CHIEF COMPLAINT: Face and right sided chest pain

PRESENT ILLNESS: this is a 54 year old patient with PMHx significant for CAD
with 4 drug eluting stents on Plavix who was riding his
motorcycle on [**7-16**] when he swerved to avoid traffic going
approximately 40 miles per hour and ended up crashing his
motorcycle into the pavement without striking another vehicle.
He
remembers striking his head on the pavement and was helmeted. He
denies LOC at the time of the crash. He came to [**Hospital1 18**] via EMS
following the crash and was found to have multiple injuires
including a left temporal SAH and contusions, high right frontal
IPH, and left tentoial SDH. Other injuries included ? right
orbital fx, rigth periorbital ecchymosis, right clavicle fx,
right 4th and 5th rib fx's, and right gluteal hematoma.

MEDICAL HISTORY: PMH: HTN (multiyear history, untreated), ankle & shoulder
fractures in childhood

MEDICATION ON ADMISSION: lisinopril 20', bystolic 10', simvastatin 40', metformin 500'',
plavix 75', asa325'

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Temp 99  BP 140/70  HR  90  RR 20   O2 sat 95% RA
Gen: multiple abrasions, obese, in no distress
HEENT: large right periorbital hematoma Pupils: PERRL EOMs
intact
Neck: cervical collar in place Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-19**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Married, lives with wife, no tobacco, no ETOH
Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Closed fracture of two ribs,Cellulitis and abscess of face,Closed fracture of other facial bones,Closed fracture of clavicle, unspecified part,Other motor vehicle traffic accident involving collision on the highway injuring motorcyclist,Contusion of buttock,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Brain lacer NEC w/o coma,Fracture two ribs-closed,Cellulitis of face,Fx facial bone NEC-close,Fx clavicle NOS-closed,Mv coll w oth obj-mocycl,Buttock contusion,DMII wo cmp nt st uncntr,Hypertension NOS,Crnry athrscl natve vssl,Status-post ptca
Admission Date:  [**2156-7-16**]              Discharge Date:   [**2156-7-20**]

Date of Birth:  [**2102-5-13**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
Face and right sided chest pain

Major Surgical or Invasive Procedure:
none


History of Present Illness:
this is a 54 year old patient with PMHx significant for CAD
with 4 drug eluting stents on Plavix who was riding his
motorcycle on [**7-16**] when he swerved to avoid traffic going
approximately 40 miles per hour and ended up crashing his
motorcycle into the pavement without striking another vehicle.
He
remembers striking his head on the pavement and was helmeted. He
denies LOC at the time of the crash. He came to [**Hospital1 18**] via EMS
following the crash and was found to have multiple injuires
including a left temporal SAH and contusions, high right frontal
IPH, and left tentoial SDH. Other injuries included ? right
orbital fx, rigth periorbital ecchymosis, right clavicle fx,
right 4th and 5th rib fx's, and right gluteal hematoma.

Past Medical History:
PMH: HTN (multiyear history, untreated), ankle & shoulder
fractures in childhood

PSH: none


Social History:
Married, lives with wife, no tobacco, no ETOH

Family History:
non contributory


Physical Exam:
Temp 99  BP 140/70  HR  90  RR 20   O2 sat 95% RA
Gen: multiple abrasions, obese, in no distress
HEENT: large right periorbital hematoma Pupils: PERRL EOMs
intact
Neck: cervical collar in place Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-19**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3mm to
2mm bilaterally. Visual fields are grossly full to
confrontation,
difficult to fully assess given eye injury.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: RUE extremity strength is limited by right clavicle
injury
but is full in bicep, tricep, grasps, and wrist extensors and
flexors. LUE, LLE< and RLE are full. Normal bulk and tone
bilaterally. No abnormal movements, tremors. Not able to assess
pronator drift given R clavicle fracture limiting movement of
proximal RUE
Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin


Pertinent Results:
[**2156-7-16**] 05:40PM   WBC-8.0 RBC-4.17* HGB-12.7* HCT-37.1* MCV-89
MCH-30.4 MCHC-34.2 RDW-14.3
[**2156-7-16**] 05:40PM   PLT COUNT-211
[**2156-7-16**] 05:40PM   PT-12.3 PTT-23.5 INR(PT)-1.0
[**2156-7-16**] 05:40PM   ASA-NEG ETHANOL-NEG ACETMNPHN-5* bnzodzpn-NEG
barbitrt-NEG tricyclic-NEG
[**2156-7-16**] 05:40PM   UREA N-17 CREAT-0.8
[**2156-7-16**] 05:55PM   GLUCOSE-146* LACTATE-3.6* NA+-143 K+-3.1*
CL--103 TCO2-25
[**2156-7-16**] 10:18PM   HCT-26.4*#

[**2156-7-16**] Chest Xray :
Distal right clavicular fracture. Otherwise, no acute
cardiopulmonary abnormality

[**2156-7-16**] Head CT :
1. Multifocal intracranial hemorrhage including left frontal and
temporal
lobe subarachnoid hemorrhage, left subdural hematoma and two
foci of right
intraparenchymal hemorrhage at the vertex in the right frontal
lobe.
2. Right periorbital hematoma with extension along the lateral
rectus muscle, which appears to be extraconal and causes some
proptosis.
3. Small foci of pneumocephalus in the left temporal fossa
without definite temporal bone fracture identified. A temporal
bone CT can be obtained for further evaluation.

[**2156-7-16**] CT C spine :
1. No acute fracture or malalignment.
2. Mild multilevel degenerative changes, most prominent at C5-C6
where there is mild canal narrowing and neural foraminal
stenosis.

[**2156-7-16**] CT Chest/Abd/pelvis :
1. No acute intrathoracic, abdominal or pelvic abnormality.
2. Right gluteal muscle hematoma with active extravasation.
3. Comminuted right clavicular fracture.
4. Nondisplaced right fourth and fifth lateral rib fractures.
5. Radiopaque density in the anterior abdominal wall of
uncertain
significance. Clinical correlation recommended.
6. 7-mm enhancing focus in the left lobe of the liver, possibly
a vascular
shunt, flash-filling hemangioma, or arterially enhancing lesion
such as an
adenoma or area of FNH. If the patient has a history of
hepatitis, chronic
liver disease, or malignancy then further evaluation with MRI is
recommended.

[**2156-7-17**] Head CT :
1. Continued evolution of left-sided subarachnoid hemorrhage and
subdural
hematoma.
2. Stable appearance of the right frontal lobe intraparenchymal
hemorrhagic contusions.
3. Resolving right-sided subgaleal and periorbital hematoma with
new resolved right-sided proptosis, with right lateral orbital
wall fracture.

NOTE ADDED IN ATTENDING REVIEW: There are also extensive
hemorrhagic
contusions in the left temporal lobe, with evolving adjacent
vasogenic edema.

[**2156-7-18**] Head CT :
1. Similar appearance of right frontal intraparenchymal
hemorrhage, left
frontotemporal subarachnoid hemorrhage, left temporal
hemorrhagic contusions, and left tentorial subdural blood;
slightly increased prominence of the intraventricular hemorrhage
layering in the occipital horns of the lateral ventricles.
2. Improved appearance of right frontal subgaleal and
periorbital soft tissue swelling.


Brief Hospital Course:
Mr. [**Known lastname 4109**] was evaluated by the Trauma team in the Emergency
Room and scans were reviewed. He had a subarachnoid and subdural
hemorrhage with a right intraparenchymal hemorrhage in the
setting of taking aspirin and Plavix. He was seen by the
Neurosurgery service and admitted to the Trauma ICU for close
neurologic monitoring. He began Dilantin therapy
prophylactically. He was also evaluated by the Plastic Surgery
service for his right orbital wall fracture which was deemed non
operable.  The Opt homology service also evaluated him on a
number of occasions to rule out a retrobulbar hematoma which was
not present.

During his ICU stay he remained hemodynamically stable despite
active extravasation.  His hematocrit on admission was 37 and
after resuscitation was in the 23 range consistently.  He did
receive a platelet transfusion on admission but never required
packed cells. Head CTs were followed daily as his second scan
showed continued evolution of his SAH and SDH.  His neurologic
exam did not change ad he had no seizure activity.

Following transfer to the Trauma floor he continued to progress.
 His aspirin and Plavix were resumed on [**2156-7-18**] without any
deleterious effects.  He was evaluated by the Physical and
Occupational Therapy services for a cognitive screen and full
evaluation for ambulating.  His cognitive screen revealed some
deficits with memory and he was referred to the Cognitive
Neurology service for an out patient evaluation. The Physical
Therapist worked with him on numerous occasions and recommended
home physical therapy to maximize his functional capacity.

His right clavicle fracture is not displaced and non operative.
He is in a sling for comfort and should do pendulum exercises
three times a day plus range of motion to his elbow and wrist.
The home physical therapist can review that with him and he
should follow up in 2 weeks here or in [**Doctor Last Name 792**]if he
chooses.

He was tolerating a regular diabetic diet, walking independently
and his hematocrit remained stable.  After an uncomplicated
recovery he was discharged to home on [**2156-7-20**].

Medications on Admission:
lisinopril 20', bystolic 10', simvastatin 40', metformin 500'',
plavix 75', asa325'


Discharge Medications:
1. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Dilantin Kapseal 100 mg Capsule Sig: One (1) Capsule PO three
times a day: thru [**2156-7-22**].
Disp:*10 Capsule(s)* Refills:*0*
3. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours)
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
5. metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Bystolic 10 mg Tablet Sig: One (1) Tablet PO once a day.
10. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.


Discharge Disposition:
Home With Service

Facility:
VNS of Greater rRode Island

Discharge Diagnosis:
S/P MCC
1. Left SAH
2. Left SDH
3. Right IPH
4. Right lateral orbital wall fracture
5. Right clavicle fracture
6. Right rib fractures [**3-23**]
7. Right gluteal hematoma


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
* You were admitted to the hospital after your motorcycle
accident with multiple injuries including bruising in your
brain, a broken collar bone, rib fractures, facial fracture and
a large hematoma on your right buttock/upper thigh
.
*  Your right ribs [**3-23**] are fractured which can cause severe pain
and subsequently cause you to take shallow breaths because of
the pain.

*  You should take your pain medication as directed to stay
ahead of the pain otherwise you won't be able to take deep
breaths. If the pain medication is too sedating take half the
dose and notify your physician.

*  Pneumonia is a complication of rib fractures.  In order to
decrease your risk you must use your incentive spirometer 4
times every hour while awake.  This will help expand the small
airways in your lungs and assist in coughing up secretions that
pool in the lungs.

*  You will be more comfortable if you use a cough pillow to
hold against your chest and guard your rib cage while coughing
and deep breathing.

*  Symptomatic relief with ice packs or heating pads for short
periods may ease the pain.

*  Narcotic pain medication can cause constipation therefore you
should take a stool softener twice daily and increase your fluid
and fiber intake if possible.

*  Do NOT smoke

* Keep your right arm in a sling for comfort and don't put any
weight in it.

* The large hematoma on your thigh will resolve over time and
color changes will continue to take place.

*  Return to the Emergency Room right away for any acute
shortness of breath, increased pain or crackling sensation
around your ribs ( crepitus ), visual changes, headaches or any
other symptoms that concern you.


Followup Instructions:
Call the [**Hospital 4695**] Clinic at [**Telephone/Fax (1) 1669**] for a follow up
appointment in 4 weeks.  You will need a non contrast head CT
prior to your appointment and the secretary can arrange that for
you.

Call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] from Cognitive Neurology at
[**Telephone/Fax (1) 1690**] for a follow up appointment in 1 week.

Call the Plastic Surgery Clinic at [**Telephone/Fax (1) 6742**] for a follow up
appointment on Friday [**2156-7-23**].

Call the [**Hospital **] Clinic at [**Telephone/Fax (1) 1228**] for a follow up
appointment in 2 weeks. If you prefer you can follow up with an
orthopedist in [**Doctor Last Name 792**]in 2 weeks.

Call the Acute Care Clinic at [**Telephone/Fax (1) 600**] for a follow up
appointment in [**1-22**] weeks.

Call your Eye doctor [**First Name (Titles) **] [**Last Name (Titles) **] for a follow up appointment in [**1-22**]
weeks.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2156-7-20**]
{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Closed fracture of two ribs,Cellulitis and abscess of face,Closed fracture of other facial bones,Closed fracture of clavicle, unspecified part,Other motor vehicle traffic accident involving collision on the highway injuring motorcyclist,Contusion of buttock,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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: Face and right sided chest pain

PRESENT ILLNESS: this is a 54 year old patient with PMHx significant for CAD
with 4 drug eluting stents on Plavix who was riding his
motorcycle on [**7-16**] when he swerved to avoid traffic going
approximately 40 miles per hour and ended up crashing his
motorcycle into the pavement without striking another vehicle.
He
remembers striking his head on the pavement and was helmeted. He
denies LOC at the time of the crash. He came to [**Hospital1 18**] via EMS
following the crash and was found to have multiple injuires
including a left temporal SAH and contusions, high right frontal
IPH, and left tentoial SDH. Other injuries included ? right
orbital fx, rigth periorbital ecchymosis, right clavicle fx,
right 4th and 5th rib fx's, and right gluteal hematoma.

MEDICAL HISTORY: PMH: HTN (multiyear history, untreated), ankle & shoulder
fractures in childhood

MEDICATION ON ADMISSION: lisinopril 20', bystolic 10', simvastatin 40', metformin 500'',
plavix 75', asa325'

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Temp 99  BP 140/70  HR  90  RR 20   O2 sat 95% RA
Gen: multiple abrasions, obese, in no distress
HEENT: large right periorbital hematoma Pupils: PERRL EOMs
intact
Neck: cervical collar in place Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-19**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Married, lives with wife, no tobacco, no ETOH 

### Response:
{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Closed fracture of two ribs,Cellulitis and abscess of face,Closed fracture of other facial bones,Closed fracture of clavicle, unspecified part,Other motor vehicle traffic accident involving collision on the highway injuring motorcyclist,Contusion of buttock,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
