CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 83 year old
male status post motor vehicle crash with no loss of
consciousness, [**Location (un) 2611**] coma scale 15, right femur fracture,
subsplenic hematoma.

MEDICAL HISTORY: Coronary artery disease, diabetes
mellitus, hypertension, paroxysmal atrial fibrillation,
congestive heart failure, ejection fraction of 35% with
aortic stenosis 1 cm, 1+ aortic insufficiency plus mitral
regurgitation and tricuspid regurgitation.

MEDICATION ON ADMISSION: Lasix 20 mg q.d.; Imdur 30 mg
q.d.; Accupril 10 mg t.i.d.; Lipitor 40 mg q.d.; Toprol XL
100 mg q.d.; Amiodarone 200 mg q.d.; Mirtazapine 15 mg q.d.;
Coumadin 2 mg q.d.; Levoxyl 50 mg q.d.; Aspirin 81 mg q.d.;
Oxycodone prn.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of subtrochanteric section of neck of femur,Injury to spleen without mention of open wound into cavity, unspecified injury,Rheumatic heart failure (congestive),Atrial fibrillation,Multiple involvement of mitral and aortic valves,Diseases of tricuspid valve,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Aortocoronary bypass status,Unspecified essential hypertension
Subtrochanteric fx-close,Spleen injury NOS-closed,Rheumatic heart failure,Atrial fibrillation,Mitr/aortic mult involv,Tricuspid valve disease,Loss control mv acc-driv,Aortocoronary bypass,Hypertension NOS
Admission Date:  [**2160-3-20**]       Discharge Date: [**2160-3-25**]


Service:  Trauma Surgery

HISTORY OF PRESENT ILLNESS:  The patient is an 83 year old
male status post motor vehicle crash with no loss of
consciousness, [**Location (un) 2611**] coma scale 15, right femur fracture,
subsplenic hematoma.

PAST MEDICAL HISTORY:  Coronary artery disease, diabetes
mellitus, hypertension, paroxysmal atrial fibrillation,
congestive heart failure, ejection fraction of 35% with
aortic stenosis 1 cm, 1+ aortic insufficiency plus mitral
regurgitation and tricuspid regurgitation.

PAST SURGICAL HISTORY:  Coronary artery bypass graft, carotid
endarterectomy in [**2151**].

MEDICATIONS ON ADMISSION:  Lasix 20 mg q.d.; Imdur 30 mg
q.d.; Accupril 10 mg t.i.d.; Lipitor 40 mg q.d.; Toprol XL
100 mg q.d.; Amiodarone 200 mg q.d.; Mirtazapine 15 mg q.d.;
Coumadin 2 mg q.d.; Levoxyl 50 mg q.d.; Aspirin 81 mg q.d.;
Oxycodone prn.

LABORATORY DATA ON ADMISSION:  White blood cells 10.8,
hemoglobin 11.9, hematocrit 36.8, platelet count 110.  PT
17.3, PTT 35.6 and INR 2.0.  Fibrinogen 428, glucose 219,
urea 36, creatinine 1.2, sodium 139, potassium 4.5, chloride
107, bicarbonate 24, anion gap of 13.  CPK 96, amylase 67,
calcium 8.2, phosphorus 4.2 and magnesium 1.8.  Toxicology
screen was negative.  There was no pertinent microbiology.

Radiology - Trauma Series performed without comparison showed
a right femoral fracture, essentially subtrochanteric
although a portion of the lesser trochanter appears to be
attached to the distal fragment.  Radiographs of the right
hand reviewed showed a fracture at the base of the right
fifth metacarpal.  Computerized tomography scan of the
abdomen revealed a right femoral fracture as described above,
subcapsular splenic hematoma and contusion, slight
enlargement of the right psoas with small areas of focal
enhancement probably representing soft tissue injury
associated with right femoral fracture, and chronic changes
of the lungs at the bases.  Radiographs of the spine revealed
cervical spine, minimal anterolisthesis of C4 on C5,
degenerative changes and osteopenia, no fracture detected.
Thoracic spine with mild anterior wedge compression fractures
of two upper thoracic vertebra bodies, questionable T4 and
T5.  These are of indeterminate acuity.  Lumbar spine,
osteopenia, no fracture detected.  The sacrum was obscured.
A computerized tomography scan reconstruction was cone on the
spine computerized tomography scan, and showed no evidence of
fracture, Grade 1 C4 on C5 anterolisthesis, degenerative
changes most pronounced at C5-6 and C6-7 areas.  The thyroid
gland appears enlarged with multiple locations and a flexion,
extension comparison of the cervical spine showed multilevel
instability of the cervical spine with flexion, multilevel
degenerative changes of the cervical spine.

HOSPITAL COURSE:  On [**2160-3-21**], an intramedullary rod
was used to fixate the right subtrochanteric femur fracture
by the Orthopedic Service without incident.  The right fifth
metacarpal fracture was splinted on [**2160-3-20**].
Flexion and extension views of the cervical spine were viewed
by Dr. [**First Name (STitle) 1022**] of the Orthopedic Team and it was decided that the
collar may come off.  The patient was also cleared clinically
with removal of the cervical collar.

DISCHARGE DIAGNOSIS:
1.  Right femoral fracture.
2.  Subcapsular splenic hematoma.
3.  Right fifth metacarpal fracture.
4.  Questionable compression fracture of T4-5.
5.  Coronary artery disease.
6.  Diabetes mellitus.
7.  Hypertension.
8.  Paroxysmal atrial fibrillation.
9.  Congestive heart failure.

An addendum will be added upon discharge of the patient.



                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D.  [**MD Number(1) 521**]

Dictated By:[**Last Name (NamePattern1) 52643**]
MEDQUIST36

D:  [**2160-3-25**]  07:36
T:  [**2160-3-25**]  07:49
JOB#:  [**Job Number 52699**]


Name:  [**Known lastname 9805**], [**Known firstname 33**]                     Unit No:  [**Numeric Identifier 9806**]

Admission Date:  [**2160-3-20**]     Discharge Date:  [**2160-3-26**]

Date of Birth:   [**2076-5-24**]     Sex:  M

Service:  Trauma Surgery

DISPOSITION:  Patient was discharged to rehab center.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSES:
1. Right femur fracture.
2. Subcapsular splenic hematoma.
3. Questionable compression fracture of T4-5.
4. Diabetes mellitus.
5. Hypertension.
6. Congestive heart failure.
7. Coronary artery disease.
8. Paroxysmal atrial fibrillation.

DISCHARGE MEDICATIONS:
1. Mirtazapine 15 mg tablet one tablet p.o. h.s.
2. Amiodarone 200 mg one tablet p.o. q.d.
3. Quinapril 10 mg tablet p.o. q.d.
4. Polyvinyl alcohol 1.___% drops 1-2 drops prn.
5. Furosemide 20 mg tablet p.o. q.d.
6. Enoxaparin 40 mg/0.4 mL syringe q.d. subq, hold if INR is
greater than or equal to 2.0.
7. Levothyroxine 50 mcg one tablet p.o. q.d.
8. Aspirin 81 mg tablet p.o. q.d.
9. Metoprolol 50 mg tablet one tablet p.o. b.i.d.
10. Isosorbide mononitrate 30 mg tablet one tablet p.o. q.d.
11. Acetaminophen 500 mg tablet two tablets p.o. q.6h.
12. Coumadin 2 mg tablet p.o. q.d.
13. Potassium 20 mEq packet two packets p.o. q.d.  Hold for
potassium over 5.0.

FOLLOW-UP PLANS:  Patient is to see Hand Clinic within two
weeks at phone number [**Telephone/Fax (1) 5721**].  Patient is also to
followup with Trauma Clinic within two weeks, [**Telephone/Fax (1) 5721**].
Patient will see the [**Hospital **] Clinic within two weeks,
[**Telephone/Fax (1) 809**], and patient was also instructed to followup
with his primary care provider within two weeks.  Primary
care provider was [**Name (NI) 178**] yesterday, and is aware that
patient is being discharged and final condition, and
diagnoses, and treatments.



                          [**First Name11 (Name Pattern1) 1080**] [**Last Name (NamePattern4) 3711**], M.D.  [**MD Number(1) 3712**]

Dictated By:[**Last Name (NamePattern1) 9794**]

MEDQUIST36

D:  [**2160-3-26**]  09:37
T:  [**2160-3-26**]  11:42
JOB#:  [**Job Number 9807**]
{'Closed fracture of subtrochanteric section of neck of femur,Injury to spleen without mention of open wound into cavity, unspecified injury,Rheumatic heart failure (congestive),Atrial fibrillation,Multiple involvement of mitral and aortic valves,Diseases of tricuspid valve,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Aortocoronary bypass status,Unspecified essential hypertension'}


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: 

PRESENT ILLNESS: The patient is an 83 year old
male status post motor vehicle crash with no loss of
consciousness, [**Location (un) 2611**] coma scale 15, right femur fracture,
subsplenic hematoma.

MEDICAL HISTORY: Coronary artery disease, diabetes
mellitus, hypertension, paroxysmal atrial fibrillation,
congestive heart failure, ejection fraction of 35% with
aortic stenosis 1 cm, 1+ aortic insufficiency plus mitral
regurgitation and tricuspid regurgitation.

MEDICATION ON ADMISSION: Lasix 20 mg q.d.; Imdur 30 mg
q.d.; Accupril 10 mg t.i.d.; Lipitor 40 mg q.d.; Toprol XL
100 mg q.d.; Amiodarone 200 mg q.d.; Mirtazapine 15 mg q.d.;
Coumadin 2 mg q.d.; Levoxyl 50 mg q.d.; Aspirin 81 mg q.d.;
Oxycodone prn.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of subtrochanteric section of neck of femur,Injury to spleen without mention of open wound into cavity, unspecified injury,Rheumatic heart failure (congestive),Atrial fibrillation,Multiple involvement of mitral and aortic valves,Diseases of tricuspid valve,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Aortocoronary bypass status,Unspecified essential hypertension'}
