CHIEF COMPLAINT: Motorcycle accident

PRESENT ILLNESS: 28 yo M presented to the ED s/p being thrown approximately 20
feet from a motorcycle at high speeds.  Helmet was intact.  Pt
was unconscious at scene, awoke with EMS.  At evaluation, pt was
in respiratory distress and demonstrated decreased right breath
sounds.  Pt was needle decompressed at the scene.

MEDICAL HISTORY: -Migraines (pediatric, resolved)
-wrist fracture, nonsurgical, left

MEDICATION ON ADMISSION: None

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Tmax 98.6 T current 98.2 HR 95 BP 132/70 RR 18 O2 97% RA
Gen: NAD
Pulm: CTAB
CV: RRRR
Ext: No C/C/E

FAMILY HISTORY: Diabetes mellitus

SOCIAL HISTORY: Non-smoker, social drinker, no drugs, works as IT consultant
Injury to liver without mention of open wound into cavity laceration, unspecified,Closed fracture of lower end of radius with ulna,Flail chest,Motor vehicle traffic accident of unspecified nature injuring motorcyclist,Closed fracture of navicular [scaphoid] bone of wrist,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed fracture of ilium,Carpal tunnel syndrome,Traumatic pneumothorax without mention of open wound into thorax,Contusion of lung without mention of open wound into thorax
Liver lacerat unspcf cls,Fx low radius w ulna-cl,Flail chest,Traffic acc NOS-motcycl,Fx navicular, wrist-clos,Fx sacrum/coccyx-closed,Fracture of ilium-closed,Carpal tunnel syndrome,Traum pneumothorax-close,Lung contusion-closed
Admission Date:  [**2180-4-21**]              Discharge Date:   [**2180-4-26**]

Date of Birth:  [**2151-7-9**]             Sex:   M

Service: SURGERY

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
Motorcycle accident

Major Surgical or Invasive Procedure:
[**4-21**]: Placement R Chest Tube
[**4-21**]: ORIF R lunate


History of Present Illness:
28 yo M presented to the ED s/p being thrown approximately 20
feet from a motorcycle at high speeds.  Helmet was intact.  Pt
was unconscious at scene, awoke with EMS.  At evaluation, pt was
in respiratory distress and demonstrated decreased right breath
sounds.  Pt was needle decompressed at the scene.

Past Medical History:
-Migraines (pediatric, resolved)
-wrist fracture, nonsurgical, left

-appendectomy
-addenoids/tonsills


Social History:
Non-smoker, social drinker, no drugs, works as IT consultant

Family History:
Diabetes mellitus

Physical Exam:
Tmax 98.6 T current 98.2 HR 95 BP 132/70 RR 18 O2 97% RA
Gen: NAD
Pulm: CTAB
CV: RRRR
Ext: No C/C/E

Pertinent Results:
CXR [**4-26**] The small right pneumothorax is noted, decreased
compared to the prior study on the expiratory view. The multiple
fractured right ribs and known slow resolving right basal
opacity are again noted. The left lung is unremarkable.


Brief Hospital Course:
Pt was brought to the emergency department s/p motorcycle wreck.
 Pt was diagnosed with R pneumothorax, Grade II-III liver
laceration, R flail chest, and R wrist injury.  A chest tube was
placed in the emergency department.  The  Pt was admitted to the
ICU.  [**Month/Year (2) 1957**] trauma and hand surgery were consulted.  Pt
underwent ORIF perilunate dislocation, ORIF right scaphoid
fracture, closed reduction and splinting of distal radius
fracture, and open carpal tunnel release on [**2180-4-21**].  Pt
reported decreased pain postoperatively.  The liver laceration
was treated conservatively.  Pain was managed with a PCA.  Pt
was transferred to the floor on [**2180-4-22**].  Physical therapy and
occupational therapy evaluated the patient and recommended
discharge home with home physical therapy and platform crutches.
 On [**2180-4-25**], the chest tube was removed.  Post-pull CXR
demonstrated no increase in PTX.  Plain films of the L wrist
demonstrated L ulnar fracture.  Hand surgery was reconsulted.
On [**4-26**], the patient was discharged home with appropriate
follow-up with orthopedics, plastic surgery, and trauma surgery.



Medications on Admission:
None

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day as needed for constipation.
Disp:*60 Capsule(s)* Refills:*0*
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
Disp:*60 Tablet(s)* Refills:*0*
5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for Breakthrough pain.
Disp:*60 Tablet(s)* Refills:*0*
6. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release(s)* Refills:*0*
7. Coumadin 1 mg Tablet Sig: One (1) Tablet PO once a day:
Please continue this medication until your follow up appt with
Dr. [**Last Name (STitle) 1005**].
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
Bayada Nurses Inc.

Discharge Diagnosis:
Primary Diagnosis: 28M s/p Motorcycle Accident
Injuries:
R [**3-6**] rib fx's
R tension PTX
RUL/RLL pulm contusions
Grade [**2-1**] liver lac
L sacral and iliac [**Doctor First Name 362**] fx's
Trans-scaphoid scaphoid wrist fx w/perilunate disloc
R Distal radial fx
Morelle lesion (right back)
L ulnar styloid fracture


Discharge Condition:
Stable.
Tolerating a diet.
Pain controlled on oral medication.
Voiding without difficulty.


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in 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.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
*Avoid lifting objects > 5lbs until your follow-up appointment
with the surgeon.
*Avoid driving or operating heavy machinery while taking pain
medications.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.
.
Incision Care:
-You may remove the watertight dressing from your right chest in
24 hrs. Please apply a dry sterile dressing to the site until a
scab forms.
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.
.
Please keep your right arm elevated at all times.  Please keep
both of your splints in place, clean & dry, until you follow up
with the Plastic Hand surgeon
.
Please continue to follow the activity instructions and teaching
you received from Physical Therapy: Right lower extremity is
Full weight bearing / Left lower extremity is Touchdown weight
bearing. You may use platform crutches but you must keep your
weight on your proximal forearm/elbow to bearing weight with
your wrists

Followup Instructions:
-Please call ([**Telephone/Fax (1) 2007**] to schedule a follow up appointment
in 4 weeks with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1005**]
-Please call [**Telephone/Fax (1) 6429**] to make a follow up appointment with
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in Trauma Clinic in one week. The stitch at the
right chest tube site will be removed at that time.
-Provider: [**Name10 (NameIs) **] XRAY (SCC 2) Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2180-5-2**] 8:40
-Provider: [**Name10 (NameIs) **] CLINIC Phone:[**Telephone/Fax (1) 3009**] Date/Time:[**2180-5-2**]
9:00
**Please make an appointment with your PCP [**Name Initial (PRE) 176**] 1-2 weeks of
discharge**



Completed by:[**2180-4-27**]
{'Injury to liver without mention of open wound into cavity laceration, unspecified,Closed fracture of lower end of radius with ulna,Flail chest,Motor vehicle traffic accident of unspecified nature injuring motorcyclist,Closed fracture of navicular [scaphoid] bone of wrist,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed fracture of ilium,Carpal tunnel syndrome,Traumatic pneumothorax without mention of open wound into thorax,Contusion of lung without mention of open wound into thorax'}


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: 28 yo M presented to the ED s/p being thrown approximately 20
feet from a motorcycle at high speeds.  Helmet was intact.  Pt
was unconscious at scene, awoke with EMS.  At evaluation, pt was
in respiratory distress and demonstrated decreased right breath
sounds.  Pt was needle decompressed at the scene.

MEDICAL HISTORY: -Migraines (pediatric, resolved)
-wrist fracture, nonsurgical, left

MEDICATION ON ADMISSION: None

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Tmax 98.6 T current 98.2 HR 95 BP 132/70 RR 18 O2 97% RA
Gen: NAD
Pulm: CTAB
CV: RRRR
Ext: No C/C/E

FAMILY HISTORY: Diabetes mellitus

SOCIAL HISTORY: Non-smoker, social drinker, no drugs, works as IT consultant 

### Response:
{'Injury to liver without mention of open wound into cavity laceration, unspecified,Closed fracture of lower end of radius with ulna,Flail chest,Motor vehicle traffic accident of unspecified nature injuring motorcyclist,Closed fracture of navicular [scaphoid] bone of wrist,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed fracture of ilium,Carpal tunnel syndrome,Traumatic pneumothorax without mention of open wound into thorax,Contusion of lung without mention of open wound into thorax'}
