CHIEF COMPLAINT: S/P Fall from bicycle

PRESENT ILLNESS: 53 yo male who was found down at bottom of [**Doctor Last Name **] on the pavement
reportedly fell from bicycle while traveling down a [**Doctor Last Name **]; +
helmet.  GCS at scene was 11. He was taken to an area hospital
and was later transferrred to [**Hospital1 18**] for continued trauma care.

MEDICAL HISTORY: DM
Hypothyroidism
Hypertension

MEDICATION ON ADMISSION: Insulin
Levoxyl
"Blood pressure" med

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vital signs: T: 95.8  HR 82  BP 126/56  RR 18  Sat 98%
General: No acute distress, alert and oriented X 3
Head: PERRL, EOMI
Neck: C-collar
Chest: Breath sounds equal bilaterally, anterior chest wall
tender to palpation
Cardio: RRR, normal S1S2
Abdomen: Soft, nontender, nondistended; FAST negative; Rectal
with normal, guiac negative.
Pelvis: Unstable
Extremeties:  Right arm + shoulder with large abrasion
Back:  No stepoffs
Skin: wwp

FAMILY HISTORY: Noncontibutory

SOCIAL HISTORY: Married, lives with his wife.
Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of pubis,Closed fracture of six ribs,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Closed fracture of shaft of clavicle,Closed fracture of upper end of tibia alone,Closed fracture of malar and maxillary bones,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Contusion of lung without mention of open wound into thorax,Open wound of forearm, without mention of complication,Abrasion or friction burn of elbow, forearm, and wrist, without mention of infection,Abrasion or friction burn of shoulder and upper arm, without mention of infection,Abrasion or friction burn of hip, thigh, leg, and ankle, without mention of infection,Pedal cycle accident injuring pedal cyclist,Unspecified essential hypertension,Unspecified acquired hypothyroidism
Cl skull vlt fx w/o coma,Traum pneumohemothor-cl,Fracture of pubis-closed,Fracture six ribs-closed,Fx sacrum/coccyx-closed,Atrial fibrillation,DMI wo cmp nt st uncntrl,Fx clavicle shaft-closed,Fx upper end tibia-close,Fx malar/maxillary-close,Cl skul base fx w/o coma,Lung contusion-closed,Open wound of forearm,Abrasion forearm,Abrasion shoulder/arm,Abrasion hip & leg,Ped cycl acc-ped cyclist,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2173-6-11**]              Discharge Date:   [**2173-6-26**]

Date of Birth:  [**2119-10-29**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
S/P Fall from bicycle

Major Surgical or Invasive Procedure:
None


History of Present Illness:
53 yo male who was found down at bottom of [**Doctor Last Name **] on the pavement
reportedly fell from bicycle while traveling down a [**Doctor Last Name **]; +
helmet.  GCS at scene was 11. He was taken to an area hospital
and was later transferrred to [**Hospital1 18**] for continued trauma care.

Past Medical History:
DM
Hypothyroidism
Hypertension

Social History:
Married, lives with his wife.

Family History:
Noncontibutory

Physical Exam:
Vital signs: T: 95.8  HR 82  BP 126/56  RR 18  Sat 98%
General: No acute distress, alert and oriented X 3
Head: PERRL, EOMI
Neck: C-collar
Chest: Breath sounds equal bilaterally, anterior chest wall
tender to palpation
Cardio: RRR, normal S1S2
Abdomen: Soft, nontender, nondistended; FAST negative; Rectal
with normal, guiac negative.
Pelvis: Unstable
Extremeties:  Right arm + shoulder with large abrasion
Back:  No stepoffs
Skin: wwp

Pertinent Results:
[**2173-6-11**] 04:03AM   GLUCOSE-338* UREA N-18 CREAT-0.8 SODIUM-133
POTASSIUM-4.9 CHLORIDE-101 TOTAL CO2-19* ANION GAP-18
[**2173-6-11**] 04:03AM   ALBUMIN-3.9 CALCIUM-8.1* PHOSPHATE-3.6
MAGNESIUM-1.9
[**2173-6-11**] 04:03AM   WBC-16.5* RBC-4.05* HGB-13.0* HCT-38.2*
MCV-94 MCH-32.0 MCHC-33.9 RDW-13.2
[**2173-6-11**] 04:03AM   PLT COUNT-211
[**2173-6-11**] 04:03AM   PT-13.0 PTT-23.3 INR(PT)-1.1

   RADIOLOGY  Final Report (Revised)

CT HEAD W/O CONTRAST  [**2173-6-10**] 11:03 PM

CT HEAD W/O CONTRAST

Reason: S/P BICYCLE FALL - ? HEAD INJURY

[**Hospital 93**] MEDICAL CONDITION:
53 year old man with
REASON FOR THIS EXAMINATION:
injuries
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 53-year-old man in trauma.

No prior studies are available for comparison.

TECHNIQUE: Noncontrast head CT scan.

FINDINGS: There is a moderate sized left-sided subdural
hematoma. There is a mild amount of subarachnoid blood
predominantly in the left frontal and left parietal gyri. A
1.3-cm hyperdense focus in the left frontal/parietal lobes may
represent an intraparenchymal hematoma/subarachnoid blood. There
is mild 2-mm shift of the normally midline structures to the
right. There is no hydrocephalus. There is a comminuted fracture
of the anterior wall of the right maxillary sinus as well as a
fracture through the medial wall of the right maxillary sinus.
Hyperdense fluid with air bubbles within the right maxillary
sinus likely represents hemorrhage. A linear nondisplaced
fracture extends from the right frontal bone into the sphenoid
bone. There is a fracture of the right zygomatic arch.

IMPRESSION:

1. Left-sided subdural hematoma. Mild shift to the right of the
normally midline structures.

2. Left-sided subarachnoid hemorrhage.

3. 1.3-cm focus of hemorrhage within the left frontal or
parietal lobe represents intraparenchymal hematoma or
subarachnoid hemorrhage.

4. Comminuted fractures through the anterior wall and medial
wall of the right maxillary sinus. Fracture through the right
zygomatic arch. Linear fracture extending from the right frontal
bone into the right sphenoid bone.

Findings conveyed to the ER via electronic dashboard.

NOTE ADDED AT ATTENDING REVIEW: There is a possible fracture of
the right orbital floor. The sinus opacification is suspicious
for a fracture, but facial CT may be helpful to confirm and
characterize the suggested fractures. In addition to the
findings noted above, there is hyperdensity along the tentorium
that may reflect a subdural hematoma in this location as well.
There is a hypodense fluid collection in the posterior fossa
adjacent to the cerebellar hemisphere that is likely a subdural
hygroma.
The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) **] [**Doctor Last Name **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) 7415**]
Approved: FRI [**2173-6-11**] 10:12 AM

Cardiology Report ECG Study Date of [**2173-6-19**]  1:08:12 AM


Atrial fibrillation with a rapid ventricular response. Since the
previous
tracing of [**2173-6-11**] atrial fibrillation is a new rhythm. The
ventricular rate is
more rapid. Otherwise, no diagnostic change.


Read by: [**Last Name (LF) **],[**First Name3 (LF) **] B.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
132 0 96 [**Telephone/Fax (2) 67733**]

DIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2173-6-20**] 5:28 AM

CHEST (PORTABLE AP)

Reason: follow pneumothorax

[**Hospital 93**] MEDICAL CONDITION:
53 year old man s/p bicycle fall, Left CT with small air leak
REASON FOR THIS EXAMINATION:
follow pneumothorax
PORTABLE CHEST, [**2173-6-20**], 05:53

INDICATION: Reassess for pneumothorax.

COMPARISON: [**2173-6-19**], 11:43.

FINDINGS: On the current study, the right chest tube appears to
be in the left angulated orientation. The left CVL remains in
place. I see no evidence of PTX. Of note, on the prior CT from
[**2173-6-10**], there tiny punctate air collections were noted at the
right apex, that may be below detectible levels on plain x-ray.
Current study has a slightly different position compared to
[**2173-6-19**] and a pleural-based density is seen along the right
lateral chest wall extending from posterior ribs 4 through 8.
The more prominent appearance on the current study may merely be
due to position.

Left CP angle cut off from view and there are no new focal
consolidations with continued retrocardiac opacification.

IMPRESSION:

No PTX seen.

More prominent appearance of right pleural-based density likely
due to positioning differences.

No new air space disease.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 4347**]
Approved: SUN [**2173-6-20**] 12:35 PM

Cardiology Report ECHO Study Date of [**2173-6-16**]



PATIENT/TEST INFORMATION:
Indication: Left ventricular function. Patient found down s/p
bike accident.
Height: (in) 72
Weight (lb): 173
BSA (m2): 2.00 m2
BP (mm Hg): 144/62
HR (bpm): 80
Status: Inpatient
Date/Time: [**2173-6-16**] at 16:05
Test: Portable TTE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2006W026-1:15
Test Location: West SICU/CTIC/VICU
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]

MEASUREMENTS:
Left Atrium - Long Axis Dimension: 3.1 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: 5.0 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: *5.1 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: *1.2 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Inferolateral Thickness: *1.2 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 5.1 cm (nl <= 5.6 cm)
Left Ventricle - Systolic Dimension: 3.3 cm
Left Ventricle - Fractional Shortening: 0.35 (nl >= 0.29)
Left Ventricle - Ejection Fraction: 60% (nl >=55%)
Aorta - Valve Level: 3.5 cm (nl <= 3.6 cm)
Aortic Valve - Peak Velocity: 1.6 m/sec (nl <= 2.0 m/sec)
Mitral Valve - E Wave: 1.0 m/sec
Mitral Valve - A Wave: 0.6 m/sec
Mitral Valve - E/A Ratio: 1.67
Mitral Valve - E Wave Deceleration Time: 200 msec
TR Gradient (+ RA = PASP): <= 25 mm Hg (nl <= 25 mm Hg)

INTERPRETATION:

Findings:

LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. Normal
interatrial septum.
No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
systolic function
(LVEF>55%). Normal regional LV systolic function. No resting
LVOT gradient.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic root diameter.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR. No
AS.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR. No
MVP.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR. Normal PA
systolic pressure.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with
physiologic PR.

PERICARDIUM: No pericardial effusion.

Conclusions:
The left atrium is normal in size. No atrial septal defect is
seen by 2D or
color Doppler. Left ventricular wall thickness, cavity size, and
systolic
function are normal (LVEF>55%). Regional left ventricular wall
motion is
normal. Right ventricular chamber size and free wall motion are
normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet
excursion and no aortic regurgitation. There is no aortic valve
stenosis. The
mitral valve appears structurally normal with trivial mitral
regurgitation.
There is no mitral valve prolapse. The estimated pulmonary
artery systolic
pressure is normal. There is no pericardial effusion.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD on [**2173-6-16**] 17:16.
[**Location (un) **] PHYSICIAN: [**Name10 (NameIs) **],[**First Name3 (LF) **]


([**Numeric Identifier 67734**])





Brief Hospital Course:
Mr. [**Known lastname **] was brought to [**Hospital1 18**] was transferred here after an
outside CT scan showed a left subdural hemorrhage, a left
subarachnoid hemorrhage, a questionable left intrparenchymal
bleed, multiple face fractures, multiple pelvic fracturs, right
clavicle fx, and ribs [**1-17**] and [**8-22**] fratures on the right.  He
was intubated in the emergency room for airway protection.
Chest tubes x 3 placed.

He was transferred immediately to the TSICU, where he was
followed for 12 days.  He was extubated on hospital day 8.
While in the ICU, he had bouts of rapid afib, controlled by
Amiodarone.

Throughout this time, he was being followed by [**Last Name (un) **] Diabetes
Center for his blood glucose levels.

On hospital day 13, he was transferred to the floor.  He
continued to progress well with physical therapy and occupation
therapy.  After discussing the issue with his family, it was
decided that he would be able to go home and follow PT/OT
recommendations there.  On hospital day 14, he had another
episode of rapid Afib.  For this, cardiology was consulted, who
recommended that he remain on amiodarone 400 mg qd x 2 weeks,
then 200 mg qd.  Anticoagulation was also recommended, however,
Neurosurgery recommended that he undergo no anticoagulation for
at least 2 weeks.  They also would like to follow up with him in
the EP lab.  [**Last Name (un) **] diabetes was reconsulted regarding his
elevated TSH.  [**Last Name (un) **] advised that his thyroid hormone not be
adjusted, as Mr. [**Known lastname **] is in close contact with his
endocrinologist.

Mr. [**Known lastname **] last chest tube was also removed on hospital day 15,
and the 6 hour chest x-ray showed a small residual pneumothorax.
 A repeat chest x-ray showed this as stable, and Mr. [**Known lastname **] was
dishcarged to his home with comprehensive follow-up.

Medications on Admission:
Insulin
Levoxyl
"Blood pressure" med

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) for 7 days.
4. Enalapril Maleate 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*1*
6. Fentanyl 25 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
Disp:*7 Patch 72HR(s)* Refills:*0*
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): Hold for loose stools. Capsule(s)
9. Outpatient Physical Therapy


Discharge Disposition:
Home

Discharge Diagnosis:
S/P Fall from bike
Left subdural hemorrhage
Left subarachnoid hemorrhage
Left frontal interparenchymal and subarachnoid hemorrhage
Right maxillary/frontal sinus/zygomatic/orbital floor fractures
Right clavicular/scapular fracture
Right [**1-17**], [**8-22**] rib fractures
Bilateral hemothorax
Pulmonary contusions
Right superior/inferior pubic ramus fracture
Right sacral [**Doctor First Name 362**] fracture


Discharge Condition:
Stable


Discharge Instructions:
Please return  for chest pain, shortness of breath, fever,
nausea/vomiting, dizziness, blurred vision, redness/discharge
from chest tube site, or any other concerns.

Do not bear weight or carry anything over 10 lbs at right upper
extremity.

Follow up in trauma surgery clinic in [**12-14**] weeks.

Follow up with plastic surgery regarding facial fractures.

Follow up with neurosurgery in [**3-18**] weeks.

Follow up with orthopaedics as needed.

Follow up with primary care physician [**Last Name (NamePattern4) **] [**12-14**] weeks.

Followup Instructions:
Follow up in trauma clinic in [**12-14**] weeks.  Please call for an
appointment [**Telephone/Fax (1) 6439**].

Follow up with neurosurgery in [**3-18**] weeks.  Please call for an
appointment at [**Telephone/Fax (1) 1669**].  Please inform the office that you
will need a repeat head CT scan for this appointment.

Follow up with orthopaedics as needed.  The number is
[**Telephone/Fax (1) 1228**].
{'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of pubis,Closed fracture of six ribs,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Closed fracture of shaft of clavicle,Closed fracture of upper end of tibia alone,Closed fracture of malar and maxillary bones,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Contusion of lung without mention of open wound into thorax,Open wound of forearm, without mention of complication,Abrasion or friction burn of elbow, forearm, and wrist, without mention of infection,Abrasion or friction burn of shoulder and upper arm, without mention of infection,Abrasion or friction burn of hip, thigh, leg, and ankle, without mention of infection,Pedal cycle accident injuring pedal cyclist,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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: S/P Fall from bicycle

PRESENT ILLNESS: 53 yo male who was found down at bottom of [**Doctor Last Name **] on the pavement
reportedly fell from bicycle while traveling down a [**Doctor Last Name **]; +
helmet.  GCS at scene was 11. He was taken to an area hospital
and was later transferrred to [**Hospital1 18**] for continued trauma care.

MEDICAL HISTORY: DM
Hypothyroidism
Hypertension

MEDICATION ON ADMISSION: Insulin
Levoxyl
"Blood pressure" med

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vital signs: T: 95.8  HR 82  BP 126/56  RR 18  Sat 98%
General: No acute distress, alert and oriented X 3
Head: PERRL, EOMI
Neck: C-collar
Chest: Breath sounds equal bilaterally, anterior chest wall
tender to palpation
Cardio: RRR, normal S1S2
Abdomen: Soft, nontender, nondistended; FAST negative; Rectal
with normal, guiac negative.
Pelvis: Unstable
Extremeties:  Right arm + shoulder with large abrasion
Back:  No stepoffs
Skin: wwp

FAMILY HISTORY: Noncontibutory

SOCIAL HISTORY: Married, lives with his wife. 

### Response:
{'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of pubis,Closed fracture of six ribs,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Closed fracture of shaft of clavicle,Closed fracture of upper end of tibia alone,Closed fracture of malar and maxillary bones,Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Contusion of lung without mention of open wound into thorax,Open wound of forearm, without mention of complication,Abrasion or friction burn of elbow, forearm, and wrist, without mention of infection,Abrasion or friction burn of shoulder and upper arm, without mention of infection,Abrasion or friction burn of hip, thigh, leg, and ankle, without mention of infection,Pedal cycle accident injuring pedal cyclist,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
