CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 87-year-old
female who was a pedestrian struck by a car at approximately
40 miles per hour.  She had a loss of consciousness
documented approximately 20 minutes.  She was intubated at
the scene and was transferred to [**Hospital1 190**] Emergency Department via Life Flight.  She was
hypotensive during transport and was given intravenous
fluids.

MEDICAL HISTORY: Unknown at the time of presentation.
Per family, hypertension.

MEDICATION ON ADMISSION: The patient takes a hypertensive
medication, the name of which is unknown.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of condyle, femoral,Closed fracture of pubis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Injury to unspecified pelvic organ, without mention of open wound into cavity,Injury to iliac artery,Other specified open wounds of ocular adnexa,Urinary tract infection, site not specified
Subarach hem-brief coma,Fx femoral condyle-close,Fracture of pubis-closed,Fx lumbar vertebra-close,Mv coll w pedest-pedest,Pelvic organ inj NOS-cl,Injury iliac artery,Opn wnd ocular adnex NEC,Urin tract infection NOS
Admission Date:  [**2198-3-14**]     Discharge Date:  [**2198-3-27**]

Date of Birth:   [**2120-10-24**]     Sex:  F

Service:  Trauma Surgery

HISTORY OF PRESENT ILLNESS:  The patient is an 87-year-old
female who was a pedestrian struck by a car at approximately
40 miles per hour.  She had a loss of consciousness
documented approximately 20 minutes.  She was intubated at
the scene and was transferred to [**Hospital1 190**] Emergency Department via Life Flight.  She was
hypotensive during transport and was given intravenous
fluids.

PAST MEDICAL HISTORY:  Unknown at the time of presentation.
Per family, hypertension.

PAST SURGICAL HISTORY:  Rhinoplasty times two.

MEDICATIONS ON ADMISSION:  The patient takes a hypertensive
medication, the name of which is unknown.

ALLERGIES:  The patient has no known drug allergies.

PHYSICAL EXAMINATION ON PRESENTATION:  The patient arrived
intubated with sedation and perlitic medications on board.
Vital signs revealed her temperature was 97, her blood
pressure was 120/69, her heart rate was 50, her respiratory
rate was 18, intubated with 100% saturation.   Her head,
eyes, ears, nose, and throat examination showed periorbital
swelling of the left eye with a sluggish pupillary reaction
to light, from 4 mm to 3 mm.  The right eye was reactive to
light from 3 mm to 2 mm.  The patient had an obvious
laceration across her left eyelid which superficial in
nature.  She had a large central forehead laceration with
tissue deficit and rectalis muscle exposure.  There were no
obvious stepoffs of her facial bone.  Her tympanic membranes
were clear bilaterally.  The tongue was midline.  Airway was
confirmed with visualization of the tube through the cords.
She had a regular rate and rhythm.  There were no murmurs.
She had clear breath sounds to auscultation bilaterally.
There were no obvious deformities of her chest.  The abdomen
was soft, nontender, and nondistended.  There were positive
bowel sounds.  However, there were multiple superficial
abrasions across her belly; consistent with "road rash."  Her
pelvis appeared stable to palpation.  The cervical and
thoracolumbosacral spine had no obvious deformities or
stepoff.  She was guaiac-negative with good rectal tone.
There were obvious deformities of the bilateral lower
extremities with ecchymoses and swelling of both knees.  She
had 2+ radial pulses bilaterally, and 2+ femoral pulses
bilaterally, and she had 2+ dorsalis pedis pulses
bilaterally.

PERTINENT LABORATORY VALUES ON PRESENTATION:  White blood
cell count was 14, her hematocrit was 22, and her platelets
were 181.  Chemistry-7 was unremarkable.  The patient had an
INR of 1.2.

PERTINENT RADIOLOGY/IMAGING:  A computed tomography on
admission showed no intracranial hemorrhage.

A computed tomography of the cervical spine showed
degenerative changes; no acute changes.

A chest computed tomography was negative.

An abdominal and pelvic computed tomography showed superior
and inferior rami fracture with right pelvic hematoma and a
right sacral ala fracture.

Thoracolumbosacral films showed a L1 compression fracture.

Bilateral femur films showed a right tibia/fibula fracture, a
right pubic fracture, and a left tibial plateau fracture.

SUMMARY OF HOSPITAL COURSE:   The patient was transferred to
the Surgical Intensive Care Unit in an intubated condition.
She required neurologic checks and serial hematocrit checks.

On hospital day two, it was noted that her hematocrit had
reached a level of 26.5, and she received 2 units of packed
red blood cells.  She was re-scanned to determine where the
bleeding was coming from, and it was found that she had
bilateral intraventricular hemorrhages and a parietal
subarachnoid hematoma.  It was also noted that the pelvic
hematoma, though initially small, was expanding in size.

Angiography of the pelvic arteries was performed, and one
small arterial branch was embolized with gelfoam.
Neurosurgery was monitoring for evaluation of her
intracranial head bleeds.  Tight blood pressure control, as
well as glycemic control, and INR parameters were maintained
while the patient was in the Intensive Care Unit.

A follow-up head computed tomography showed no increase in
the bleeding.  The patient was awakened each day from
sedation and was found to be moving all extremities.

Neurosurgery also assisted the clearance of her cervical
spine, and a magnetic resonance imaging of the entire spine
was obtained.  Her cervical spine was subsequently cleared.

As the patient was going to the operating room for
orthopaedic repair, [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] bolt was placed for intracranial
pressure monitoring on hospital day three and was taken out
on hospital day six.  The intracranial pressure was noted to
be within normal limits.  No operative intervention was found
to be needed for the patient's intracranial hemorrhage.

Orthopaedics was consulted for the patient's multiple pelvic
and lower extremity fractures.  They recommended open
reduction and internal fixation of these fractures.  This
occurred on hospital day four, as the patient's hemodynamic
status needed to be stabilized.  In addition, her
neurosurgical issues took precedence at that time.

On [**3-17**], on hospital day four, the patient went to the
operating room for open reduction/internal fixation of
bilateral tibial plateau fractures as well as open
reduction/internal fixation of the left intercondylar lateral
femur fracture.  Please see the Operative Report for full
details.  The operation occurred without any complications,
and intracranial pressure was monitored with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] bolt as
mentioned previously.

As the patient was unable to be anticoagulated given her
pelvic and intracranial bleeding, and inferior vena cava
filter was placed on hospital day three.  A week out from her
injuries, and when it was determined her intracranial
hemorrhage was stable, the patient was able to be started on
Lovenox for anticoagulation, and the inferior vena cava
filter was discontinued on [**3-26**] (on hospital day 13).

Per Orthopaedics, the patient is in [**Doctor Last Name **] braces to both
extremities on a continuous passive motion machine
bilaterally.  She was to be nonweightbearing for an extended
period of time, which will be determined specifically at her
outpatient appointment with her orthopaedic doctor (Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) in two weeks after discharge.  There was no
operative repair of her pelvic fractures.

Plastic Surgery was consulted for repair of her deep facial
lacerations which included a central forehead laceration with
tissue deficit and exposure of the rectalis muscle.  The
repair of this occurred in the operating room at the same
time that the orthopaedic procedure was taking place with
galea undermining and suturing of the laceration.  She also
had sutures placed at the bedside over her left eyelid with
good approximation and repair.

An Ophthalmology consultation was obtained given the left
periorbital swelling and asymmetry of the left pupil.  This
was thought to be due to a direct blow to the orbit region
rather than any intracranial etiology.  Ophthalmology
documented corneal abrasions, no entrapment, and recommended
prophylactic antibiotic ointments and eyedrops.

A Spinal Service consultation was obtained for evaluation of
the patient's L1 compression fracture.  The magnetic
resonance images of this region were reviewed.  The patient
was fitted for a lumbosacral brace, which she is to wear at
all times except when she is supine.

In addition, the Spinal Service was consulted for the
patient's right upper extremity weakness which was thought to
be related to her cervical stenosis and spondylosis.  This
right upper extremity weakness was brought to the doctors'
attention after the patient was extubated.  It was thought
that it is an acute-on-chronic exacerbation.  Recommendation
was made for the patient to consider cervical decompression
at a future date when she is fully recovered from this
current incident.

The Orthopaedic spine doctors spoke with the patient about
this.  As they were following her for her lumbar fracture,
they will be able to readdress this issue when she sees them
for followup.

The patient was extubated on hospital day seven; however,
this proved to be unsuccessful, and the patient needed
reintubation approximately two hours later due to coughing
and subjective feeling of being unable to breathe.  A chest
x-ray was performed, and it was thought that the patient was
too fluid overloaded to sustain spontaneous breathing.  She
was aggressively diuresed and then successfully extubated on
hospital day ten.

While in the Intensive Care Unit, the patient became febrile
and was pan-cultured.  It was determined that she had a
urinary tract infection which was positive for Pseudomonas.
The patient was started on levofloxacin, and the Foley was
changed, and she became afebrile.

CONDITION AT DISCHARGE:  The patient was discharged in stable
condition.  At the time of discharge, she was hemodynamically
stable.  Alert and oriented times three.  Eating solid foods,
though of a soft consistency; as she is edentulous.  She is
nonweightbearing of the lower extremities and had a Foley in
place.

DISCHARGE DISPOSITION:   To an extended care facility.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to be nonweightbearing for a lengthy
period of time; to be determined by her orthopaedic (Dr.
[**Last Name (STitle) **] with whom she will follow up with two weeks after her
discharge date.
2.  The patient was instructed to continue with continuous
passive motion machine of the bilateral lower extremities and
wear her braces to her bilateral lower extremities.
3.  Given her nonweightbearing status, she will be discharged
with a Foley.
4.  The patient was instructed to follow up with Plastic
Surgery for evaluation of her central forehead wound and
eyelid laceration.  This should occur in two weeks with Dr.
[**First Name (STitle) 3228**] (telephone number [**Telephone/Fax (1) 56307**]).
5.  The patient was instructed to follow up in Orthopaedics
with Dr. [**Last Name (STitle) **] for evaluation of her bilateral leg fractures;
status post open reduction/internal fixation.  She was to see
him in two weeks.  She was to call telephone number
[**Telephone/Fax (1) 9118**] for an appointment.
6.  The patient was instructed to follow up in Spine Surgery
with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 363**].  He will evaluate the healing of her L1
compression fracture and a future need for cervical surgery.
She was to call telephone number [**Telephone/Fax (1) 3573**] in three to
four weeks for an appointment.
7.  The patient was instructed to follow up in Neurosurgery
with Dr. [**First Name (STitle) **] in one month.  She will need to have a head
computed tomography prior to this appointment.  She may call
telephone number [**Telephone/Fax (1) 1669**] for an appointment.
8.  There was no scheduled appointment with the Trauma
Clinic; however, if the patient has questions or concerns she
may call telephone number [**Telephone/Fax (1) 274**] for an appointment.

DISCHARGE DIAGNOSES:
 1.  Right superior and inferior pubic rami fractures.
 2.  Right sacral ala fracture.
 3.  Right tibia/fibula fracture; status post open
reduction/internal fixation.
 4.  Left lateral tibial plateau fracture; status post open
reduction/internal fixation.
 5.  Left lateral femoral condyle fracture; status post open
reduction/internal fixation.
 6.  Multiple rib fractures.
 7.  L1 compression fracture.
 8.  Bilateral intraventricular hemorrhage; stable.
 9.  Subarachnoid hemorrhage in the parietal region; stable.
10.  Central forehead wound with rectalis muscle exposed and
tissue deficit; repaired by Plastic Surgery.
11.  Left eyelid laceration; repaired by Plastic Surgery.
12.  Right upper extremity weakness; acute-on-chronic in
origin.
13.  Cervical spondylosis/stenosis.
14.  Urinary tract infection (Pseudomonas); status post
antibiotic treatment for 10 days.

MEDICATIONS ON DISCHARGE:
 1.  Bacitracin ointment applied to wounds twice per day.
 2.  Albuterol nebulizer 1 to 2 puffs q.6h. as needed.
 3.  Artificial Tear ointment apply 1 to 2 drops in eyes as
needed.
 4.  Lovenox 30 mg subcutaneously q.12h.
 5.  Colace 100 mg by mouth twice per day.
 6.  Tylenol 650 mg by mouth q.4-6h.
 7.  Metoprolol 50 mg by mouth three times per day.
 8.  Hydralazine 25 mg by mouth q.6h.
 9.  Combivent nebulizer 1 nebulizer q.6h. as needed.
10.  Erythromycin ointment 0.5 inches to the left eye four
times per day.





                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9325**], M.D.  [**MD Number(1) 10637**]

Dictated By:[**Last Name (NamePattern1) 37631**]

MEDQUIST36

D:  [**2198-3-26**]  16:07
T:  [**2198-3-26**]  16:29
JOB#:  [**Job Number 56308**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of condyle, femoral,Closed fracture of pubis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Injury to unspecified pelvic organ, without mention of open wound into cavity,Injury to iliac artery,Other specified open wounds of ocular adnexa,Urinary tract infection, site not specified'}


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: 

PRESENT ILLNESS: The patient is an 87-year-old
female who was a pedestrian struck by a car at approximately
40 miles per hour.  She had a loss of consciousness
documented approximately 20 minutes.  She was intubated at
the scene and was transferred to [**Hospital1 190**] Emergency Department via Life Flight.  She was
hypotensive during transport and was given intravenous
fluids.

MEDICAL HISTORY: Unknown at the time of presentation.
Per family, hypertension.

MEDICATION ON ADMISSION: The patient takes a hypertensive
medication, the name of which is unknown.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of condyle, femoral,Closed fracture of pubis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Injury to unspecified pelvic organ, without mention of open wound into cavity,Injury to iliac artery,Other specified open wounds of ocular adnexa,Urinary tract infection, site not specified'}
