CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 25-year-old male
pedestrian struck by a car while walking across the street
and thrown 10 feet.  He was found unresponsive at the scene
with a GCS of 8.  He became combative in the ambulance and
was taken to [**Hospital6 5016**].  He was hemodynamically
stable.  At [**Hospital6 5016**], the patient was found to
have a subarachnoid hemorrhage on head CT along with a large
skull fracture.  He was seen by Neurosurgery at [**Hospital6 10443**] but his family requested transfer to [**Hospital6 1760**].

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Weekend use of alcohol.
Closed fracture of vault of skull with cerebral laceration and contusion, with brief [less than one hour] loss of consciousness,Alcohol abuse, unspecified,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Open wound of scalp, without mention of complication,Abnormality of gait,Sixth or abducens nerve palsy,Injury to other specified cranial nerves
Cl skull vlt fx-brf coma,Alcohol abuse-unspec,Mv coll w pedest-pedest,Open wound of scalp,Abnormality of gait,Sixth nerve palsy,Injury cranial nerve NEC
Admission Date:  [**2132-8-10**]       Discharge Date:  [**2132-8-15**]

Date of Birth:   [**2106-1-17**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  Patient is a 25-year-old male
pedestrian struck by a car while walking across the street
and thrown 10 feet.  He was found unresponsive at the scene
with a GCS of 8.  He became combative in the ambulance and
was taken to [**Hospital6 5016**].  He was hemodynamically
stable.  At [**Hospital6 5016**], the patient was found to
have a subarachnoid hemorrhage on head CT along with a large
skull fracture.  He was seen by Neurosurgery at [**Hospital6 10443**] but his family requested transfer to [**Hospital6 1760**].

At the outside hospital, the patient received 2 mg of Ativan
and mannitol and a question of Dilantin for his head injury.
On arrival, the patient was hemodynamically stable with a GCS
of 14, slightly agitated, but stable.

PAST MEDICAL HISTORY:  None.

PAST SURGICAL HISTORY:  None.

MEDICATIONS:  None.

ALLERGIES:  None.

SOCIAL HISTORY:  Weekend use of alcohol.

PHYSICAL EXAMINATION:  Vital signs:  GCS 14.  Alert and
oriented times one.  Vitals:  Temperature 97.2.  Heart rate
100.  Blood pressure 161/90.  Respiratory rate 14.  Oxygen
saturation 100% on four liters.  Physical examination:
Pupils equal, round and reactive to light.  Extraocular
movements intact.  Face was stable.  TMs were clear.  Neck:
Trachea was midline with no crepitus.  Mandible was stable.
His heart was regular rate and rhythm.  Chest was clear to
auscultation bilaterally with no crepitus.  Abdomen was soft,
nontender, nondistended and his fast exam was negative.
Rectal was normal tone, no gross blood, guaiac was negative.
Extremities without deformities.  Patient was moving all four
extremities.  His strength was equal throughout, as well as
his sensation and nonfocal neurological exam.  There was a
small laceration noted on the right occipital area of his
head.

LABORATORIES:  Patient had a normal hematocrit of 45.0.  He
also had normal coagulations with a PT of 13, PTT of 23 and
INR of 1.2.  Laboratories were also notable for an alcohol
level of 112 and a toxicology screen that was positive for
opiates and cocaine.

RADIOLOGY:  Chest x-ray and pelvis x-ray were negative.  CT
of the abdomen was negative.  CT of the C spine was negative
for fracture.  Plain films of the TLS spine were also
negative for fracture and stability.  CT of the head showed
orbital frontal contusions with subarachnoid hemorrhage.
There was extra-atrial blood noted with a question of left
epidural versus subdural hemorrhage and there was a large
associated parasagittal skull fracture running along the
midline of the cranium into the left orbital area.

HOSPITAL COURSE:  The patient was admitted to the Trauma
Surgical Intensive Care Unit for q. 1 hour neurological
checks, as well as for intravenous fluids.  The patient was
protecting his own airway, so intubation was not of concern.
The patient had an immediate consultation from Neurosurgery
who recommended that operative management would not be
necessary that it was sufficient to continue with the q. 1
hour neurological checks, as well as following the coags
every 4 hours, as well as to try to limit the amount of
sedation in order to not cloud the examination of medical
status.  The patient continued to remain agitative through
the first three hospital days requiring occasional use of
benzodiazepines and narcotics to relieve pain and agitation.

On hospital day number two, he received a repeat head CT,
which again demonstrated the parasagittal fracture, as well
as slight increase in the size of a frontal epidural
hemorrhage now with a right sided component.  While in the
Trauma Surgical Intensive Care Unit, the patient was also
started on Dilantin for seizure prophylaxis, as well as on
oxacillin for infectious prophylaxis of the open head wound.

On hospital day number four, the patient's mental status had
improved enough, to where his agitation had decreased
slightly allowing him to be transferred from the Trauma
Intensive Care Unit to the floor still under a 1:1 sitter due
to occasional agitation.  A Neurobehavioral consult was
obtained and per the recommendations of the Neurobehavioral
consult, the patient was removed from all sedating
medications aside from occasional Percocets for pain control
and instead was added Seroquel 25 q.p.m., as well as
trazodone 25 q.p.m. to repeat times one for helping the
patient sleep at night.

On hospital day number five, the patient was slightly
decreased in agitation in the morning, although, still
getting up out of bed and walking, even with a 1:1 sitter,
however, he continued to improve throughout the day clearing
his mental status, becoming alert and oriented times three
and becoming more aware of his surroundings.  In an attempt
to try to regulate his sleep cycles and decrease the morning
agitation, the trazodone was discontinued, but the Seroquel
was continued.  The morning of hospital day number six, the
patient showed a marked decrease in his agitation in the
morning, showing greater incite into his situation, not
getting out of bed on his own and being fully alert and
oriented.

Also, on hospital day number six, Occupational Therapy and
Physical Therapy, as well as Social Work were consulted.
Occupational Therapy and Physical Therapy had helped the
patient work with his cognitive and functional deficits,
principally, his gait, which was still mostly ataxic six days
following his head injury.  Social Work was consulted
primarily for providing references for substance abuse
programs to deal with the patient's noted alcohol abuse.  The
patient continued to deny any us of opiates or cocaine,
although, did not remember if he had taken any substances the
night the injury was sustained, so the patient was referred
to substance abuse clinics for further follow-up for this.

On hospital day number six, it was determined that the
patient would be eligible for [**Hospital **] rehabilitation
inpatient therapy, so that several facilities were contact[**Name (NI) **]
and one facility determined that the patient would be
suitable for a rehabilitation stay there.  The patient was
stable enough for discharge to the rehabilitation facility
under constant 1:1 supervision to decrease any fall risk.
Thus, the patient was discharged to a neurological
rehabilitation facility on hospital day number six.

FINAL DISCHARGE DIAGNOSES:
1.  Pedestrian struck by car.
2.  Parasagittal skull fracture.
3.  Frontal lobe contusions.
4.  Bilateral epidural hemorrhages with result in cognitive
and functional disabilities.
5.  Substance abuse.

POST DISCHARGE MEDICATIONS:
1.  Dulcolax 5 mg 2 tablets q.d. as needed for constipation.
2.  Tylenol 650 mg q. 4-6 hours as needed for pain.
3.  Hydromorphone 10 mg, 1-2 tablets every 4 hours as needed
for pain.
4.  Seroquel 25 mg, 1 tablet q.p.m. times four weeks.
5.  Dicloxacillin 500 mg, 1 capsule po q. 6 hours times eight
days.

FOLLOW-UP:
1.  The patient will be followed up at the Rehabilitation
Facility by a physician to take out the staples and evaluate
the head wound in seven to ten days.
2.  Neurosurgery follow-up in three weeks with Dr. [**Last Name (STitle) 1327**]
with a repeat CT prior to the appointment.
3.  Trauma Clinic in two weeks.
4.  Neurobehavioral follow-up with Dr. [**First Name8 (NamePattern2) 51572**] [**Last Name (NamePattern1) **] in one
month.
5.  Alcohol and other substance abuse.  Patient was provided
referrals for follow-up at each of these places.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D.  [**MD Number(1) 2214**]

Dictated By:[**First Name3 (LF) 51573**]
MEDQUIST36

D:  [**2132-8-15**]  12:53
T:  [**2132-8-15**]  13:18
JOB#:  [**Job Number 51574**]


Name:  [**Known lastname 9594**], [**Known firstname 963**]                        Unit No:  [**Numeric Identifier 9595**]

Admission Date:  [**2132-8-10**]     Discharge Date:  [**2132-8-20**]

Date of Birth:   [**2106-1-17**]     Sex:  M

Service:  Trauma Surgery

ADDENDUM:  Over the final weekend prior to discharge, the
patient reported difficulty with vision as well as with smell
and taste.

For the visual difficulties, the patient said that
occasionally he had double vision but mostly his vision was
just blurry in the right eye, but with closing the right his
vision would improve.  He said this also partly effected the
way that he was walking and that his walking was better with
the right eye closed.

For the new reported visual changes, on physical examination,
showed a slight decrease in the later movement ability of the
right eye; consistent with a sixth nerve palsy.  The visual
fields were intact, however.

Given these new findings, a repeat head computed tomography
was ordered which showed no interval changes.  No effects of
the area in or around the orbit but still showing the
bilateral epidural hemorrhages and frontal edema.

Regarding the difficulties in smell and taste, over the
course of the weekend the patient did notice an improving
anosmia; which, per the behavioral neurologist, was
considered likely to improve over time.  For the anosmia,
which decreased the patient's appetite, they were
supplementing his diet with Boost drinks three times per day.

The patient had been on fluid restriction during her
hospitalization to reduce cerebral edema; as ordered by
Neurosurgery.  This restriction was safely discontinued prior
to his discharge to the rehabilitation facility.

The patient was re-evaluated for neurologic rehabilitation
centers after being rejected on the original day of discharge
and was approved by [**Hospital3 6841**] Clinic in [**Location (un) 5905**] for discharge to an inpatient setting on [**2132-8-20**].

MEDICATIONS ON DISCHARGE:  No changes made to medications on
discharge.

DISCHARGE STATUS:  The patient was discharged to the
[**Hospital3 6841**] Clinic.





                          [**First Name11 (Name Pattern1) 389**] [**Last Name (NamePattern1) 3595**], M.D.  [**MD Number(1) 3596**]

Dictated By:[**Last Name (NamePattern1) 9596**]

MEDQUIST36

D:  [**2132-8-20**]  17:01
T:  [**2132-8-21**]  07:58
JOB#:  [**Job Number 9597**]
{'Closed fracture of vault of skull with cerebral laceration and contusion, with brief [less than one hour] loss of consciousness,Alcohol abuse, unspecified,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Open wound of scalp, without mention of complication,Abnormality of gait,Sixth or abducens nerve palsy,Injury to other specified cranial nerves'}


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: Patient is a 25-year-old male
pedestrian struck by a car while walking across the street
and thrown 10 feet.  He was found unresponsive at the scene
with a GCS of 8.  He became combative in the ambulance and
was taken to [**Hospital6 5016**].  He was hemodynamically
stable.  At [**Hospital6 5016**], the patient was found to
have a subarachnoid hemorrhage on head CT along with a large
skull fracture.  He was seen by Neurosurgery at [**Hospital6 10443**] but his family requested transfer to [**Hospital6 1760**].

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Weekend use of alcohol. 

### Response:
{'Closed fracture of vault of skull with cerebral laceration and contusion, with brief [less than one hour] loss of consciousness,Alcohol abuse, unspecified,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Open wound of scalp, without mention of complication,Abnormality of gait,Sixth or abducens nerve palsy,Injury to other specified cranial nerves'}
