CHIEF COMPLAINT: s/p motor vehicle crash

PRESENT ILLNESS: 20yo M s/p MVC, unrestrained, resulting in ejection from car,
intubated in field for GCS 3. The mechanism of the crash is not
known at the time. He was apparently noted to have some arm
twitching activity, and per report, his pupils were not
reactive. He was paralyzed with rocuronium at the field and had
been given ativan in the ED. It is not known if any drugs or
alcohol were involved. Became hypertensive and bradycardic in
ED, given mannitol.

MEDICAL HISTORY: ADHD per family

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Upon arrival to trauma bay:
VS: HR 40, BP 180s systolic
GEN: Intubated, sedated with propofol, rigors throughout his
extremities. Multiple lacerations noted.
HEENT: Intubated, left temporal scalp laceration. HARD C-collar
in place.
CV: Slow, regular, no murmurs
RESP: Clear anteriorly
ABD: Soft
EXT: Multiple lacerations, left wrist is particularly affected
NEURO: Pupils are reactive 2.5-1.5mm bilaterally, no corneals,
[**Name8 (MD) **] RN positive gag/cough. VOR not performed. Spontaneous
extensor posturing of his upper extremities, as well as to
nailbed pressure. Lower extremities withdraw to Babinski testing
and nailbed pressure.. Reflexes are symmetric and hyporeflexic
throughout. Toe is upgoing on the left.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: social EtOH, positive for smoking
Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Closed fracture of unspecified part of ulna (alone),Closed fracture of seventh cervical vertebra,Closed fracture of one rib,Closed fracture of orbital floor (blow-out),Motor vehicle traffic accident of unspecified nature injuring driver of motor vehicle other than motorcycle,Open wound of scalp, without mention of complication
Cl skul base fx-coma NOS,Food/vomit pneumonitis,Fracture ulna NOS-closed,Fx c7 vertebra-closed,Fracture one rib-closed,Fx orbital floor-closed,Traffic acc NOS-driver,Open wound of scalp
Admission Date:  [**2101-10-28**]              Discharge Date:   [**2101-11-1**]

Date of Birth:  [**2080-10-3**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
s/p motor vehicle crash

Major Surgical or Invasive Procedure:
None


History of Present Illness:
20yo M s/p MVC, unrestrained, resulting in ejection from car,
intubated in field for GCS 3. The mechanism of the crash is not
known at the time. He was apparently noted to have some arm
twitching activity, and per report, his pupils were not
reactive. He was paralyzed with rocuronium at the field and had
been given ativan in the ED. It is not known if any drugs or
alcohol were involved. Became hypertensive and bradycardic in
ED, given mannitol.

Past Medical History:
ADHD per family

Social History:
social EtOH, positive for smoking

Family History:
non-contributory

Physical Exam:
Upon arrival to trauma bay:
VS: HR 40, BP 180s systolic
GEN: Intubated, sedated with propofol, rigors throughout his
extremities. Multiple lacerations noted.
HEENT: Intubated, left temporal scalp laceration. HARD C-collar
in place.
CV: Slow, regular, no murmurs
RESP: Clear anteriorly
ABD: Soft
EXT: Multiple lacerations, left wrist is particularly affected
NEURO: Pupils are reactive 2.5-1.5mm bilaterally, no corneals,
[**Name8 (MD) **] RN positive gag/cough. VOR not performed. Spontaneous
extensor posturing of his upper extremities, as well as to
nailbed pressure. Lower extremities withdraw to Babinski testing
and nailbed pressure.. Reflexes are symmetric and hyporeflexic
throughout. Toe is upgoing on the left.


Pertinent Results:
[**2101-10-28**] 09:02PM   WBC-11.6* RBC-4.35* HGB-14.5 HCT-41.8 MCV-96
MCH-33.3* MCHC-34.7 RDW-12.2
[**2101-10-28**] 09:02PM   GLUCOSE-83 UREA N-12 CREAT-1.0 SODIUM-136
POTASSIUM-3.7

[**10-28**] CT chest/abd/pelvis (PRELIM READ): Non-displaced fracture
through R posterior 10th rib. Small amount of dense fluid in the
pelvis. Bibasial dense opacities likely aspiration.

[**10-28**] CT head w/o contrast (PRELIM READ): 1. tiny foci of
hemorrhage in the left basal ganglia, lt subependymal and corpus
callosum (ant genu) concerning for [**Doctor First Name **].  2. fracture of the left
lamina paprycea. ?? fx left orbital floor - dedicated ct facial
bones advised.  3. no skull fracture. B/l subgaleal hematoma.

[**10-28**] CT c-spine (PRELIM READ): Left C7 superior facet fracture.

no alignment abnormalities.

[**10-28**] CXR (PRELIM READ): Appropriately positioned ET and NG
tubes. No acute intrathoracic process.

[**10-29**] CT head: Decreased conspicuity of one white matter
hyperdense focus with two persistent additional hyperdense foci,
suggestive of diffuse axonal injury.

[**10-29**] CT max/face: Left orbital fracture. Disruption of the
medial wall of the left maxillary sinus with near-complete
opacification of the left maxillary sinus.

10/29 L forearm/elbow: transverse fracture of the proximal shaft
of the left ulna, with slight medial displacement of the distal
fracture fragment.

[**10-30**] CXR: New RLL opacification concerning for aspiration.


Brief Hospital Course:
Mr. [**Known lastname 91747**] was admitted to TICU for monitoring & continued
care. Neurosurgery was consulted for the punctate brain
hemorrhage and surgical intervention not warranted. Repeat CT
head consistent with persistent [**Doctor First Name **]. His neuro exam was followed
closely and continued to improve, moving all extremities and
following commands intermittently.

Orthopedic spine was consulted for the left C7 superior facet
fracture; he was placed in a hard cervical collar which will
remain in place for at least 8 weeks.

Plastics was consulted for the facial fractures which were also
managed non operatively. He was initially recommended for Unasyn
and placed on sinus precautions. Ophthalmology consulted for
assessing for globe entrapment and no acute issues were
identified.

He was seen by orthopedics for the left ulnar fracture which was
placed in a splint, he will return to [**Hospital 1957**] clinic in 2 weeks
for more xrays and assessment for the need for operative repair
at that time.

During his ICU stay he was noted with fever to 103.7 and was
pan-cultured. His CXR showed new RLL opacity; bronch was
performed which showed thick, purulent sputum (R>>L), BAL sent.
Empiric antibiotic coverage for aspiration pneumonia was started
with Vanc/Zosyn/Cipro.

He received 500cc NS bolus x2 given for low urinary output and
tachycardia with good response  He remained stable and was
subsequently extubated. As he showed significant improvement he
was transferred to the regular nursing unit for ongoing care.

Once on the surgical [**Hospital1 **] he continued to progress. He was seen
by Occupational therapy and deemed appropriate for home with 24
hour supervision given his head injury. His IV antibiotics were
changed to po Levaquin. At time of discharge he was ambulating
independently and tolerating a regular diet. He and his family
were provided instructions on his necessary follow up
appointments and his medications were reviewed in depth.

He was discharged to home with his family.

Medications on Admission:
none

Discharge Medications:
1. Tylenol Extra Strength 500 mg Tablet Sig: Two (2) Tablet PO
every six (6) hours as needed for pain.
2. Levaquin 750 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
3. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
4. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
5. senna 8.6 mg Tablet Sig: 1-2 Tablets PO twice a day as needed
for constipation.
6. trazodone 100 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.
Disp:*30 Tablet(s)* Refills:*1*
7. Zyprexa Zydis 5 mg Tablet, Rapid Dissolve Sig: One (1)
Tablet, Rapid Dissolve PO twice a day as needed for agitation.
Disp:*60 Tablet, Rapid Dissolve(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
s/p Motor vehicle crash
Injuries:
Closed head injury
Bilateral subgaleal hematomas
Left C7 superior facet fracture
Right post 10th rib fracture
Aspiration
Right femoral hematoma
Left orbital floor fracture
Fracture of the left lamina paprycea
Maxillary sinus medial wall fracture
Left ulnar fracture


Discharge Condition:
Level of Consciousness: Alert and interactive. Impulsive due to
brain injury.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital after a motor vehicle crash
where you sustained multiple injuries which include a small
closed brain injury with some bleeding beneath the scalp;
fracture of the bones in your face and around your eye called
the orbital bone; a fracture of the lower arm bone called the
ulnar and a spine bone fracture in the cervical bones that are
located in your neck - there was no injury to your spinal cord
itself. Because of this injury you are required to wear a hard
neck (cervical) collar for at least 8-12 weeks. You will then
follow up with the Orthopedic Spine doctor for more xrays after
that time period.

You were seen by the Occupational therapist and being
recommended to follow up with the Cognitive Neurologist after
discharge for your head injury.

Followup Instructions:
Follow up in Cognitive [**Hospital 86820**] clinic with Dr. [**First Name (STitle) **] in 1
week. Call [**Telephone/Fax (1) 1690**] for an appointment.

Follow up in [**Hospital **] clinic with Dr. [**Last Name (STitle) 1005**] in 2 weeks for
reassessment of your ulnar fracture. Call [**Telephone/Fax (1) 1228**] for an
appointment.

Follow up in [**Hospital 3595**] clinic with Dr. [**First Name (STitle) 3228**] for your facial
fractures in 2 weeks. Call [**Telephone/Fax (1) 5343**] for an appointment.

Follow up in Orthopedic Spine with Dr. [**Last Name (STitle) 1352**] clinic in 4
weeks. Call [**Telephone/Fax (1) 1228**] for an appointment.





Completed by:[**2101-11-2**]
{'Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Closed fracture of unspecified part of ulna (alone),Closed fracture of seventh cervical vertebra,Closed fracture of one rib,Closed fracture of orbital floor (blow-out),Motor vehicle traffic accident of unspecified nature injuring driver of motor vehicle other than motorcycle,Open wound of scalp, 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 motor vehicle crash

PRESENT ILLNESS: 20yo M s/p MVC, unrestrained, resulting in ejection from car,
intubated in field for GCS 3. The mechanism of the crash is not
known at the time. He was apparently noted to have some arm
twitching activity, and per report, his pupils were not
reactive. He was paralyzed with rocuronium at the field and had
been given ativan in the ED. It is not known if any drugs or
alcohol were involved. Became hypertensive and bradycardic in
ED, given mannitol.

MEDICAL HISTORY: ADHD per family

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Upon arrival to trauma bay:
VS: HR 40, BP 180s systolic
GEN: Intubated, sedated with propofol, rigors throughout his
extremities. Multiple lacerations noted.
HEENT: Intubated, left temporal scalp laceration. HARD C-collar
in place.
CV: Slow, regular, no murmurs
RESP: Clear anteriorly
ABD: Soft
EXT: Multiple lacerations, left wrist is particularly affected
NEURO: Pupils are reactive 2.5-1.5mm bilaterally, no corneals,
[**Name8 (MD) **] RN positive gag/cough. VOR not performed. Spontaneous
extensor posturing of his upper extremities, as well as to
nailbed pressure. Lower extremities withdraw to Babinski testing
and nailbed pressure.. Reflexes are symmetric and hyporeflexic
throughout. Toe is upgoing on the left.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: social EtOH, positive for smoking 

### Response:
{'Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Closed fracture of unspecified part of ulna (alone),Closed fracture of seventh cervical vertebra,Closed fracture of one rib,Closed fracture of orbital floor (blow-out),Motor vehicle traffic accident of unspecified nature injuring driver of motor vehicle other than motorcycle,Open wound of scalp, without mention of complication'}
