CHIEF COMPLAINT: Gunshot wound to abdomen

PRESENT ILLNESS: Mr. [**Known lastname 18937**] is a 15-year-old male who was shot in the right lower
quadrant at approximately 0300 on [**2186-11-21**].  He was taken to [**Hospital 40576**] by EMS where he evidently had a GCS of 15,
positive FAST, and hemorrhagic shock.  He was taken to the
operating room and I (Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]) have discussed the
details of this with Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) **] of [**Hospital3 **].  He
evidently had a stapled repair of a cecal injury as well as
ligation of the right iliac vein.  He also had a segmental loss
of external iliac artery for which he had an external iliac to
common femoral artery inter-position graft.  The bullet was
reported to remain in the right iliac fossa.  He was then
transferred here due to blood bank depletion and need for
critical care.  During transfer (helicopter), he evidently had a
systolic pressure between 30 and 90 mmHg.
.
On arrival, his pressure was 50 systolic.  He had had
approximately 30 units of packed cells, 2 units of platelets, 23
liters of crystalloid, and 6 units of plasma prior to arrival.
His blood loss had been estimated at 18 liters and his urine
output had been 100 mL.  He was hypothermic (initial temperature
here was 88 degrees Fahrenheit), profoundly acidotic (pH of 6.7,
Base deficit of 29, Lactate of 20), and profoundly coagulopathic
(INR reported at 7, would later increase to 22).  CXR from
referring hospital demonstrates no pneumothorax or effusion by
attending surgeon read.
.
Upon his arrival to the TSICU, massive transfusion protocol was
initiated and the patient was taken emergently to the operating
room for exploration of his open (covered) abdominal wound.

MEDICAL HISTORY: Reportedly in good health prior to admission
.
Past Surgical History: Appendectomy, date unspecified.

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pt expired.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Per report from his mother, the patient has been a "runaway"
since [**2186-11-14**].  Parents are divorced.  Mother lives locally,
Father lives in [**State 108**].  No other social history obtained.
Injury to other intra-abdominal organs with open wound into cavity, unspecified intra-abdominal organ,Traumatic shock,Other and unspecified coagulation defects,Acute posthemorrhagic anemia,Injury to iliac artery,Rhabdomyolysis,Assault by handgun,Hypothermia,Injury to other gastrointestinal sites, with open wound into cavity,Hyperpotassemia
Intra-abdom inj NOS-open,Traumatic shock,Coagulat defect NEC/NOS,Ac posthemorrhag anemia,Injury iliac artery,Rhabdomyolysis,Assault-handgun,Hypothermia,GI injury NEC-open,Hyperpotassemia
Admission Date:  [**2186-11-21**]              Discharge Date:   [**2186-11-22**]

Date of Birth:  [**2171-9-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
Gunshot wound to abdomen

Major Surgical or Invasive Procedure:
Exploratory laparotomy
Abdominal Washout
Right lower extremity fasciotomy
Placement of Swann-Ganz catheter
Placement of central venous catheters


History of Present Illness:
Mr. [**Known lastname 18937**] is a 15-year-old male who was shot in the right lower
quadrant at approximately 0300 on [**2186-11-21**].  He was taken to [**Hospital 40576**] by EMS where he evidently had a GCS of 15,
positive FAST, and hemorrhagic shock.  He was taken to the
operating room and I (Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]) have discussed the
details of this with Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) **] of [**Hospital3 **].  He
evidently had a stapled repair of a cecal injury as well as
ligation of the right iliac vein.  He also had a segmental loss
of external iliac artery for which he had an external iliac to
common femoral artery inter-position graft.  The bullet was
reported to remain in the right iliac fossa.  He was then
transferred here due to blood bank depletion and need for
critical care.  During transfer (helicopter), he evidently had a
systolic pressure between 30 and 90 mmHg.
.
On arrival, his pressure was 50 systolic.  He had had
approximately 30 units of packed cells, 2 units of platelets, 23
liters of crystalloid, and 6 units of plasma prior to arrival.
His blood loss had been estimated at 18 liters and his urine
output had been 100 mL.  He was hypothermic (initial temperature
here was 88 degrees Fahrenheit), profoundly acidotic (pH of 6.7,
Base deficit of 29, Lactate of 20), and profoundly coagulopathic
(INR reported at 7, would later increase to 22).  CXR from
referring hospital demonstrates no pneumothorax or effusion by
attending surgeon read.
.
Upon his arrival to the TSICU, massive transfusion protocol was
initiated and the patient was taken emergently to the operating
room for exploration of his open (covered) abdominal wound.


Past Medical History:
Reportedly in good health prior to admission
.
Past Surgical History: Appendectomy, date unspecified.

Social History:
Per report from his mother, the patient has been a "runaway"
since [**2186-11-14**].  Parents are divorced.  Mother lives locally,
Father lives in [**State 108**].  No other social history obtained.

Family History:
Noncontributory

Physical Exam:
Pt expired.

Pertinent Results:
[**2186-11-22**] CXR: FINDINGS:  In comparison with the study of [**11-21**],
there is probable progression of the diffuse bilateral alveolar
opacifications presenting a bat-[**Doctor First Name 362**] pattern.  Although most
consistent with noncardiogenic pulmonary edema, the possibility
of diffuse hemorrhage or even infection or ARDS must be
considered. Swan-Ganz catheter has been pulled back to the tip
of the pulmonary outflow tract.  Endotracheal tube remains in
place, as does the nasogastric tube.
.
[**2186-11-21**] XR PELVIS:  Tubing and a balloon device overlies the
pelvis. Multiple other iatrogenic devices are seen.  Skin
staples are present. Of note, there is a bullet overlying the
soft tissues of the medial proximal right thigh. Although bony
detail on this image is quite limited, no obvious fracture is
identified.
.
[**2186-11-21**] KUB PORTABLE: HISTORY:  Critical gunshot.  No other
clinical indication available to me at this time. Single AP
portable view obtained in the OR of the abdomen. An NG tube is
present, tip over stomach.  Two drains are present.  Additional
surgical instrumentation and skin staples and overlying artifact
are present. Assessment of fine detail in the abdomen is limited
-- ? fluid in abdomen. No bullet is detected in the abdomen on
this film. At the periphery of these films, there are findings
raising the question of increased density at the lung bases.
.
[**2186-11-22**] 12:00AM   GLUCOSE-47* UREA N-12 CREAT-1.8* SODIUM-145
POTASSIUM-6.4* CHLORIDE-110* TOTAL CO2-19* ANION GAP-22*
[**2186-11-22**] 12:00AM   CALCIUM-10.1 PHOSPHATE-6.8* MAGNESIUM-2.2
[**2186-11-22**] 12:00AM   WBC-1.6* RBC-3.01* HGB-9.8* HCT-26.7* MCV-89
MCH-32.5* MCHC-36.5* RDW-14.2
[**2186-11-22**] 12:00AM   PLT COUNT-96*
[**2186-11-22**] 12:00AM   PT-18.8* PTT-48.6* INR(PT)-1.7*
[**2186-11-21**] 10:11PM   TYPE-ART PO2-143* PCO2-44 PH-7.24* TOTAL
CO2-20* BASE XS--8
[**2186-11-21**] 10:01PM   WBC-1.5* RBC-3.26* HGB-10.2* HCT-28.9* MCV-89
MCH-31.4 MCHC-35.4* RDW-14.0
[**2186-11-21**] 10:01PM   PT-22.0* PTT-67.5* INR(PT)-2.1*
[**2186-11-21**] 08:13PM   ALT(SGPT)-446* AST(SGOT)-783* LD(LDH)-1099*
ALK PHOS-49 AMYLASE-143* TOT BILI-0.7
[**2186-11-21**] 08:13PM   LIPASE-89*
[**2186-11-21**] 08:13PM   ALBUMIN-2.4* CALCIUM-10.5 PHOSPHATE-5.3*
MAGNESIUM-1.7

Brief Hospital Course:
Upon his arrival to the TSICU, massive transfusion protocol was
initiated and the patient was taken emergently to the operating
room for exploration of his open (covered) abdominal wound by
Dr. [**Last Name (STitle) **]. (see op note for detail) After leaving the
operating room, Pt arrived to TSICU with tenuous blood pressure.
 Pt arrested multiple times and was resuscitated with
blood/platelets/plasma and pressor support. Pt received 90+
units of blood products, was on vasopressor support throughout,
multiple amps of bicarb, Factor 7.  On postoperative day 1, the
patient was hyperkalemic, continued to be acidotic, coded
multiple time for bradycardic arrest, ventricular fibrillation,
asystole, profound hypotension.  Right lower extremity
fasciotomies were performed by the Vascular Surgery team.
Muscle appeared to be somewhat viable but did not bleed well.
Pt. again arrest approximately at 515 PM and expired.

Medications on Admission:
None

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Gunshot wound to abdomen


Discharge Condition:
Expired


Discharge Instructions:
None

Followup Instructions:
None - Patient Expired
{'Injury to other intra-abdominal organs with open wound into cavity, unspecified intra-abdominal organ,Traumatic shock,Other and unspecified coagulation defects,Acute posthemorrhagic anemia,Injury to iliac artery,Rhabdomyolysis,Assault by handgun,Hypothermia,Injury to other gastrointestinal sites, with open wound into cavity,Hyperpotassemia'}


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: Gunshot wound to abdomen

PRESENT ILLNESS: Mr. [**Known lastname 18937**] is a 15-year-old male who was shot in the right lower
quadrant at approximately 0300 on [**2186-11-21**].  He was taken to [**Hospital 40576**] by EMS where he evidently had a GCS of 15,
positive FAST, and hemorrhagic shock.  He was taken to the
operating room and I (Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]) have discussed the
details of this with Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) **] of [**Hospital3 **].  He
evidently had a stapled repair of a cecal injury as well as
ligation of the right iliac vein.  He also had a segmental loss
of external iliac artery for which he had an external iliac to
common femoral artery inter-position graft.  The bullet was
reported to remain in the right iliac fossa.  He was then
transferred here due to blood bank depletion and need for
critical care.  During transfer (helicopter), he evidently had a
systolic pressure between 30 and 90 mmHg.
.
On arrival, his pressure was 50 systolic.  He had had
approximately 30 units of packed cells, 2 units of platelets, 23
liters of crystalloid, and 6 units of plasma prior to arrival.
His blood loss had been estimated at 18 liters and his urine
output had been 100 mL.  He was hypothermic (initial temperature
here was 88 degrees Fahrenheit), profoundly acidotic (pH of 6.7,
Base deficit of 29, Lactate of 20), and profoundly coagulopathic
(INR reported at 7, would later increase to 22).  CXR from
referring hospital demonstrates no pneumothorax or effusion by
attending surgeon read.
.
Upon his arrival to the TSICU, massive transfusion protocol was
initiated and the patient was taken emergently to the operating
room for exploration of his open (covered) abdominal wound.

MEDICAL HISTORY: Reportedly in good health prior to admission
.
Past Surgical History: Appendectomy, date unspecified.

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pt expired.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Per report from his mother, the patient has been a "runaway"
since [**2186-11-14**].  Parents are divorced.  Mother lives locally,
Father lives in [**State 108**].  No other social history obtained. 

### Response:
{'Injury to other intra-abdominal organs with open wound into cavity, unspecified intra-abdominal organ,Traumatic shock,Other and unspecified coagulation defects,Acute posthemorrhagic anemia,Injury to iliac artery,Rhabdomyolysis,Assault by handgun,Hypothermia,Injury to other gastrointestinal sites, with open wound into cavity,Hyperpotassemia'}
