CHIEF COMPLAINT: Fall down stairs

PRESENT ILLNESS: Mr. [**Known lastname 108855**] is an 84 yo M with history of atrial fibrillation
on coumadin, ventricular tachycardia, and systolic CHF (ejection
fraction 35-40%), and baseline rhythm complete heart block
status post pacer placements who presents after a fall down
stairs with loss of consciousness. At around 2am the morning of
admission, Mr. [**Known lastname 108855**] got up from bed and went into the
kitchen to drink scotch. He drank "[**1-16**] cup." Immediately after,
he attempted to go down the stairs to the bedroom and this was
the last thing he remembered before being in the ED. Per wife,
she heard "thumps" and immediately went to the stairs, where she
found the patient unconscious with blood behind his head. He was
completely still and she [**Month/Day (2) **] any shaking, tongue biting, or
incontinence. She immediately called 911. Upon EMT arriving, the
patient became somewhat interactive.
.
The patient [**Month/Day (2) **] feeling shortness of breath, chest pain, or
lightheaded before the fall. He does not recall tripping. He did
not feel any different than usual yesterday evening and [**Month/Day (2) **]
any recent viral illness. Of note, two days before admission the
patient did have one episode of light headedness after getting
out of bed in the morning, requiring him to lean against the
wall. He felt much better after drinking [**Location (un) 2452**] juice and felt
completely improved after lunch that day. He now complains of
chest pain since the fall.
.
Mr. [**Known lastname 108855**] [**Last Name (Titles) **] fever, chills, night sweats, headache,
vision changes, sore throat, abdominal pain, nausea, vomiting,
diarrhea, constipation, hematochezia, dysuria, hematuria.

MEDICAL HISTORY: PMH: ventricular tachycardia, dilated cardiomyopathy with EF
35-40%,- CAD s/p stenting; chronic systolic CHF, atrial
tachycardia, atrial fibrillation, rectal cancer s/p chemo
radiation and surgery in [**2157**],  GI bleed [**2-16**] angiectasia in the
duodenum [**1-/2162**], CVA in [**2150**] with right hand dysthesia, prior
mechanical falls, depression

MEDICATION ON ADMISSION: CITALOPRAM -10 mg Tablet - 1 Tablet(s) by mouth once a day
FUROSEMIDE - 40 mg Tablet - 1(One) Tablet(s) by mouth twice a
day
GABAPENTIN - 100 mg Capsule - one Capsule(s) by mouth daily at
bedtime
LISINOPRIL - 2.5 mg Tablet - one Tablet(s) by mouth once a day
METOPROLOL SUCCINATE - 25 mg Tablet Extended Release 24 hr - one

ALLERGIES: Penicillins / Erythromycin Base / Streptomycin / Citric Acid /
Atenolol / Torsemide

PHYSICAL EXAM: Admission Physical Exam
VS: T 98 BP 118/56 HR 66 RR 32 O2 Sat 95% 3L
GENERAL: Man laying still in bed. NAD. Sleeping but easily
arousable.
HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear.
NECK: Supple, no thyromegaly, JVP 11cm. no carotid bruits.
LUNGS: No increased work of breathing. Diffuse wheezes and
rhonci with crackles at the bases.
HEART: RRR, III/VI holosystolic murmer at the lower right
sternal border. Chest is tender to palpation.
ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding.
EXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses.
SKIN: No rashes or lesions.
LYMPH: No cervical LAD.
NEURO: Awake, A&Ox3, CNs II-XII intact, muscle strength 5/5
throughout but patient has pain in moving them. sensation intact
at distal extremities.

FAMILY HISTORY: Father died in 80s from MI. Mother died in 80s from PE. No
family history of colon, breast, uterine, or ovarian cancer. No
family history of seizures.

SOCIAL HISTORY: Mr. [**Known lastname 108855**] lives in [**Location 745**] with his wife. They are currently
in the process of moving to an apartment. Per wife, Mr.
[**Known lastname 108855**] has been feeling stress/depressed about moving out of
their 42 year home. They have 2 children. He is a retired
computer science professor. [**First Name (Titles) **] [**Last Name (Titles) 22381**] smoked 5 cigars a day
for 30 years and quit in [**2150**] after his CVA. He drinks once or
twice a week. His wife says that even just a little alcohol
'affects him quite a bit' in changing his mood and makes 'him
sick'
Traumatic hemothorax without mention of open wound into thorax,Acute respiratory failure,Acute on chronic combined systolic and diastolic heart failure,Pneumonitis due to inhalation of food or vomitus,Closed fracture of eight or more ribs,Acute kidney failure, unspecified,Accidental fall on or from other stairs or steps,Concussion, with loss of consciousness of 30 minutes or less,Acute posthemorrhagic anemia,Unspecified septicemia,Sepsis,Hyperosmolality and/or hypernatremia,Urinary tract infection, site not specified,Glucocorticoid deficiency,Closed fracture of shaft of clavicle,Other and unspecified open wound of head without mention of complication,Atrial fibrillation,Alcohol abuse, unspecified,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Percutaneous transluminal coronary angioplasty status,History of fall,Other drugs and medicinal substances causing adverse effects in therapeutic use,Attention to colostomy,Fitting and adjustment of automatic implantable cardiac defibrillator,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site
Traum hemothorax-closed,Acute respiratry failure,Ac/chr syst/dia hrt fail,Food/vomit pneumonitis,Fx eight/more rib-closed,Acute kidney failure NOS,Fall on stair/step NEC,Concus-brief coma <31 mn,Ac posthemorrhag anemia,Septicemia NOS,Sepsis,Hyperosmolality,Urin tract infection NOS,Glucocorticoid deficient,Fx clavicle shaft-closed,Open wound of head NEC,Atrial fibrillation,Alcohol abuse-unspec,Long-term use anticoagul,Hx-rectal & anal malign,Status-post ptca,Personal history of fall,Adv eff medicinal NEC,Atten to colostomy,Ftng autmtc dfibrillator,Proteus infection NOS
Admission Date:  [**2163-6-23**]              Discharge Date:   [**2163-7-7**]

Date of Birth:  [**2079-1-17**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Erythromycin Base / Streptomycin / Citric Acid /
Atenolol / Torsemide

Attending:[**First Name3 (LF) 1390**]
Chief Complaint:
Fall down stairs

Major Surgical or Invasive Procedure:
Chest tube placement ([**2163-6-26**])
Intubation ([**2163-6-27**])
Failed extubation and reintubation ([**2163-6-30**])
Trach and PEG ([**2163-7-1**])

History of Present Illness:
Mr. [**Known lastname 108855**] is an 84 yo M with history of atrial fibrillation
on coumadin, ventricular tachycardia, and systolic CHF (ejection
fraction 35-40%), and baseline rhythm complete heart block
status post pacer placements who presents after a fall down
stairs with loss of consciousness. At around 2am the morning of
admission, Mr. [**Known lastname 108855**] got up from bed and went into the
kitchen to drink scotch. He drank "[**1-16**] cup." Immediately after,
he attempted to go down the stairs to the bedroom and this was
the last thing he remembered before being in the ED. Per wife,
she heard "thumps" and immediately went to the stairs, where she
found the patient unconscious with blood behind his head. He was
completely still and she [**Month/Day (2) **] any shaking, tongue biting, or
incontinence. She immediately called 911. Upon EMT arriving, the
patient became somewhat interactive.
.
The patient [**Month/Day (2) **] feeling shortness of breath, chest pain, or
lightheaded before the fall. He does not recall tripping. He did
not feel any different than usual yesterday evening and [**Month/Day (2) **]
any recent viral illness. Of note, two days before admission the
patient did have one episode of light headedness after getting
out of bed in the morning, requiring him to lean against the
wall. He felt much better after drinking [**Location (un) 2452**] juice and felt
completely improved after lunch that day. He now complains of
chest pain since the fall.
.
Mr. [**Known lastname 108855**] [**Last Name (Titles) **] fever, chills, night sweats, headache,
vision changes, sore throat, abdominal pain, nausea, vomiting,
diarrhea, constipation, hematochezia, dysuria, hematuria.


Past Medical History:
PMH: ventricular tachycardia, dilated cardiomyopathy with EF
35-40%,- CAD s/p stenting; chronic systolic CHF, atrial
tachycardia, atrial fibrillation, rectal cancer s/p chemo
radiation and surgery in [**2157**],  GI bleed [**2-16**] angiectasia in the
duodenum [**1-/2162**], CVA in [**2150**] with right hand dysthesia, prior
mechanical falls, depression

PSH: CAD s/p stenting of the OM in [**2-/2159**] following cardiac
arrest, - s/p dual chamber [**Year (4 digits) 3941**] in [**2-/2159**]

Social History:
Mr. [**Known lastname 108855**] lives in [**Location 745**] with his wife. They are currently
in the process of moving to an apartment. Per wife, Mr.
[**Known lastname 108855**] has been feeling stress/depressed about moving out of
their 42 year home. They have 2 children. He is a retired
computer science professor. [**First Name (Titles) **] [**Last Name (Titles) 22381**] smoked 5 cigars a day
for 30 years and quit in [**2150**] after his CVA. He drinks once or
twice a week. His wife says that even just a little alcohol
'affects him quite a bit' in changing his mood and makes 'him
sick'

Family History:
Father died in 80s from MI. Mother died in 80s from PE. No
family history of colon, breast, uterine, or ovarian cancer. No
family history of seizures.

Physical Exam:
Admission Physical Exam
VS: T 98 BP 118/56 HR 66 RR 32 O2 Sat 95% 3L
GENERAL: Man laying still in bed. NAD. Sleeping but easily
arousable.
HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear.
NECK: Supple, no thyromegaly, JVP 11cm. no carotid bruits.
LUNGS: No increased work of breathing. Diffuse wheezes and
rhonci with crackles at the bases.
HEART: RRR, III/VI holosystolic murmer at the lower right
sternal border. Chest is tender to palpation.
ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding.
EXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses.
SKIN: No rashes or lesions.
LYMPH: No cervical LAD.
NEURO: Awake, A&Ox3, CNs II-XII intact, muscle strength 5/5
throughout but patient has pain in moving them. sensation intact
at distal extremities.


Pertinent Results:
CXR ([**2163-6-23**]) - There is moderate cardiomegaly, mild vascular
congestion, slightly increased compared to [**2162-11-20**].
Severe pulmonary artery dilatation indicating pulmonary arterial
hypertension has worsened. Transvenous pacemaker/defibrillator
leads end in the right atrium and right ventricle respectively.
There is no pleural effusion and no pneumothorax. No displaced
fractures.

CT head ([**2163-6-23**]) - No acute intracranial process.

CT cspine ([**2163-6-23**]) - No fractures and no malalignment. Moderate
denerative changes.

CT A/P ([**2163-6-23**]) - No acute process of the abdomen and pelvis
including no evidence of retroperitoneal hematoma. No splenic
injury and no left lower rib fractures. Small left pleural
effusion. Tiny small right pneumothorax and focus of mediastinal
air which could be explained by attempted line placement.

Echo ([**2163-6-24**]) - Poor image quality. The left atrium is
moderately dilated. The right atrium is markedly dilated. No
atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. Due to suboptimal technical
quality, a focal wall motion abnormality cannot be fully
excluded. Overall left ventricular systolic function is probably
mildly depressed (LVEF= 40-45 %). There is no ventricular septal
defect. The right ventricular cavity is dilated The ascending
aorta is mildly dilated. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is mild bileaflet mitral valve prolapse. An
eccentric, posteriorly directed jet of mild to moderate ([**1-16**]+)
mitral regurgitation is seen. The tricuspid valve leaflets are
mildly thickened. At least mild pulmonary hypertension is
detected.There is no pericardial effusion.

CTA chest ([**2163-6-24**]) - Acute fractures of the left first through
tenth ribs, with some fracture displacement, with subjacent
moderate-sized left pleural fluid collection,likely containing
blood layering in the dependent portion. There is left lower
lobe collapse, and mild left upper lobe atelectasis. No
pneumothorax. No pulmonary embolus detected to the subsegmental
levels. No dissection.  Equivocal right 5th-7th rib injuries.
The right lung is clear.

CT torso ([**2163-6-25**]) - No evidence of active bleeding in the chest
or abdomen. Innumerable left-sided rib fractures and
questionable, right rib fractures as previously described. In
addition, there is a non-displaced fracture of the left clavicle
near the sternoclavicular junction. There is a lytic lesion in
the distal left clavicle adjacent to the aromioclavicular joint
which appears new from a radiograph in [**2163-5-15**] and is
concerning for a metastatic focus. Decreased attenuation in the
T4 vertebral body on the right may represent a second lytic
lesion. Continued atelectasis involving the left lower lobe with
left pleural effusion, not significantly increased from prior
and other, additionally described, chronic findings in the
abdomen, unchanged.

L shoulder R|XR ([**2163-6-26**]) - There is an acute fracture involving
the left distal clavicle extending into the AC joint. This was
not present on the prior study from [**2163-6-7**]. There is also
severe degenerative changes of the left humeral head with
spurring. There is a left-sided pacemaker. Moreover, there is
increased density to the left lung which may be due to
hemorrhage or pleural effusion which has increased since the
Chest CT scan


Brief Hospital Course:
[**6-23**]: Initial trauma workup in the ED including CXR, CT head, CT
c-spine, CT abdomen/pelvis did not show significant trauma and
the patient was admitted to medicine for workup for syncope. On
the SIRS team, the patient was noted to have an increasing
oxygen requirement and was initially diuresed for a potential
CHF exacerbation.

[**6-24**]: CTA to r/o PE and showed left-sided pleural effusion
concerning for a hemothorax in the context of the down-trending
hct 30 on initial presentation ([**6-23**])->28 ([**6-24**])-> 26 ([**6-25**])->24
([**6-25**])->21 ([**6-25**]) between w/increasing hypoxia.

[**6-25**]: Repeat CT torso showed [**10-26**] left-sided rib fractures, up
to 3 questionable right rib fractures, atelectasis vs scarring
at the posterior right lung base, and stable left pleural
effusion. Received 2 units FFP and 1 unit PRBC

[**6-26**]: Increasing O2 requirement with PO2 in the low 90's on 4-5L
NC. 1 additional unit PRBC, diuresing with Lasix 40mg IV x3 with
the transfusions. IV Morphine and pain regimen was up-titrated
for splinting. Repeat CXR showed large left pleural effusion and
Thoracic surgery and IP were consulted for the concern of
hemothorax. IP placed a pigtail catheter, which drained 750cc of
red blood on insertion, and the patient developed hypotension to
the 80's systolic from a prior range of SBP 90's-120's.
Triggered for hypotension and received 250cc bolus. PO2 was
noted to be 98% on 6L NC with decreasing UOP.

[**6-27**]: He was transferred to the MICU for hypoxia. The Trauma
Surgery service was consulted and assumed care of the patient.
He was transferred to the Trauma ICU.  He was placed on a
facemask.  The Acute Pain Service was consulted and an epidural
was placed for improved pain control.  On imaging a white out of
the right lung was placed and the patient became increasingly
hypoxemic and dyspneic.  He was intubated and bronch with
copious secrections throughout the left lung.  Left lung
pneumonia was demonstrated on CT chest.  He was treated with
vanco and cefepime.

[**6-28**]: A right subclavian central line was placed and his pigtail
catheter was discontinued.  Bronch was repeated with additional
BAL.  Ciprofloxacin was added to antibiotic regimen.

[**6-29**]: Bronch was repeated this time with thin secretions.  He
remained on pressors.

[**6-30**]: He was tranfused one unit of PRBC and started on
solumedrol.  He was extubated but immediately failed and was
reintubated.  His epidural was discontinued.

[**7-1**]: Patient underwent bedside trach and PEG.  Upper GI
endoscopy done at the time was negative for any abnormal
findings.

[**7-2**]: Patient remained on ventilator.

[**7-3**]: He was weaned to trach mask and remained stable off the
vent all day.  He was put back on the vent on CPAP settings at
night.  BAL demonstrated MSSA and his antibiotics were narrowed
to just vanco/cipro.  Home antihypertensives and lasix were
restarted.

[**7-4**]: He tolerated trach mask all day. Steroid taper was
started.  Started prednisone taper with plans to taper by 10mg
every 48hours. Remaining antibiotics were dc'ed.

[**Date range (1) 40196**]: Tube feedings were adjusted to correct sodium levels.
 He was initially hypernatremic to 154.  His tube feeds were
changed from Novasource Renal to Replete with Fiber at 70cc/hr
with 250cc q4hr free water flushes.  His lasix was held and he
was put on D5W at 100cc/hr.  His sodium decreased to 148 on the
morning of [**7-7**] and he was felt to be stable for discharge.  His
free water flushes were continued and his D5W was dc'ed.

Medications on Admission:
CITALOPRAM -10 mg Tablet - 1 Tablet(s) by mouth once a day
FUROSEMIDE - 40 mg Tablet - 1(One) Tablet(s) by mouth twice a
day
GABAPENTIN - 100 mg Capsule - one Capsule(s) by mouth daily at
bedtime
LISINOPRIL - 2.5 mg Tablet - one Tablet(s) by mouth once a day
METOPROLOL SUCCINATE - 25 mg Tablet Extended Release 24 hr - one

Tablet(s) by mouth once a day
PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1
Tablet(s)
by mouth once a day
PHYSICAL THERAPY-LEFT SHOULDER PAIN - - Evaluate and treat .
POTASSIUM CHLORIDE [KLOR-CON M20] - 20 mEq Tablet, ER
Particles/Crystals - 1 Tab(s) by mouth daily
SPIRONOLACTONE - 25 mg Tablet - 1 Tablet(s) by mouth daily
TEDS STOCKINGS - 1 PAIR - WEAR DAILY TO PREVENT ANKLE SWELLING
WARFARIN - (med list update) - 2.5 mg Tablet - one Tablet(s) by

mouth 2 tabs on MWF, daily as directed by MD
FERROUS SULFATE - 325 mg Tablet - 1 Tablet(s) by mouth once a
day
MULTIVITAMIN - Tablet - 1 Tablet(s) by mouth once a day
PRAMOXINE-ZINC ACETATE [ITCH RELIEF] - 0.5 %-0.5 % Lotion - [**Hospital1 **]



Discharge Medications:
1. citalopram 20 mg Tablet [**Hospital1 **]: 0.5 Tablet PO DAILY (Daily).
2. gabapentin 300 mg Capsule [**Hospital1 **]: One (1) Capsule PO Q12H (every
12 hours).
3. carvedilol 3.125 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2
times a day).
4. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
5. ferrous sulfate 300  mg (60 mg iron) Tablet [**Last Name (STitle) **]: One (1)
Tablet PO DAILY (Daily).
6. acetaminophen 325 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO Q6H (every
6 hours) as needed for fever, pain.
7. heparin, porcine (PF) 10 unit/mL Syringe [**Last Name (STitle) **]: Two (2) ML
Intravenous PRN (as needed) as needed for line flush.
8. folic acid 1 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily).

9. oxycodone 5 mg/5 mL Solution [**Last Name (STitle) **]: Five (5) mL PO Q4H (every 4
hours) as needed for pain.
10. docusate sodium 50 mg/5 mL Liquid [**Last Name (STitle) **]: One (1)  PO BID (2
times a day).
11. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler [**Last Name (STitle) **]:
2-4 Puffs Inhalation Q2H (every 2 hours) as needed for wheezing.

12. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler
[**Last Name (STitle) **]: Four (4) Puff Inhalation Q4H (every 4 hours).
13. prednisone 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day:
please wean to 10mg qday on [**7-9**] and then discontinue on [**7-9**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital -[**Hospital1 8**]

Discharge Diagnosis:
Multiple bilateral rib fractures
Respiratory failure
Left clavicular fracture

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


Discharge Instructions:
Please call your doctor or nurse practitioner or return to the
Emergency Department for any of the following:

*You experience new chest pain, pressure, squeezing or
tightness.

*New or worsening cough, shortness of breath, or wheeze.

*If you are vomiting and cannot keep down fluids or your
medications.

*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.

*You see blood or dark/black material when you vomit or have a
bowel movement.

*You experience burning when you urinate, have blood in your
urine, or experience a discharge.

*Your pain is not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.

*You are NOT being restarted on your home medication of COUMADIN
which you take for atrial fibrillation.  Once you are discharged
from rehab please follow-up with your primary care provider to
discuss restarting this medication.

*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.

*Any change in your symptoms, or any new symptoms that concern
you.


Followup Instructions:
Please follow up in the Acute Care Surgery Clinic in two weeks.
Call ([**Telephone/Fax (1) 2537**] for an appointment.

Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] IM (NHB)
Date/Time:[**2163-7-19**] 2:00
Provider: [**Name10 (NameIs) 13953**] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 3965**]
Date/Time:[**2163-7-28**] 2:45
Provider:  [**Name10 (NameIs) 3941**] CALL TRANSMISSIONS Phone:[**Telephone/Fax (1) 59**]
Date/Time:[**2163-8-8**] 12:00
{'Traumatic hemothorax without mention of open wound into thorax,Acute respiratory failure,Acute on chronic combined systolic and diastolic heart failure,Pneumonitis due to inhalation of food or vomitus,Closed fracture of eight or more ribs,Acute kidney failure, unspecified,Accidental fall on or from other stairs or steps,Concussion, with loss of consciousness of 30 minutes or less,Acute posthemorrhagic anemia,Unspecified septicemia,Sepsis,Hyperosmolality and/or hypernatremia,Urinary tract infection, site not specified,Glucocorticoid deficiency,Closed fracture of shaft of clavicle,Other and unspecified open wound of head without mention of complication,Atrial fibrillation,Alcohol abuse, unspecified,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Percutaneous transluminal coronary angioplasty status,History of fall,Other drugs and medicinal substances causing adverse effects in therapeutic use,Attention to colostomy,Fitting and adjustment of automatic implantable cardiac defibrillator,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}


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: Fall down stairs

PRESENT ILLNESS: Mr. [**Known lastname 108855**] is an 84 yo M with history of atrial fibrillation
on coumadin, ventricular tachycardia, and systolic CHF (ejection
fraction 35-40%), and baseline rhythm complete heart block
status post pacer placements who presents after a fall down
stairs with loss of consciousness. At around 2am the morning of
admission, Mr. [**Known lastname 108855**] got up from bed and went into the
kitchen to drink scotch. He drank "[**1-16**] cup." Immediately after,
he attempted to go down the stairs to the bedroom and this was
the last thing he remembered before being in the ED. Per wife,
she heard "thumps" and immediately went to the stairs, where she
found the patient unconscious with blood behind his head. He was
completely still and she [**Month/Day (2) **] any shaking, tongue biting, or
incontinence. She immediately called 911. Upon EMT arriving, the
patient became somewhat interactive.
.
The patient [**Month/Day (2) **] feeling shortness of breath, chest pain, or
lightheaded before the fall. He does not recall tripping. He did
not feel any different than usual yesterday evening and [**Month/Day (2) **]
any recent viral illness. Of note, two days before admission the
patient did have one episode of light headedness after getting
out of bed in the morning, requiring him to lean against the
wall. He felt much better after drinking [**Location (un) 2452**] juice and felt
completely improved after lunch that day. He now complains of
chest pain since the fall.
.
Mr. [**Known lastname 108855**] [**Last Name (Titles) **] fever, chills, night sweats, headache,
vision changes, sore throat, abdominal pain, nausea, vomiting,
diarrhea, constipation, hematochezia, dysuria, hematuria.

MEDICAL HISTORY: PMH: ventricular tachycardia, dilated cardiomyopathy with EF
35-40%,- CAD s/p stenting; chronic systolic CHF, atrial
tachycardia, atrial fibrillation, rectal cancer s/p chemo
radiation and surgery in [**2157**],  GI bleed [**2-16**] angiectasia in the
duodenum [**1-/2162**], CVA in [**2150**] with right hand dysthesia, prior
mechanical falls, depression

MEDICATION ON ADMISSION: CITALOPRAM -10 mg Tablet - 1 Tablet(s) by mouth once a day
FUROSEMIDE - 40 mg Tablet - 1(One) Tablet(s) by mouth twice a
day
GABAPENTIN - 100 mg Capsule - one Capsule(s) by mouth daily at
bedtime
LISINOPRIL - 2.5 mg Tablet - one Tablet(s) by mouth once a day
METOPROLOL SUCCINATE - 25 mg Tablet Extended Release 24 hr - one

ALLERGIES: Penicillins / Erythromycin Base / Streptomycin / Citric Acid /
Atenolol / Torsemide

PHYSICAL EXAM: Admission Physical Exam
VS: T 98 BP 118/56 HR 66 RR 32 O2 Sat 95% 3L
GENERAL: Man laying still in bed. NAD. Sleeping but easily
arousable.
HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear.
NECK: Supple, no thyromegaly, JVP 11cm. no carotid bruits.
LUNGS: No increased work of breathing. Diffuse wheezes and
rhonci with crackles at the bases.
HEART: RRR, III/VI holosystolic murmer at the lower right
sternal border. Chest is tender to palpation.
ABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding.
EXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses.
SKIN: No rashes or lesions.
LYMPH: No cervical LAD.
NEURO: Awake, A&Ox3, CNs II-XII intact, muscle strength 5/5
throughout but patient has pain in moving them. sensation intact
at distal extremities.

FAMILY HISTORY: Father died in 80s from MI. Mother died in 80s from PE. No
family history of colon, breast, uterine, or ovarian cancer. No
family history of seizures.

SOCIAL HISTORY: Mr. [**Known lastname 108855**] lives in [**Location 745**] with his wife. They are currently
in the process of moving to an apartment. Per wife, Mr.
[**Known lastname 108855**] has been feeling stress/depressed about moving out of
their 42 year home. They have 2 children. He is a retired
computer science professor. [**First Name (Titles) **] [**Last Name (Titles) 22381**] smoked 5 cigars a day
for 30 years and quit in [**2150**] after his CVA. He drinks once or
twice a week. His wife says that even just a little alcohol
'affects him quite a bit' in changing his mood and makes 'him
sick' 

### Response:
{'Traumatic hemothorax without mention of open wound into thorax,Acute respiratory failure,Acute on chronic combined systolic and diastolic heart failure,Pneumonitis due to inhalation of food or vomitus,Closed fracture of eight or more ribs,Acute kidney failure, unspecified,Accidental fall on or from other stairs or steps,Concussion, with loss of consciousness of 30 minutes or less,Acute posthemorrhagic anemia,Unspecified septicemia,Sepsis,Hyperosmolality and/or hypernatremia,Urinary tract infection, site not specified,Glucocorticoid deficiency,Closed fracture of shaft of clavicle,Other and unspecified open wound of head without mention of complication,Atrial fibrillation,Alcohol abuse, unspecified,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Percutaneous transluminal coronary angioplasty status,History of fall,Other drugs and medicinal substances causing adverse effects in therapeutic use,Attention to colostomy,Fitting and adjustment of automatic implantable cardiac defibrillator,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}
