CHIEF COMPLAINT: left thumb traumatic amputation

PRESENT ILLNESS: Mr. [**Known lastname 65285**] is a 41-year-old man who was brought to the emergency
room today after he had sustained a traumatic amputation of his
left thumb on a table saw. He works as a truck driver and was at
his home doing some woodworking. He amputated a portion that had
be fished out of the saw and brought with him. There is a
multilevel injury on the amputated part.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: As previously noted, prior to the patient arriving in the
operating room, dissection of the amputated part had been
done. The amputation was an oblique one at the metaphysis to
the proximal phalanx with the most tissue on the radial side.
The radial neurovascular bundle had been amputated much more
proximal than the ulnar. An avulsion of the ulnar digital
nerve however was obvious. Reattachment of the radial digital
nerve to the thumb proximally was joined to the ulnar digital
nerve distally. This should give him good protective
sensibility in the very important ulnar pulp surface. In
addition to the proximal amputation, there was a midline deep
laceration through the flexor mechanism through the pulp to
the bone. This was explored, as well, and at this level the
digital vessels had not been injured. After dissecting out
flexors, extensors, nerves, arteries and veins, it was
decided to go ahead with a reattachment effort.

FAMILY HISTORY: NC

SOCIAL HISTORY: nonsmoker, occ EtOH
Traumatic amputation of thumb (complete)(partial), without mention of complication,Other complications due to other vascular device, implant, and graft,Accidents caused by other powered hand tools,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution
Amputation thumb,Comp-oth vasc dev/graft,Acc-power hand tool NEC,Abn react-anastom/graft,Accid in resident instit
Admission Date:  [**2122-12-3**]              Discharge Date:   [**2122-12-16**]

Date of Birth:  [**2081-6-18**]             Sex:   M

Service: PLASTIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7733**]
Chief Complaint:
left thumb traumatic amputation

Major Surgical or Invasive Procedure:
Left thumb replant [**1-3**]
Left thumb revascularization [**1-5**]


History of Present Illness:
Mr. [**Known lastname 65285**] is a 41-year-old man who was brought to the emergency
room today after he had sustained a traumatic amputation of his
left thumb on a table saw. He works as a truck driver and was at
his home doing some woodworking. He amputated a portion that had
be fished out of the saw and brought with him. There is a
multilevel injury on the amputated part.


Past Medical History:
none

Social History:
nonsmoker, occ EtOH

Family History:
NC

Physical Exam:
As previously noted, prior to the patient arriving in the
operating room, dissection of the amputated part had been
done. The amputation was an oblique one at the metaphysis to
the proximal phalanx with the most tissue on the radial side.
The radial neurovascular bundle had been amputated much more
proximal than the ulnar. An avulsion of the ulnar digital
nerve however was obvious. Reattachment of the radial digital
nerve to the thumb proximally was joined to the ulnar digital
nerve distally. This should give him good protective
sensibility in the very important ulnar pulp surface. In
addition to the proximal amputation, there was a midline deep
laceration through the flexor mechanism through the pulp to
the bone. This was explored, as well, and at this level the
digital vessels had not been injured. After dissecting out
flexors, extensors, nerves, arteries and veins, it was
decided to go ahead with a reattachment effort.


Pertinent Results:
[**2122-12-3**] 11:50AM   WBC-8.0 RBC-5.28 HGB-15.8 HCT-41.7 MCV-79*
MCH-29.9 MCHC-37.9* RDW-12.4

[**2122-12-12**] 02:38AM BLOOD Hct-18.0*
[**2122-12-15**] 02:52AM BLOOD Hct-21.8*

Brief Hospital Course:
Pt was taken to OR for replant of L thumb on [**12-3**]. He was
extubated in the OR, recovered for the usual amount of time in
the PACU, and transferred to the surgical floor. He improved
over POD#1, but on POD#2 the thumb was noted to be dusky. He was
urgently taken back to the OR on [**12-5**], where the replanted
artery was found to be thrombosed. The thumb was revascularized
(see operative report for details) and he was transferred to the
PACU in stable condition. Due to the thrombosis, an aggressive
program of anticoagulation was started to protect the venous
outflow. He was started on a heparin drip as well as leeches and
heparin-soaked sponges. He was transferred to the SICU for close
monitoring of his thumb and blood levels. He syncopized twice
due to blood loss and required several units of RBC transfusion.
After 6 days in the SICU the anticoagulation was gradually
reversed and he was transferred to the surgical floor. He
continued to improve and was discharged home in stable condition
on POD#[**10-18**]. He will follow-up in plastic surgery hand clinic
as instructed.

Medications on Admission:
none

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 2 weeks.
Disp:*28 Capsule(s)* Refills:*0*
3. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain for 2 weeks.
Disp:*50 Tablet(s)* Refills:*0*
5. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 10 days.
Disp:*40 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 8300**] VNA

Discharge Diagnosis:
left thumb traumatic amputation


Discharge Condition:
stable


Discharge Instructions:
Take all medications as prescribed. Keep all follow-up
appointments. Keep the thumb clean and dry. The visiting nurse
will change the dressings daily. Wear the splint at all times.
You may use your fingers but do not put pressure or weight
through the thumb.

Call your doctor or go to the ER if you experience:
-chest pain or shortness of breath
-fevers or chills
-change in color or temperature of the thumb
-drainage, redness, increased pain at the incision sites

Followup Instructions:
Follow-up in the hand clinic on Tuesday ([**12-22**]). Call
[**Telephone/Fax (1) 4652**] to schedule your appointment.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 7738**]
{'Traumatic amputation of thumb (complete)(partial), without mention of complication,Other complications due to other vascular device, implant, and graft,Accidents caused by other powered hand tools,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}


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: left thumb traumatic amputation

PRESENT ILLNESS: Mr. [**Known lastname 65285**] is a 41-year-old man who was brought to the emergency
room today after he had sustained a traumatic amputation of his
left thumb on a table saw. He works as a truck driver and was at
his home doing some woodworking. He amputated a portion that had
be fished out of the saw and brought with him. There is a
multilevel injury on the amputated part.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: As previously noted, prior to the patient arriving in the
operating room, dissection of the amputated part had been
done. The amputation was an oblique one at the metaphysis to
the proximal phalanx with the most tissue on the radial side.
The radial neurovascular bundle had been amputated much more
proximal than the ulnar. An avulsion of the ulnar digital
nerve however was obvious. Reattachment of the radial digital
nerve to the thumb proximally was joined to the ulnar digital
nerve distally. This should give him good protective
sensibility in the very important ulnar pulp surface. In
addition to the proximal amputation, there was a midline deep
laceration through the flexor mechanism through the pulp to
the bone. This was explored, as well, and at this level the
digital vessels had not been injured. After dissecting out
flexors, extensors, nerves, arteries and veins, it was
decided to go ahead with a reattachment effort.

FAMILY HISTORY: NC

SOCIAL HISTORY: nonsmoker, occ EtOH 

### Response:
{'Traumatic amputation of thumb (complete)(partial), without mention of complication,Other complications due to other vascular device, implant, and graft,Accidents caused by other powered hand tools,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}
