CHIEF COMPLAINT: single-car MVC, amnestic to event

PRESENT ILLNESS: 55yo M MVC head on collision w/parked trailer, unknown speed.
Amnestic to event. AAOx3 upon arrival. IO infiltrated during
transport.

MEDICAL HISTORY: HTN, gout, chronic low back pain

MEDICATION ON ADMISSION: Paroxetine 20mg daily
amitryptiline 25mg daily
trazadone 150mg daily
norvasc 10mg daily
atenolol 50mg [**Hospital1 **]
simvastatin 40mg daily
actos 45mg daily
allopurinol 100mg daily
indomethacin 50mg TID:prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: unk

SOCIAL HISTORY: Married. Self-employed courrier. UNK ETOH, tobacco, drugs
Closed fracture of lower end of femur, unspecified part,Urinary tract infection, site not specified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Pulmonary collapse,Closed fracture of eight or more ribs,Closed fracture of ilium,Functional quadriplegia,Closed fracture of unspecified part of fibula with tibia,Injury to other gastrointestinal sites, without mention of open wound into cavity,Closed fracture of patella,Street and highway accidents,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Gout, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other iatrogenic hypotension,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abnormal sputum
Fx low end femur NOS-cl,Urin tract infection NOS,Fx dorsal vertebra-close,Pulmonary collapse,Fx eight/more rib-closed,Fracture of ilium-closed,Functional quadriplegia,Fx tibia w fibula NOS-cl,GI injury NEC-closed,Fracture patella-closed,Accid on street/highway,Mv collision NOS-driver,Hypertension NOS,Gout NOS,Enterococcus group d,Iatrogenc hypotnsion NEC,Abn react-procedure NEC,DMII wo cmp nt st uncntr,Abnormal sputum
Admission Date:  [**2163-12-8**]              Discharge Date:   [**2163-12-30**]

Date of Birth:  [**2113-8-30**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 974**]
Chief Complaint:
single-car MVC, amnestic to event

Major Surgical or Invasive Procedure:
1. Open reduction internal fixation of left femur distal
fracture with 9-hole [**Last Name (un) 101**] plate.
2. Traction and closed reduction of right tibia pilon and fibula
fracture with application of multi-plate internal fixator for
restoration of alignment.
3. Removal of external fixator for R pilon fracture
4. Open reduction internal fixation R pilon (distal tibia and
distal fibular) fracture.
5. Tracheostomy.
6. Percutaneous endoscopic gastrostomy.
7. Inferior vena cava filter (Bard G2) placement.


History of Present Illness:
55yo M MVC head on collision w/parked trailer, unknown speed.
Amnestic to event. AAOx3 upon arrival. IO infiltrated during
transport.

Past Medical History:
HTN, gout, chronic low back pain

Social History:
Married. Self-employed courrier. UNK ETOH, tobacco, drugs

Family History:
unk

Pertinent Results:
.
Radiographic Studies:
[**2163-12-8**] CT cspine: "1. No acute cervical fracture.
2. Mild rotation of C1 compared to C2, likely positional, but
cannot
completely exclude rotatory subluxation."

[**2163-12-8**] CT head:  "No acute intracranial hemorrhage or
fracture."

[**2163-12-9**] CT Tspine: "Again noted is a fracture of the T8
vertebral body with minimal displacement of fracture fragments
extending into the posterior one-third of the vertebral body. No
definite involvement of the pedicles is seen."

[**12-24**] CT Torso: "1. No CT findings to explain the patient's
fevers. No evidence of pneumonia. 2. Unchanged bibasilar
atelectasis and small pleural effusions. 3. Unchanged diffuse
fatty infiltration of the liver.
4. Dense material within the gallbladder could represent
vicarious excretion of contrast from previous radiographic
studies, versus concentrated bile. 5. Unchanged stranding
adjacent to the hepatic flexure of the colon, most consistent
with mesenteric hematoma. There may also be a small adjacent
subcapsular liver hematoma."

Microbiology studies:
[**2163-12-10**] 9:00 pm URINE      Source: Catheter.

URINE CULTURE (Final [**2163-12-13**]):
      ENTEROCOCCUS SP..    10,000-100,000 ORGANISMS/ML..

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ENTEROCOCCUS SP.
                             |
AMPICILLIN------------   <=2 S
NITROFURANTOIN--------  <=16 S
TETRACYCLINE----------  =>16 R
VANCOMYCIN------------     2 S

[**2163-12-12**] 10:49 am URINE      Source: Catheter.
.
URINE CULTURE (Final [**2163-12-14**]):
      ENTEROCOCCUS SP..    >100,000 ORGANISMS/ML..

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ENTEROCOCCUS SP.
                             |
AMPICILLIN------------   <=2 S
NITROFURANTOIN--------  <=16 S
TETRACYCLINE----------  =>16 R
VANCOMYCIN------------     2 S

[**2163-12-19**] 5:36 am URINE      Source: Catheter.
.
URINE CULTURE (Final [**2163-12-20**]):    NO GROWTH.
.
[**2163-12-11**] 8:48 am SPUTUM      Source: Endotracheal.
GRAM STAIN (Final [**2163-12-11**]):
      >25 PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   GRAM NEGATIVE ROD(S).
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS, CHAINS, AND
CLUSTERS.
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE ROD(S).
      SMEAR REVIEWED; RESULTS CONFIRMED.

   RESPIRATORY CULTURE (Final [**2163-12-13**]):
      MODERATE GROWTH OROPHARYNGEAL FLORA.
      STAPH AUREUS COAG +.    MODERATE GROWTH.
         Staphylococcus species may develop resistance during
prolonged
         therapy with quinolones.   Therefore, isolates that are
initially
         susceptible may become resistant within three to four
days after
         initiation of therapy.  Testing of repeat isolates may
be
         warranted.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------<=0.25 S
ERYTHROMYCIN----------<=0.25 S
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------  0.25 S
OXACILLIN-------------<=0.25 S
PENICILLIN G---------- =>0.5 R
TRIMETHOPRIM/SULFA---- <=0.5 S
.
[**2163-12-12**] 10:40 am BRONCHOALVEOLAR LAVAGE
GRAM STAIN (Final [**2163-12-12**]):
      4+   (>10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
      2+   (1-5 per 1000X FIELD):   GRAM NEGATIVE ROD(S).
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE ROD(S).
      SMEAR REVIEWED; RESULTS CONFIRMED.

   RESPIRATORY CULTURE (Final [**2163-12-14**]):
      OROPHARYNGEAL FLORA ABSENT.
      STAPH AUREUS COAG +.    >100,000 ORGANISMS/ML..
         SENSITIVITIES PERFORMED ON CULTURE # [**Numeric Identifier 81468**] FROM
[**2163-12-11**].
.
[**2163-12-19**] 5:36 am SPUTUM      Source: Endotracheal.
GRAM STAIN (Final [**2163-12-19**]):
      <10 PMNs and <10 epithelial cells/100X field.
      NO MICROORGANISMS SEEN.
      QUALITY OF SPECIMEN CANNOT BE ASSESSED.

   RESPIRATORY CULTURE (Final [**2163-12-21**]):    NO GROWTH.
.


Brief Hospital Course:
[**2163-12-8**]: Admitted to TICU, RIJ CVL placed. Serial Hct overnight.
Requiring phenylephrine for BP support.
[**12-9**]: weaned neo -> pt. off early afternoon then temp to 101.6,
BP down, and tachy to 120s -> restarted neo -> changed to levo
in the evening -> weaned off early AM, gave 1u PRBCs; gave one
dose of ablumin; Spine ordered TLSO brace; repeat CT of abdomen
stable; UOP marginal but picking up in last several hours; CKs
trending down; Bump in Cr overnight -> but now trending down
[**12-10**]: transfused 2 U pRBC, spiked temp of 101.9
[**12-11**]: Checking q8H Hct, gets agitated when off sedation
[**12-12**]: temp to 101.3 in am -> pan cultured, TLSO delivered ->
neuro still rec log roll and brace when HOB>30deg, bronch for
copious secretions LL>RL -> BAL sent; urine w/low number of
enterococcus in culture -> ua still negative; ETT with cuff leak
-> one-way stop cock placed on balloon and improved balloon
integrity
[**12-13**]: vanc started, colchicine started for gout, to OR in AM w
ortho and trach/PEG [**12-14**], enterococcus in urine and BAL w coag +
staph.
[**12-14**]: Started on [**1-25**] strength feeds and meds switched to D5W
diluent. UC resent. Spiked temp overnight and was pancultured.
[**12-15**]: foley replaced; vanco to continue for the next 2 days ->
then switch to nafcillin for MSSA pna; TF held in anticipation
of OR --> to go [**12-16**] with trauma for trach/PED/IVC
[**12-16**]:BLENIs negative, PEEP decreased, OR case cancelled, TFs
restarted and held again after midnight
[**12-17**]: went to OR for trach, PEG, IVC filter. Dc'd vanco, started
on nafcillin. To start using GJ tube [**12-17**] evening. Will have
full strenth TFs at 85cc/hr with 125cc free water q 4H. Started
on metoprolol via J tube. Pancultured overnight.
[**12-18**]: a-line resited to L radial, PS for good part of the day -
then with pCO2 near 60 -> switched to CMV; spike fever at 0445
am to 101.2 -> pan cultured, given tylenol -> will need CVL
changed out
[**12-19**]: 2u PRBCs given; OR for RLE ORIF; weaned to trach mask;
weaning sedation; methadone started; [**Doctor Last Name 6587**] ordered; mental
status clearing. New SCV Line.
[**12-20**]: Trial of trach mask, switched back to PSV. Received
dulcolax supp to move bowels, continue free water, wearing TLS
support and knee brace, requested podiatry consult for gout,
speech and swallow and PT consult. Awaiting Trapeze and new bed.

.
[**12-24**]: continued to spike fevers and rising WBC;  a repeat CT
torso was obtained that demonstrated no changes to his prior CT.
 Again, tolerated short periods of trach collar.  He was
restarted on Colchine for a presumptive gout flare.

From the period of [**3-13**], his WBC normalized and he did not
spike any fevers.  ABGs and VBGs did demonstrate hypercarbia.
He still required periods of CPAP/PS during the day/night.
Given his persistent hypercarbia, his tube feeds were changed
from Replete with Fiber to Pulmacare tube feedings, of a lower
carbohydrate composition.  His CVL was removed and a PICC was
placed with confirmation of position.  Speech and swallow
attempted Passy-Muir valve trials, but he only tolerated a brief
period and recommended continued therapy in rehab.  He currently
has a Shiley #8, extended length, cuffed.

Medications on Admission:
Paroxetine 20mg daily
amitryptiline 25mg daily
trazadone 150mg daily
norvasc 10mg daily
atenolol 50mg [**Hospital1 **]
simvastatin 40mg daily
actos 45mg daily
allopurinol 100mg daily
indomethacin 50mg TID:prn

Discharge Medications:
1. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Five (5) ML
Mucous membrane [**Hospital1 **] (2 times a day).
2. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection TID (3 times a day).
3. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed.
4. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ml PO Q8H
(every 8 hours) as needed for oral thrush.
5. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
TID (3 times a day) as needed for itching.
6. Oxycodone 5 mg/5 mL Solution Sig: Five (5) ml PO Q3H (every 3
hours) as needed for pain / aggitation.
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
10. Insulin Regular Human 100 unit/mL Solution Sig: One (1) inj
Injection ASDIR (AS DIRECTED).
11. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Haloperidol 2 mg Tablet Sig: One (1) Tablet PO QID (4 times
a day) as needed.
13. Atenolol 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
14. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

15. Dicloxacillin 500 mg Capsule Sig: One (1) Capsule PO Q6H
(every 6 hours): to end on [**2164-1-4**].
16. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
17. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
18. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
19. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day). Tablet(s)
20. Indomethacin 25 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
21. Erythromycin 5 mg/g Ointment Sig: One (1) gtt Ophthalmic QID
(4 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] Northeast - [**Location (un) 701**]

Discharge Diagnosis:
Left distal femur fracture,
right tibial and fibular fracture,
mesenteric hematoma,
left 5,7,10 rib fractures,
right iliac [**Doctor First Name 362**] fracture extending to the acetabulum,
superior sternal fracture,
T8 vertebral body fracture.
ventilator-associated pneumonia
ventilator-dependence


Discharge Condition:
Afebrile.  Vital signs stable. Intermittently tolerating trach
mask for short intervals. Ice chips PO w/tube feeds at goal
through the PEG.


Discharge Instructions:
Do not take anything by mouth except ice chips until you are
evaluated again by speech and swallow.  You need to wear your
TLSO brace until your are told not to by Dr [**Last Name (STitle) 548**].

Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
diarrhea or other reasons. Signs of dehydration include dry
mouth, rapid heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.


Followup Instructions:
Please follow up with Dr [**Last Name (STitle) **] in trauma clinic in 2 weeks. Call
[**Telephone/Fax (1) 600**] to make an appointment. You will need a repeat
chest xray before this appointment, make sure to let the
secretary know when you make your appointment.

Please follow up regarding your T8 fracture with Dr [**Last Name (STitle) 548**] in 4
weeks.  Call ([**Telephone/Fax (1) 11314**] to schedule this appointment.  You
will need to have repeat lumbar and thoracic xrays before this
visit.  Let the secretary know this when you make your
appointment.

Please follow up in 1 week with Dr [**Last Name (STitle) 1005**] for your femur,
tibia, and fibula fractures. Call ([**Telephone/Fax (1) 2007**] to make an
appointment.  You will also need repeat xrays of your left femur
and right tibia and fibula before this appointment, let the
secretary know this when you schedule your appointment.





Name:  [**Known lastname 13060**],[**Known firstname 77**]                 Unit No:   [**Numeric Identifier 13061**]

Admission Date:  [**2163-12-8**]              Discharge Date:   [**2163-12-30**]

Date of Birth:  [**2113-8-30**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 10929**]
Addendum:
**Patient is not on allopurinol or Flomax**

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2215**] Northeast - [**Location (un) 50**]

                             [**First Name11 (Name Pattern1) 389**] [**Last Name (NamePattern1) 3595**] MD [**MD Number(1) 3596**]

Completed by:[**2163-12-30**]
{'Closed fracture of lower end of femur, unspecified part,Urinary tract infection, site not specified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Pulmonary collapse,Closed fracture of eight or more ribs,Closed fracture of ilium,Functional quadriplegia,Closed fracture of unspecified part of fibula with tibia,Injury to other gastrointestinal sites, without mention of open wound into cavity,Closed fracture of patella,Street and highway accidents,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Gout, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other iatrogenic hypotension,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abnormal sputum'}


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: single-car MVC, amnestic to event

PRESENT ILLNESS: 55yo M MVC head on collision w/parked trailer, unknown speed.
Amnestic to event. AAOx3 upon arrival. IO infiltrated during
transport.

MEDICAL HISTORY: HTN, gout, chronic low back pain

MEDICATION ON ADMISSION: Paroxetine 20mg daily
amitryptiline 25mg daily
trazadone 150mg daily
norvasc 10mg daily
atenolol 50mg [**Hospital1 **]
simvastatin 40mg daily
actos 45mg daily
allopurinol 100mg daily
indomethacin 50mg TID:prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: unk

SOCIAL HISTORY: Married. Self-employed courrier. UNK ETOH, tobacco, drugs 

### Response:
{'Closed fracture of lower end of femur, unspecified part,Urinary tract infection, site not specified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Pulmonary collapse,Closed fracture of eight or more ribs,Closed fracture of ilium,Functional quadriplegia,Closed fracture of unspecified part of fibula with tibia,Injury to other gastrointestinal sites, without mention of open wound into cavity,Closed fracture of patella,Street and highway accidents,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Gout, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other iatrogenic hypotension,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abnormal sputum'}
