CHIEF COMPLAINT: s/p fall down stairs, found down

PRESENT ILLNESS: 66M unwitnessed fall down 7 steps, found confused.  By report,
was down for at least one hour before found.  Also by report had
roughly 4 drinks before fall. GCS reported @ 11 at OSH,
intubated for airway concerns/transfer.

MEDICAL HISTORY: HTN, Hyperchol

MEDICATION ON ADMISSION: ?

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 96.8 rectal  BP: 105/70  HR:52  R: 16 100% on CMV
Gen: intubated, sedated, lying on bed in c-collar
Lungs: CTAB
Cardiac: RRR
Abd: Soft, NT, BS+
Neuro: Propofol turned off for exam briefly prior to repeat CT
pupils equal and reactive 2->1 bilat
Not following commands, moving bilat upper extremities
spontaneously.  No w/d to noxious stimuli bil lower extremities
Toes downgoing bilaterally

FAMILY HISTORY: unknown

SOCIAL HISTORY: Apparently long drinking history
Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Accidental fall on or from other stairs or steps,Unspecified essential hypertension,Pure hypercholesterolemia
Cl skl fx NEC/mening hem,Fall on stair/step NEC,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2109-10-27**]              Discharge Date:   [**2109-10-29**]

Date of Birth:  [**2043-7-17**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
s/p fall down stairs, found down

Major Surgical or Invasive Procedure:
none

History of Present Illness:
66M unwitnessed fall down 7 steps, found confused.  By report,
was down for at least one hour before found.  Also by report had
roughly 4 drinks before fall. GCS reported @ 11 at OSH,
intubated for airway concerns/transfer.

On Arrival to [**Hospital1 18**] pt. was intubated and sedated with obvious
deformity of the occipital skull.  No other trauma was noted.
He was mildly hypertensive, and bradycardic.  He was stabalized
and taken to CT.  Neurosurgery was emergently called.

Past Medical History:
HTN, Hyperchol


Social History:
Apparently long drinking history

Family History:
unknown

Physical Exam:
T: 96.8 rectal  BP: 105/70  HR:52  R: 16 100% on CMV
Gen: intubated, sedated, lying on bed in c-collar
Lungs: CTAB
Cardiac: RRR
Abd: Soft, NT, BS+
Neuro: Propofol turned off for exam briefly prior to repeat CT
pupils equal and reactive 2->1 bilat
Not following commands, moving bilat upper extremities
spontaneously.  No w/d to noxious stimuli bil lower extremities
Toes downgoing bilaterally


Pertinent Results:
[**2109-10-27**] 03:47AM BLOOD WBC-15.4* RBC-3.55* Hgb-11.5* Hct-33.7*
MCV-95 MCH-32.3* MCHC-34.1 RDW-13.3 Plt Ct-262
[**2109-10-28**] 02:45AM BLOOD WBC-16.7* RBC-3.02* Hgb-9.8* Hct-28.5*
MCV-95 MCH-32.4* MCHC-34.3 RDW-13.5 Plt Ct-192
[**2109-10-29**] 01:33AM BLOOD WBC-14.6* RBC-2.71* Hgb-8.7* Hct-24.9*
MCV-92 MCH-32.1* MCHC-34.9 RDW-13.6 Plt Ct-176
[**2109-10-27**] 03:47AM BLOOD PT-12.4 PTT-28.5 INR(PT)-1.1
[**2109-10-29**] 01:33AM BLOOD Plt Ct-176
[**2109-10-27**] 03:47AM BLOOD Fibrino-242
[**2109-10-27**] 03:47AM BLOOD UreaN-16 Creat-0.9
[**2109-10-27**] 05:51AM BLOOD Glucose-198* UreaN-14 Creat-0.8 Na-138
K-2.8* Cl-99 HCO3-18* AnGap-24*
[**2109-10-29**] 01:33AM BLOOD Glucose-167* UreaN-23* Creat-0.8 Na-136
K-3.5 Cl-103 HCO3-22 AnGap-15
[**2109-10-28**] 02:45AM BLOOD ALT-22 AST-46* AlkPhos-45 Amylase-36
TotBili-0.9
[**2109-10-27**] 05:51AM BLOOD Calcium-7.4* Phos-3.7 Mg-1.6
[**2109-10-29**] 01:33AM BLOOD Calcium-8.3* Phos-2.1* Mg-2.0
[**2109-10-27**] 03:47AM BLOOD ASA-NEG Ethanol-219* Acetmnp-NEG
Bnzodzp-POS Barbitr-NEG Tricycl-NEG
[**2109-10-27**] 05:59AM BLOOD Type-ART pO2-419* pCO2-44 pH-7.29*
calTCO2-22 Base XS--4
[**2109-10-27**] 04:42PM BLOOD Type-[**Last Name (un) **] pO2-48* pCO2-31* pH-7.45
calTCO2-22 Base XS-0
[**2109-10-29**] 01:45AM BLOOD Type-ART pO2-197* pCO2-30* pH-7.54*
calTCO2-26 Base XS-4
[**2109-10-27**] 03:50AM BLOOD Glucose-170* Lactate-4.5* Na-142 K-2.7*
Cl-100 calHCO3-22
[**2109-10-28**] 03:02AM BLOOD Lactate-2.4*

CT HEAD W/O CONTRAST

Reason: ? patholgy

[**Hospital 93**] MEDICAL CONDITION:
66 year old man with ICH, cranial rx, s/p fall down 7 stairs,
sent from OSH, vomiting on arrival
REASON FOR THIS EXAMINATION:
? patholgy
CONTRAINDICATIONS for IV CONTRAST: None.

CLINICAL HISTORY: 66-year-old male status post fall down seven
flights of stairs sent from outside hospital with intracranial
hemorrhage and cranial fracture.

COMPARISON: None.

NON-CONTRAST HEAD CT: Extensively comminuted fracture of the
skull from the vertex involving the bilateral parietal and
occipital bones. There is diffuse intracranial hemorrhage with
bihemispheric subarachnoid blood, extra-axial hematoma along the
occiput and parafalcine. Given such extensive subarachnoid
hemorrhage, it is difficult to ascertain with certainty the
exact areas of intraparenchymal blood vs. subarachnoid blood. A
6 mm focus of high density is seen in the superoposterior aspect
of the left lateral ventricle which likely represents
intraparenchymal blood. Blood is also seen within the
interpeduncular fossa. The ventricles appear somewhat dilated,
and there are prominent extra-axial collections bilaterally.
Small air-fluid level is noted within the right maxillary sinus
and ethmoid air cell as well as polypoidal mucosal thickening
within the left sphenoid sinus and left frontal sinus. The
mastoid air cells remain normally aerated.

IMPRESSION:

1. Extensive fracture involving bilateral parietal and occipital
bones. Extensive intracranial hemorrhage with a combination of
subarachnoid, extra- axial and intraparenchymal blood.

2. The ventricles appear dilated and bilateral frontal prominent
extra-axial spaces are noted.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Name (STitle) 7410**]
DR. [**First Name (STitle) 3905**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3906**]

CT HEAD W/O CONTRAST

Reason: assess interval change. please do HEAD CT at [**2109-10-27**]
20:0

[**Hospital 93**] MEDICAL CONDITION:
66 year old man with SAH s/p fall
REASON FOR THIS EXAMINATION:
assess interval change. please do HEAD CT at [**2109-10-27**] 20:00
CONTRAINDICATIONS for IV CONTRAST: None.

STUDY: CT of the head without contrast.

INDICATION: 66-year-old male status post arachnoid hemorrhage
status post fall. Assess interval change.

COMPARISONS: [**2109-10-27**] CT at 9:00 a.m.

TECHNIQUE: Non-contrast head CT.

FINDINGS: Extensive intraventricular, intraparenchymal, and
bihemispheric subarachnoid hemorrhage is relatively unchanged in
appearance compared to the examination from 12 hours prior.
There is a small right sided subdural versus epidural hematoma
over the right frontal lobe as before. There are small SDH along
the falx and the tentorium as before. There is a slight increase
in the edema within the left cerebral hemisphere with shift of
normally midline structures 2 mm to the right. No new foci of
hemorrhage are identified. Prominent extra- axial spaces
overlying the frontal lobes are unchanged in appearance.
Comminuted fracture of the parietal and occipital bones
bilaterally is unchanged. The mastoid air cells remain well
aerated. The paranasal sinuses are otherwise unchanged in
appearance.

IMPRESSION:

1. Relatively unchanged distribution of diffuse intracranial
hemorrhage including subarachnoid, intraventricular,
intraparenchymal, subdural, and possible epidural components.
Close interval followup is recommended.

2. Unchanged comminuted fractures involving the parietal and
occipital bones bilaterally.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) 2618**] [**Doctor Last Name **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Approved: MON [**2109-10-28**] 10:03 AM

CT HEAD W/O CONTRAST

Reason: F/u SAHCTVPlease perform at 10am

[**Hospital 93**] MEDICAL CONDITION:
66 year old man s/p fall with skull fx and SAH
REASON FOR THIS EXAMINATION:
F/u SAHCTVPlease perform at 10am
CONTRAINDICATIONS for IV CONTRAST: None.

CT HEAD WITHOUT CONTRAST

INDICATION: 66-year-old man status post fall with skull
fractures and subarachnoid hemorrhage.

COMPARISON: [**2109-10-27**], 4:10 a.m.

FINDINGS: Compared to the study performed five hours earlier,
there is significant increase in intraventricular component of
the hemorrhage, with no filling defects in the occipital horns
of the lateral ventricles bilaterally. Diffuse bihemispheric
subarachnoid hemorrhage has increased in extent compared to the
examination performed five hours earlier. It is again difficult
to exclude an intraparenchymal component of the hemorrhage. The
degree of ventricular dilatation appears somewhat increased.
Again noted are prominent extra-axial spaces.

Again noted extensive comminuted fracture of the parietal and
occipital bones. Mastoid air cells are well aerated. There is
mucosal thickening in the sphenoid sinus and ethmoid sinus.
There is a small air-fluid level in the right maxillary sinus,
unchanged.

IMPRESSION: Interval increase in the extent of diffuse
intracranial hemorrhage with subarachnoid, extra-axial, and
probably intraparenchymal blood.

Extensive comminuted fracture involving parietal and occipital
bones bilaterally.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) **] [**Name (STitle) **]
DR. [**First Name (STitle) 3905**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3906**]
Approved: SUN [**2109-10-27**] 6:06 PM

CT HEAD W/O CONTRAST  [**2109-10-29**] 3:04 AM

CT HEAD W/O CONTRAST

Reason: TRAUMATIC BRAIN INJURY. ? INTERVAL CHANGE.

[**Hospital 93**] MEDICAL CONDITION:
66 year old man with traumatic brain injury
REASON FOR THIS EXAMINATION:
interval change?
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 66-year-old man with traumatic brain injury.
Evaluate for interval change.

COMPARISON: [**2109-8-27**], 8:30 p.m.

TECHNIQUE: Non-contrast CT of the head.

FINDINGS: There has been interval decrease in blood within the
right lateral ventricle and left sylvian fissure. Otherwise, the
extensive intraventricular, intraparenchymal, and bihemispheric
subarachnoid hemorrhages are similar in appearance compared to
two days prior. There is a similar 2 mm shift of the midline
rightward. There are no new areas of hemorrhage. Multiple skull
fractures within the parietal and occipital lobes bilaterally
are unchanged. The mastoid air cells are clear. The paranasal
sinuses are stable.

IMPRESSION:
1. Improved subarachnoid and intraventricular hemorrhage with
similar appearing intraparenchymal and extraaxial hematomas.
2. No change in mild rightward midline shift.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10270**]
DR. [**First Name8 (NamePattern2) 11136**] [**Last Name (NamePattern1) 11137**]


Brief Hospital Course:
Pt. was brought to the trauma bay and stabalized as noted in the
HPI.  Upon the findings noted on the CT, neurosurgery was
emergently consulted.  The patient was kept with HOB at >30, NS
IVF was used, the patient was given Dilaudid and q1hr neuro
check were performed.  The patient was maintained NPO in case
there was need for surgical intervention.  Ventilation via ETT
was continued.  No signs of elevated ICP were detected.

Serial CT scans of the head showed interval worsening of the
hemmorhage with no resolution of the midline shift.  With no
further neurosurgical options a family meeting was held and the
patient was made first DNR, then CMO.

On [**10-29**] after the patient was made CMO, at 1542, the patient
was pronouced dead after examination revealed no pulse, no
breath sounds, and no reflexes.

Medications on Admission:
?

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired secondary to extensive SAH, s/p cranial trauma

Discharge Condition:
Expired

Discharge Instructions:
none

Followup Instructions:
none
{'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Accidental fall on or from other stairs or steps,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: s/p fall down stairs, found down

PRESENT ILLNESS: 66M unwitnessed fall down 7 steps, found confused.  By report,
was down for at least one hour before found.  Also by report had
roughly 4 drinks before fall. GCS reported @ 11 at OSH,
intubated for airway concerns/transfer.

MEDICAL HISTORY: HTN, Hyperchol

MEDICATION ON ADMISSION: ?

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 96.8 rectal  BP: 105/70  HR:52  R: 16 100% on CMV
Gen: intubated, sedated, lying on bed in c-collar
Lungs: CTAB
Cardiac: RRR
Abd: Soft, NT, BS+
Neuro: Propofol turned off for exam briefly prior to repeat CT
pupils equal and reactive 2->1 bilat
Not following commands, moving bilat upper extremities
spontaneously.  No w/d to noxious stimuli bil lower extremities
Toes downgoing bilaterally

FAMILY HISTORY: unknown

SOCIAL HISTORY: Apparently long drinking history 

### Response:
{'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Accidental fall on or from other stairs or steps,Unspecified essential hypertension,Pure hypercholesterolemia'}
