CHIEF COMPLAINT: s/p MVC

PRESENT ILLNESS: 29F s/p MVC on [**11-15**] who initially presented to [**Hospital 487**]
Hospital for UTI symptoms and nausea/vomiting. She was given
medication for her nausea and UTI and then while driving home
struck a guardrail at high speed. She was then transported back
to [**Hospital 487**] hospital where she was agitated and intubated. Head
CT revealed intracranial bleed and she was transferred to [**Hospital1 18**]
for further care.  Upon arrival to [**Hospital1 18**] she was found to have
facial lacerations which were sutured by Plastics in the ER.
Repeat Head CT showed some interval increase in Right frontal
SAH from OSH imaging as well as a punctate hemmorhage with in
the left vertex consistent with shear injury.

MEDICAL HISTORY: anxiety
migraines

MEDICATION ON ADMISSION: Klonapin, Zomig

ALLERGIES: Codeine

PHYSICAL EXAM: On admission:
intubated, pupils 2mm and reactive, BUE localize, BLE w/d, no
EO, no commands
multiple facial lacerations.  Multiple areas of ecchymosis over
face and chin and upper extremities.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: occasional ETOH use
Cortex (cerebral) contusion without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Open wound of lip, without mention of complication,Anemia, unspecified
Cortex contus-brief coma,Mv collision NOS-driver,Open wound of lip,Anemia NOS
Admission Date:  [**2139-11-15**]              Discharge Date:   [**2139-11-18**]

Date of Birth:  [**2110-1-14**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Codeine

Attending:[**First Name3 (LF) 2724**]
Chief Complaint:
s/p MVC

Major Surgical or Invasive Procedure:
None


History of Present Illness:
29F s/p MVC on [**11-15**] who initially presented to [**Hospital 487**]
Hospital for UTI symptoms and nausea/vomiting. She was given
medication for her nausea and UTI and then while driving home
struck a guardrail at high speed. She was then transported back
to [**Hospital 487**] hospital where she was agitated and intubated. Head
CT revealed intracranial bleed and she was transferred to [**Hospital1 18**]
for further care.  Upon arrival to [**Hospital1 18**] she was found to have
facial lacerations which were sutured by Plastics in the ER.
Repeat Head CT showed some interval increase in Right frontal
SAH from OSH imaging as well as a punctate hemmorhage with in
the left vertex consistent with shear injury.

Past Medical History:
anxiety
migraines

Social History:
occasional ETOH use

Family History:
noncontributory

Physical Exam:
On admission:
intubated, pupils 2mm and reactive, BUE localize, BLE w/d, no
EO, no commands
multiple facial lacerations.  Multiple areas of ecchymosis over
face and chin and upper extremities.

On Discharge:
Neurologically intact:
Alert and Oriented x3, following commands, Fluent speech.
CN II-XII intact. PERRLA 4mm and briskly reactive.
Broken central and lateral incisors.
Motor: full strength in all muscle groups
Sensation: intact throughout


Pertinent Results:
CT HEAD [**11-15**]
1. Minor extent of subarachnoid hemorrhage within the right
frontal and
bilateral parietal lobe regions, minimally progressed since the
outside
hospital study, and better visualized on the current study.
2. Punctate hemorrhage within the left vertex frontal lobe
subcortical white matter is unchanged, likely reflecting
shear-type injury.

CT HEAD [**11-16**]
1. Interval redistribution of subarachnoid hemorrhage, which is
stable since the prior study, and now predominantly seen in the
parietal vertex.
2. Multiple punctate foci of parenchymal hemorrhage, suggestive
of diffuse
axonal injury, are unchanged since the prior study.
ADDENDUM AT ATTENDING REVIEW: I believe that there has been
minimal resorption of the initially small quantity of
subarchnoid hemorrhage, as opposed to simple redistribution.
Also, there is normal pneumatization of the mastoid sinuses, but
with mild opacificaton of the right mastoid sinus, compatible
with an ongoing inflammatory process.

[**2139-11-16**] 02:59AM BLOOD Phenyto-14.8

Brief Hospital Course:
Patient presented to [**Hospital1 18**] as a transfer from an OSH, upon
arrival she was intubated and sedated.  Off sedation she had
reactive pupils was localizing with her upper extremities and
withdrawing with her lowers.  Her eyes were not opening to
noxious stimuli and she was not following any commands.  She was
bolused and started on dilantin and admitted to the ICU.  On
[**11-16**] her exam was improved and she was attempting to open her
eyes, following commands with all 4 extremities as well as
sticking her tongue out to command.  Repeat head CT was stable
and so she was extubated. As her exam continued to improve she
was cleared for transfer to the floor. Dilantin level was 14.8.
On [**11-17**] she was neurologically stable but continued to be
confused. Her cervical  spine was cleared and collar was
removed. It was noted that she had multiple fractured teeth
therefore OMFS was consulted.  A semi-rigid splint with
stainless steel wires and composite resin were placed at bedside
by OMFS from teeth #[**5-2**] in order to stabilize the mobile teeth.
Clindamycin, peridex and lidocaine oral solution were started at
their recommendation. Panorex films were performed on [**11-17**] for
baseline imaging of her dental fractures with a plan to followup
in Oral Surgery Clinic at [**Hospital6 **] on Tuesday
[**2139-12-1**] at 2pm.  Plan for Clindamycin for 10days, Peridex
solution for 2weeks.
On the day of discharge the patient's mental status continued to
improve. She was seen by Physical therapy and Occupational
therapy who felt that she was safe to return home with PT and OT
services and 24 hour supervision which will be fulfilled by her
family and friends.  [**Name (NI) 15110**] to her Dental fractures she was
maintained on a soft and non chew diet.  At the time of
discharge she was tolerating a diet, ambulating with assistance,
afebrile with stable vital signs.

Medications on Admission:
Klonapin, Zomig

Discharge Medications:
1. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
2. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: [**11-22**]
Tablets PO every six (6) hours as needed for headache.
Disp:*40 Tablet(s)* Refills:*0*
3. ferrous sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. clindamycin HCl 150 mg Capsule Sig: Two (2) Capsule PO Q6H
(every 6 hours) for 10 days.
Disp:*80 Capsule(s)* Refills:*0*
5. chlorhexidine gluconate 0.12 % Mouthwash Sig: Thirty (30) ML
Mucous membrane [**Hospital1 **] (2 times a day) for 2 weeks: Do not swallow.
Disp:*840 ML(s)* Refills:*0*
6. phenytoin sodium extended 100 mg Capsule Sig: One (1) Capsule
PO three times a day for 5 days.
Disp:*15 Capsule(s)* Refills:*0*
7. oxycodone 5 mg Capsule Sig: [**11-22**] Capsules PO every four (4)
hours as needed for pain: Do not drive while taking narcotic
pain medications.
Disp:*40 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Bifrontal Contusions
Right traumatic Subarachnoid Hemorrhage
Left Intraparenchymal Hemorrhage
non-complicated dental fractures of teeth#7,8,24
complicated dental fractures of #9,10 (vertical fracture
in tooth #10)


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.

Activity Status: Out of Bed with assistance at all times.


Discharge Instructions:
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, or
Ibuprofen etc.
??????	You have been prescribed Dilantin (Phenytoin) for anti-seizure
medicine, take it as prescribed and follow up with laboratory
blood drawing in one week.  This can be drawn at your PCP??????s
office, but please have the results faxed to [**Telephone/Fax (1) 87**].
- DO NOT DRIVE WHILE TAKING NARCOTIC PAIN MEDICATION

CALL NEUROSURGERY IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion, lethargy or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	New onset of the loss of function, or decrease of function on
one whole side of your body.


Followup Instructions:
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) 548**], to be seen in [**2-24**] weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.

Please follow up:
F/U with OMFS at Oral Surgery Clinic at [**Hospital6 **]
(Address: [**Last Name (NamePattern1) **]. Yawkey Building [**Location (un) 442**]. [**Location (un) 86**],
[**Numeric Identifier 66635**]) on Tuesday [**2139-12-1**] at 2pm.



Completed by:[**2139-11-18**]
{'Cortex (cerebral) contusion without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Open wound of lip, without mention of complication,Anemia, unspecified'}


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 MVC

PRESENT ILLNESS: 29F s/p MVC on [**11-15**] who initially presented to [**Hospital 487**]
Hospital for UTI symptoms and nausea/vomiting. She was given
medication for her nausea and UTI and then while driving home
struck a guardrail at high speed. She was then transported back
to [**Hospital 487**] hospital where she was agitated and intubated. Head
CT revealed intracranial bleed and she was transferred to [**Hospital1 18**]
for further care.  Upon arrival to [**Hospital1 18**] she was found to have
facial lacerations which were sutured by Plastics in the ER.
Repeat Head CT showed some interval increase in Right frontal
SAH from OSH imaging as well as a punctate hemmorhage with in
the left vertex consistent with shear injury.

MEDICAL HISTORY: anxiety
migraines

MEDICATION ON ADMISSION: Klonapin, Zomig

ALLERGIES: Codeine

PHYSICAL EXAM: On admission:
intubated, pupils 2mm and reactive, BUE localize, BLE w/d, no
EO, no commands
multiple facial lacerations.  Multiple areas of ecchymosis over
face and chin and upper extremities.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: occasional ETOH use 

### Response:
{'Cortex (cerebral) contusion without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Open wound of lip, without mention of complication,Anemia, unspecified'}
