CHIEF COMPLAINT: motor cycle collision

PRESENT ILLNESS: 33 year old male s/p MCC presented to [**Location (un) 745**]-Welleslwy and was
transferred by med-flight to [**Hospital1 18**]. The patient was driving at a
high rate of speed, lost control of his motorcycle, was ejected,
and rolled 30 feet. He was intubated and a right chest tube was
placed at the OSH prior to transfer.

MEDICAL HISTORY: HIV+

MEDICATION ON ADMISSION: methadone 20"

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 100.9F, 72, 120/p, 96% ambu bag
pupils [**3-15**] equal, sluggishly reactive.  GCS 3T.  midface
unstable ?fx
trachea midline, no JVD
blood in mouth, no ear or nasal discharge
CTAB, r chest tube in place, chest wall stable
abd soft, ND
rectal decr tone, no high riding prostate
ext palpable pulses, RUE appear broken
Neck/back: no step offs

FAMILY HISTORY: NC

SOCIAL HISTORY: married, lives in [**Hospital1 **] NH, no tob, h/o IVDA on methadone
Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Hyposmolality and/or hyponatremia,Candidiasis of mouth,Opioid type dependence, continuous,Closed fracture of greater tuberosity of humerus,Open wound of jaw, without mention of complication,Other specified disorders of the teeth and supporting structures,Abrasion or friction burn of trunk, without mention of infection,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring motorcyclist,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Asymptomatic human immunodeficiency virus [HIV] infection status,Traumatic pneumothorax without mention of open wound into thorax,Injury to other specified intrathoracic organs without mention of open wound into cavity
Fx mult ribs NOS-closed,Fx dorsal vertebra-close,Hyposmolality,Thrush,Opioid dependence-contin,Fx gr tuberos humerus-cl,Open wound of jaw,Dental disorder NEC,Abrasion trunk,Loss control mv-mocycl,Mth sus Stph aur els/NOS,Inf mcrg rstn pncllins,Asymp hiv infectn status,Traum pneumothorax-close,Intrathoracic inj NEC-cl
Admission Date:  [**2198-5-29**]              Discharge Date:   [**2198-6-20**]

Date of Birth:  [**2164-1-4**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5880**]
Chief Complaint:
motor cycle collision

Major Surgical or Invasive Procedure:
Intubated x 2
Percutaneous tracheostomy
Right chest tube
ORIF left humerus


History of Present Illness:
33 year old male s/p MCC presented to [**Location (un) 745**]-Welleslwy and was
transferred by med-flight to [**Hospital1 18**]. The patient was driving at a
high rate of speed, lost control of his motorcycle, was ejected,
and rolled 30 feet. He was intubated and a right chest tube was
placed at the OSH prior to transfer.


Past Medical History:
HIV+

Social History:
married, lives in [**Hospital1 **] NH, no tob, h/o IVDA on methadone

Family History:
NC

Physical Exam:
100.9F, 72, 120/p, 96% ambu bag
pupils [**3-15**] equal, sluggishly reactive.  GCS 3T.  midface
unstable ?fx
trachea midline, no JVD
blood in mouth, no ear or nasal discharge
CTAB, r chest tube in place, chest wall stable
abd soft, ND
rectal decr tone, no high riding prostate
ext palpable pulses, RUE appear broken
Neck/back: no step offs

Pertinent Results:
[**2198-5-29**] 06:35PM URINE  bnzodzpn-POS barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-POS
[**2198-5-29**] 10:23PM   TYPE-ART PO2-164* PCO2-42 PH-7.39 TOTAL
CO2-26 BASE XS-0
[**2198-5-29**] 10:23PM   LACTATE-3.1*
[**2198-5-29**] 08:24PM   GLUCOSE-148* UREA N-15 CREAT-0.9 SODIUM-138
POTASSIUM-3.9 CHLORIDE-106 TOTAL CO2-26 ANION GAP-10
[**2198-5-29**] 08:24PM   WBC-20.6* RBC-4.01* HGB-12.2* HCT-36.5*
MCV-91 MCH-30.4 MCHC-33.4 RDW-12.7
[**2198-5-29**] 08:24PM   PT-14.3* PTT-23.6 INR(PT)-1.3
[**2198-5-29**] 08:24PM   PLT SMR-NORMAL PLT COUNT-194
[**2198-5-29**] 06:10PM   AMYLASE-50
[**2198-5-29**] 06:10PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
.
CXR/PXR: LLL atelectasis/consolidation, R tension PTX, multi R
rib fx
CT Head: mucosal sinus thickening
CT C spine: mult R rib fxs, B thoracic vertebral transverse
process fx, left C5-6 facet fx, R tension PTX, subQ emphysema
CT Chest/Abd/Pelvis: large R tension PTX, collapse of RUL/LUL,
atelectasis bilateral lower lobes, mult. R rib fractures,
transverse processes fx T2/T3, ? small subcapsular hematoma
CT face: neg
CXR [**6-11**]: worse LLL atelectasis

Brief Hospital Course:
TRAUMA:
The patient was admitted to the SICU on [**2198-5-29**].  He was
initially loaded on dilantin and given ativan prn for seizure
prophylaxis.  His preliminary radiology studies revealed
(1)multiple right rib fractures, (2)bilateral thoracic vertebral
transverse process fractures T2/3, (3)left C5-6 facet fracture,
and (4)right tension pneumothorax.  His C-spine was cleared by
MRI which showed no fracture or ligamentous injuries.  After a
prolonged course of intubation (see below), swelling of the left
shoulder was noted and an xray on [**2198-5-29**] revealed a L humeral
head fracture.  The patient was taken to the OR with the
orthopedic surgeons on [**2198-6-12**] for ORIF of the left humerus.

ID:
The patient became febrile on HD#3 and was started on levoquin
and vancomycin.  His sputum culture from [**2198-5-31**] grew out MSSA
and the vanco was d/c'ed on [**2198-6-4**] while the levoquin was
continued for a total of 12 days.  Despite a tooth extraction on
[**2198-6-2**], and multiple line changes the patient remained febrile.
 A sputum culture from [**2198-6-12**] grew MRSA and the vancomycin was
re-started on [**2198-6-14**].  He was also started on bactim prophylaxis
because he had thrush and there was a concern for PCP pneumonia,
but [**Name Initial (PRE) **] CD4 count was 324 and the bactrim was d/c'ed.  The
possibility of starting HAART was discussed with the ID team,
and they felt that the therapy should be started as an
outpatient.  The patient was given dicscharge instructions to
follow up in the [**Hospital **] clinic.

RESPIRATORY:
The patient was brought from the OSH intubated, and self
extubated on HD# 6.  He required re-intubation the following day
due to excessive secretions.  He had a few episodes of hypoxia
and a worsening CXR.  The decission was made to place a
percutaneous tracheostomy on HD # 9.  After the trach was placed
he continued to have episodes of hypoxia and a CTA was performed
which was negative for PE.

The patient was discharged to a tracheostomy care rehab facility
and will finish his 10 day course of vancomycin and will take 3
more weeks of lovenox there.

Medications on Admission:
methadone 20"

Discharge Medications:
1. Acetaminophen 160 mg/5 mL Elixir Sig: 0.5-1 Elixir PO Q4-6H
(every 4 to 6 hours) as needed.
2. Nystatin 100,000 unit/mL Suspension Sig: Ten (10) ML PO QID
(4 times a day) as needed for Thrush.
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
5. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb
Inhalation Q4H (every 4 hours) as needed.
6. Enoxaparin Sodium 30 mg/0.3 mL Syringe Sig: Thirty (30) mg
Subcutaneous Q12H (every 12 hours) for 3 weeks.
7. Methadone HCl 40 mg Tablet, Soluble Sig: One (1) Tablet,
Soluble PO TID (3 times a day).
8. Lorazepam 1 mg Tablet Sig: 2-4 Tablets PO Q2-4H (every 2 to 4
hours) as needed.
9. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
11. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN
10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units
heparin) each lumen Daily and PRN.  Inspect site every shift.
12. Vancocin HCl 1,000 mg Recon Soln Sig: One (1) gram
Intravenous  twice a day for 4 days: Last day [**2198-6-23**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
motor cycle collision
left humerus fracture


Discharge Condition:
stable

Discharge Instructions:
Take your medications as prescribed
Wear sling,  Left shoulder pendulum swings exercises, left elbow
and wrist may move as comfortable.

Call your doctor [**First Name (Titles) **] [**Last Name (Titles) **] to 101.4F, redness or pus around your
wound, change in color or sensation of your hand, trouble
breathing, chest pain, or any other concerns


Followup Instructions:
Please follow up in the infectious disease clinic as soon as
possible.  Please call for an appointment, [**Telephone/Fax (1) 457**].

Please follow up in the trauma clinic in 2 weeks.  Please call
for an appointment, [**Telephone/Fax (1) 2359**].

Please follow up with Dr [**Last Name (STitle) 2719**] (orthopedics) in [**3-15**] weeks.
Please call for an appointment, [**Telephone/Fax (1) 1228**].
{'Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Hyposmolality and/or hyponatremia,Candidiasis of mouth,Opioid type dependence, continuous,Closed fracture of greater tuberosity of humerus,Open wound of jaw, without mention of complication,Other specified disorders of the teeth and supporting structures,Abrasion or friction burn of trunk, without mention of infection,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring motorcyclist,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Asymptomatic human immunodeficiency virus [HIV] infection status,Traumatic pneumothorax without mention of open wound into thorax,Injury to other specified intrathoracic organs without mention of open wound into cavity'}


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: motor cycle collision

PRESENT ILLNESS: 33 year old male s/p MCC presented to [**Location (un) 745**]-Welleslwy and was
transferred by med-flight to [**Hospital1 18**]. The patient was driving at a
high rate of speed, lost control of his motorcycle, was ejected,
and rolled 30 feet. He was intubated and a right chest tube was
placed at the OSH prior to transfer.

MEDICAL HISTORY: HIV+

MEDICATION ON ADMISSION: methadone 20"

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 100.9F, 72, 120/p, 96% ambu bag
pupils [**3-15**] equal, sluggishly reactive.  GCS 3T.  midface
unstable ?fx
trachea midline, no JVD
blood in mouth, no ear or nasal discharge
CTAB, r chest tube in place, chest wall stable
abd soft, ND
rectal decr tone, no high riding prostate
ext palpable pulses, RUE appear broken
Neck/back: no step offs

FAMILY HISTORY: NC

SOCIAL HISTORY: married, lives in [**Hospital1 **] NH, no tob, h/o IVDA on methadone 

### Response:
{'Closed fracture of multiple ribs, unspecified,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Hyposmolality and/or hyponatremia,Candidiasis of mouth,Opioid type dependence, continuous,Closed fracture of greater tuberosity of humerus,Open wound of jaw, without mention of complication,Other specified disorders of the teeth and supporting structures,Abrasion or friction burn of trunk, without mention of infection,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring motorcyclist,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Asymptomatic human immunodeficiency virus [HIV] infection status,Traumatic pneumothorax without mention of open wound into thorax,Injury to other specified intrathoracic organs without mention of open wound into cavity'}
