CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 71 year old
male with mild dementia who was a pedestrian hit by a truck
at 40 miles an hour, thrown 20 feet away with loss of
consciousness and laceration of the head. He was combative at
the scene with worsening mental status. Upon arrival of EMS,
he was intubated. His blood pressure remained in the 70s. He
was found to have a flail chest on both sides and he was
transported to [**Hospital1 18**] for further management. In flight, the
patient's chest was needle decompressed on both sides. Upon
arrival into the Trauma Bay, the patient was intubated and
nonresponsive (the patient received a small amount of
fentanyl and one dose of paralytic in flight).

MEDICAL HISTORY: 1. Mild mental retardation.
2. Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Injury to multiple blood vessels of abdomen and pelvis,Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Traumatic shock,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Closed fracture of upper end of tibia alone,Motor vehicle traffic accident involving collision with pedestrian injuring passenger in motor vehicle other than motorcycle,Open unspecified fracture of pelvis,Closed fracture of sacrum and coccyx with unspecified spinal cord injury,Closed fracture of shaft of femur,Traumatic pneumohemothorax without mention of open wound into thorax,Contusion of lung without mention of open wound into thorax,Unspecified essential hypertension
Inj mult abd/pelv vessel,Brain lac NEC-brief coma,Ac posthemorrhag anemia,Hemorrhage complic proc,Traumatic shock,Retroperitoneum inj-cl,Fx upper end tibia-close,Mv coll w pedest-pasngr,Pelvic fracture NOS-open,Fx sacrum-cl/crd inj NOS,Fx femur shaft-closed,Traum pneumohemothor-cl,Lung contusion-closed,Hypertension NOS
Admission Date: [**2191-2-25**]        Discharge Date: [**2191-2-26**]

Date of Birth:  [**2119-7-13**]        Sex:  M

Service:  TRA


HISTORY OF PRESENT ILLNESS:  The patient is a 71 year old
male with mild dementia who was a pedestrian hit by a truck
at 40 miles an hour, thrown 20 feet away with loss of
consciousness and laceration of the head. He was combative at
the scene with worsening mental status. Upon arrival of EMS,
he was intubated. His blood pressure remained in the 70s. He
was found to have a flail chest on both sides and he was
transported to [**Hospital1 18**] for further management. In flight, the
patient's chest was needle decompressed on both sides. Upon
arrival into the Trauma Bay, the patient was intubated and
nonresponsive (the patient received a small amount of
fentanyl and one dose of paralytic in flight).

PHYSICAL EXAMINATION:  He was intubated, moving bilateral
upper and lower extremities minimally. The pupils were 2 mm
and nonreactive. There was significant laceration on the
patient's forehead and head down to the skull; however, no
evidence of skull fracture on visual inspection. TMs are
clear bilaterally. Mucous membranes seemed intact. He had a
flail chest and crepitus on the right side. Abdomen seems
mildly distended. Pelvis is visibly unstable. There is blood
at the meatus. Rectal exam - decreased tone and guaiac
negative. There is visibly inverted and shortened right leg
with unstable hip, unstable left knee, bruising over the left
hand. The pulses are 2 plus bilaterally throughout. Upon
arrival, the patient had a heart rate of 110 with blood
pressure of 70 systolic, sating around 90 percent.

PERTINENT LABS:  Upon arrival, the patient's white blood cell
count was 12.5, hematocrit 30.2, PT 16.4, PTT 53.8, INR 1.7,
fibrinogen 1.8. His ToxScreen was negative. Sodium was 143,
potassium 3.9, chloride 110, bicarb 22, glucose 264, BUN 13,
creatinine 1.3, amylase 92, lactate of 7.5, calcium 8.8. His
first gas was 7.13, 47, 115, 17, -13.

PAST MEDICAL HISTORY:
1. Mild mental retardation.
2. Hypertension.


ALLERGIES:  No known drug allergies.

PAST SURGICAL HISTORY:  None.

OUTPATIENT MEDICATIONS:  Unknown.

HOSPITAL COURSE:  Upon arrival, the ET tube positioning was
confirmed with CO2 indicator and bilateral chest tubes were
placed for prophylaxis. The patient started receiving blood
products, initially untyped blood followed by FFP, platelets
and cryoprecipitate which improved his blood pressure to 120s-
140s and heart rate decreased down to 80s. Because there was
blood in the meatus, the Urology service was consulted over
the phone who recommended one pass at the Foley. The Foley
was placed easily; however, only a minimal amount of urine
was obtained, so the Foley was left in place. However,
balloon was not inflated. The patient's pelvis was fixed with
a sheath. Orthopedic Service was consulted immediately and
recommended external fixation of both pelvis and bilateral
lower extremities. As we were finishing these procedures, the
patient became again hypotensive down to 70s-80s and
tachycardic. More blood products were given. Given a very
high possibility of bleeding into the pelvis from a pelvic
fracture, Interventional Radiology consult was immediately
obtained. At the same time, given distended abdomen, a DPL
was performed which was essentially negative. At that time,
the patient again improved his blood pressure to 120s-140s
with normal heart rate. Given seemingly hemodynamic
stability, the Interventional Radiology attending wished to
attempt a CT scan before proceeding to angio. The patient was
brought into the CT Suite. A quick scan of the chest and
abdomen was performed that revealed still a pneumothorax on
the left side. At that point, the patient started dropping
his saturations down to 80s. Another chest tube with a 6-
French was placed in the CT Suite. At the same time, the
right chest tube which was still functional and was in place
by way of CT scan, started putting out more bloody discharge
which had then totalled about 1 liter in 6 hours. The CT scan
revealed, as above, persistent pneumothorax on the left which
was fixed with another chest tube, hemothorax on the right
with significant bilateral contusions. There were multiple
rib fractures on the right, some mesenteric stranding,
partial rupture of the right kidney and the Foley looked like
it was in the bladder. No other abnormalities were noted. The
bony abnormalities included, as above, rib fractures,
bilateral acetabular fractures, pelvic fracture. At that
point, the patient was brought into the Angio Suite where
angio was performed (I forgot to mention that a left
subclavian Cordis as well as a left femoral Cordis were
placed emergently from the initial workup). The patient had
an angio which revealed slight bleeding from the right lower
pole of the kidney which was embolized. It also revealed a
small aneurysm in the spleen which was unclear whether it was
a new or old finding and it was embolized as well. No other
significant abnormalities were found. Throughout that, the
patient remained intermittently hemodynamically unstable,
requiring continuous amounts of blood products, fluids as
well as pressor support with epinephrine. The patient was
brought into Intensive Care Unit where his temperature was
found to be 88. His groin arterial and venous line were
changed and AV rewarming was initiated. A new set of labs was
sent which showed continuous coagulopathy and anemia with a
hematocrit of 20. The patient continued to receive red blood
cells, platelets, FFP and fibrinogen. Temperature was coming
up with AV rewarming, although it was getting continuously
more difficult to ventilate the patient. He had desaturations
in the mid 80s. In the meantime, the patient's abdomen was
becoming bigger and more tense. The measured bladder pressure
was 48. A chest x-ray done emergently revealed no significant
pneumothorax, but significant bilateral contusions, edema as
well as the fluid overload. Throughout this process,
continuous discussions with the family were undertaken and
through these discussions as we were updating the family,
they requested less and less of invasive support until
finally, given the fatality of the situation, they decided to
change the patient to CMO status until finally the patient
expired at 3:24.

CONDITION ON DISCHARGE:  The patient expired. The coroner was
contact[**Name (NI) **] and accepted the case.

DISCHARGE DIAGNOSES:
1. Motor vehicle accident.
2. Rib fractures.
3. Bilateral pulmonary contusions.
4. Bilateral pneumothoraces.
5. Pelvic fracture.
6. Right femur fracture.
7. Bilateral acetabular fractures.
8. Left knee fracture.
9. Skull laceration.
10.      History of hypertension.
11.      History of mental retardation.
12.      Anemia due to bleeding into ? pelvis and right
   thigh.
13.      Hypomagnesemia.
14.      Hypocalcemia.
15.      Respiratory failure.
16.      Abdominal compartment syndrome.
17.      Acute lung injury.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5732**], [**MD Number(1) 5733**]

Dictated By:[**Doctor Last Name 5186**]
MEDQUIST36
D:  [**2191-2-26**] 06:57:57
T:  [**2191-2-26**] 07:46:03
Job#:  [**Job Number 58662**]
{'Injury to multiple blood vessels of abdomen and pelvis,Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Traumatic shock,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Closed fracture of upper end of tibia alone,Motor vehicle traffic accident involving collision with pedestrian injuring passenger in motor vehicle other than motorcycle,Open unspecified fracture of pelvis,Closed fracture of sacrum and coccyx with unspecified spinal cord injury,Closed fracture of shaft of femur,Traumatic pneumohemothorax without mention of open wound into thorax,Contusion of lung without mention of open wound into thorax,Unspecified essential hypertension'}


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 a 71 year old
male with mild dementia who was a pedestrian hit by a truck
at 40 miles an hour, thrown 20 feet away with loss of
consciousness and laceration of the head. He was combative at
the scene with worsening mental status. Upon arrival of EMS,
he was intubated. His blood pressure remained in the 70s. He
was found to have a flail chest on both sides and he was
transported to [**Hospital1 18**] for further management. In flight, the
patient's chest was needle decompressed on both sides. Upon
arrival into the Trauma Bay, the patient was intubated and
nonresponsive (the patient received a small amount of
fentanyl and one dose of paralytic in flight).

MEDICAL HISTORY: 1. Mild mental retardation.
2. Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Injury to multiple blood vessels of abdomen and pelvis,Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Traumatic shock,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Closed fracture of upper end of tibia alone,Motor vehicle traffic accident involving collision with pedestrian injuring passenger in motor vehicle other than motorcycle,Open unspecified fracture of pelvis,Closed fracture of sacrum and coccyx with unspecified spinal cord injury,Closed fracture of shaft of femur,Traumatic pneumohemothorax without mention of open wound into thorax,Contusion of lung without mention of open wound into thorax,Unspecified essential hypertension'}
