CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 79-year-old male,
was a pedestrian struck by a car and subsequently run over by
the car.  The patient had loss of consciousness, but on
arrival to the emergency department the patient had a GCS of
15.

MEDICAL HISTORY: Diabetes mellitus, type 2.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of unspecified part of fibula with tibia,Closed fracture of sternum,Other motor vehicle nontraffic accident involving collision with moving object injuring pedestrian,Contusion of chest wall,Acute posthemorrhagic anemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia
Fx tibia w fibula NOS-cl,Fracture of sternum-clos,Oth coll mov obj-pedest,Contusion of chest wall,Ac posthemorrhag anemia,Cor ath unsp vsl ntv/gft,DMII wo cmp nt st uncntr,Pure hypercholesterolem
Admission Date:  [**2195-11-28**]       Discharge Date:  [**2195-12-2**]

Date of Birth:   [**2120-1-14**]       Sex:  M

Service:  TRAUMA

HISTORY OF THE PRESENT ILLNESS:   This is a 79-year-old male,
was a pedestrian struck by a car and subsequently run over by
the car.  The patient had loss of consciousness, but on
arrival to the emergency department the patient had a GCS of
15.

PAST MEDICAL HISTORY:  Diabetes mellitus, type 2.

PAST SURGICAL HISTORY:  History of eye surgery.

MEDICATIONS:
1.  Lopressor.
2.  Oral hypoglycemics.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  VITAL SIGNS:  Blood pressure 148/84.
Heart rate 60.  Respiratory rate 22.  O2 saturation 91% to
98% on 100% nonrebreather.  Temperature 98.9.  HEENT:  Pupils
equal, round, and reactive to light.  There were abrasions
over the forehead and scalp.  There was ecchymosis over the
nose and cheeks.  The TMs were clear.  The C-spine was
nontender without stepoff.  Chest was clear to auscultation
bilaterally.  There were abrasions over the right chest and
epigastrium.  Cardiovascular revealed regular rate and
rhythm.  Abdomen was distended and tender diffusely.  There
was no rebound.  Pelvis was stable.  Extremities revealed
deformity of the left lower extremity.  The dorsalis pedis
pulse was present in both left and right extremities.  The
patient also had an abrasion of the left elbow.  Rectal
examination was guaiac negative with normal tone.  Foley
catheter was placed and clear urine was drained.

LABORATORY DATA:  Laboratory data revealed the following:
White blood cell count 9.3; hematocrit 39.3; platelet count
277; INR 1.1.  The electrolytes revealed the sodium 140,
potassium 4.3, chloride 100, bicarbonate 30, BUN 22,
creatinine 1.1, glucose 160.

Radiology chest x-ray demonstrated a slightly wide
mediastinum.  Chest CT demonstrated a nondisplaced sternal
fracture and a small mediastinal hematoma.  Plain film of the
pelvis was negative.  Plain film of the cervical spine
demonstrated degenerative changes.  The CT of the head was
negative.  CT of the abdomen and pelvis was also negative.
CT of the cervical spine was also done, which was negative.

HOSPITAL COURSE:  The patient was originally admitted to the
Surgical Intensive Care Unit for observation, given his age
and mediastinal hematoma.  The patient was ruled out for a
myocardial infarction.  Cardiothoracic and Orthopedic
consultations were obtained.  Cardiothoracic consultation
recommended a followup CT scan in two to three days, which
was obtained on [**12-1**].  This demonstrated a stable
mediastinal hematoma, which was likely smaller than before.
Cardiothoracic Surgery stated that there was no followup
necessary.

Plain film of the left lower extremity demonstrated
comminuted fractures of the left tibia and fibula.  The
patient was taken to the operating room with the Department
of Orthopedics on [**11-29**].  The patient had an IM rod
placed in his left tibia.  The patient tolerated the
procedure well.  The Orthopedic Surgeon was Dr. [**First Name (STitle) **].  The
patient was treated with Ancef for twenty-four hours.  The
patient has been maintained on Lovenox for DVT prophylaxis.

The patient's blood sugars have remained slightly elevated in
the hospital in the range of 230 to 260.  The primary care
physician was [**Name (NI) 653**].  [**Name2 (NI) **] stated that the patient has done
well on oral hypoglycemia therapy with a normal hemoglobin
A1c.

Plan for the patient was to restart oral hypoglycemics and
cover with a sliding-scale Insulin in the interim while the
blood sugars remained high.

The [**Hospital 228**] hospital course has, otherwise, been
uneventful.  Plan is for discharge to rehabilitation for
anticoagulation.  The Department of Orthopedics has
recommended switching to Coumadin and when the INR is
therapeutic, between 2 and 3, the patient's Lovenox can be
discontinued.  The patient requires anticoagulation for six
weeks.

The patient also had a hematocrit of 21.4 on [**12-1**],
for which he was transfused two units in order to increase
his reserve given his age and risk factors for coronary
disease.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  The patient was discharged to [**Hospital **]
Rehabilitation.

DISCHARGE MEDICATIONS:
1.  Lovenox 30 mg subcutaneously b.i.d. until the INR is
therapeutic.
2.  Coumadin 5 mg p.o.q.d. times three days and then adjusted
based on INR.
3.  Avandia 4 mg p.o.q.d.
4.  Glucophage 1000 mg p.o.b.i.d.
5.  Glucotrol 10 mg p.o.b.i.d.
6.  Lipitor 10 mg p.o.q.d.
7.  Lopressor 25 mg p.o.b.i.d.
8.  Colace 100 mg p.o.b.i.d.
9.  Dulcolax 10 mg p.o.p.r.n.
10. Tylenol 650 mg p.o.q.4h.p.r.n.
11. Percocet 1 to 2 tabs p.o. q.4 to 6h p.r.n.
12. Sliding-scale Insulin.

DISCHARGE DIAGNOSES:
1.  Status post motor vehicle collision.
2.  Nondisplaced sternal fracture.
3.  Stable mediastinal hematoma.
4.  Status post open reduction and internal fixation of
comminuted left tibia fracture.
5.  Type 2 diabetes mellitus.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

Dictated By:[**Dictator Info **]
MEDQUIST36

D:  [**2195-12-2**]  10:40
T:  [**2195-12-2**]  10:56
JOB#:  [**Job Number 36493**]


Admission Date:  [**2195-11-28**]       Discharge Date:  [**2195-12-2**]

Date of Birth:   [**2120-1-14**]       Sex:  M

Service:  TRAUMA

HISTORY OF THE PRESENT ILLNESS:   This is a 79-year-old male,
was a pedestrian struck by a car and subsequently run over by
the car.  The patient had loss of consciousness, but on
arrival to the emergency department the patient had a GCS of
15.

PAST MEDICAL HISTORY:  Diabetes mellitus, type 2.

PAST SURGICAL HISTORY:  History of eye surgery.

MEDICATIONS:
1.  Lopressor.
2.  Oral hypoglycemics.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  VITAL SIGNS:  Blood pressure 148/84.
Heart rate 60.  Respiratory rate 22.  O2 saturation 91% to
98% on 100% nonrebreather.  Temperature 98.9.  HEENT:  Pupils
equal, round, and reactive to light.  There were abrasions
over the forehead and scalp.  There was ecchymosis over the
nose and cheeks.  The TMs were clear.  The C-spine was
nontender without stepoff.  Chest was clear to auscultation
bilaterally.  There were abrasions over the right chest and
epigastrium.  Cardiovascular revealed regular rate and
rhythm.  Abdomen was distended and tender diffusely.  There
was no rebound.  Pelvis was stable.  Extremities revealed
deformity of the left lower extremity.  The dorsalis pedis
pulse was present in both left and right extremities.  The
patient also had an abrasion of the left elbow.  Rectal
examination was guaiac negative with normal tone.  Foley
catheter was placed and clear urine was drained.

LABORATORY DATA:  Laboratory data revealed the following:
White blood cell count 9.3; hematocrit 39.3; platelet count
277; INR 1.1.  The electrolytes revealed the sodium 140,
potassium 4.3, chloride 100, bicarbonate 30, BUN 22,
creatinine 1.1, glucose 160.

Radiology chest x-ray demonstrated a slightly wide
mediastinum.  Chest CT demonstrated a nondisplaced sternal
fracture and a small mediastinal hematoma.  Plain film of the
pelvis was negative.  Plain film of the cervical spine
demonstrated degenerative changes.  The CT of the head was
negative.  CT of the abdomen and pelvis was also negative.
CT of the cervical spine was also done, which was negative.

HOSPITAL COURSE:  The patient was originally admitted to the
Surgical Intensive Care Unit for observation, given his age
and mediastinal hematoma.  The patient was ruled out for a
myocardial infarction.  Cardiothoracic and Orthopedic
consultations were obtained.  Cardiothoracic consultation
recommended a followup CT scan in two to three days, which
was obtained on [**12-1**].  This demonstrated a stable
mediastinal hematoma, which was likely smaller than before.
Cardiothoracic Surgery stated that there was no followup
necessary.

Plain film of the left lower extremity demonstrated
comminuted fractures of the left tibia and fibula.  The
patient was taken to the operating room with the Department
of Orthopedics on [**11-29**].  The patient had an IM rod
placed in his left tibia.  The patient tolerated the
procedure well.  The Orthopedic Surgeon was Dr. [**First Name (STitle) **].  The
patient was treated with Ancef for twenty-four hours.  The
patient has been maintained on Lovenox for DVT prophylaxis.

The patient's blood sugars have remained slightly elevated in
the hospital in the range of 230 to 260.  The primary care
physician was [**Name (NI) 653**].  [**Name2 (NI) **] stated that the patient has done
well on oral hypoglycemia therapy with a normal hemoglobin
A1c.

Plan for the patient was to restart oral hypoglycemics and
cover with a sliding-scale Insulin in the interim while the
blood sugars remained high.

The [**Hospital 228**] hospital course has, otherwise, been
uneventful.  Plan is for discharge to rehabilitation for
anticoagulation.  The Department of Orthopedics has
recommended switching to Coumadin and when the INR is
therapeutic, between 2 and 3, the patient's Lovenox can be
discontinued.  The patient requires anticoagulation for six
weeks.

The patient also had a hematocrit of 21.4 on [**12-1**],
for which he was transfused two units in order to increase
his reserve given his age and risk factors for coronary
disease.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  The patient was discharged to [**Hospital **]
Rehabilitation.

DISCHARGE MEDICATIONS:
1.  Lovenox 30 mg subcutaneously b.i.d. until the INR is
therapeutic.
2.  Coumadin 5 mg p.o.q.d. times three days and then adjusted
based on INR.
3.  Avandia 4 mg p.o.q.d.
4.  Glucophage 1000 mg p.o.b.i.d.
5.  Glucotrol 10 mg p.o.b.i.d.
6.  Lipitor 10 mg p.o.q.d.
7.  Lopressor 25 mg p.o.b.i.d.
8.  Colace 100 mg p.o.b.i.d.
9.  Dulcolax 10 mg p.o.p.r.n.
10. Tylenol 650 mg p.o.q.4h.p.r.n.
11. Percocet 1 to 2 tabs p.o. q.4 to 6h p.r.n.
12. Sliding-scale Insulin.

DISCHARGE DIAGNOSES:
1.  Status post motor vehicle collision.
2.  Nondisplaced sternal fracture.
3.  Stable mediastinal hematoma.
4.  Status post open reduction and internal fixation of
comminuted left tibia fracture.
5.  Type 2 diabetes mellitus.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

Dictated By:[**Dictator Info **]
MEDQUIST36

D:  [**2195-12-2**]  10:40
T:  [**2195-12-2**]  10:56
JOB#:  [**Job Number 36493**]
rp11/07/[**2195**]
{'Closed fracture of unspecified part of fibula with tibia,Closed fracture of sternum,Other motor vehicle nontraffic accident involving collision with moving object injuring pedestrian,Contusion of chest wall,Acute posthemorrhagic anemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}


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: This is a 79-year-old male,
was a pedestrian struck by a car and subsequently run over by
the car.  The patient had loss of consciousness, but on
arrival to the emergency department the patient had a GCS of
15.

MEDICAL HISTORY: Diabetes mellitus, type 2.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of unspecified part of fibula with tibia,Closed fracture of sternum,Other motor vehicle nontraffic accident involving collision with moving object injuring pedestrian,Contusion of chest wall,Acute posthemorrhagic anemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}
