CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 79 yo man w/ PMH of Afib on pradaxa, was the restrained front
seat passenger in a motor vehcile crash going ~45 mph. He
presented initially to [**Hospital3 **] hospital and was intubated and a
left chest tube placed. At presentation to [**Hospital1 18**] he was
hypotensive to 70's/palp, with OSH CT demonstrating hemothorax
with rib fractures to [**8-8**] and bilateral pelvic fractures.

MEDICAL HISTORY: HTN, afib

MEDICATION ON ADMISSION: Multivitamins 1 TAB PO DAILY
 Colchicine 0.6 mg PO DAILY
 Dabigatran Etexilate 150 mg PO BID
 Metoprolol Succinate XL 100 mg PO DAILY

ALLERGIES: Penicillins

PHYSICAL EXAM: Upon presentation to [**Hospital1 18**]:
Constitutional: The patient does not grimace, wince, or
exhibit other objective sign of distress
HEENT: NC/AT
Moist mucous membranes
Chest: CTA
Cardiovascular: No murmur
Abdominal: No guarding, rigidity, or rebound
Rectal: no rectal tone
GU/Flank: No CVAT
Extr/Back: Trace edema
Skin: No rash
Neuro: the patient shows no spontaneous movement
Psych: obtunded
Heme/[**Last Name (un) **]/[**Last Name (un) **]: No petechiae

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married and resides in [**State 531**] with his wife
Closed fracture of upper end of tibia alone,Traumatic shock,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Traumatic hemothorax without mention of open wound into thorax,Pneumonia due to Klebsiella pneumoniae,Acute posthemorrhagic anemia,Paroxysmal ventricular tachycardia,Closed fracture of five ribs,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Closed unspecified fracture of pelvis,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Fracture of medial malleolus, closed,Injury to renal artery,Closed fracture of metacarpal bone(s), site unspecified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other unspecified back disorders,Gout, unspecified,Other fluid overload,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle
Fx upper end tibia-close,Traumatic shock,Fx sacrum/coccyx-closed,Traum hemothorax-closed,K. pneumoniae pneumonia,Ac posthemorrhag anemia,Parox ventric tachycard,Fracture five ribs-close,Urin tract infection NOS,Delirium d/t other cond,Pelvic fracture NOS-clos,Retroperitoneum inj-cl,Fx medial malleolus-clos,Injury renal artery,Fx metacarpal NOS-closed,Thrombocytopenia NOS,Hypertension NOS,Enterococcus group d,Back disorder NOS,Gout NOS,Fluid overload NEC,Mv collision NOS-driver
Admission Date:  [**2136-9-5**]              Discharge Date:   [**2136-9-20**]

Date of Birth:  [**2057-5-30**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
[**2136-9-5**] Embolization of lower left renal pole artery
[**2136-9-11**] ORIF tibia right; placement of IVC filter right grion;
chest tube placement [**Location (un) **]
[**2136-9-12**] T12-L2 POSTERIOR SPINAL STABILIZATION INSTRUMETATION


History of Present Illness:
79 yo man w/ PMH of Afib on pradaxa, was the restrained front
seat passenger in a motor vehcile crash going ~45 mph. He
presented initially to [**Hospital3 **] hospital and was intubated and a
left chest tube placed. At presentation to [**Hospital1 18**] he was
hypotensive to 70's/palp, with OSH CT demonstrating hemothorax
with rib fractures to [**8-8**] and bilateral pelvic fractures.


Past Medical History:
HTN, afib

Social History:
Married and resides in [**State 531**] with his wife

Family History:
Noncontributory

Physical Exam:
Upon presentation to [**Hospital1 18**]:
Constitutional: The patient does not grimace, wince, or
exhibit other objective sign of distress
HEENT: NC/AT
Moist mucous membranes
Chest: CTA
Cardiovascular: No murmur
Abdominal: No guarding, rigidity, or rebound
Rectal: no rectal tone
GU/Flank: No CVAT
Extr/Back: Trace edema
Skin: No rash
Neuro: the patient shows no spontaneous movement
Psych: obtunded
Heme/[**Last Name (un) **]/[**Last Name (un) **]: No petechiae



Pertinent Results:
[**2136-9-5**] 09:15PM   GLUCOSE-138* UREA N-14 CREAT-0.8 SODIUM-145
POTASSIUM-3.7 CHLORIDE-112* TOTAL CO2-22 ANION GAP-15
[**2136-9-5**] 09:15PM   CALCIUM-7.0* PHOSPHATE-5.0* MAGNESIUM-1.7
[**2136-9-5**] 09:15PM   WBC-5.5 RBC-3.36* HGB-10.6* HCT-30.2* MCV-90
MCH-31.6 MCHC-35.1* RDW-15.9*
[**2136-9-5**] 09:15PM   PLT COUNT-66*
[**2136-9-5**] 09:15PM   PT-15.4* PTT-45.8* INR(PT)-1.4*

IMAGING:
[**9-6**] MR [**Name13 (STitle) **]: No ligamentous injury or signs of bony injury.
[**9-6**] MR [**Name13 (STitle) **]: Transverse fracture which appears to extend
through pedicles (Chance fracture). CT lumbar spine can help for
better assessment as clinically indicated. Edema in sacrum
indicates a fracture.
[**9-6**] CT R knee/prox tibia: Comminuted intraarticular fracture of
the proximal tibia with fracture lines extending into the medial
and lateral tibial plateaus (400, 45 and 50). The dominant
fracture line is transverse through the metaphysis and likely
involves the insertion of the patellar tendon. There is mild
impaction and postero-lateral displacement of the distal
fragment.Minimally displaced fracture of the proximal fibula
(401b, 19). Hemorrhagic knee effusion. Severe degenerative
changes and diffuse osteopenia.
[**9-6**] am CXR: The assessment of the lung films reveals no
interval development of new abnormalities besides the right
middle lobe atelectasis that is apparently new. Bilateral small
pleural effusions are better appreciated on the CT torso.
[**9-6**] pm CXR: No change from [**2136-9-6**]. Left basilar opacity is
likely
atelectasis, but supervening infection cannot be excluded.
[**9-8**]: pCXR no clear infiltrate
[**9-9**]: No pneumothorax is identified on the left. There are
bilateral
pleural effusions. There is increased pulmonary vascular
redistribution and alveolar infiltrates, predominantly in the
right lower lobe. There is dense retrocardiac opacity. The
overall impression is that of worsened fluid status.
[**9-10**] CXR: No evidence of pneumothorax. There is evidence of
elevated pulmonary venous pressure. Mild haziness of the lower
zones is consistent with small bilateral pleural effusions and
compressive atelectasis at the bases.
[**9-11**] CXR: Minimal left basal atelectasis. There is no evidence
of pneumothorax. The subtle parenchymal changes at the right
lung bases are constant.
[**9-13**] CXR: Unchanged bilateral parenchymal opacities, combined to
mild-to-moderate right pleural effusion and areas of bilateral
basal atelectasis.


Brief Hospital Course:
On presentation, the OSH CT demonstrated a left retroperitoneal
hematoma with evidence of active extravasation. He was actively
resuscitated in the ED with 7u pRBC, 4u FFP and several liters
crystalloid and taken to IR for embolization. Blush was seen at
the inferior pole of the left kidney and was embolized at that
time.  He was transferred to the trauma ICU afterwards for close
monitoring.

His ICU course as follows:

N: He was intubated and weaned off sedation. He was following
commands and responding appropriately. His pain was controlled
with narcotics.

CV: He had short runs of ventricular tachycardia and on HD2 he
went into afib w/ RVR. He was started on an Amiodarone gtt and
he converted to sinus on HD 3. During that time, he was on some
neo, which was weaned off.

Pulm: He was intubated and sedated. he had a left chest tube in
place to suction for him  hemothorax. It was placed to water
seal. He had multiple rib fractures

GI: He was NPO and on IV fluids. He had an OGT in place
initially which was later removed, a Dobbhoff was placed and
tube feedings started.

GU: His urine output was monitored closely with Foley catheter
in place.

Heme: He required intermittent blood transfusions with packed
cells during his ICU stay. On HD 2, he was transfused 1u pRBC
for a hct of 24, which had decreased from 33. He also received
albumin and FFP.

MSK: He had multiple fractures in his ribs, spine, pelvis, and
RLE. His pelvic fractures were non-operative and he was weight
bearing as tolerated. However, he was on log roll precautions
for his L1 chance fracture. He underwent repair of his distal
right lower extremity fractures on [**9-11**] by Orthopedics and his
spine fracture was repaired by Orthopedic Spine Surgery on [**9-12**].
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Once stabilized in the ICU he was transferred to the floor. He
was noted with rapid afib with hypotension within the first 24
hours after leaving the ICU. He was given several doses of IV
Lopressor which was effective. His daily scheduled beta blockers
were subsequently adjusted. His Afib was felt secondary to fluid
volume overload for which he received diuresis with IV Lasix
for. Since this initial episode of afib his heart rate has range
in 70-80's. At home he takes Metoprolol XL 100 mg twice a day -
his home dose was restarted at a lower dose to determine if his
blood pressure remains stable. Once at rehab and with continued
stable blood pressures his home regimen should be resumed.

He underwent a Swallow evaluation at bedside and passed allowing
his diet to be upgraded to regular with thin liquids. The
Dobbhoff was removed and tube feedings stopped. Supplements with
Ensure were initiated as well.

His home medications were resumed.

His Foley was removed on HD#13 and he is voiding without any
difficulties.

He was evaluated by Physical and Occupational therapy and being
recommended for rehab after his acute hospital stay.

Medications on Admission:
 Multivitamins 1 TAB PO DAILY
 Colchicine 0.6 mg PO DAILY
 Dabigatran Etexilate 150 mg PO BID
 Metoprolol Succinate XL 100 mg PO DAILY


Discharge Medications:
1. Acetaminophen [**Telephone/Fax (1) 1999**] mg PO Q6H pain
2. Artificial Tear Ointment 1 Appl BOTH EYES TID:PRN dry eye
3. Heparin 5000 UNIT SC TID
4. Bisacodyl 10 mg PO/PR DAILY
5. Multivitamins 1 TAB PO DAILY
6. Senna 1 TAB PO BID:PRN constipation
7. Quetiapine Fumarate 12.5 mg PO Q12H
8. Colchicine 0.6 mg PO DAILY
9. Dabigatran Etexilate 150 mg PO BID
10. Docusate Sodium 100 mg PO BID
11. Metoprolol Succinate XL 100 mg PO DAILY
hold for SBP <110; HR <60


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Rehab Hospital

Discharge Diagnosis:
s/p Motor vehicle crash
Injuries:
Right sacral fracture
Bilateral pelvic fractures
Left hemothorax
Left retroperitoneal bleed
Left rib fractures [**8-8**]
L1 vertebral body racture
Sternal fracture
Right rib fracture Right proximal tibia & distal fibula fracture

Left 5th metacarpal fracture
Acute blood loss anemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
You were admitted to the hospital following a motor vehicle
crash where you sustained multiple injuires inclusidng rib
fractures; collapsed lung; broken bones in your pelvis, back and
right leg. Your spine and leg fractures required operation to
repair the injuries.

You were evaluated by the Physical therapists and being
recommended to go to a rehabilitation facility after you are
discharged from the hospital.

Followup Instructions:
You will need to follow up with your primary care doctor after
you are discharged from the rehabilitation facility.

You will need to follow up with an Orthopedic and Orthopedic
Spine surgeon in the next 3-4 weeks. If you choose to follow up
in [**Location (un) 86**] please contact the following:
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], Orthopedics [**Telephone/Fax (1) 1228**]
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1352**], Orthopedic Spine [**Telephone/Fax (1) 1228**]


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2136-9-20**]
{'Closed fracture of upper end of tibia alone,Traumatic shock,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Traumatic hemothorax without mention of open wound into thorax,Pneumonia due to Klebsiella pneumoniae,Acute posthemorrhagic anemia,Paroxysmal ventricular tachycardia,Closed fracture of five ribs,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Closed unspecified fracture of pelvis,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Fracture of medial malleolus, closed,Injury to renal artery,Closed fracture of metacarpal bone(s), site unspecified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other unspecified back disorders,Gout, unspecified,Other fluid overload,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: s/p Motor vehicle crash

PRESENT ILLNESS: 79 yo man w/ PMH of Afib on pradaxa, was the restrained front
seat passenger in a motor vehcile crash going ~45 mph. He
presented initially to [**Hospital3 **] hospital and was intubated and a
left chest tube placed. At presentation to [**Hospital1 18**] he was
hypotensive to 70's/palp, with OSH CT demonstrating hemothorax
with rib fractures to [**8-8**] and bilateral pelvic fractures.

MEDICAL HISTORY: HTN, afib

MEDICATION ON ADMISSION: Multivitamins 1 TAB PO DAILY
 Colchicine 0.6 mg PO DAILY
 Dabigatran Etexilate 150 mg PO BID
 Metoprolol Succinate XL 100 mg PO DAILY

ALLERGIES: Penicillins

PHYSICAL EXAM: Upon presentation to [**Hospital1 18**]:
Constitutional: The patient does not grimace, wince, or
exhibit other objective sign of distress
HEENT: NC/AT
Moist mucous membranes
Chest: CTA
Cardiovascular: No murmur
Abdominal: No guarding, rigidity, or rebound
Rectal: no rectal tone
GU/Flank: No CVAT
Extr/Back: Trace edema
Skin: No rash
Neuro: the patient shows no spontaneous movement
Psych: obtunded
Heme/[**Last Name (un) **]/[**Last Name (un) **]: No petechiae

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married and resides in [**State 531**] with his wife 

### Response:
{'Closed fracture of upper end of tibia alone,Traumatic shock,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Traumatic hemothorax without mention of open wound into thorax,Pneumonia due to Klebsiella pneumoniae,Acute posthemorrhagic anemia,Paroxysmal ventricular tachycardia,Closed fracture of five ribs,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Closed unspecified fracture of pelvis,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Fracture of medial malleolus, closed,Injury to renal artery,Closed fracture of metacarpal bone(s), site unspecified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other unspecified back disorders,Gout, unspecified,Other fluid overload,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}
