CHIEF COMPLAINT: s/p Rollover motor vehicle crash

PRESENT ILLNESS: 38 yo female driver of a vehicle that was hit from the side at
an
intersection and rolled over several times - she was ejected
from
the vehicle, and appeared "combative" at the scene per EMS
report, though another report says she was complaining of throat
pain and had hemoptysis.  She was intubated in the field after
receiving Ativan, Succ, Etomidate and Vec.  She also received
Reglan
10 mg, Zofran 8 mg, Protonix, Tetanus shot, Protonix and started
on Fentanyl and Propofol drips.  She was taken initially to an
area hospital
then transferred to [**Hospital1 18**] where ER note says "moving all
extremities but altered."  UCG was negative.  PHT was given (1g)
at [**Hospital1 18**], but this has not been continued as an inpt.  She was
admitted to the trauma ICU with multiple injuries and fractures
identified on imaging, including basilar skull fracture,
multiple
facial and orbital fractures (report: "Extensive fractures
involving the sinuses and orbits are most consistent with Lefort
type 3 fracture with R Lefort 1 and B Lefort 2; R temp bone fx;
L
petrous opacification w/o fx; +fx R temporal bone.")  CT of
Cspine revealed "Nondisplaced hairline fracture involving
posterior elements of C6. R soft tissue neck swelling with small
amount of air w/o evidence of laryngeal injury."  There was no
intracranial hemorrhage.

MEDICAL HISTORY: Migraines
Depression
FUO
Pyelonephritis
Hypothyroid
Raynaud's

MEDICATION ON ADMISSION: Levothyroxine

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Closed fracture of nasal bones,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Open wound of scalp, without mention of complication,Open wound of ear, part unspecified, without mention of complication
Nasal bone fx-closed,Mv collision NOS-driver,Open wound of scalp,Open wound of ear NOS
Admission Date:  [**2119-7-4**]              Discharge Date:   [**2119-7-18**]

Date of Birth:  [**2081-6-4**]             Sex:   F

Service: SURGERY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
s/p Rollover motor vehicle crash

Major Surgical or Invasive Procedure:
Tracheostomy
Repair of facial fractures


History of Present Illness:
38 yo female driver of a vehicle that was hit from the side at
an
intersection and rolled over several times - she was ejected
from
the vehicle, and appeared "combative" at the scene per EMS
report, though another report says she was complaining of throat
pain and had hemoptysis.  She was intubated in the field after
receiving Ativan, Succ, Etomidate and Vec.  She also received
Reglan
10 mg, Zofran 8 mg, Protonix, Tetanus shot, Protonix and started
on Fentanyl and Propofol drips.  She was taken initially to an
area hospital
then transferred to [**Hospital1 18**] where ER note says "moving all
extremities but altered."  UCG was negative.  PHT was given (1g)
at [**Hospital1 18**], but this has not been continued as an inpt.  She was
admitted to the trauma ICU with multiple injuries and fractures
identified on imaging, including basilar skull fracture,
multiple
facial and orbital fractures (report: "Extensive fractures
involving the sinuses and orbits are most consistent with Lefort
type 3 fracture with R Lefort 1 and B Lefort 2; R temp bone fx;
L
petrous opacification w/o fx; +fx R temporal bone.")  CT of
Cspine revealed "Nondisplaced hairline fracture involving
posterior elements of C6. R soft tissue neck swelling with small
amount of air w/o evidence of laryngeal injury."  There was no
intracranial hemorrhage.





Past Medical History:
Migraines
Depression
FUO
Pyelonephritis
Hypothyroid
Raynaud's

Family History:
Noncontributory

Pertinent Results:
[**2119-7-4**] 06:45PM   GLUCOSE-119* UREA N-17 CREAT-1.0 SODIUM-139
POTASSIUM-4.1 CHLORIDE-108 TOTAL CO2-26 ANION GAP-9
[**2119-7-4**] 06:45PM   CALCIUM-7.9* PHOSPHATE-3.5 MAGNESIUM-1.9
[**2119-7-4**] 06:45PM   WBC-8.7 RBC-3.11* HGB-9.9* HCT-27.8* MCV-90
MCH-31.8 MCHC-35.5* RDW-14.3
[**2119-7-4**] 06:45PM   PLT COUNT-392
[**2119-7-4**] 04:40PM   AMYLASE-163*
[**2119-7-4**] 04:40PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

CT SINUS/MANDIBLE/MAXILLOFACIA

Reason: need to evaluate the mandibular placement

[**Hospital 93**] MEDICAL CONDITION:
38 year old woman status post open reduction and internal
fixation of mandibular fracture
REASON FOR THIS EXAMINATION:
need to evaluate the mandibular placement
CONTRAINDICATIONS for IV CONTRAST: None.

EXAMINATION: CT of the facial bone.

CLINICAL INFORMATION: Patient with internal fixation of
mandibular fracture.

TECHNIQUE: Axial images of the facial bone were obtained with
reformatted images in the coronal plane.

FINDINGS: Comparison was made with the previous CT examination
of [**2119-7-4**]. Again multiple facial fractures as well as
mandibular fracture are identified. Since the previous study
there has been internal fixation of the mandibular fracture with
plate and screws. The fracture fragments appear to be in
apposition. Small amount of air is seen in the soft tissues near
the mandible. An NG tube is visualized.

Again extensive facial fractures are seen involving the right
zygomatic arch, right maxillary sinus and also the left
maxillary sinus. Extensive soft tissue changes are seen in the
visualized paranasal sinuses. Extensive soft tissue edema and
soft tissue stranding is identified as before.

IMPRESSION: Status post internal fixation of the mandibular
fracture. The plate and screws in position with fragments in
apposition. Soft tissue changes are seen in the sinuses with
facial fractures as before.

CT HEAD W/O CONTRAST

Reason: bleed?

[**Hospital 93**] MEDICAL CONDITION:
38 year old woman s/p MVC roll over, high spiking fevers
REASON FOR THIS EXAMINATION:
bleed?
CONTRAINDICATIONS for IV CONTRAST: None.

STUDY: CT of the head without contrast.

INDICATION: 38-year-old female status post MVC rollover, spiking
high fevers. Assess for intracranial hemorrhage.

COMPARISONS: CT of the facial bones from [**2119-7-4**].

TECHNIQUE: Non-contrast head CT.

FINDINGS: The images are slightly limited secondary to patient
motion. There is no acute intracranial hemorrhage, shift of
normally midline structures, hydrocephalus or major vascular
territorial infarction. The density values of the brain
parenchyma are maintained. Bone windows again demonstrate the
multiple and extensive facial fractures, better delineated on
the most recent CT of the facial bones from [**2119-7-4**]. In summary,
there is bilateral hemorrhage within the maxillary sinuses.
There is a comminuted fracture of the posterior wall of the
right maxillary sinus in addition to a fracture of the superior
aspect along the lateral side. There is a possible right lamina
papyracea fracture as well. High density material within the
left maxillary sinus is also consistent with hemorrhage. There
is a minimally displaced fracture of the posterior wall of the
left maxillary sinus. There is a possible fracture of the left
lamina papyracea. There is a minimally displaced fracture of the
nasal septum. There is a left orbital roof fracture. A left
temporal bone fracture is presumed secondary to opacification of
the mastoid air cells and associated subcutaneous foreign body
which may be a fragment of bone but no definitive fracture line
is seen on this particular examination, although it should be
noted that this examination less sensitive to the detection of
small fractures compared to the more recent examination. There
is a small depressed fracture of the right temporal bone of the
skull. There is a fracture of the right zygomatic arch, which is
minimally displaced. High density fluid material can be found
within the sphenoid sinus, layering within the frontal sinus and
within the ethmoid air cells. The right-sided mastoid air cells
are unremarkable. There is diffuse facial swelling bilaterally
with subcutaneous emphysema again noted along the inferior
aspect of the left orbit.

IMPRESSION: No acute intracranial hemorrhage. Extensive facial
fractures as described above, better visualized on the recent CT
examination of the facial bones from [**2119-7-4**].

CT C-SPINE W/O CONTRAST

Reason: fracture
Field of view: 18

[**Hospital 93**] MEDICAL CONDITION:
38 year old woman s/p MVC
REASON FOR THIS EXAMINATION:
fracture
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Status post MVC. Evaluate for fracture.

COMPARISON: Outside priors not currently available for
comparison but will be loaded into PACS.

TECHNIQUE: Non-contrast axial images of the cervical spine were
obtained with multiplanar reformatted images.

NON-CONTRAST C-SPINE: A nondisplaced hairline fracture of the
posterior elements of C6 involves the lamina bilaterally and
extends into the anterior aspect of the base of that spinous
process. No other cervical spine fractures are identified and
there is no evidence of an acute alignment abnormality.
Vertebral body and disc heights are well preserved. Cervical
lordosis is also preserved.

Limited evaluation of the skull base demonstrates partial
imaging of patient's known multiple facial fractures including
involvement of the posterior right maxillary sinus, which likely
extends to the right medial and lateral pterygoid plates.
Involvement of the the left pterygoid processes is more
equivocal on this study. Fractures of the left zygomatic process
are also partially imaged. Evaluation of traumatic injury to the
nasal septum is incomplete. Opacification of the maxillary
sinuses and air-fluid levels within the sphenoid sinuses are
observed, as is opacification of multiple left mastoid air
cells.

Complete evaluation of soft tissue structures is limited by the
presence of endotracheal and nasogastric tubes. However,
swelling and hematoma involves the right paratracheal and
submandibular soft tissues with apparent enlargement of the
submandibular gland. Small scattered foci of subcutaneous
emphysema extend along the deep soft tissues of the right neck;
however no definite laryngeal skeleton injury is seen. There is
no evidence of pneumothorax at the lung apices.

IMPRESSION:
1. Nondisplaced hairline fracture of the posterior elements of
C6.

2. Partially imaged facial bone fractures are better evaluated
on dedicated maxillofacial CT.

3. Right neck swelling and hematoma with small pockets of
subcutaneous emphysema involving the deep cervical soft tissues
and fascia. While no definite laryngeal skeletal injury is
noted, direct, perhaps fiberoptic, visualization of the larynx
is recommended to exclude more subtle injury.


Brief Hospital Course:
She was admitted to the Trauma Service with multiple injuries
and fractures
identified on imaging, including basilar skull fracture,
multiple facial and orbital fractures (report: "Extensive
fractures involving the sinuses and orbits are most consistent
with LeFort III fracture with R LeFort 1 and B LeFort 2; R temp
bone fx; L
petrous opacification w/o fx; +fx R temporal bone.")  CT of
cervical spine revealed "Nondisplaced hairline fracture
involving posterior elements of C6. R soft tissue neck swelling
with small amount of air w/o evidence of laryngeal injury."
There was no intracranial hemorrhage.

She was taken to the operating room on [**7-7**] for closed reduction
of her LeFort III facial fractures and placement of a
tracheostomy. Her jaws were wired shut. She was later evaluated
by Speech and Swallow and was started on a liquid diet. She will
follow up with Dr. [**First Name (STitle) **] 1-2 weeks after hospital discharge.

She was taken to the operating room by Plastic surgery for
repair of her orbital, zygomatic and nasal fractures. A nasal
splint was placed and will remain until follow up in [**Hospital 3595**]
Clinic at end of week of [**7-16**]. She will remain on Augmentin
until seen by Plastics in clinic. Her nasal splint fell off on
day of discharge; only 1 day prior to planned removal of this.
Plastic Surgery was made aware of this and did not have any
concerns. She will follow up at the end of the week in [**Hospital 3595**]
clinic.

She will need to continue to wear the hard cervical collar until
follow up with Orthopedic Spine Surgery; an MRI of her cervical
spine will likely be done once the jaw wires are removed to
assess the hairline nondisplaced fracture of C6.

Neurology follow up is also being recommended as a consult was
initiated during her hospital stay for concerns over reflex
myoclonus. She underwent CTA of her head which ruled out venous
sinus thrombosis.

Physical and Occupational therapy have worked with her and have
recommended rehab stay post hospitalization. She was also
evaluated by Speech and Swallow; she is on full liquid diet,
which she is tolerating. There was a trial with Passy Muir
valve; she was unable tolerate this because of bronchospasm. it
is being recommended Speech continue to follow her once in
rehab.


Medications on Admission:
Levothyroxine


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ML
Injection TID (3 times a day).
2. Docusate Sodium 50 mg/5 mL Liquid Sig: Ten (10) ML's PO BID
(2 times a day).
3. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for constipation.
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15) ML
Mucous membrane TID (3 times a day).
7. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
RX Inhalation Q6H (every 6 hours).
8. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed for pain.
9. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1)
ML Intravenous DAILY (Daily): daily flush.
10. Augmentin 250-62.5 mg/5 mL Suspension for Reconstitution
Sig: Ten (10) ML's PO twice a day for 4 days.
11. Compazine 25 mg Suppository Sig: One (1) supp Rectal twice a
day as needed for nausea.
12. Ativan 1 mg Tablet Sig: One (1) Tablet PO every 4-6 hours as
needed for anxiety.
13. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO once a
day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
s/p Motor vehicle crash
Facial fractures
Scalp & ear lacerations
Right orbital fracture


Discharge Condition:
Stable


Discharge Instructions:
You must continue to wear the nasal splint until follow up with
Plastic Surgery this week in clinic.

Avoid any nose blowing.

Continue with the antibiotics until stopped by Plastic Surgery.

You must continue to wear your cervical collar.

Followup Instructions:
Follow up this Friday in [**Hospital 3595**] Clinic, call [**Telephone/Fax (1) 5343**] for
an appointment.

Follow up with Dr. [**First Name (STitle) **] on [**2119-7-28**] in Oral [**Hospital 34690**]
Clinic; call [**Telephone/Fax (1) 274**] for an appointment time.

Follow up with Dr. [**Last Name (STitle) 363**], Orthopedic Spine Surgery, in 2 weeks,
call [**Telephone/Fax (1) 3573**] for an appointment.

Follow up in [**Hospital 878**] Clinic in 2 weeks, call [**Telephone/Fax (1) 44**] for
an appointment.



Completed by:[**2119-7-18**]
{'Closed fracture of nasal bones,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Open wound of scalp, without mention of complication,Open wound of ear, part unspecified, without mention of complication'}


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 Rollover motor vehicle crash

PRESENT ILLNESS: 38 yo female driver of a vehicle that was hit from the side at
an
intersection and rolled over several times - she was ejected
from
the vehicle, and appeared "combative" at the scene per EMS
report, though another report says she was complaining of throat
pain and had hemoptysis.  She was intubated in the field after
receiving Ativan, Succ, Etomidate and Vec.  She also received
Reglan
10 mg, Zofran 8 mg, Protonix, Tetanus shot, Protonix and started
on Fentanyl and Propofol drips.  She was taken initially to an
area hospital
then transferred to [**Hospital1 18**] where ER note says "moving all
extremities but altered."  UCG was negative.  PHT was given (1g)
at [**Hospital1 18**], but this has not been continued as an inpt.  She was
admitted to the trauma ICU with multiple injuries and fractures
identified on imaging, including basilar skull fracture,
multiple
facial and orbital fractures (report: "Extensive fractures
involving the sinuses and orbits are most consistent with Lefort
type 3 fracture with R Lefort 1 and B Lefort 2; R temp bone fx;
L
petrous opacification w/o fx; +fx R temporal bone.")  CT of
Cspine revealed "Nondisplaced hairline fracture involving
posterior elements of C6. R soft tissue neck swelling with small
amount of air w/o evidence of laryngeal injury."  There was no
intracranial hemorrhage.

MEDICAL HISTORY: Migraines
Depression
FUO
Pyelonephritis
Hypothyroid
Raynaud's

MEDICATION ON ADMISSION: Levothyroxine

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Closed fracture of nasal bones,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Open wound of scalp, without mention of complication,Open wound of ear, part unspecified, without mention of complication'}
