CHIEF COMPLAINT: Motorcycle accident

PRESENT ILLNESS: 58 yo M med-flighted to [**Hospital1 18**] from [**Location (un) 3844**] following an
unhelmuted, over the handlebar, motorcycle accident. Pt
reportedly intoxicated, but was awake and alert at the accident
scene, talking with paramedics, but became increasingly
combative, and then less responsive and was intubated prior to
transfer.

MEDICAL HISTORY: bullous emphysema, COPD, HTN, anxiety, EtOH dependence

MEDICATION ON ADMISSION: Zoloft 100 mg qday
albuterol inhaler 2 puffs qid
spiriva 1 puff qid
Nexium 40 mg qday
Luesta 2 mg qday
Vicadin 7.5/750 qid
klonipin 1mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.8 BP 132/87 HR 100 BP 132/87  RR 28  O2 98%

FAMILY HISTORY: Non-Contribultory

SOCIAL HISTORY: Non-contributory
Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Chronic airway obstruction, not elsewhere classified,Open fracture of clavicle, unspecified part,Closed fracture of scapula, unspecified part,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Unspecified essential hypertension,Closed fracture of other facial bones,Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury
Subarachnoid hem-no coma,Brain hem NEC w/o coma,Traum pneumohemothor-cl,Traum subcutan emphysema,Chr airway obstruct NEC,Fx clavicle NOS-open,Fx scapula NOS-closed,Mv collis NOS-motorcycl,Hypertension NOS,Fx facial bone NEC-close,Fx mult ribs NOS-closed,Fx dorsal vertebra-close
Admission Date:  [**2179-7-20**]              Discharge Date:   [**2179-7-30**]

Date of Birth:  [**2121-2-12**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
Motorcycle accident

Major Surgical or Invasive Procedure:
Tracheostomy
Percutaneous Gastrostomy
Incision and Drainage L scapular hematoma
Thoracic epidural catheter

History of Present Illness:
58 yo M med-flighted to [**Hospital1 18**] from [**Location (un) 3844**] following an
unhelmuted, over the handlebar, motorcycle accident. Pt
reportedly intoxicated, but was awake and alert at the accident
scene, talking with paramedics, but became increasingly
combative, and then less responsive and was intubated prior to
transfer.

Past Medical History:
bullous emphysema, COPD, HTN, anxiety, EtOH dependence

Social History:
Non-contributory

Family History:
Non-Contribultory

Physical Exam:
T 97.8 BP 132/87 HR 100 BP 132/87  RR 28  O2 98%

Gen: AOx3
HEENT: PERRLA
CVS: RRR
Resp: coarsh breathsounds bilaterally
Ab: soft, non-tender, non distended, + BS
ext: 1+ edema bilaterally


Pertinent Results:
[**7-21**] Echo: Hyperdynamic left ventricle suggestive of hypovolemia
with hyperdynamic left ventricular systolic function. No
evidence of traumatic valvular dysfunction or cardiac contusion.
There is a trivial/physiologic pericardial effusion.

Films:
[**7-20**] cxr: Small left sided pneumothorax. Left-sided chest tube
courses apically. Distal left clavicle fracture and left glenoid
fracture. Displaced left-sided rib fractures involving the left
third through seventh ribs posterolaterally.

[**7-20**] CT c/a/p
1. Moderate sized left lung pneumothorax with chest tube in good
position.
Extensive surrounding subcutaneous emphysema tracking into the
left neck and
extending into the posterior soft tissues through to the pelvis.

2. Fractures involving the left second through ninth posterior
ribs. Fracture
of the posterior [**Doctor First Name 362**] of the left scapula as well as a fracture
involving the
left glenoid. Comminuted fracture of the left distal clavicle.
4. Nondisplaced fracture of the left transverse process of the
T6 vertebral
body. Otherwise, the thoracic and lumbar spines are without
fracture or
malalignment.
5. Severe centrilobular emphysema. 9 mm right apical spiculated
nodule.
While this may represent scar, followup dedicated chest CT is
recommended in
[**3-2**] months to confirm stability.

[**7-21**] CXR Increased density at the right lung base and in the
left
perihilar region which may represent evolving infiltrates.
Evidence for
interval decrease in small left pneumothorax. Extensive
subcutaneous
emphysema unchanged. Left rib fractures and left clavicular
fracture.

[**7-20**] CT head/C-spine
1. Diffuse subarachnoid hemorrhage overlying the left temporal
lobe with a
few foci of intraparenchymal hemorrhage, likely representing
hemorrhagic
contusions. Tiny subdural hematoma layering along the temporal
bone convexity.
No significant associated mass effect aside from local edema.
2. No skull fracture identified. Left orbital fracture better
delineated on
the CT of the facial bones performed on the same date.
3. High-density material within the left maxillary sinus. Occult
fracture suspected.
4. Large left temporoparietal subgaleal hematoma.

[**7-20**] CT Max/fac
1. Minimally displaced, comminuted left zygoma fracture which
extends to
involve the inferolateral orbital wall and zygomaticosphenoid
suture on the left.
2. Non-displaced left inferior orbital rim fracture.
3. Left lamina papyracea fracture.
4. Bilateral periorbital hematomas. No intraconal abnormalities
identified.

[**7-21**] head CT - unchanged


Brief Hospital Course:
58 yo M med-flighted to [**Hospital1 18**] from [**Location (un) 3844**] following an
unhelmeted, over the handlebar, motorcycle accident.  Accident
was head-first, with no LOC Pt reportedly intoxicated, but was
awake and alert at the accident scene, talking with paramedics,
but became increasingly combative, and then less responsive and
was intubated prior to transfer.

Neuro: SAH and left parietal hemorrhagic contusion.  no midline
shift
Loaded with 1g dilantin and continued until [**7-31**].  recieved neuro
checks q4hr, and was sedated with propfol and fentanyl.
Neurosurgery was c/s and believed no surgical managment was
needed.

HEENT: minimally displaced comminuted L zygoma fracute with
involvment of inferolateral orbital wall on left.  Left lamina
papyracea fracture.  Bilateral perioribal hematomas.
c/s plastics for above injuries.  Head of bed remained elevated
at 30 degrees
Head CT repeated on [**7-21**] with no significant change
Per plastics, injuries non-operatative

Chest: comminuted fx of L proximal clavical.  Fracture of L
scapula in the post [**Doctor First Name 362**] and glenoid with minimal displacement.
fracture of posterior L ribs [**2-5**] with extensive SQ emphasema
small non displaced fx of post T6 vertebral body
Clavicle fracture believed to be open, and was taken to the OR
[**7-29**] for I and D.

CV:  was placed on levophed for BP support, eventually weened
HCT decreased and recieved 2 u RBC on [**7-24**], with appropriate
response
TEE to r/o tamponade - echo was normal
PICC line was inserted [**7-29**] for access

resp: Intubated on arrival, confirmed by CXR
L tension pneumothorax on arrival - needle decompressed with 30
cc air, then 14 g chest tube inserted.  CT replaced at [**Hospital1 18**]
[**7-27**] tracheostomy
[**7-27**] sputum showed gram negative rods, Levoquin started [**7-28**]
CT removed [**7-28**]
Patient weaned from vent. Given his significant pulmonary
history of bronchitis, COPD and asthma, he remaine tachypnic
throughout hospitalization with respiratory rates in high 20's
to 30's.  He was weaned to pressure support ventilation and
trach mask with adequate ABGs for his baseline disease.

GI:  NG tube was placed and pt was given tube feeds
nutrition was consulted and set goal of tube feeds for 1800 cal
with 25 g  beneprotein
[**7-27**] percutaneous-gastrostomy for continuing nutritional needs.

Prophylaxis with H2 blocker, heparin SC and pneumoboots

Pain was controled by acute pain survice.  They placed an
epidural catheter [**7-22**] to give an IV fentanyl infusion.
Epidural removed [**7-27**], subsequently pain was controlled with
percocet elixir.

Endocrine: given hydrocort to maintain steroid response and
subsequently weaned.

ID: on Ancef for open clavicle fracture x3 doses. Subsequently
stopped.
Levoquine for total of 7 days for positive sputum culture.

PT/OT

Medications on Admission:
Zoloft 100 mg qday
albuterol inhaler 2 puffs qid
spiriva 1 puff qid
Nexium 40 mg qday
Luesta 2 mg qday
Vicadin 7.5/750 qid
klonipin 1mg [**Hospital1 **]

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
2. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
3. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed.
4. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 4 days.
Disp:*4 Tablet(s)* Refills:*0*
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Lorazepam 0.5-1 mg IV Q4H:PRN anxiety
7. Albuterol 90 mcg/Actuation Aerosol Sig: 6-8 Puffs Inhalation
Q2-3H (every 2-3 hours) as needed.
8. Calcium Gluconate 100 mg/mL (10%) Solution Sig: One (1)
Intravenous ASDIR (AS DIRECTED).
9. Potassium Chloride 20 mEq Packet Sig: One (1)  PO once a day:
prn.
10. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO every 6-8 hours as needed: PRN pain.
11. Insulin
[**Known lastname **],[**Known firstname **] H. [**Numeric Identifier 74196**]

Insulin SC  (per Insulin Flowsheet)
      Sliding Scale

Fingerstick QACHSInsulin SC Sliding Scale
  Breakfast Lunch Dinner Bedtime
Regular Regular Regular Regular
Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose
0-80   mg/dL [**12-29**] amp D50 [**12-29**] amp D50 [**12-29**] amp D50 [**12-29**] amp D50
81-120   mg/dL 0   Units 0   Units 0   Units 0   Units
121-160   mg/dL 2   Units 2   Units 2   Units 2   Units
161-200   mg/dL 4   Units 4   Units 4   Units 4   Units
201-240   mg/dL 6   Units 6   Units 6   Units 6   Units
241-280   mg/dL 8   Units 8   Units 8   Units 8   Units

12. Tube Feeding
Tubefeeding: Nutren Pulmonary Full strength;
Starting rate: 10 ml/hr; Advance rate by 10 ml q6h Goal rate: 60
ml/hr
Residual Check: q4h Hold feeding for residual >= : 100 ml
Flush w/ 200 ml water q6h

Adjust free water flushes as needed to treat hypernatremia.
13. Outpatient Lab Work
[**Hospital1 **] electrolytes. Replete prn.
14. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
15. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
16. Potassium & Sodium Phosphates [**Telephone/Fax (3) 4228**] mg Packet Sig: One
(1) Packet PO PRN (as needed) as needed for Phos < 3.0.
17. Magnesium Sulfate 4 % Solution Sig: One (1)  Injection PRN
(as needed): PRN Mag < 2.0.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
L-SAH/IPH/SDH (temporal)
Large L-temporoparietal subgaleal hematoma
Grade 4 L scapula fracture
L clavicle fx
Pneumothorax
Small HemoPTX
Multiple L-sided rib fx ([**2-6**])
L orbital wall fx


Discharge Condition:
Stable to rehabilitation facility


Discharge Instructions:
Continue Levoquin for 7 days
Remove sutures on chest in [**10-10**] days
Continue Oxygen to trach collar at 10-15 L/min
Continue trach and peg care
Continue tube feeds to goal of 1800 Kcal per day with 25 g of
beneprotein
Ativan as needed for agitation

Followup Instructions:
Remove sutures in [**10-10**] days



Completed by:[**2179-7-30**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Chronic airway obstruction, not elsewhere classified,Open fracture of clavicle, unspecified part,Closed fracture of scapula, unspecified part,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Unspecified essential hypertension,Closed fracture of other facial bones,Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury'}


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: Motorcycle accident

PRESENT ILLNESS: 58 yo M med-flighted to [**Hospital1 18**] from [**Location (un) 3844**] following an
unhelmuted, over the handlebar, motorcycle accident. Pt
reportedly intoxicated, but was awake and alert at the accident
scene, talking with paramedics, but became increasingly
combative, and then less responsive and was intubated prior to
transfer.

MEDICAL HISTORY: bullous emphysema, COPD, HTN, anxiety, EtOH dependence

MEDICATION ON ADMISSION: Zoloft 100 mg qday
albuterol inhaler 2 puffs qid
spiriva 1 puff qid
Nexium 40 mg qday
Luesta 2 mg qday
Vicadin 7.5/750 qid
klonipin 1mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.8 BP 132/87 HR 100 BP 132/87  RR 28  O2 98%

FAMILY HISTORY: Non-Contribultory

SOCIAL HISTORY: Non-contributory 

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Chronic airway obstruction, not elsewhere classified,Open fracture of clavicle, unspecified part,Closed fracture of scapula, unspecified part,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Unspecified essential hypertension,Closed fracture of other facial bones,Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury'}
