CHIEF COMPLAINT: Unresponsiveness s/p assault.

PRESENT ILLNESS: This patient is a 33 year old female who presents to [**Hospital1 18**] via
med flight s/p assault. She was found in her bathroom down,
bleeding from her head and a nearby bathroom scale covered in
blood.  Questionable assault. She was unresponsive and her head
was covered in blood. She was intubated on scene and transferred
to [**Hospital1 18**] for evaluation by [**Location (un) **]. Per EMS she is known to be
in an abusive relationship.

MEDICAL HISTORY: PMHx:  EtOH abuse, h/o seizures w/ DTs, bipolar disorder.

MEDICATION ON ADMISSION: Gabapentin 800''', trazodone 200 qhs, buspirone 10''', baclofen
20''' PRN, depakote 250 qAM, 500 qPM, hydroxyzine 25 q6h, celexa
40'.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:

FAMILY HISTORY: 

SOCIAL HISTORY: History of alchoholism, abusive relationship.
Concussion with loss of consciousness of unspecified duration,Acute respiratory failure following trauma and surgery,Closed fracture of nasal bones,Open wound of jaw, without mention of complication,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Alcohol withdrawal,Laceration of skin of eyelid and periocular area,Superficial injury of cornea,Leukocytosis, unspecified,Fever, unspecified,Anemia, unspecified,Alcohol abuse, unspecified,Anxiety state, unspecified,History of physical abuse,Assault by striking by blunt or thrown object
Concussion w coma NOS,Ac resp flr fol trma/srg,Nasal bone fx-closed,Open wound of jaw,Bipol I cur depres NOS,Alcohol withdrawal,Lac eyelid skn/perioculr,Superficial inj cornea,Leukocytosis NOS,Fever NOS,Anemia NOS,Alcohol abuse-unspec,Anxiety state NOS,Hx of physical abuse,Assault-striking w obj
Admission Date:  [**2125-5-29**]              Discharge Date:   [**2125-6-6**]

Date of Birth:  [**2091-12-13**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1390**]
Chief Complaint:
Unresponsiveness s/p assault.

Major Surgical or Invasive Procedure:
Intubated for altered mental status on admission, [**2125-5-29**].


History of Present Illness:
This patient is a 33 year old female who presents to [**Hospital1 18**] via
med flight s/p assault. She was found in her bathroom down,
bleeding from her head and a nearby bathroom scale covered in
blood.  Questionable assault. She was unresponsive and her head
was covered in blood. She was intubated on scene and transferred
to [**Hospital1 18**] for evaluation by [**Location (un) **]. Per EMS she is known to be
in an abusive relationship.


Past Medical History:
PMHx:  EtOH abuse, h/o seizures w/ DTs, bipolar disorder.

PSHx:  Unknown.

Social History:
History of alchoholism, abusive relationship.

Physical Exam:
On admission:

Temp: afebrile HR: 106 BP: 170/72 Resp: 20 O(2)Sat: 100%
vent

Constitutional: intubated, sedated
HEENT: + facial trauma, orbital edema
ETT in place; c-collar in place
Chest: Clear to auscultation
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Soft, Nondistended
Pelvic: No obvious GU trauma
Extr/Back: No cyanosis, clubbing or edema
Skin: No rash, Warm and dry
Heme/[**Last Name (un) **]/[**Last Name (un) **]: No petechiae

On discharge:

VS Temp 97.8, BP 109/56, HR 80, RR 16, sat 96% on room air.
Neuro:  AAO x person, place, needed reorientation to date.
EENT:  Periorbital swelling and resolving ecchymosis.
Pulm:  Clear bilaterally in full lung fields.
Abdomen:  Soft, non-tender, non-distended.  Hypoactive BS.
Extremities:  Warm, well-perfused.

Pertinent Results:
[**2125-5-29**] 05:15PM BLOOD ASA-NEG Ethanol-98* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2125-5-29**] 05:15PM BLOOD WBC-16.0* RBC-3.90* Hgb-10.3* Hct-32.4*
MCV-83 MCH-26.3* MCHC-31.7 RDW-18.1* Plt Ct-364
[**2125-5-29**] 05:15PM BLOOD PT-13.9* PTT-27.4 INR(PT)-1.3*
[**2125-5-29**] 05:15PM BLOOD Plt Ct-364
[**2125-5-29**] 05:15PM BLOOD Fibrino-171*
[**2125-5-29**] 05:15PM BLOOD UreaN-14 Creat-0.6
[**2125-5-30**] 12:23AM BLOOD Calcium-8.6 Phos-3.9 Mg-1.7
[**2125-5-30**] 12:23AM BLOOD HBsAb-NEGATIVE
[**2125-5-29**] 05:24PM BLOOD Glucose-107* Na-140 K-3.4 Cl-105
calHCO3-15*
[**2125-6-4**] 06:06AM BLOOD WBC-6.3 RBC-3.49* Hgb-9.0* Hct-28.6*
MCV-82 MCH-25.9* MCHC-31.5 RDW-19.5* Plt Ct-386
[**2125-6-4**] 06:06AM BLOOD Plt Ct-386
[**2125-6-4**] 06:06AM BLOOD Glucose-93 UreaN-13 Creat-0.5 Na-142
K-3.7 Cl-102 HCO3-27 AnGap-17
[**2125-6-4**] 06:06AM BLOOD Calcium-8.9 Phos-4.1 Mg-1.9

[**2125-5-29**] CT of sinus/mandible/maxilla
1. Bilateral nasal bone, frontal processes of the maxilla and
anterior nasal spine fractures.
2. Diffuse soft tissue swelling of the scalp and face.

[**2125-5-29**] CT of head without contrast
1.  Bilateral nasal bone and frontal process of the maxilla
fractures.
2.  Diffuse facial and scalp subcutaneous edema and subgaleal
hematoma noted towards the left posterior vertex.


Brief Hospital Course:
33F who presents to [**Hospital1 18**] s/p assault. She was found in her
bathroom down, bleeding from her head. Questionable assault. She
was unresponsive and her head was covered in blood. She was
intubated on the scene and transferred to [**Hospital1 18**] for further
management.

She was pan-scanned in the ED (see results section above).  FAST
scan was negative and the patient was hemodynamically stable.
Due to the question of sexual assault, [**Name Initial (MD) **] SANE RN was contact[**Name (NI) **].
She was evaluated by that individual and evidence was collected
for processing.  The patient was admitted to trauma SICU for
continued care on [**2125-5-29**].

ICU course ([**2125-5-29**] - [**2125-6-3**]):
Pt was admitted to TSICU intubated, sedated on [**5-29**].
CT spine shows acute fractures. CT maxillary sinus show
bilateral nasal bone, frontal process of the maxilla and
anterior nasal spine fractures. Diffuse facial and scalp
subcutaneous edema. CT head show bilateral nasal bone fractures.
And CT abd/pelvis shows no acute abnormality. On [**5-30**], the chin
lac was repaired and T+L spine cleared. Pt was bolused 500 LR x1
for low UOP, and IVF increased to 125 with improvment. We were
unable to extubate pt due to severe agitation and inability to
follow commands. Pt also spiked temperature of 101, blood
culture was sent. Home depakote was also restarted at this time.
Pt was extubated with improvement in mental status on [**5-31**]. On
[**6-1**], pt has altered mental status that requiring repeat doses
of valium and haldol for agitation. On [**6-2**], we have to repeat
multiple doses of valium and haldol throughout the day, we
restarted psych meds in the afternoon, which resulted in great
improvement in her mental status. On [**6-3**], pt's diet was
advanced to regular, she was stable to transfer to regular
floor.

Her [**Hospital **] hospital course per organs system are detailed below:
Neurologic:
-pain: oxycodone PO, dilaudid iv prn breakthrough, tylenol PO
-hx heavy ETOH: decrease valium dosing to 20 q2, restart home
depakote
Cardiovascular:
Tachycardia: Withdrawal vs. pain: continue ciwa and pain control

Pulmonary: NAI
Gastrointestinal: No acute issues
Nutrition: advance as tolerates
Renal: NAI
Hematology: cont to monitor HCT, her anemia likely [**12-21**] ETOH use,
and acute dilutional
Endocrine: RISS
Infectious Disease: augmentin
MSK: facial fractures/lacerations: augmentin, sinus precautions,
PRS f/u outpt, HOB elevation
Ophthal: b/l orbital edema, ecchymosis, continue ointment. Optho
f/u in 1 week
Social: SANE nursing was involved for possible sexual assault
- testing per protocol, privacy protection, check ID of all male
visitors
Psych: restarted home meds
Consults: ACS, opthalomology, PRS, social work
Prophylaxis:
- DVT: boots, SQH

Mrs. [**Known lastname 111871**] was transferred from trauma SICU to the surgical
floor on [**2125-6-3**].  At that time, she was hemodynamically
stable.  Neurologically, the patient was agitated at times and
uncooperative.  A CIWA scale was initiated due to the patient's
history of alcohol use.  Unasyn was continued for facial
fractures and later transitioned to PO augmentin.  The total
course of antibiotics was completed.
The patient's foley was discontinued and she later voided
without issue.

Mrs. [**Known lastname 111871**] was being followed by the plastic surgery group for
her nasal bone fractures, as well as physical and occupational
therapy.  The patient's mental status slowly returned and she
required occupational therapy to assist with cognitive recovery.
 Physical therapy had assisted Mrs. [**Known lastname 111871**] with rehabilitation
of her right arm, leg and ankle.  It was their recommendation
that she continue with outpatient OT and PT, as well as
neuro-cognitive evaluation.

The patient was discharged hemodynamically stable and afebrile.
Social work has evaluated the patient during her stay.  The
patient felt that she was safe being discharged with her fiance.
 He will be taking time off to care for her full-time until her
cognitive status improves.  Discharge teaching was provided by
myself and the bedside RN.

Medications on Admission:
Gabapentin 800''', trazodone 200 qhs, buspirone 10''', baclofen
20''' PRN, depakote 250 qAM, 500 qPM, hydroxyzine 25 q6h, celexa
40'.


Discharge Medications:
1. Acetaminophen 650 mg PO Q6H pain
2. Senna 2 TAB PO HS
3. Docusate Sodium 100 mg PO BID
4. BusPIRone 10 mg PO TID PRN anxiety
5. Gabapentin 800 mg PO TID
6. Baclofen 20 mg PO TID
7. Divalproex (DELayed Release) 250 mg PO QAM
8. Divalproex (DELayed Release) 500 mg PO QPM
9. Citalopram 40 mg PO DAILY
10. HydrOXYzine 25 mg PO QID
11. Nicotine Patch 14 mg TD DAILY agitation
12. traZODONE 200 mg PO HS:PRN insomnia
hold for sedation
13. OxycoDONE (Immediate Release)  10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**11-20**] tablet(s) by mouth every four (4) hours
Disp #*40 Tablet Refills:*0
14. Ibuprofen 600 mg PO Q8H:PRN pain
RX *ibuprofen 600 mg 1 tablet(s) by mouth every six (6) hours
Disp #*30 Tablet Refills:*0
15. Artificial Tears Preserv. Free 1-2 DROP BOTH EYES PRN
irritation
16. Outpatient Physical Therapy
Outpatient PT to address R knee, R ankle, and R shoulder
impairments/pain.
17. Outpatient Occupational Therapy
OT evaluation to maximize safety secondary to cognitive
deficits.
Treatment Plan: cognition, ADLs, mobility, balance, patient and
family education
Frequency: 1-2x wk
Duration: one week


Discharge Disposition:
Home

Discharge Diagnosis:
Bilateral nasal bone and frontal process of the maxilla
fractures


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to [**Hospital1 **] Hospital after you
were assaulted.  Your injuries include bilateral (both sides)
nasal bone fractures, frontal process maxillary fracture and a
subgaleal hematoma.  You have also experienced pain to your
right arm, knee and ankle.

MEDICATIONS:
o Resume all your home medications as you were prior to being
admitted to the hospital.
o In regards to your pain, you have been prescribed narcotic
(oxycodone) and non-narcotic (ibuprofen) medications.  They
often work well when taken together.  Follow the directions on
the prescription bottles and take them when needed.
o Do not drive or operate machinery when taking narcotics.  The
medicine can make you drowsy and impair your thinking.
o Narcotics may cause constipation.  You may take over the
counter colace and senna if you experience this symptom.  Drink
plenty of water and get exercise, as tolerated, to reduce the
risk of constipation.

SINUS PRECAUTIONS:
Regarding your nasal bone and sinus fractures: Certain
precautions will assist healing and we ask that you faithfully
follow these instructions:

1. Take the prescribed medications as directed.

2. Do not forcefully spit for several days.

3. Do not smoke for several days.

4. Do not use straws for several days.

5. Do not forcefully blow your nose for at least 2 weeks, even
though your sinus may feel ??????stuffy?????? or there may be some nasal
drainage.

6. Try not to sneeze; it will cause undesired sinus pressure. If
you must sneeze, keep your mouth open.

7. Do not rinse vigorously for several days. GENTLE salt water
swishes may be used. Slight bleeding from the nose is not
uncommon for several days after the surgery. Please keep our
office advised of any changes in your condition, especially if
drainage or pain increases. It is important that you keep all
future appointments until this condition has resolved.

You will require 24 hour assistance at home while you recover
from your injuries.  Physical and occupational therapy have been
ordered to assist you in regaining bothing cognitive and
physical abilities as you were prior to your injuries.  Also,
follow-up appointments have been made for you as noted below.

Followup Instructions:
Department: DIV OF PLASTIC SURGERY
When: FRIDAY [**2125-6-15**] at 1:30 PM
With: [**First Name11 (Name Pattern1) 2053**] [**Last Name (NamePattern1) 6751**], MD [**Telephone/Fax (1) 6742**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: COGNITIVE NEUROLOGY UNIT
When: THURSDAY [**2125-6-21**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6403**], MD [**Telephone/Fax (1) 1690**]
Building: Ks [**Hospital Ward Name 860**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage



Completed by:[**2125-6-7**]
{'Concussion with loss of consciousness of unspecified duration,Acute respiratory failure following trauma and surgery,Closed fracture of nasal bones,Open wound of jaw, without mention of complication,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Alcohol withdrawal,Laceration of skin of eyelid and periocular area,Superficial injury of cornea,Leukocytosis, unspecified,Fever, unspecified,Anemia, unspecified,Alcohol abuse, unspecified,Anxiety state, unspecified,History of physical abuse,Assault by striking by blunt or thrown object'}


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: Unresponsiveness s/p assault.

PRESENT ILLNESS: This patient is a 33 year old female who presents to [**Hospital1 18**] via
med flight s/p assault. She was found in her bathroom down,
bleeding from her head and a nearby bathroom scale covered in
blood.  Questionable assault. She was unresponsive and her head
was covered in blood. She was intubated on scene and transferred
to [**Hospital1 18**] for evaluation by [**Location (un) **]. Per EMS she is known to be
in an abusive relationship.

MEDICAL HISTORY: PMHx:  EtOH abuse, h/o seizures w/ DTs, bipolar disorder.

MEDICATION ON ADMISSION: Gabapentin 800''', trazodone 200 qhs, buspirone 10''', baclofen
20''' PRN, depakote 250 qAM, 500 qPM, hydroxyzine 25 q6h, celexa
40'.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:

FAMILY HISTORY: 

SOCIAL HISTORY: History of alchoholism, abusive relationship. 

### Response:
{'Concussion with loss of consciousness of unspecified duration,Acute respiratory failure following trauma and surgery,Closed fracture of nasal bones,Open wound of jaw, without mention of complication,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Alcohol withdrawal,Laceration of skin of eyelid and periocular area,Superficial injury of cornea,Leukocytosis, unspecified,Fever, unspecified,Anemia, unspecified,Alcohol abuse, unspecified,Anxiety state, unspecified,History of physical abuse,Assault by striking by blunt or thrown object'}
