CHIEF COMPLAINT: Status post motor vehicle collision.

PRESENT ILLNESS: Mr. [**Known lastname 60013**] is a 46 year old male s/p 3 vehicle rollover
collision. He was a restrained driver and denied LOC. Initial
GCG was 15. The patient presented with multiple deformities of
the lower extremities bilaterally and a laceration to the right
side of the head.

MEDICAL HISTORY: Denies.

MEDICATION ON ADMISSION: None.

ALLERGIES: Keflex

PHYSICAL EXAM: GEN: NAD.
HEENT: 3 cm laceration to left side of head, 7cm laceration on
the right side of head with exposed galea. PERRLA, EOMI.
CSPINE: In collar.
PULM: CTAB
CV/CHEST: chest abrasions. RRR.
ABD: soft, NT/ND, +BS, stable pelvis
RECTAL: nl tone, guaiac negative
EXT: bilateral deformities of the tibia/fibula. Left femur
deformity with a medial angulation of the the left leg. Open
right knee. Palpable DP pulses bilaterally.
NEURO: A&Ox3, speech fluent, CN2-12 intact, motor nl bilaterally
upper extremities, lower extremities moving spontaneously, exam
limited due to injuries.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Denies etoh, tobacco, or recreational drug use.
Closed fracture of vault of skull without mention of intracranial injury, with no loss of consciousness,Injury to spleen without mention of open wound into cavity, unspecified injury,Closed fracture of subtrochanteric section of neck of femur,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Open fracture of patella,Closed fracture of shaft of tibia alone,Fracture of medial malleolus, closed,Fracture of calcaneus, closed,Closed fracture of three ribs,Other and unspecified open wound of head without mention of complication,Anemia, unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle
Cl skull vlt fx w/o coma,Spleen injury NOS-closed,Subtrochanteric fx-close,Fx dorsal vertebra-close,Fracture patella-open,Fx shaft tibia-closed,Fx medial malleolus-clos,Fracture calcaneus-close,Fracture three ribs-clos,Open wound of head NEC,Anemia NOS,Mv collision NOS-driver
Admission Date:  [**2178-12-25**]              Discharge Date:   [**2179-1-5**]

Date of Birth:  [**2132-8-7**]             Sex:   M

Service: SURGERY

Allergies:
Keflex

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
Status post motor vehicle collision.

Major Surgical or Invasive Procedure:
1.  Incision and drainage down to bone of patellar fracture.
2.  Open reduction internal fixation of right patellar
    fracture.
3.  Application of external fixator for treatment of the left
    femur fracture.
4.  External fixation of left tib-fib fracture.
5.  Removal of femur external fixator.
6.  Removal of tibia external fixator.
7.  Open reduction, internal fixation of subtrochanteric
    femur fracture with Gamma nail.
8.  Open reduction, internal fixation femoral neck fracture
    with lag screw through Gamma nail.
9.  Open reduction, internal fixation of femoral shaft
    fracture with long Gamma nail.
10.  Open reduction, internal fixation tibia pilon fracture.
11.  Open reduction, internal fixation fibula fracture.
12.  Intramedullary nailing tibia shaft segmented fracture.
13.  Closed reduction right calcaneus fracture.
14.  Placement of [**Location (un) 260**] IVC filter.


History of Present Illness:
Mr. [**Known lastname 60013**] is a 46 year old male s/p 3 vehicle rollover
collision. He was a restrained driver and denied LOC. Initial
GCG was 15. The patient presented with multiple deformities of
the lower extremities bilaterally and a laceration to the right
side of the head.

Past Medical History:
Denies.

Social History:
Denies etoh, tobacco, or recreational drug use.

Family History:
Noncontributory.

Physical Exam:
GEN: NAD.
HEENT: 3 cm laceration to left side of head, 7cm laceration on
the right side of head with exposed galea. PERRLA, EOMI.
CSPINE: In collar.
PULM: CTAB
CV/CHEST: chest abrasions. RRR.
ABD: soft, NT/ND, +BS, stable pelvis
RECTAL: nl tone, guaiac negative
EXT: bilateral deformities of the tibia/fibula. Left femur
deformity with a medial angulation of the the left leg. Open
right knee. Palpable DP pulses bilaterally.
NEURO: A&Ox3, speech fluent, CN2-12 intact, motor nl bilaterally
upper extremities, lower extremities moving spontaneously, exam
limited due to injuries.


Pertinent Results:
[**2178-12-25**] 10:06PM   GLUCOSE-127* LACTATE-2.2* NA+-142 K+-4.3
CL--107 TCO2-25
[**2178-12-25**] 10:06PM   HGB-14.1 calcHCT-42 O2 SAT-86
[**2178-12-25**] 10:00PM   GLUCOSE-115* UREA N-18 CREAT-1.1 SODIUM-141
POTASSIUM-4.3 CHLORIDE-104 TOTAL CO2-25 ANION GAP-16
[**2178-12-25**] 10:00PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2178-12-25**] 10:00PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-NEG

----IMAGING-----
TRAUMA #2 (AP CXR & PELVIS POR   Clip # [**Clip Number (Radiology) 70264**]
TRAUMA CHEST:  Details obscured by the underlying trauma board.
There are low lung volumes.  There is prominence of the
mediastinum that will be further evaluated on the CT of the
chest that has already been ordered. There is no definite
pneumothorax.  No rib fractures are seen.
TRAUMA PELVIS:  There is a medially displaced horizontally
oriented left
proximal femur fracture.  No definite pelvic fractures are seen,
although this will be further evaluated on the CT scan that has
already been ordered. The sacrum is obscured by overlying bowel
gas.
-----

CT CHEST W/CONTRAST; CT ABDOMEN W/CONTRAST   Clip # [**Clip Number (Radiology) 70265**]
IMPRESSION:
1.  Splenic contusion/laceration without active extravasation of
contrast or subcapsular hematoma.
2.  Obliquely oriented acute fracture of T11.
3.  Right posterior first rib, left posterior eleventh rib, and
left posterior tenth rib fractures.  No pneumothorax identified.

4.  Comminuted left proximal femur fracture.
5.  Mild thickening of the terminal ileum wall, significance of
this is
uncertain.
-------

CT C-SPINE W/O CONTRAST   Clip # [**Clip Number (Radiology) 70266**]
IMPRESSION:
1.  No cervical spine fracture identified.
2.  Slightly displaced fracture of the right posterior first rib
at the
costovertebral junction.
--------

CT HEAD W/O CONTRAST   Clip # [**Clip Number (Radiology) 70267**]
IMPRESSION:  Right parietal bone fracture with involvement of
the inner and outer tables with small underlying focus of
pneumocephalus.  No definite intracranial hemorrhage identified.

--------

CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST   Clip # [**Clip Number (Radiology) 70268**]

IMPRESSION:
1.  Splenic lacerations with no evidence of any perisplenic
fluid or acute
hemorrhage.
2.  Multiple bony fractures involving the left proximal femur,
left
acetabulum, and left ninth and tenth ribs.
3.  Mild thickening of the terminal ileum, which is unchanged.
4.  Gallstone and some pericholecystic fluid.
-----















Brief Hospital Course:
Mr. [**Known lastname 60013**] was found to have multiple orthopedic injuries
including rib fractures, lower extremity fractures, a T10/T11
fracture and a small right parietal bone fracture. He was taken
to the OR from the emergency department with the orthopedics
team for washout and external fixation of his lower extremity
fractures. His scalp lacerations were repaired in the emergency
department and the patient was admitted to the trauma surgical
intensive care unit (TSICU). On hospital day #3 he was returned
to the OR for definitive repair of his lower extremity
fractures, with the exception of his calcaneal fracture. He was
fitted for a TLSO brace given his non-operative fracture at T11.
A repeat CT scan did not reveal any evidence of progression of
his splenic laceration, or worsening bleeding. The acute pain
service was consulted for management of his pain. His hematocrit
dropped to a nadir of 20 on hospital day #4 and he was
transfused successfully. Serial hematocrits were followed and
they stabilized without incident. He was transferred to the
floor on 4. He returned to the OR for placement of an IVC filter
on the same day, which he tolerated well. Mr. [**Known lastname 60013**] continued
to improve throughout his hospital stay, and on hospital day 12
he was discharged to [**Hospital 100**] Rehab for further treatment.

Medications on Admission:
None.

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
s/p Motor vehicle crash
Skull fracture
Right 1st rib fracture
Left posterior rib fractures [**11-18**]


Discharge Condition:
Good


Discharge Instructions:
DO NOT bear any weight on your left lower extremity.

Call your doctor or return to the emergency department if you
experience any of the following: Worsening pain, fever,
redness/swelling/discharge from your wound, any new or
concerning symptom.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) 7376**], Orthopedics in 1 week for your ankle
fracture, call [**Telephone/Fax (1) 1228**] for an appointment.

Follow up with Dr. [**Last Name (STitle) 1005**] in 2 weeks, Orthopedics for your
other orthopedic injuires; call [**Telephone/Fax (1) 1228**].
{'Closed fracture of vault of skull without mention of intracranial injury, with no loss of consciousness,Injury to spleen without mention of open wound into cavity, unspecified injury,Closed fracture of subtrochanteric section of neck of femur,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Open fracture of patella,Closed fracture of shaft of tibia alone,Fracture of medial malleolus, closed,Fracture of calcaneus, closed,Closed fracture of three ribs,Other and unspecified open wound of head without mention of complication,Anemia, unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}


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: Status post motor vehicle collision.

PRESENT ILLNESS: Mr. [**Known lastname 60013**] is a 46 year old male s/p 3 vehicle rollover
collision. He was a restrained driver and denied LOC. Initial
GCG was 15. The patient presented with multiple deformities of
the lower extremities bilaterally and a laceration to the right
side of the head.

MEDICAL HISTORY: Denies.

MEDICATION ON ADMISSION: None.

ALLERGIES: Keflex

PHYSICAL EXAM: GEN: NAD.
HEENT: 3 cm laceration to left side of head, 7cm laceration on
the right side of head with exposed galea. PERRLA, EOMI.
CSPINE: In collar.
PULM: CTAB
CV/CHEST: chest abrasions. RRR.
ABD: soft, NT/ND, +BS, stable pelvis
RECTAL: nl tone, guaiac negative
EXT: bilateral deformities of the tibia/fibula. Left femur
deformity with a medial angulation of the the left leg. Open
right knee. Palpable DP pulses bilaterally.
NEURO: A&Ox3, speech fluent, CN2-12 intact, motor nl bilaterally
upper extremities, lower extremities moving spontaneously, exam
limited due to injuries.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Denies etoh, tobacco, or recreational drug use. 

### Response:
{'Closed fracture of vault of skull without mention of intracranial injury, with no loss of consciousness,Injury to spleen without mention of open wound into cavity, unspecified injury,Closed fracture of subtrochanteric section of neck of femur,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Open fracture of patella,Closed fracture of shaft of tibia alone,Fracture of medial malleolus, closed,Fracture of calcaneus, closed,Closed fracture of three ribs,Other and unspecified open wound of head without mention of complication,Anemia, unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}
