CHIEF COMPLAINT: Type III raidal deficiency w/ severe radially clubbed Hand

PRESENT ILLNESS: 17 yo M history Type III radial deficiency and severed radial
clubbed hand at birth, s/p ex-fix placement for stretching of
forearm presents for tubular transplant of L fibula to L forearm
with ORIF.

MEDICAL HISTORY: Vatar Syndrome
L radial club II deformity
Cleft palate s/p L rhinoplasty
Polycystic Kidney disease s/p R nephrectomy
Scoliosis
s/p L thumb surgery

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 100.5  93  115/36  17  98%
NAD A+Ox3
neck supple
RRR
CTA B
EXTR- warm, good cap refull
Soft, NT, ND
sensation intact

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Live with moth, in high school, plays trumpet and soccer
Unspecified anomaly of upper limb,Other specified congenital anomalies,Unspecified anomaly of urinary system,Other orthopedic aftercare,Acquired absence of kidney,Other specified hypertrophic and atrophic conditions of skin,Contracture of joint, forearm,Unspecified disorder of synovium, tendon, and bursa
Upper limb anomaly NOS,Specfied cong anomal NEC,Urinary anomaly NOS,Orthopedic aftercare NEC,Acquired absence kidney,Skin hypertro/atroph NEC,Jt contracture-forearm,Synov/tend/bursa dis NOS
Admission Date:  [**2139-4-30**]              Discharge Date:   [**2139-5-5**]

Date of Birth:  [**2122-1-5**]             Sex:   M

Service: PLASTIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7733**]
Chief Complaint:
Type III raidal deficiency w/ severe radially clubbed Hand

Major Surgical or Invasive Procedure:
free fibula transposition to left forearm


History of Present Illness:
17 yo M history Type III radial deficiency and severed radial
clubbed hand at birth, s/p ex-fix placement for stretching of
forearm presents for tubular transplant of L fibula to L forearm
with ORIF.

Past Medical History:
Vatar Syndrome
L radial club II deformity
Cleft palate s/p L rhinoplasty
Polycystic Kidney disease s/p R nephrectomy
Scoliosis
s/p L thumb surgery

Social History:
Live with moth, in high school, plays trumpet and soccer

Family History:
Noncontributory

Physical Exam:
100.5  93  115/36  17  98%
NAD A+Ox3
neck supple
RRR
CTA B
EXTR- warm, good cap refull
Soft, NT, ND
sensation intact

Pertinent Results:
[**2139-4-30**] 04:52PM BLOOD WBC-11.5* RBC-3.67* Hgb-11.4* Hct-31.3*
MCV-86 MCH-31.0 MCHC-36.2* RDW-12.8 Plt Ct-164
[**2139-4-30**] 04:52PM BLOOD Plt Ct-164
[**2139-4-30**] 04:52PM BLOOD PT-13.1 PTT-29.8 INR(PT)-1.1
[**2139-5-1**] 02:15AM BLOOD Glucose-132* UreaN-9 Creat-0.8 Na-140
K-4.3 Cl-105 HCO3-25 AnGap-14
[**2139-4-30**] 04:52PM BLOOD Glucose-204* UreaN-11 Creat-0.9 Na-142
K-4.0 Cl-110* HCO3-21* AnGap-15
[**2139-5-1**] 02:15AM BLOOD Calcium-8.6* Phos-5.6*# Mg-1.7
[**2139-4-30**] 04:52PM BLOOD Calcium-7.9* Phos-2.3* Mg-1.2*

Brief Hospital Course:
The patient was admitted to the hospital for removal L forearm
orthofix istractor, coverage with free fibula flap,
osteosynthesis with plate/screws, L wrist arthodesist, and L
opponensplasty. The patient tolerated the procedures well and
returned to the recovery room in satisfactory condition. From
here, he was transferred to the S/ICU for flap checks. He
remained in the ICU for 48 hours, during which ime his
flap/fingers remained warm and well perfused and viable. He was
transferred to the floor on POD#3, where his most significant
issue was continued postoperative pain, controlled with
morphine, then on oral analgesics. The patient had an
intermittent nighttime fevers throughout the admission, however,
the operative sites remained without clinical evidence of
infection, and the patient was on Ancef throughout his
admission. The fevers resolved as the patient was better able to
mobilize from bed, possibly indicating atelectasis as an
etiology for the fever. The patient was discharged to home on
POD#4, ambulating, with pain well controlled and in improved
condition.

Medications on Admission:
None

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
2. Keflex 500 mg Tablet Sig: One (1) Tablet PO four times a day
for 7 days.
Disp:*28 Tablet(s)* Refills:*0*
3. Tylenol 325 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for pain.
4. Aspirin 162 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day for 3 months.
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
left radial club hand


Discharge Condition:
stable


Discharge Instructions:
having worsening pains, fevers, chills, nausea, vomiting,
increasing redness or drainage about the wounds, or if there are
any questions or concerns.  Patient to take all medications as
directed

Followup Instructions:
Patient to follow up with Dr. [**Last Name (STitle) 5385**] in one week and to call to
schedule and confirm appointment at [**0-0-**]


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 7738**]
{'Unspecified anomaly of upper limb,Other specified congenital anomalies,Unspecified anomaly of urinary system,Other orthopedic aftercare,Acquired absence of kidney,Other specified hypertrophic and atrophic conditions of skin,Contracture of joint, forearm,Unspecified disorder of synovium, tendon, and bursa'}


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: Type III raidal deficiency w/ severe radially clubbed Hand

PRESENT ILLNESS: 17 yo M history Type III radial deficiency and severed radial
clubbed hand at birth, s/p ex-fix placement for stretching of
forearm presents for tubular transplant of L fibula to L forearm
with ORIF.

MEDICAL HISTORY: Vatar Syndrome
L radial club II deformity
Cleft palate s/p L rhinoplasty
Polycystic Kidney disease s/p R nephrectomy
Scoliosis
s/p L thumb surgery

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 100.5  93  115/36  17  98%
NAD A+Ox3
neck supple
RRR
CTA B
EXTR- warm, good cap refull
Soft, NT, ND
sensation intact

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Live with moth, in high school, plays trumpet and soccer 

### Response:
{'Unspecified anomaly of upper limb,Other specified congenital anomalies,Unspecified anomaly of urinary system,Other orthopedic aftercare,Acquired absence of kidney,Other specified hypertrophic and atrophic conditions of skin,Contracture of joint, forearm,Unspecified disorder of synovium, tendon, and bursa'}
