CHIEF COMPLAINT: s/p plane crash

PRESENT ILLNESS: 51M deaf pilot s/p plane crash over [**Hospital3 4298**] [**6-4**], who
was first seen at [**Hospital **] Hospital, where he was intubated & received
1 unit RBC on top of his trauma resuscitation. He was
transferred to [**Hospital1 18**] for further management of his multiple
traumatic injuries.

MEDICAL HISTORY: Deaf

MEDICATION ON ADMISSION: none

ALLERGIES: Kefzol

PHYSICAL EXAM: On admission to trauma bay:
T 98.6   P 112   BP 180/palp    97%
Intubated, sedated.  GCS 3T
Foreign body embedded in L scalp
PERRLA
+C collar
RRR
CTA B
Soft, NT, ND, FAST neg
Rectal-decreased tone, guaiac neg
Foley in place, obvious hematuria
Open R distal femoral fracture,
Open L tibial fractures w/ assoc compartment sx, lac in medial L
calf
Palp DP pulses

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Supportive family. Resides in [**State 531**]
Closed fracture of T7-T12 level with complete lesion of cord,Traumatic shock,Open fracture of upper end of tibia alone,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pneumonia due to Pseudomonas,Hemorrhage complicating a procedure,Accident to powered aircraft, other and unspecified, injuring occupant of other powered aircraft,Open fracture of lower end of femur, unspecified part,Fracture of lateral malleolus, closed,Contusion of lung without mention of open wound into thorax,Open wound of scalp, complicated,Unspecified hearing loss,Morbid obesity,Other and unspecified coagulation defects
T7-t12 fx-cl/com crd les,Traumatic shock,Fx upper end tibia-open,Ac posthemorrhag anemia,React-oth vasc dev/graft,Pseudomonal pneumonia,Hemorrhage complic proc,Oth powered aircraft acc,Fx low end femur NOS-opn,Fx lateral malleolus-cl,Lung contusion-closed,Open wound scalp-compl,Hearing loss NOS,Morbid obesity,Coagulat defect NEC/NOS
Admission Date:  [**2189-6-4**]              Discharge Date:   [**2189-7-9**]

Date of Birth:  [**2138-5-2**]             Sex:   M

Service: SURGERY

Allergies:
Kefzol

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
s/p plane crash

Major Surgical or Invasive Procedure:
[**6-4**] irrigation, debridement & ex fix of open left tibial
fracture;
compartment release of left lower extremity; irrigation,
debridement & ex fix of open right femur fracture; closed
reduction of right ankle

[**6-5**] placement of swan ganz catheter & esophageal balloon for
hemodynamic monitoring

[**6-7**] T12 vertebrectomy; T11-L1 fusion & anterior cage placement;
CPR following severe blood loss

[**6-11**] placement of IVC filter

[**6-12**] open tracheostomy; right ankle ORIF; nailing of R femur
fracture

[**6-17**] left tibia ORIF with plate

[**6-22**] closure of LLE fasciotomies

[**6-4**] irrigation, debridement & ex fix of open left tibial
fracture;
compartment release of left lower extremity; irrigation,
debridement & ex fix of open right femur fracture; closed
reduction of right ankle

[**6-5**] placement of swan ganz catheter & esophageal balloon for
hemodynamic monitoring

[**6-7**] T12 vertebrectomy; T11-L1 fusion & anterior cage placement;
CPR following severe blood loss; post-repair [**6-25**]

[**6-11**] placement of IVC filter

[**6-12**] open tracheostomy; right ankle ORIF; nailing of R femur
fracture

[**6-17**] left tibia ORIF with plate

[**6-22**] closure of LLE fasciotomies


History of Present Illness:
51M deaf pilot s/p plane crash over [**Hospital3 4298**] [**6-4**], who
was first seen at [**Hospital **] Hospital, where he was intubated & received
1 unit RBC on top of his trauma resuscitation. He was
transferred to [**Hospital1 18**] for further management of his multiple
traumatic injuries.

Past Medical History:
Deaf

Social History:
Supportive family. Resides in [**State 531**]

Family History:
noncontributory

Physical Exam:
On admission to trauma bay:
T 98.6   P 112   BP 180/palp    97%
Intubated, sedated.  GCS 3T
Foreign body embedded in L scalp
PERRLA
+C collar
RRR
CTA B
Soft, NT, ND, FAST neg
Rectal-decreased tone, guaiac neg
Foley in place, obvious hematuria
Open R distal femoral fracture,
Open L tibial fractures w/ assoc compartment sx, lac in medial L
calf
Palp DP pulses

Pertinent Results:
See attached CD-ROM for significant rads images.
On presentation: hct 32.7
[**6-25**] sputum culture: Pseudomonas aeruginosa, heavy growth
[**2189-6-4**] 04:50PM   FIBRINOGE-167
[**2189-6-4**] 04:50PM   PT-14.4* PTT-26.4 INR(PT)-1.4
[**2189-6-4**] 04:50PM   PLT COUNT-189
[**2189-6-4**] 04:50PM   WBC-26.9* RBC-3.85* HGB-11.8* HCT-32.7*
MCV-85 MCH-30.7 MCHC-36.1* RDW-12.8
[**2189-6-4**] 04:50PM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2189-6-4**] 04:50PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2189-6-4**] 04:50PM   CK-MB-8 cTropnT-<0.01
[**2189-6-4**] 04:50PM   CK(CPK)-1145* AMYLASE-36
[**2189-6-4**] 04:50PM   UREA N-15 CREAT-1.1
[**2189-6-4**] 05:03PM   GLUCOSE-141* LACTATE-3.5* NA+-140 K+-4.4
CL--110 TCO2-24
[**2189-6-4**] 05:07PM   TYPE-ART PO2-68* PCO2-50* PH-7.27* TOTAL
CO2-24 BASE XS--4 INTUBATED-INTUBATED
[**2189-6-4**] 06:49PM   HCT-26.2*
[**2189-6-4**] 07:40PM   FIBRINOGE-122*
[**2189-6-4**] 07:40PM   PT-14.6* PTT-30.7 INR(PT)-1.4
[**2189-6-4**] 07:55PM   freeCa-1.01*
[**2189-6-4**] 07:55PM   HGB-8.7* calcHCT-26
[**2189-6-4**] 07:55PM   GLUCOSE-150* LACTATE-3.7* NA+-135 K+-4.4
CL--113*

Brief Hospital Course:
[**6-4**] Patient was admitted after transfer from [**Hospital3 46817**], and taken emergently to the OR by orthopedics.  Please
refer to catalog of interventions that Mr. [**Known lastname 63895**] received
during this admission.  After surgery, he was admitted to the
TSICU.  Please refer to the medical record for the details of
his extended ICU stay.  Below is an organ system-based synopsis
of Mr. [**Known lastname 63896**] relevant medical issues during this admission.

NEURO: Mr [**Known lastname 63895**] had high pain medication requirements during
this stay, and was slow to awaken after his sedation was
discontinued after tracheostomy.  He is on a regimen of standing
methadone with PO Dilaudid prn for pain.  At the time of DC, he
was able to follow commands & to express himself through sign
language.  He is able to move his arms but movement of his legs
was not seen, likely because of transection of the spinal cord
at the level of T12.  However, he does appear to have retained
sensation in his legs.

CV: He has a high baseline heart rate, which has been controlled
with lopressor.  [**6-5**] Echo showed good retained LV function and
no valvular abnormalities.

RESP: He had bilateral pulmonary contusions on presentation,
which contributed to his ARDS/[**Doctor Last Name **].  He had high PEEP
requirements early in his ICU course, which were gradually
weaned.  A chest tube was placed perioperatively around the 1st
operation, and was DC'd without complication.  After the
tracheostomy was performed, he weaned off the ventilator. 4 days
prior to presentation, the tracheostomy tube fell out post
coughing. The patient has tolerated breathing without the
tracheostomy.

FEN: He was sustained on enteral tube feeds via a postpyloric
dobhoff.  Prior to DC, he passed a swallow evaluation and has
been able to maintain nutrition on a PO diet.  He is on prevacid
as well.

HEME: He received multiple transfusions for blood loss anemia,
especially around the time of his 1st surgery, during which he
lost about 11 L of blood.  He has been prophylaxed against
DVT/PE with lovenox & an IVC filter. He has had a persistent
mild leukocytosis (15-18k), the etiology of which has not been
discovered despite triple antibiotic therapy and repeated
workups.

ID: He developed several line infections, with + blood cultures
with staph epidermidis.  After removal of the lines, he promptly
defervesced.  A sputum culture from [**6-25**] revealed pseudomonas
and he was started on levoquin & zosyn.  He then developed
copious diarrhea and was started empirically on flagyl while
stool cultures were sent. See above under heme for brief
discussion of leukocytosis.

ENDO: regular insulin sliding scale to FBS 80-120.

DISPO: full code, father [**Name (NI) **] is HCP (cell [**Telephone/Fax (1) 63897**], home
[**Telephone/Fax (1) 63898**])

Medications on Admission:
none

Discharge Medications:
1. Methadone 10 mg Tablet Sig: Three (3) Tablet PO TID (3 times
a day).
Disp:*270 Tablet(s)* Refills:*2* On for pain management.
2. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
3. Enoxaparin Sodium 30 mg/0.3 mL Syringe Sig: One (1) syringe
Subcutaneous Q12H (every 12 hours).
Disp:*60 syringe* Refills:*2*
4. Acetaminophen 160 mg/5 mL Solution Sig: Four (4) teaspoons PO
Q6H (every 6 hours).
Disp:*300 ML* Refills:*2*
5. Nystatin 100,000 unit/mL Suspension Sig: Ten (10) ML PO four
times a day as needed for thrush.
Disp:*250 ML(s)* Refills:*3*
6. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1) teaspoon PO
BID (2 times a day).
Disp:*60 teaspoon* Refills:*2*
7. Multivit-Iron-Min-Folic Acid     Syrup Sig: One (1) dose PO
once a day.
Disp:*250 ML* Refills:*2*
8. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: Ten (10) Recon
Soln Intravenous  Q8H (every 8 hours) for 10 days.
Disp:*30 doses* Refills:*0*
9. Regular insulin sliding scale
Fingersticks q6.  Dose insulin as follows: less than 70, 4 oz
juice via dobhoff; 121-160, 3 units; 161-200, 6 units; 201-240,
9 units; 241-280, 12 units; more than 281, 15 units & notify MD.
10. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-14**]
Puffs Inhalation Q6H (every 6 hours) as needed.
Disp:*1 inhaler* Refills:*5*
11. Dulcolax 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO twice a day as needed for
constipation.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
12. Haloperidol Lactate 5 mg/mL Solution Sig: [**12-17**] ml Injection
Q1-2H () as needed for agitation: follow QTc regularly.
Disp:*250 ml* Refills:*0*
13. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q3-4H
(Every 3 to 4 Hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
14. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day): Continue for 5 more days.
15. Tobramycin Sulfate 10 mg/mL Solution Sig: One (1)  Injection
Q8H (every 8 hours): Continue for 7 more days.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **]

Discharge Diagnosis:
s/p plane crash
T12 burst fracture
retroperitoneal hematoma
multiple rib fractures
bilateral pulmonary contusions
ARDS/acute lung injury
paraplegia
right femur fracture
bilateral tibia/fibula fractures
left leg compartment syndrome
respiratory failure
pseudomonas pneumonia
line sepsis
allergic dermatitis
kefzol allergy


Discharge Condition:
improved

Discharge Instructions:
Tube feeding & medications via dobhoff tube as prescribed.
Check patient's swallowing function as he becomes more
responsive.

Culture for fevers or leukocytosis as appropriate.  Feel free to
contact [**Hospital1 18**] trauma team with any questions or concerns.
Culture for fevers or leukocytosis as appropriate. Patient has
had history of mild leukocytosis (15K to 18K) on triple therapy
antibiotics, with repeated negative work-ups.

We are reccomending that the patient continues his current
antibiotic regimen so he recieves a 2 week course of each
medicine. As of today ([**7-9**]) he is on day [**11-25**] of IV Zosyn,
[**8-26**] po Flagyl, and [**6-25**] of IV tobramycin.
Patient has been undergoing PT/OT and currently is able to get
out of bed with assist to chair daily.

 Feel free to contact [**Hospital1 18**] trauma team with any questions or
concerns.

Followup Instructions:
You will be an inpatient at the [**Hospital **] [**Hospital **] Hospital in
[**State 531**].

Contact the Trauma Surgery office at [**Telephone/Fax (1) 6439**] with any
questions or concerns.



Completed by:[**2189-7-9**]
{'Closed fracture of T7-T12 level with complete lesion of cord,Traumatic shock,Open fracture of upper end of tibia alone,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pneumonia due to Pseudomonas,Hemorrhage complicating a procedure,Accident to powered aircraft, other and unspecified, injuring occupant of other powered aircraft,Open fracture of lower end of femur, unspecified part,Fracture of lateral malleolus, closed,Contusion of lung without mention of open wound into thorax,Open wound of scalp, complicated,Unspecified hearing loss,Morbid obesity,Other and unspecified coagulation defects'}


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 plane crash

PRESENT ILLNESS: 51M deaf pilot s/p plane crash over [**Hospital3 4298**] [**6-4**], who
was first seen at [**Hospital **] Hospital, where he was intubated & received
1 unit RBC on top of his trauma resuscitation. He was
transferred to [**Hospital1 18**] for further management of his multiple
traumatic injuries.

MEDICAL HISTORY: Deaf

MEDICATION ON ADMISSION: none

ALLERGIES: Kefzol

PHYSICAL EXAM: On admission to trauma bay:
T 98.6   P 112   BP 180/palp    97%
Intubated, sedated.  GCS 3T
Foreign body embedded in L scalp
PERRLA
+C collar
RRR
CTA B
Soft, NT, ND, FAST neg
Rectal-decreased tone, guaiac neg
Foley in place, obvious hematuria
Open R distal femoral fracture,
Open L tibial fractures w/ assoc compartment sx, lac in medial L
calf
Palp DP pulses

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Supportive family. Resides in [**State 531**] 

### Response:
{'Closed fracture of T7-T12 level with complete lesion of cord,Traumatic shock,Open fracture of upper end of tibia alone,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Pneumonia due to Pseudomonas,Hemorrhage complicating a procedure,Accident to powered aircraft, other and unspecified, injuring occupant of other powered aircraft,Open fracture of lower end of femur, unspecified part,Fracture of lateral malleolus, closed,Contusion of lung without mention of open wound into thorax,Open wound of scalp, complicated,Unspecified hearing loss,Morbid obesity,Other and unspecified coagulation defects'}
