CHIEF COMPLAINT: Pedestrian struck

PRESENT ILLNESS: The patient is an 80 yo homeless woman who was attempting to
[**Street Address(1) 66737**] and was struck by a car traveling at
approximately 45 MPH, unknown LOC. She was BIBEMS awake and
alert c/o hip pain, and was not answering questions
appropriately. Initial imaging revealed a L pelvic fracture and
R fibula fx.

MEDICAL HISTORY: Psychaitric disorder - ? schizophrenia

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS upon admission to trauma bay:
BP 152/palp  HR 100  RR 16  O2 Sat 95%
PERRLA, TM's clear
CTA bilat
RRR
+ tenderness to T/L/S
Abdomen soft
Ecchymosis to LLE
5/5 strength with normal sensation
Alert and oriented to person/time

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Homeless, reportedly estranged from her family, visits a shelter
Reportedly known to Mass Mental Health
Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed unspecified fracture of pelvis,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Closed fracture of unspecified part of fibula alone,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Lack of housing
Fx sacrum/coccyx-closed,Pelvic fracture NOS-clos,Urin tract infection NOS,Paranoid schizo-unspec,Fx fibula NOS-closed,Mv coll w pedest-pedest,Lack of housing
Admission Date:  [**2132-6-7**]              Discharge Date:   [**2132-6-17**]

Date of Birth:  [**2051-10-20**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5880**]
Chief Complaint:
Pedestrian struck

Major Surgical or Invasive Procedure:
-Endotracheal intubation
-Angiography pelvic vessels
-ORIF, pelvic fracture


History of Present Illness:
The patient is an 80 yo homeless woman who was attempting to
[**Street Address(1) 66737**] and was struck by a car traveling at
approximately 45 MPH, unknown LOC. She was BIBEMS awake and
alert c/o hip pain, and was not answering questions
appropriately. Initial imaging revealed a L pelvic fracture and
R fibula fx.

Past Medical History:
Psychaitric disorder - ? schizophrenia

Social History:
Homeless, reportedly estranged from her family, visits a shelter
Reportedly known to Mass Mental Health

Family History:
Noncontributory

Physical Exam:
VS upon admission to trauma bay:
BP 152/palp  HR 100  RR 16  O2 Sat 95%
PERRLA, TM's clear
CTA bilat
RRR
+ tenderness to T/L/S
Abdomen soft
Ecchymosis to LLE
5/5 strength with normal sensation
Alert and oriented to person/time

Pertinent Results:
[**2132-6-7**] 07:50PM   LACTATE-1.6
[**2132-6-7**] 07:39PM   WBC-10.0 RBC-2.92* HGB-8.8* HCT-24.4* MCV-84
MCH-30.3 MCHC-36.2* RDW-14.1
[**2132-6-7**] 07:39PM   PLT COUNT-151
[**2132-6-7**] 04:28PM   GLUCOSE-122* UREA N-16 CREAT-0.6 SODIUM-141
POTASSIUM-3.5 CHLORIDE-110* TOTAL CO2-22 ANION GAP-13
[**2132-6-7**] 04:28PM   PLT COUNT-155#

UNILAT LOWER EXT VEINS LEFT  [**2132-6-14**] 2:11 PM

UNILAT LOWER EXT VEINS LEFT

Reason: L LEG SWELLING, ? DVT

[**Hospital 93**] MEDICAL CONDITION:
80 year old woman with fall and fracture with unilateral LLE
swelling
REASON FOR THIS EXAMINATION:
? DVT
HISTORY: 80-year-old female status post fall with fibular
fracture, left lower extremity swelling and concern for DVT.

LEFT LOWER EXTREMITY ULTRASOUND: [**Doctor Last Name **]-scale and Doppler
son[**Name (NI) 1417**] of the common femoral, superficial femoral, deep
femoral, popliteal, and tibial veins of the left lower extremity
were performed. There is normal waveform, augmentation, flow and
compressibility. No intraluminal thrombus is identified.

IMPRESSION: No DVT in the left lower extremity.

PATIENT/TEST INFORMATION:
Indication: Left ventricular function. SVT.
Height: (in) 61
Weight (lb): 138
BSA (m2): 1.61 m2
BP (mm Hg): 133/75
HR (bpm): 112
Status: Inpatient
Date/Time: [**2132-6-12**] at 15:42
Test: TTE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2006W017-0:40
Test Location: West Echo Lab
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

MEASUREMENTS:
Left Atrium - Long Axis Dimension: 3.2 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: 4.9 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: 4.5 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: 1.1 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: 1.1 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 3.4 cm (nl <= 5.6 cm)
Left Ventricle - Systolic Dimension: 2.2 cm
Left Ventricle - Fractional Shortening: 0.35 (nl >= 0.29)
Left Ventricle - Ejection Fraction: >= 75% (nl >=55%)
Aorta - Valve Level: 2.9 cm (nl <= 3.6 cm)
Aorta - Ascending: 2.6 cm (nl <= 3.4 cm)
Aortic Valve - Peak Velocity: *2.2 m/sec (nl <= 2.0 m/sec)
Aortic Valve - Peak Gradient: 19 mm Hg
Aortic Valve - Mean Gradient: 9 mm Hg
Mitral Valve - E Wave: 0.9 m/sec
Mitral Valve - A Wave: 0.9 m/sec
Mitral Valve - E/A Ratio: 1.00
Mitral Valve - E Wave Deceleration Time: 176 msec
TR Gradient (+ RA = PASP): *31 mm Hg (nl <= 25 mm Hg)

INTERPRETATION:

Findings:

LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

LEFT VENTRICLE: Normal LV cavity size. Normal regional LV
systolic function.
Hyperdynamic LVEF.

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

AORTA: Normal aortic root diameter.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AR.


MITRAL VALVE: Mildly thickened mitral valve leaflets. Trivial
MR.

TRICUSPID VALVE: Mild PA systolic hypertension.

PERICARDIUM: No pericardial effusion.

Conclusions:
1. The left ventricular cavity size is normal. Regional left
ventricular wall
motion is normal. Left ventricular systolic function is
hyperdynamic (EF>75%).
2. There is mild pulmonary artery systolic hypertension.




 CHEST (PORTABLE AP)  [**2132-6-11**] 5:28 AM

CHEST (PORTABLE AP)

Reason: eval for aspiration

[**Hospital 93**] MEDICAL CONDITION:
80 year old woman on TF with agitation/ tachycardia & coarse bs.

REASON FOR THIS EXAMINATION:
eval for aspiration
INDICATION: 80-year-old female with TF and agitation and
tachycardia. Coarse breath sounds. Evaluate for aspiration.

COMPARISON: [**2132-6-10**].

AP UPRIGHT CHEST RADIOGRAPH:

This exam is limited by respiratory motion. No gross infiltrates
or opacities are identified. Heart size, mediastinum and hilar
contours are unchanged.
IMPRESSION: No gross evidence of infiltrate. Limited by
respiratory motion.

Sinus rhythm, rate 90. Low voltage is seen in the limb and
standard leads.
There may be a previous anteroseptal wall myocardial infarction.
Diffuse
ST-T wave abnormalities are present. No previous tracing
available for
comparison.


Read by: [**Last Name (LF) **],[**First Name3 (LF) 1730**]

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
90 144 92 396/443.71 66 6 51

 CT HEAD W/O CONTRAST  [**2132-6-7**] 9:46 AM

CT HEAD W/O CONTRAST

Reason: ? ICH, fx

[**Hospital 93**] MEDICAL CONDITION:
80 year old woman ped struck
REASON FOR THIS EXAMINATION:
? ICH, fx
CONTRAINDICATIONS for IV CONTRAST: ?

INDICATION: Struck by automobile.

NON-CONTRAST HEAD CT: No prior for comparison. No hydrocephalus,
shift of normally midline structures, intra or extra-axial
hemorrhage, or acute major vascular territorial infarct is
identified. There are diffuse hypodensities scattered throughout
both corona radiata and in the basal ganglia, indicating chronic
microvascular change. The [**Doctor Last Name 352**]-white differentiation appears
preserved. There is a hematoma along the left parieto-occipital
region, however, no fracture is identified. There is scattered
opacification of mastoid air cells.

IMPRESSION: No acute intracranial hemorrhage, mass effect, or
fracture.


Brief Hospital Course:
The patient was admitted to the Trauma service.While in the ED,
her blood pressure dropped into the 70s systolic range, and a
repeat Hct revealed a nine point drop. On CT there was evidence
of left presacral hemtoma with active contrast extravasation
with additional small foci of extravasation in left
posterolateral thigh.  She was emergently intubated for airway
protection, 2 U pRBCs were transfused immediately, and she was
taken to Angiography, where an arteriogram of left superior and
inferior gluteal as well as left profunda femoris was negative;
the bleeding had stopped. The patient was transferred to the
T-SICU for further management.

Orthopedic surgery was consulted because of her injuries; and
she was taken to the operating room for ORIF left pelvis on
[**2132-6-8**]. She is to remain NWB LLE until follow up with Dr.
[**Last Name (STitle) 1005**], Orthopedics.

Psychiatry was consulted because of her history of paranoid
schizophrenia and delirium which developed during her ICU stay.
Initially she required 1:1 sitters; these have been
discontinued. She was started on Zyprexa [**Hospital1 **] dosing which has
improved her mental status significantly.

Geriatrics was also consulted because of her age and mechanism
of injury. Several recommendations pertaining to her medications
were made and implemented. She was started on Vit B12 1000 mg
daily.

Cardiology was consulted for sinus tachycardia; recommendations
were made for echocardiogram (see Pertinent results) and beta
blockade. She is currently receiving Lopressor 75 mg [**Hospital1 **]. She
was also transfused for a low hematocrit; her last Hct on [**6-12**]
was 29.1.

Physical and Occupational therapy has worked with patient and
have recommended rehab.


Medications on Admission:
Unknown

Discharge Medications:
1. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO BID (2
times a day).
2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
3. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
Q12H (every 12 hours).
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
5. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day): Hold for HR <60 and/or SBP <110.
6. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: Three (3) Tablet,
Rapid Dissolve PO QHS (once a day (at bedtime)).
7. Cyanocobalamin 500 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2222**] - [**Location (un) 538**]

Discharge Diagnosis:
s/p Pedestrian Struck
Displaced left superior and inferior pubic ramus fracture


Discharge Condition:
Stable


Discharge Instructions:
Follow up with Orthopedics in 2 weeks

Follow up in Trauma Clinic in [**3-14**] weeks

Followup Instructions:
Call [**Telephone/Fax (1) 1228**] for an appointment with Orthopedics in 2
weeks.

Call [**Telephone/Fax (1) 6439**] for an appointment in Trauma Clinic in [**3-14**]
weeks.



Completed by:[**2132-6-17**]
{'Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed unspecified fracture of pelvis,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Closed fracture of unspecified part of fibula alone,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Lack of housing'}


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: Pedestrian struck

PRESENT ILLNESS: The patient is an 80 yo homeless woman who was attempting to
[**Street Address(1) 66737**] and was struck by a car traveling at
approximately 45 MPH, unknown LOC. She was BIBEMS awake and
alert c/o hip pain, and was not answering questions
appropriately. Initial imaging revealed a L pelvic fracture and
R fibula fx.

MEDICAL HISTORY: Psychaitric disorder - ? schizophrenia

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS upon admission to trauma bay:
BP 152/palp  HR 100  RR 16  O2 Sat 95%
PERRLA, TM's clear
CTA bilat
RRR
+ tenderness to T/L/S
Abdomen soft
Ecchymosis to LLE
5/5 strength with normal sensation
Alert and oriented to person/time

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Homeless, reportedly estranged from her family, visits a shelter
Reportedly known to Mass Mental Health 

### Response:
{'Closed fracture of sacrum and coccyx without mention of spinal cord injury,Closed unspecified fracture of pelvis,Urinary tract infection, site not specified,Paranoid type schizophrenia, unspecified,Closed fracture of unspecified part of fibula alone,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Lack of housing'}
