CHIEF COMPLAINT: Pedestrian struck by motor vehicle.

PRESENT ILLNESS: This is a 68-year-old gentleman
with a history of prostatitis who was hit by a car at slow
speed. He hit the windshield, flipped over the car and landed
on the pavement. The patient had positive loss of
consciousness and complained of hip pain and left knee pain
the Emergency Department. He denied any paresthesias and had
generalized left-sided pain.

MEDICAL HISTORY: Prostatitis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No tobacco or alcohol. Married and lives
with his wife.
Closed fracture of upper end of fibula with tibia,Closed fracture of pubis,Contusion of lung without mention of open wound into thorax,Closed fracture of malar and maxillary bones,Closed fracture of base of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum
Fx up tibia w fibula-cl,Fracture of pubis-closed,Lung contusion-closed,Fx malar/maxillary-close,Cl skul base fx-coma NOS,Fx sacrum/coccyx-closed,Retroperitoneum inj-cl
Admission Date: [**2186-6-17**]        Discharge Date: [**2186-6-21**]

Date of Birth:  [**2118-3-21**]        Sex:  M

Service:  Trauma Surgery


CHIEF COMPLAINT:  Pedestrian struck by motor vehicle.

HISTORY OF PRESENT ILLNESS:  This is a 68-year-old gentleman
with a history of prostatitis who was hit by a car at slow
speed. He hit the windshield, flipped over the car and landed
on the pavement. The patient had positive loss of
consciousness and complained of hip pain and left knee pain
the Emergency Department. He denied any paresthesias and had
generalized left-sided pain.

PAST MEDICAL HISTORY:  Prostatitis.

PAST SURGICAL HISTORY:  Status post appendectomy.

MEDICATIONS:
1. Betimol, one drop O.S. q a.m.
2. Lumigan, one drop O.U. q h.s.
3. Hytrin 2 mg p.o. q h.s.


ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  No tobacco or alcohol. Married and lives
with his wife.

PHYSICAL EXAMINATION:  Initially, temperature was 100.0,
heart rate 84, blood pressure 115 over palpable, respirations
12, O2 saturation of 100 percent on a non-rebreather. He was
an alert and oriented Russian speaking male in mild distress.
Pupils equal, round and reactive bilaterally. Extraocular
movements intact. Tympanic membranes were clear. He had left
subconjunctival hematoma. Oropharynx was clear. Trachea was
midline. Cardiac:  Regular rate and rhythm. Chest was clear
to auscultation bilaterally without crepitus or tenderness or
deformities. Abdomen was soft, nontender and nondistended.
Pelvis was stable. He had tenderness with left lateral
compression and abrasion above the left ASIS. There were no
frank deformities. Back:  No deformities, no tenderness, no
step-offs, no tenderness. Rectum:  Guaiac negative, good
rectal tone. Right upper extremity had no deformities. The
left upper extremity had degloving of the left posterior
elbow with no deformities. Right lower extremity:  No
deformities, full range of motion. Left lower extremity:
There was a deformity with swelling around the left tibial
plateau. Distal pulses are intact throughout.

LABORATORY DATA:  White blood cell count 9.0, hematocrit
36.8, platelets 171, creatinine 0.9, INR 1.1, amylase 83,
lipase 173, lactate 3.6.

Imaging fast exam:  Within normal limits. Chest x-ray:
Normal pelvis, showed a pubic symphysis fracture. CT of the
head showed no intracranial hemorrhage. CT of the C-spine:
No fracture or dislocation. CT of the face:  Fractures
through the left zygomatic arch, the left anterior and
posterior medial maxillary sinus walls, left nasal fracture
with fluid in the left sphenoid sinus. CT of the chest showed
a left pulmonary contusion. CT of the abdomen showed no solid
organ injury or free fluid. CT of the pelvis:  There is
minimal diastasis of the left sacroiliac joint with a
comminuted left pubic symphysis fracture with fracture also
of the anterior and inferior acetabulum with slight extension
into the articular surface, a left inferior pubic rami
fracture and a linear fracture of the left lateral sacrum
with small pelvic hematomas times two. TLS films:
Degenerative changes, no acute fracture. X-ray of the left
knee and leg showed a proximal tibial plateau fracture with
medial displacement of the anterior portion. Pelvis Judet
views showed left superior and inferior pubic rami fracture
and a possible fracture of the left supra-acetabular region
of the iliac bone on the left. Plain film of the left ankle
showed an old [**Doctor Last Name 11586**] B fracture with hardware. Left elbow x-
ray:  No fracture.

HOSPITAL COURSE:  Mr. [**Name14 (STitle) 55479**] was transported to the trauma
bay by Emergency Medical Services. He was alert with a GCS of
15 and hemodynamically stable initially with a heart rate in
the 80s and systolic blood pressure of 100. He was then taken
to X-ray and CT where he had the above mentioned studies.
However, while in X-ray, his systolic blood pressure fell to
the 70s. He was bolused with crystalloid and transfused two
units of packed red blood cells with good response. Repeat CT
scan of the pelvis showed slight increased size of the pelvic
hematoma anterior to the bladder with unchanged appearance of
the additional pelvic hematoma and multiple fractures as
described above. He stabilized and was transferred to the
Trauma Intensive Care Unit for further management. He was
kept on bedrest, made NPO and placed on pneumatic compression
boots for deep venous thrombosis prophylaxis. He was then
taken to the Operating Room with orthopedic surgeon for open
reduction, internal fixation of the left tibial plateau
fracture. Plastic Surgery was also consulted for the facial
fractures. They deemed these to be nonoperative and
recommended head elevation and ice soaked saline gauze to the
eye. His facial lacerations were sutured in the Emergency
Department. He also had his left elbow degloving injury
irrigated and that was primarily repaired in the Emergency
Department as well.

Postoperatively, he was extubated and returned to the Trauma
Surgical Intensive Care Unit. He was continued on bedrest
with serial hematocrit checks. His hematocrit trended down to
28, so he was transfused. Additionally, his platelets were
72, but the decision was made to monitor these. His cervical
spine was cleared as was his TLS spine. He was maintained on
pneumatic compression boots for deep venous thrombosis
prophylaxis through hospital day one. His hematocrit
stabilized at around 28 so he was started on Lovenox on
hospital day two. However, his platelet count continued to
trend down to 62. Heparin dependent antibody test was sent.
However, the following day, his platelets trended down to 58.
He was transfused one six pack of platelets with good
response and he has maintained his platelet count in the 100
range. His hematocrit failed to increase appropriately in
spite of multiple transfusions. He received a total of nine
packed red blood cells at the time of this dictation with his
hematocrit finally stabilizing between 28 and 29.

He was initially mildly tachycardiac and was started on
Lopressor in the Intensive Care Unit which he tolerated well,
however, his blood pressure continued to be on the low side,
so his dose was decreased, but he was kept on it given his
age and need for perioperative beta blockage. He was seen by
Physical Therapy. Orthopedic Surgery activity restrictions
were for non-weightbearing status to the left leg. He was
able to be mobilized out of bed with physical therapy and
they saw him for ambulation and deemed that he would require
a rehabilitation stay. His diet was advanced. His intravenous
fluids were Hep-locked. He remained afebrile and otherwise
stable.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient will be discharged to a
rehabilitation facility.

DISCHARGE INSTRUCTIONS:  He is to remain non-weightbearing on
the left lower extremity and ambulate with a walker or
crutches. He is to continue on Lovenox for four weeks after
his injury.

FOLLOW UP:  Follow-up with Dr. [**Last Name (STitle) 284**] from Orthopedic
Surgery two weeks after discharge from the hospital, with the
Trauma Clinic two weeks after discharge and with Plastic
Surgery.

DISCHARGE DIAGNOSES:  Closed head injury.

Multiple facial fractures.

Multiple pelvic fractures with pelvic hematoma.

Left tibia and fibular fracture.

Pelvic hematoma.

Left pulmonary contusion.

Left arm degloving injury.

Blood loss anemia requiring transfusion.

DISCHARGE MEDICATIONS:
1. Lovenox 40 mg subcutaneously q d for four weeks.
2. Percocet [**12-30**] p.o. q 4-6 hours p.r.n.
3. Terazosin 2 mg p.o. q h.s.
4. Betimol eyedrops, one O.S. q a.m.
5. Lumigan eyedrops, one O.U. q h.s.
6. Lopressor 12.5 mg p.o. b.i.d.
7. Colace 100 mg p.o. b.i.d.
8.
   Milk of Magnesia 30 cc p.o. q 4-6 hours p.r.n.
9. Dulcolax 10 mg p.o. q d p.r.n.




                        [**First Name11 (Name Pattern1) 518**] [**Last Name (NamePattern4) **], [**MD Number(1) 17554**]

Dictated By:[**Last Name (NamePattern1) 13030**]
MEDQUIST36
D:  [**2186-6-21**] 13:40:48
T:  [**2186-6-21**] 15:09:21
Job#:  [**Job Number **]
{'Closed fracture of upper end of fibula with tibia,Closed fracture of pubis,Contusion of lung without mention of open wound into thorax,Closed fracture of malar and maxillary bones,Closed fracture of base of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum'}


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: Pedestrian struck by motor vehicle.

PRESENT ILLNESS: This is a 68-year-old gentleman
with a history of prostatitis who was hit by a car at slow
speed. He hit the windshield, flipped over the car and landed
on the pavement. The patient had positive loss of
consciousness and complained of hip pain and left knee pain
the Emergency Department. He denied any paresthesias and had
generalized left-sided pain.

MEDICAL HISTORY: Prostatitis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No tobacco or alcohol. Married and lives
with his wife. 

### Response:
{'Closed fracture of upper end of fibula with tibia,Closed fracture of pubis,Contusion of lung without mention of open wound into thorax,Closed fracture of malar and maxillary bones,Closed fracture of base of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum'}
