CHIEF COMPLAINT: Polytrauma following MVC

PRESENT ILLNESS: [**Age over 90 **]F unrestrained passenger in MVC that rear-ended truck in front
of them. Pt had entrapment of lower extremities, requiring
extrication.  No airbag deployment.  In field, patient attempted
to be intubated for GCS 4, however, only combitube able to be
placed.  Oxygen saturation noted to be no greater than 80%
during transport.  Pt transported as basic trauma to [**Hospital1 18**] ED
(called as STAT but paged out as basic).

MEDICAL HISTORY: -Alzheimers
-Remainder of history unknown

MEDICATION ON ADMISSION: Unknown

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: On admission:

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Patient is reported to have one daughter, and both she and her
daughter receive 24hr care from the driver involved in the MVC.
Family friend, [**Name (NI) 501**], is a nurse and is acting as a support to
patient's daughter.
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery,Closed supracondylar fracture of femur,Traumatic shock,Closed fracture of five ribs,Closed fracture of upper end of fibula with tibia,Closed fracture of first cervical vertebra,Closed fracture of lower end of radius with ulna,Acute posthemorrhagic anemia,Anoxic brain damage,Acidosis,Closed fracture of mandible, unspecified site,Closed fracture of subtrochanteric section of neck of femur,Open wound of cheek, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle,Hypotension, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Traumatic pneumohemothorax without mention of open wound into thorax,Do not resuscitate status,Contusion of lung without mention of open wound into thorax
Cl skl base fx-deep coma,Ot pul insuf fol trm/srg,Supracondyl fx femur-cl,Traumatic shock,Fracture five ribs-close,Fx up tibia w fibula-cl,Fx c1 vertebra-closed,Fx low radius w ulna-cl,Ac posthemorrhag anemia,Anoxic brain damage,Acidosis,Mandible fx NOS-closed,Subtrochanteric fx-close,Open wound of cheek,Mv collision NOS-pasngr,Hypotension NOS,Alzheimer's disease,Dementia w/o behav dist,Traum pneumohemothor-cl,Do not resusctate status,Lung contusion-closed
Admission Date:  [**2181-1-16**]              Discharge Date:   [**2181-1-20**]


Service: SURGERY

Allergies:
No Allergies/ADRs on File

Attending:[**First Name3 (LF) 2836**]
Chief Complaint:
Polytrauma following MVC

Major Surgical or Invasive Procedure:
1. Endotracheal intubation, [**2181-1-16**]
2. Exploratory laparotomy, [**2181-1-16**]
3. Bilateral chest tube placement, [**2181-1-16**]


History of Present Illness:
[**Age over 90 **]F unrestrained passenger in MVC that rear-ended truck in front
of them. Pt had entrapment of lower extremities, requiring
extrication.  No airbag deployment.  In field, patient attempted
to be intubated for GCS 4, however, only combitube able to be
placed.  Oxygen saturation noted to be no greater than 80%
during transport.  Pt transported as basic trauma to [**Hospital1 18**] ED
(called as STAT but paged out as basic).



Past Medical History:
-Alzheimers
-Remainder of history unknown

Social History:
Patient is reported to have one daughter, and both she and her
daughter receive 24hr care from the driver involved in the MVC.
Family friend, [**Name (NI) 501**], is a nurse and is acting as a support to
patient's daughter.

Family History:
Unknown

Physical Exam:
On admission:

HR 116,  BP 80/49,  RR Bagged,  O2Sat 75%

GEN: GCS 4T
HEENT: Multiple facial lacerations including large laceration
over her left zygoma. Raccoon eyes. Pupils 4 mm & nonreactive.
+Rhinorrhea. Combitube in place.
Chest: Clear to auscultation
Cardiovascular: Tachycardic, regular.
Abdominal: Soft, nondistended. No palpable masses.
Pelvic: Pelvis stable.
Extr/Back: Left leg internally rotated, left wrist deformity.
Skin: Face laceration as described above. Multiple leg
lacerations.
Neuro: +gag. +corneal reflex. Minimal response to noxious
stimuli.

Pertinent Results:
LABS:
On admission:

WBC-8.6 RBC-3.31* Hgb-10.5* Hct-28.7* MCV-87 MCH-31.6 MCHC-36.5*
RDW-13.7 Plt Ct-242
PT-16.0* PTT-42.8* INR(PT)-1.5*
Fibrino-45*
Glucose-223* UreaN-19 Creat-0.6 Na-146* K-4.0 Cl-113* HCO3-19*
AnGap-18
Calcium-6.5* Phos-7.2* Mg-1.5*
CENTRAL VE pO2-31* pCO2-57* pH-7.18* calTCO2-22 Base XS--8
Lactate-5.1*

IMAGING:

[**1-16**] CT head
1. Left frontal subarachnoid hemorrhage, small right frontal
subarachnoid hemorrhage, intraventricular hemorrage, and small
medial left temporal hemorrhage, which may be parenchymal or
intraventricular.
2. Multiple facial fractures.
3. Large right intraorbital air and extensive facial soft tissue
air.

[**1-16**] X-Ray Chest: Left 4th and 6th rib fracture. Right 6-8th
rib fx.

[**1-16**] X-Ray Pelvis: No fracture

[**1-16**] X-Ray Left Wrist: Comminuted fracture of distal radius and
ulna.

[**1-16**] X-Ray Right Wrist: Comminuted fracture of distal radius
and ulna.

[**1-16**] X-Ray Left Femur/Tibia and Fibula: Subtrochanteric femur
fracture. Supracondular femur fracture. Tibial plateau and
fibular head fracture.

[**1-16**] X-Ray Right Femur/Tibia: Supracondular femur fracture.
Tibial plateau and fibular head fracture

Brief Hospital Course:
[**Age over 90 **]F transported to [**Hospital1 18**] ED as STAT trauma.  On arrival pt's
combitube was changed over to an endotracheal tube, and a left
subclavian cordis was placed.  Her oxygen saturation improved
after tube exchange.  The pt was initially hypotensive but
responded to fluid boluses.  Following completion of
primary/secondary surveys, she underwent radiographic imaging.
She proceeded to become hypotensive again, and was thus taken
emergently to the OR for exploratory laparotomy.  No abdominal
injuries were identified intraop.  Bilateral chest tubes were
placed for pneumothoraces and noted significant right-sided
hemothorax as well.  Postoperatively, the patient was admitted
to the Trauma Surgical ICU under care of the ACS service with
the following injuries:

-Left cheek lac w/masseter injury
-Right frontal subgaleal hematoma
-Right maxillary sinus lateral wall fx
-Bilateral pterygoid plate fx
-Left zygomatic arch fx
-Left mandibular fx
-Left orbit lateral wall fx
-Left 4,6 rib fx
-Right [**6-28**] rib fx
-Bilateral comminuted distal radius/ulna fx
-Left subtrochanteric, supracondylar femur fx
-Left tibial plateau and fibular head fx
-Right supracondylar femur fx
-Left tibial plateau and fibular head fx
-Bilateral IVH
-Left frontal contusion
-Left parietal SAH
-Right pons SAH
-Bitemporal SAH
-Displaced C1 anterior arch fx

The patient remained on pressors postoperatively despite
aggressive resuscitation.  She underwent splinting of all
extremity injuries, as well as having nasal packing and facial
laceration packing.  She was not stable enough to undergo
further imaging studies.  The patient's family was notified of
the devastating severity of the patient's injuries.

On HD 2 the patient was made DNR secondary to an extremely poor
prognosis related to unsurvivable injuries.  Discussions
continued with patient's family, who was unable to come to the
hospital.  Palliative care and Ethics consults were requested
for assistance with care goals for the patient.

On HD 3 the patient's daughter requested that the patient's
comfort be ensured.  No excalation of care was made.

On HD 5 patient's daughter requested [**Name2 (NI) 60655**] [**Name (NI) 3225**] status.  She
was terminally extubated and expired thereafter.

Medications on Admission:
Unknown

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Polytrauma with the following specific injuries:

-Left cheek lac w/masseter injury
-Right frontal subgaleal hematoma
-Right maxillary sinus lateral wall fx
-Bilateral pterygoid plate fx
-Left zygomatic arch fx
-Left mandibular fx
-Left orbit lateral wall fx
-Left 4,6 rib fx
-Right [**6-28**] rib fx
-Bilateral comminuted distal radius/ulna fx
-Left subtrochanteric, supracondylar femur fx
-Left tibial plateau and fibular head fx
-Right supracondylar femur fx
-Left tibial plateau and fibular head fx
-Bilateral IVH
-Left frontal contusion
-Left parietal SAH
-Right pons SAH
-Bitemporal SAH
-Displaced C1 anterior arch fx


Discharge Condition:
Expired


Discharge Instructions:
N/A

Followup Instructions:
N/A
{"Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery,Closed supracondylar fracture of femur,Traumatic shock,Closed fracture of five ribs,Closed fracture of upper end of fibula with tibia,Closed fracture of first cervical vertebra,Closed fracture of lower end of radius with ulna,Acute posthemorrhagic anemia,Anoxic brain damage,Acidosis,Closed fracture of mandible, unspecified site,Closed fracture of subtrochanteric section of neck of femur,Open wound of cheek, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle,Hypotension, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Traumatic pneumohemothorax without mention of open wound into thorax,Do not resuscitate status,Contusion of lung without mention of open wound into thorax"}


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: Polytrauma following MVC

PRESENT ILLNESS: [**Age over 90 **]F unrestrained passenger in MVC that rear-ended truck in front
of them. Pt had entrapment of lower extremities, requiring
extrication.  No airbag deployment.  In field, patient attempted
to be intubated for GCS 4, however, only combitube able to be
placed.  Oxygen saturation noted to be no greater than 80%
during transport.  Pt transported as basic trauma to [**Hospital1 18**] ED
(called as STAT but paged out as basic).

MEDICAL HISTORY: -Alzheimers
-Remainder of history unknown

MEDICATION ON ADMISSION: Unknown

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: On admission:

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Patient is reported to have one daughter, and both she and her
daughter receive 24hr care from the driver involved in the MVC.
Family friend, [**Name (NI) 501**], is a nurse and is acting as a support to
patient's daughter. 

### Response:
{"Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery,Closed supracondylar fracture of femur,Traumatic shock,Closed fracture of five ribs,Closed fracture of upper end of fibula with tibia,Closed fracture of first cervical vertebra,Closed fracture of lower end of radius with ulna,Acute posthemorrhagic anemia,Anoxic brain damage,Acidosis,Closed fracture of mandible, unspecified site,Closed fracture of subtrochanteric section of neck of femur,Open wound of cheek, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle,Hypotension, unspecified,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Traumatic pneumohemothorax without mention of open wound into thorax,Do not resuscitate status,Contusion of lung without mention of open wound into thorax"}
