CHIEF COMPLAINT: Neck pain

PRESENT ILLNESS: 87 y/o man s/p fall evening [**6-10**]. Unwitnessed; no recall of
details surrounding this event. Imaging shows unstable C-spine
fx C5-6.

MEDICAL HISTORY: HTN
a.fib
bronchitis
depression
h/o multiple falls
hypercholesterolemia
s/p CVA
syncope

MEDICATION ON ADMISSION: coumadin
lipitor
citalopram

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General:
VS: 96.9 151/88, HR97 (tele with afib with RVR) RR18 94%RA
Skin: no rashes
HEENT: PERRL, +cataracts, EOMI, OP with thick dry mucous,
severely dry MM
Neck: in soft collar; anterior cervical incision clean, dry and
intact
Chest: CTAB,
Cards: [**Last Name (un) 3526**], [**Last Name (un) 3526**] no m/r/g
Abd: +BS, NTND
Ext: no edema
Neuro: AAOx3, CN 2-12 grossly intact, 5/5 strength throughout,
sensation intact to light touch, coord r. alt. m.

FAMILY HISTORY: N/C

SOCIAL HISTORY: Was living at home independently until incident. Son involved in
care.
Closed fracture of fifth cervical vertebra,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Hyperosmolality and/or hypernatremia,Accidental fall on or from other stairs or steps,Unspecified essential hypertension,History of fall,Delirium due to conditions classified elsewhere,Long-term (current) use of anticoagulants,Cervical spondylosis without myelopathy
Fx c5 vertebra-closed,Atrial fibrillation,Food/vomit pneumonitis,Hyperosmolality,Fall on stair/step NEC,Hypertension NOS,Personal history of fall,Delirium d/t other cond,Long-term use anticoagul,Cervical spondylosis
Admission Date:  [**2135-6-11**]              Discharge Date:   [**2135-6-28**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2641**]
Chief Complaint:
Neck pain

Major Surgical or Invasive Procedure:
ACDF C5-6
Pacemaker placement [**Company **] VVI


History of Present Illness:
87 y/o man s/p fall evening [**6-10**]. Unwitnessed; no recall of
details surrounding this event. Imaging shows unstable C-spine
fx C5-6.

Past Medical History:
HTN
a.fib
bronchitis
depression
h/o multiple falls
hypercholesterolemia
s/p CVA
syncope

Social History:
Was living at home independently until incident. Son involved in
care.

Family History:
N/C

Physical Exam:
General:
VS: 96.9 151/88, HR97 (tele with afib with RVR) RR18 94%RA
Skin: no rashes
HEENT: PERRL, +cataracts, EOMI, OP with thick dry mucous,
severely dry MM
Neck: in soft collar; anterior cervical incision clean, dry and
intact
Chest: CTAB,
Cards: [**Last Name (un) 3526**], [**Last Name (un) 3526**] no m/r/g
Abd: +BS, NTND
Ext: no edema
Neuro: AAOx3, CN 2-12 grossly intact, 5/5 strength throughout,
sensation intact to light touch, coord r. alt. m.


Pertinent Results:
[**2135-6-22**] 10:10AM BLOOD WBC-6.5 RBC-3.53* Hgb-11.4* Hct-34.1*
MCV-96 MCH-32.3* MCHC-33.5 RDW-14.3 Plt Ct-210
[**2135-6-21**] 06:14AM BLOOD WBC-5.5 RBC-3.63* Hgb-11.8* Hct-34.5*
MCV-95 MCH-32.6* MCHC-34.3 RDW-14.1 Plt Ct-209
[**2135-6-17**] 01:46AM BLOOD WBC-4.5 RBC-3.32* Hgb-10.9* Hct-31.8*
MCV-96 MCH-32.8* MCHC-34.2 RDW-13.8 Plt Ct-201
[**2135-6-22**] 10:10AM BLOOD Glucose-139* UreaN-29* Creat-PND Na-144
K-3.7 Cl-109* HCO3-26 AnGap-13
[**2135-6-13**] 03:31PM BLOOD CK(CPK)-184*
[**2135-6-12**] 10:43PM BLOOD CK(CPK)-319*
[**2135-6-11**] 09:00AM BLOOD CK(CPK)-675*
[**2135-6-12**] 10:43PM BLOOD CK-MB-5 cTropnT-0.02*
[**2135-6-22**] 10:10AM BLOOD Calcium-8.9 Phos-2.0* Mg-2.2
.
C-Spine MRI:
FINDINGS: At C5-6 level, there is widening of the anterior disc
space identified with increased signal in this region on
inversion recovery images. In addition, there is buckling of the
ligamentum flavum visualized posteriorly with subtle increased
signal in the interspinous region. Findings are indicative of
ligamentous disruption both in the anterior and posterior
portion of the spine. In addition, there is a large prevertebral
hematoma identified extending from C2 to the upper thoracic
region. There is no evidence of intraspinal hematoma seen. There
is increased signal identified within the spinal cord at C4-5
level which could be related to cord edema or contusion.
Multilevel degenerative changes are seen at other levels in the
cervical region extending at C3-4, C4-5, C6-7 and C7-T1 level
with mild anterolisthesis of C7 or T1.
Of concern is absence of flow void within both vertebral
arteries in the cervical region. This is best visualized on
axial T2-weighted axial images which show high signal is seen
within both vertebral arteries. These findings are indicative of
extremely slow flow or occlusion of both vertebral arteries.
IMPRESSION:
1. Probable extension injury with disruption of the anterior
longitudinal and the intraspinous and nuchal ligaments in the
region of C5-6 level.
2. Large prevertebral hematoma in the cervical region.
3. Abnormal signal within both vertebral arteries in the neck
suspicious for slow flow or occlusion. MRA or CTA would help for
further assessment.
4. Multilevel degenerative changes in the cervical region.
5. Focus of increased signal within the spinal cord at C4-5
level suspicious for cord edema/contusion.


Brief Hospital Course:
Brief Hospital Course:
.
Mr. [**Known lastname 72979**] was admitted to the Trauma service after being
evaluated in the EW and found to have an unstable C5-6 fracture
dislocation.  It was his lone injury and he was admitted and
given a floor bed.  Transfered to floor & had episode of
deliriumsundowning, continually trying to get out of bed.
Scheduled for surgical repair of C-spine [**6-12**] but INR was 2.3
and procedure deferred until [**6-13**]. In holding area was noted to
be gurgling, still confused. Decision made to electively
intubate, done in OR with fiberoptic scope/surgical airway
back-up. Intermittently bradycardic and an EP consult was
sought.  Tachy/brady syndrome was observed and a pacemaker was
placed by EP [**6-13**].  At this time he was stable for an anterior
cervical discectomy and fusion C5-6.  Post-opertively he was
transfered back to the T/SICU for further care.  While there, he
had significant episodes of tachycardia & bradycardia and
required placement of a pacemaker because of this.
.
He was eventually transferred to the wards, where he had
difficulty swallowing and continued delirium.  A Geriatrics
consult was sought for a possible CVA leading to his difficulty
swallowing.  A CT of the head was obtained which showed no
evidence of acute intracranial process.  He was [**Hospital 72980**]
transfered to the Geriatrics service for further managment.
.
Shortly after transfer to the medicine wards, pt he became
dyspneic in the settig copious oral secretions. He was found to
have pneumonia (likely aspiration) and was transferred to the
MICU for treatment of PNA and copious secretions.  He was
initially treated with levo/flagyl for probable aspiration PNA;
this was then broadened to vanc/Zosyn.  Pt did not require
intubation/pressors in MICU.  Rather, he was weaned off oxygen
and was treated for HTN.
While in the MICU, the MICU team met with the family to discuss
the pt's overall prognosis and review the pt's goals of care.
They explained that the pt's  aspiration/dysphagia was likely a
complication from the sugery, and that the pt would not likely
regain his swallowing function.  Given the degree of the pt's
injury, including the possibility that he may not be able to
walk again and his inability to take PO (at least for the
foreseeable future), the pt decided that pursuing agressive care
would not fit with his wishes or goals.  His son corroborated
these feelings.  Another meeting was had with the family and the
medicine [**Hospital1 **] team on [**2135-6-27**] (following transfer out of the
MICU).  During this meeting, the son reiterated his and his
father's wish to move to hospice care.  He explained that they
understand that the pt could at some point regain swallowing
function.  Yet, waiting for that possibility would be not be in
line with his wishes and goals.  As the pt stated on [**2135-6-26**], he
feels "the end is near...I have lived a good life."  He then
expressed his wish to be out of the hospital setting and to
enjoy what time he has left.
.
He was treated with care and comfort measures only prior to
discharge. At time of discharge, pt had very dry mucous
membranes for which he was receiving supportive care.  He denied
having any pain.

Medications on Admission:
coumadin
lipitor
citalopram

Discharge Medications:
1. Acetaminophen 650 mg Suppository Sig: One (1) Suppository
Rectal Q4HR ().
2. Lorazepam 0.5 mg Tablet Sig: 1-4 Tablets PO Q4-6H (every 4 to
6 hours) as needed.
3. Morphine Concentrate 20 mg/mL Solution Sig: 5-20 mg PO Q1-2H
() as needed.
4. Artificial Saliva 0.15-0.15 % Solution Sig: 1-3 MLs Mucous
membrane DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
Hospice House

Discharge Diagnosis:
Cervical spondylosis and C6 fracture dislocation at C5-C6.
Tachycardia/Bradycardia syndrome


Discharge Condition:
Good


Discharge Instructions:
Please continue to take your pain medication with an over the
counter laxative.  Call the clinic if you notice any redness or
discharge from the incision site.  Call the clinic for any
additional concerns.  Please wear the hard collar when
ambulating and the soft collar when in bed.


Followup Instructions:
Please follow up in the Spine Clinic in the [**Hospital Ward Name 23**] Bldg Floor
#2 on Wednesday, [**6-29**].  Call [**Telephone/Fax (1) 11061**] to schedule an
appointment.
{'Closed fracture of fifth cervical vertebra,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Hyperosmolality and/or hypernatremia,Accidental fall on or from other stairs or steps,Unspecified essential hypertension,History of fall,Delirium due to conditions classified elsewhere,Long-term (current) use of anticoagulants,Cervical spondylosis without myelopathy'}


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: Neck pain

PRESENT ILLNESS: 87 y/o man s/p fall evening [**6-10**]. Unwitnessed; no recall of
details surrounding this event. Imaging shows unstable C-spine
fx C5-6.

MEDICAL HISTORY: HTN
a.fib
bronchitis
depression
h/o multiple falls
hypercholesterolemia
s/p CVA
syncope

MEDICATION ON ADMISSION: coumadin
lipitor
citalopram

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General:
VS: 96.9 151/88, HR97 (tele with afib with RVR) RR18 94%RA
Skin: no rashes
HEENT: PERRL, +cataracts, EOMI, OP with thick dry mucous,
severely dry MM
Neck: in soft collar; anterior cervical incision clean, dry and
intact
Chest: CTAB,
Cards: [**Last Name (un) 3526**], [**Last Name (un) 3526**] no m/r/g
Abd: +BS, NTND
Ext: no edema
Neuro: AAOx3, CN 2-12 grossly intact, 5/5 strength throughout,
sensation intact to light touch, coord r. alt. m.

FAMILY HISTORY: N/C

SOCIAL HISTORY: Was living at home independently until incident. Son involved in
care. 

### Response:
{'Closed fracture of fifth cervical vertebra,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Hyperosmolality and/or hypernatremia,Accidental fall on or from other stairs or steps,Unspecified essential hypertension,History of fall,Delirium due to conditions classified elsewhere,Long-term (current) use of anticoagulants,Cervical spondylosis without myelopathy'}
