympanum he
C. collar placed
Chest: Clear to auscultation
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Normal
Extr/Back: Right leg shortened and externally rotated pain
on palpation no pain on palpation of the knee or ankle +2 DP
bilaterally
Skin: No rash, Warm and dry
HEENT: sm left forehead laceration, left eye ecchymosis, left
ear
tympanum, no battle sign or otorrhea Pupils: 3-2.5mm
EOMs:
intact
Neck: hard cervical collar in place
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-28**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: married, lives with with who is [**Name8 (MD) **] RN, drives an 18 [**Doctor Last Name **]
No tobacco, no ETOH
Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with brief [less than one hour] loss of consciousness,Other closed transcervical fracture of neck of femur,Closed fracture of base of skull without mention of intra cranial injury, with brief [less than one hour] loss of consciousness,Pedal cycle accident injuring pedal cyclist,Accidents occurring in other specified places
Cl skull vlt fx-brf coma,Fx femur intrcaps NEC-cl,Cl skul base fx-brf coma,Ped cycl acc-ped cyclist,Accident in place NEC
Admission Date:  [**2123-7-24**]              Discharge Date:   [**2123-7-27**]

Date of Birth:  [**2061-10-21**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
left hip pain and headache

Major Surgical or Invasive Procedure:
[**2123-7-24**]
Open  reduction and internal fixation of left femoral neck
fracture/basicervical fracture.


History of Present Illness:
This is a 61 year old gentleman who was riding his bicycle at
0815 this morning on his usual 25 mile route with friends when
he
lost balance and fell off his bicycle.  There was loss of
consciousness and the patient is amnestic to the event.  The
patient wife is present at the bedside but she was not present
during the accident.

The patient c/o headache in the left frontal region and nausea.
He c/o left shoulder/clavicle pain and left hip pain. He denies
weakness, numbness tingling hearing or visual disturbance,
vomiting bowel or bladder dysfunction

Past Medical History:
PMH: none
PSH: ? L leg fx as a child


Social History:
married, lives with with who is [**Name8 (MD) **] RN, drives an 18 [**Doctor Last Name **]
No tobacco, no ETOH

Family History:
non contributory

Physical Exam:
Temp 97.3 BP 122/84   HR 66    R 18    O2Sats:100%
Constitutional: Comfortable
HEENT: Extraocular muscles intact, Pupils equal, round and
reactive to light left hemotympanum he
C. collar placed
Chest: Clear to auscultation
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Normal
Extr/Back: Right leg shortened and externally rotated pain
on palpation no pain on palpation of the knee or ankle +2 DP
bilaterally
Skin: No rash, Warm and dry
HEENT: sm left forehead laceration, left eye ecchymosis, left
ear
tympanum, no battle sign or otorrhea Pupils: 3-2.5mm
EOMs:
intact
Neck: hard cervical collar in place
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-28**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.


Pertinent Results:
[**2123-7-24**] 12:15PM   WBC-18.2* RBC-5.23 HGB-15.7 HCT-44.3 MCV-85
MCH-29.9 MCHC-35.3* RDW-12.6
[**2123-7-24**] 12:15PM   PLT COUNT-266
[**2123-7-24**] 12:15PM   PT-11.9 PTT-18.5* INR(PT)-1.0
[**2123-7-24**] 12:15PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2123-7-24**] 12:15PM   UREA N-19 CREAT-0.9
[**2123-7-24**] 12:24PM   GLUCOSE-115* LACTATE-2.4* NA+-138 K+-4.2
CL--99 TCO2-29

[**2123-7-24**] CT Head :
1. Transversely oriented left temporal bone fracture extending
into the
middle ear, with hemorrhage within the middle ear, mastoid, and
external
auditory canal, as well as into the temporomandibular joint and
the base of the styloid process. Recommend temporal bone CT for
more detailed assessment of middle and inner ear structures.
2. Nondisplaced left parietal and sphenoid bone fractures,
extending into the left sphenoid sinus and disrupting the
foramen ovale.
3. Stable small left temporal extraaxial, probably epidural
hematoma with
pneumocephalus.
4. Diffuse subarachnoid hemorrhage along bilateral convexities,
which appears more prominent since the prior CT. However, the
patient received intravenous contrast at for a CT torso, and the
subarachnoid hemorrhage may appear more prominent because of the
presence of iv contrast.
5. Small bifrontal subdural hematomas.
6. Possible small right temporal hemorrhagic contusions, versus
nodular
subarachnoid hemorrhage.

[**2123-7-24**] CT Torso :
1. Comminuted fracture of the left femoral neck with a small
surrounding
hematoma. No other fractures identified.
2. No other acute post-traumatic injuries noted within the
chest, abdomen or pelvis.
3. Small rounded hypodense structure along the lesser curvature
of the
stomach measuring up to 18 mm. This does not have the appearance
of a
hematoma. It could represent a small gastric diverticulum or a
hypoenhancing lymph node.

[**2123-7-24**] Left femur :
Complete fracture of the femoral neck, without major
displacement
or laxation of the ruptured bone elements and with normal
position of the
femoral head in the acetabulum

[**2123-7-24**] CT Orbits :
1. Oblique-transverse fracture through the temporal bone
extending through
the mastoid air cells, middle layer, inner ear, and posterior
wall of the
internal auditory canal. While the ossicles appear grossly
unremarkable,
evaluation is limited secondary to hemorrhage within the middle
ear.
The fracture line extends through the posterior aspect of the
basal turn of the cochlea. The fracture also approaches the
labyrinthine canal of cranial nerve VII, and close clinical
(including audiologic) correlation is recommended.
2. Minimally displaced complex fracture extending from the left
parietal bone through the greater [**Doctor First Name 362**] of the left sphenoid
bone. This fracture extends posteriorly to involve the anterior
wall of the foramen ovale.
3. Subtle fracture of the lateral wall of the left sphenoid
sinus with
associated hemorrhage within the left sphenoid sinus, not
significantly
changed in appearance compared to the prior head CT.
4. Hemorrhage within the left mastoid air cells and left
external auditory
canal.
5. Subarachnoid hemorrhage overlying the bilateral cerebral
hemispheres,
fully described on the accompanying head CT.
6. Bilateral thickening of the temporal bones within the
external auditory
canals could be due to "surfer's ear."

[**2123-7-24**] Head CT :
1. No significant change in the overall extent of subarachnoid
hemorrhage
overlying the cerebral convexities, over the ensuing roughly six
hours.
2. No significant change in the thin left-sided extra-axial,
likely epidural  hematoma, given the adjacent temporal bone
fracture, overlying the left temporal lobe.
3. Unchanged subdural hemorrhage along the frontal convexities,
bilaterally.  Possible minimal intraparenchymal hemorrhage
within the right temporal lobe, not significantly changed. There
is no new intracranial hemorrhage.
4. Left temporal and parietal bone, and greater [**Doctor First Name 362**] of sphenoid
fractures, as fully described on the CT from earlier on [**7-24**], [**2122**].
5. No shift of normally midline structures or central
herniation.



Brief Hospital Course:
Mr. [**Known lastname **] was evaluated by the Trauma team in the Emergency Room
and scans were reviewed along with the Ortho Trauma service and
Neurosurgery. He was admitted to the Trauma SICU for frequent
neuro checks along with pain control for his left hip fracture.
He maintained stable hemodynamics and complained of headache
pain. He was alert and oriented but was amnestic to the event
and trouble with short term memory and perseveration.

He was taken to the Operating Room on [**2123-7-24**] and underwent ORIF
of the left femoral neck fracture with DHS (see formal Op note
for details).  He tolerated the procedure well and returned to
the TSICU in stable condition. He maintained stable hemodynamics
and his pain was well controlled.  He gradually started a liquid
diet and was advanced to regular without difficulty. After an
uneventful ICU stay he was transferred to the Trauma floor on
[**2123-7-25**].

The Neurosurgeons recommended treating him prophylactically with
Dilantin or Keppra and the Head Ct was repeated to assess the
epidural hematoma which remained stable. ENT was also consulted
as he had a left temporal bone fracture extending to the middle
ear.  He also had hemotympanum of the left ear.  He was placed
on CSF leak precautions and Cipro ear drops were started in both
ears for 10 days.  He had some hearing loss in the left ear and
had an audiogram done to assess conductive versus sensoral
hearing loss.  In the interim he was placed on steroids.  The
audiogram was done on [**2123-7-26**] and demonstrated conductive
hearing loss in the left ear and his steroids were stopped.

He was evaluated by the Physical Therapy service and
Occupational Therapy service and rehab was recommended to help
safely increase his mobility as his left leg is non weight
bearing until he is further evaluated by Dr. [**First Name (STitle) **] in 2 weeks.
The Occupational Therapist noted deficits on his cognitive exam
due to his TBI and also recommended follow up with Dr. [**First Name (STitle) **]
from Cognitive Neurology.

Following discharge from rehab he will need a primary care
physician to follow him closely and work up the cause of his
fall.  His wife noted that the team of bicyclists noted that his
head was slumped down just before he fell.  She is working on
obtaining a PCP for her husband.

He was discharged to TBI rahab on [**2123-7-27**].

Medications on Admission:
none

Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain/fever. Tablet(s)
2. ciprofloxacin 0.3 % Drops Sig: Two (2) Drop Ophthalmic TID (3
times a day): both ears
thru9/6/11.
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
5. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day): thru [**2123-8-3**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 979**] - [**Location (un) 246**]

Discharge Diagnosis:
S/P Fall off bike
1. Bilateral subarachnoid hemorrhages
2. Left temporal epidural hematoma
3. Left parietal fracture to temporal bone/sphenoid [**Doctor First Name 362**]
4. Left temporal bone fracture to middle ear
5. Comminuted left femoral neck fracture
6. TBI
7. Hemotympanum left ear


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
* You were admitted to the hospital after you fell off your
bicycle with multiple injuries including diffuse bruising on
both sides of your brain, a skull fracture along with a temporal
bone fracture which extends to your middle ear and a broken hip
requiring surgery.
* The bruising in your brain is slowly resolving but you will
continue to have some cognitive deficits which will get better
in time. The Neurosurgeons would like you to continue taking
Keppra to prevent any potential seizures which could happen
during this early phase.
* You have a conductive hearing loss in the left ear which will
need to be followed by the ENT doctors along with a repeat
audiogram as you get better.
* Due to the location of the broken bones in your face/head you
are at risk to leak spinal fluid out of your ear.  To prevent
this do not blow your nose, sneeze with your mouth opened, keep
the head of your bed at 30 degrees or greater and.....
* Your left hip was repaired in the Operating Room and is
healing well.  You have your staples out next week and your
weight bearing status is non weight bearing on the left leg for
the next 6-8 weeks.
* Due to all of your problems we are sending you to rehab prior
to returning home so that you can safely increase your mobility
and also receive some cognitive therapy.

Followup Instructions:
Call the [**Hospital **] Clinic at [**Telephone/Fax (1) 1228**] for a follow up
appointment in 2 weeks with Dr. [**Last Name (STitle) **] [**Location (un) **]. Staples will be
removed at that time.

Call the [**Hospital **] Clinic at [**Telephone/Fax (1) 41**] for a follow up appointment
in [**1-1**] weeks with Dr. [**Last Name (STitle) **] ( [**Hospital **] Medical Building [**Location (un) **],
[**Last Name (NamePattern1) **]. [**Hospital Ward Name 517**])

Call the [**Hospital 4695**] Clinic at [**Telephone/Fax (1) 1669**] for a follow up
appointment in 6 weeks with Dr. [**Last Name (STitle) **].  You will need a head CT
prior to your appointment and the secretary can arrange that for
you.

Call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] from Cognitive Neurology at
[**Telephone/Fax (1) 1690**] for a follow up appointment after your are
discharged from rehab.



Completed by:[**2123-7-27**]
{'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with brief [less than one hour] loss of consciousness,Other closed transcervical fracture of neck of femur,Closed fracture of base of skull without mention of intra cranial injury, with brief [less than one hour] loss of consciousness,Pedal cycle accident injuring pedal cyclist,Accidents occurring in other specified places'}


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: left hip pain and headache

PRESENT ILLNESS: This is a 61 year old gentleman who was riding his bicycle at
0815 this morning on his usual 25 mile route with friends when
he
lost balance and fell off his bicycle.  There was loss of
consciousness and the patient is amnestic to the event.  The
patient wife is present at the bedside but she was not present
during the accident.

MEDICAL HISTORY: PMH: none
PSH: ? L leg fx as a child

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Temp 97.3 BP 122/84   HR 66    R 18    O2Sats:100%
Constitutional: Comfortable
HEENT: Extraocular muscles intact, Pupils equal, round and
reactive to light left hemotympanum he
C. collar placed
Chest: Clear to auscultation
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Normal
Extr/Back: Right leg shortened and externally rotated pain
on palpation no pain on palpation of the knee or ankle +2 DP
bilaterally
Skin: No rash, Warm and dry
HEENT: sm left forehead laceration, left eye ecchymosis, left
ear
tympanum, no battle sign or otorrhea Pupils: 3-2.5mm
EOMs:
intact
Neck: hard cervical collar in place
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-28**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: married, lives with with who is [**Name8 (MD) **] RN, drives an 18 [**Doctor Last Name **]
No tobacco, no ETOH 

### Response:
{'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with brief [less than one hour] loss of consciousness,Other closed transcervical fracture of neck of femur,Closed fracture of base of skull without mention of intra cranial injury, with brief [less than one hour] loss of consciousness,Pedal cycle accident injuring pedal cyclist,Accidents occurring in other specified places'}
