CHIEF COMPLAINT: stab wounds

PRESENT ILLNESS: 24yoM found in snowbank with mod blood loss from bicep and
anterior chest stab wounds.  BIBEMS to [**Hospital3 **] hospital, AOx1,
hypothermic to 93*F, pos ETOH, SBP 70 responsive to IVF to SBP
100, CT chest with right pneumothorax and ?mediastinal injury, R
chest tube placed, intubated, and then transferred to [**Hospital1 18**] for
further evaluation.  On arrival to [**Hospital1 18**], intubated, sedated, HD
stable.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 34.1, 150/P, 104, 14, 100%intubated
PERRL pupil 3mm
no cervical stepoff
bilateral coarse breath sounds equally
soft nt nd bswnl abdomen
rectal no gross blood, nl tone
ext b/l palp DP and radial, R upper arm stab wound stapled by
OSH
neuro sedated
back no stepoff, no lesions

FAMILY HISTORY: nc

SOCIAL HISTORY: alcohol abuse
Accident due to excessive cold due to weather conditions,Open wound of chest (wall), without mention of complication,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Open wound of upper arm, without mention of complication,Assault by cutting and piercing instrument,Anemia, unspecified,Hypopotassemia,Hypothermia
Excessive cold: weather,Open wound of chest,Peritoneum injury-closed,Open wound of upper arm,Assault-cutting instr,Anemia NOS,Hypopotassemia,Hypothermia
Admission Date:  [**2171-2-24**]              Discharge Date:   [**2171-2-28**]

Date of Birth:  [**2147-2-10**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 974**]
Chief Complaint:
stab wounds

Major Surgical or Invasive Procedure:
right chest tube placement
mechanical ventilation/ intubation
s/p anterior chest and arm wound closure

History of Present Illness:
24yoM found in snowbank with mod blood loss from bicep and
anterior chest stab wounds.  BIBEMS to [**Hospital3 **] hospital, AOx1,
hypothermic to 93*F, pos ETOH, SBP 70 responsive to IVF to SBP
100, CT chest with right pneumothorax and ?mediastinal injury, R
chest tube placed, intubated, and then transferred to [**Hospital1 18**] for
further evaluation.  On arrival to [**Hospital1 18**], intubated, sedated, HD
stable.

Past Medical History:
none

Social History:
alcohol abuse

Family History:
nc

Physical Exam:
34.1, 150/P, 104, 14, 100%intubated
PERRL pupil 3mm
no cervical stepoff
bilateral coarse breath sounds equally
soft nt nd bswnl abdomen
rectal no gross blood, nl tone
ext b/l palp DP and radial, R upper arm stab wound stapled by
OSH
neuro sedated
back no stepoff, no lesions

Pertinent Results:
[**2171-2-24**] 05:15AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-100 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2171-2-24**] 05:15AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.020
[**2171-2-24**] 05:15AM   PT-13.5 PTT-19.1* INR(PT)-1.2
[**2171-2-24**] 05:15AM   WBC-20.5* RBC-3.87* HGB-12.7* HCT-37.4*
MCV-97 MCH-32.9* MCHC-34.0 RDW-14.0
[**2171-2-24**] 05:15AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-POS amphetmn-NEG mthdone-NEG
[**2171-2-24**] 05:15AM   ASA-NEG ETHANOL-170* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2171-2-24**] 05:27AM   HGB-13.1* calcHCT-39 O2 SAT-91 CARBOXYHB-1
MET HGB-1
[**2171-2-24**] 05:27AM   GLUCOSE-132* LACTATE-4.2* NA+-143 K+-4.2
CL--112
[**2171-2-24**] 05:27AM   PO2-71* PCO2-44 PH-7.27* TOTAL CO2-21 BASE
XS--6 COMMENTS-GREEN TOP
[**2171-2-24**] 08:09PM   HCT-27.5*
[**2171-2-28**] 06:00AM BLOOD WBC-4.9 RBC-2.80* Hgb-9.1* Hct-26.4*
MCV-95 MCH-32.6* MCHC-34.4 RDW-14.0 Plt Ct-219

CT CHEST from OSH [**2-24**]: read here by radiology and trauma
attending, R CT in place, Right apical ptx, no mediastinal air,
no mediastinal injury

XR R humerus [**2-24**]: IMPRESSION: No foreign bodies.

XR TLS [**2-24**]: IMPRESSION: No fracture.

CXR [**2-24**]: IMPRESSION
1. Endotracheal tube is above the level of the thoracic inlet,
and should be advanced. Nasogastric tube sideport terminates
above the level of the GE junction and should be advanced. These
findings were communicated to the Trauma Team caring for the
patient at the time of interpretation.
2. Hazy mediastinal density, particularly along the right
mediastinal border. This finding is unchanged from the frontal
chest radiograph provided from [**Hospital3 **] Hospital, although this
is unavailable for comparison on PACS. A CT was performed at the
outside hospital without evidence of large mediastinal hematoma.
This mediastinal density could related to consolidation within
the adjacent lung. As it is difficult to exclude an underlying
mediastinal hematoma, a repeat CT could be performed with the
patient is able. These findings were discussed with the Trauma
Team caring for the patient at the time of image acquisition and
interpretation.
3. A small right pneumothorax with right-sided chest tube in
place.

ECHO [**2-25**]
IMPRESSION: No echocardiographic evidence of thoracic aortic
injury (this
cannot be excluded by this technique). Normal biventricular size
and systolic function. No significant pericardial effusion seen.


CXR [**2-26**]
IMPRESSION:
1. No significant changes in the size of the right apical
pneumothorax.
2. Application of the right chest tube and partial atelectasis
of the right lower lobe.

CTA Chest [**2-26**]
IMPRESSION:
1) Limited examination for pulmonary embolus. No large central
pulmonary embolus is present. No definite segmental pulmonary
embolus is identified.
2) Moderate right-sided pneumothorax. The chest tube is located
within the minor fissure.
3) Consolidation within the right lower lobe medially and
associated right lower lobe atelectasis. Additional patchy
consolidation within the right upper lobe and left lower lobe.
These findings could be due to aspiration, pulmonary contusion
or hemorrhage.

CXR [**2-27**]
FINDINGS: A right-sided chest tube and small right apical
pneumothorax are unchanged. Lung volumes remain low. Bibasilar
atelectasis persists.

CXR [**2-28**] (s/p CT d/c on [**2-27**])- interval decrease in right apical
ptx


Brief Hospital Course:
CT chest from OSH read by trauma attending, cardiothoracic team,
and radiology, all agreed no s/s of cardiothoracic trauma or
mediastinal injury by CT or physical exam.  Pt stable and
transferred to TSICU after ED evaluation.  Extubated on HD1
which he tolerated well.  Echo done which did not demonstrate
any cardiovasc injury.  Stab wound edges of chest approximated
with suture.  HD 2 Chest Tube externally kinked and patient
developed desaturations and tachypnea which resolved with chest
tube unkinked. HD 3 Pt evaluated by thoracic surgery and
bronchoscopy done on HD 3 and no tracheal or airway injury seen.
 S/p bronchoscopy, patient had 3 hr episode of desaturation,
worsening back pain, and tachycardia- CXR stable ptx, and CTA
chest which r/o'd pulmonary embolism.  Pt improved
spontaneously, with no further episodes over remaining hospital
course.  HD 4 Chest tube removed, pt remained stable, and bicep
stab wound volar edge sutured with dorsal edge left open for
secondary intention closure.  HD 5, repeat CXR with decreased
size of pneumothorax, pt ambulating, tolerating PO pain meds and
house diet, and was discharged home with VNA services for his
arm wound dressing changes.  He will followup with trauma clinic
in 7-10days for followup of course and suture removal.

Medications on Admission:
none

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*45 Tablet(s)* Refills:*0*
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day:
please take while taking percoset.


Discharge Disposition:
Home

Discharge Diagnosis:
stab wound to the Right chest
stab wound to the Right arm
anemia
pneumothorax
hypokalemia
hypomagnesimia


Discharge Condition:
good

Discharge Instructions:
ambulate as much as possible
Diet as tolerated
may take shower, no baths, no swimming
please call/come back if develop fever, chills, shortness of
breath, purulent discharge from the wound

Followup Instructions:
Please follow up in trauma clinic in 7-10days, call [**Numeric Identifier 59536**]
for appt on a tuesday afternoon, for reevaluation and suture
removal





Name:  [**Known lastname **],[**Known firstname **]                    Unit No:   [**Numeric Identifier 10928**]

Admission Date:  [**2171-2-24**]              Discharge Date:   [**2171-2-28**]

Date of Birth:  [**2147-2-10**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 10929**]
Addendum:
On further eval by case management, the patient does not have
insurance and cannot be followed as an outpatient by VNA.  Will
give instructions on wound care wet to dry QD and will followup
with trauma clinic.

Discharge Disposition:
Home with Service

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

Completed by:[**2171-2-28**]
{'Accident due to excessive cold due to weather conditions,Open wound of chest (wall), without mention of complication,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Open wound of upper arm, without mention of complication,Assault by cutting and piercing instrument,Anemia, unspecified,Hypopotassemia,Hypothermia'}


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: stab wounds

PRESENT ILLNESS: 24yoM found in snowbank with mod blood loss from bicep and
anterior chest stab wounds.  BIBEMS to [**Hospital3 **] hospital, AOx1,
hypothermic to 93*F, pos ETOH, SBP 70 responsive to IVF to SBP
100, CT chest with right pneumothorax and ?mediastinal injury, R
chest tube placed, intubated, and then transferred to [**Hospital1 18**] for
further evaluation.  On arrival to [**Hospital1 18**], intubated, sedated, HD
stable.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 34.1, 150/P, 104, 14, 100%intubated
PERRL pupil 3mm
no cervical stepoff
bilateral coarse breath sounds equally
soft nt nd bswnl abdomen
rectal no gross blood, nl tone
ext b/l palp DP and radial, R upper arm stab wound stapled by
OSH
neuro sedated
back no stepoff, no lesions

FAMILY HISTORY: nc

SOCIAL HISTORY: alcohol abuse 

### Response:
{'Accident due to excessive cold due to weather conditions,Open wound of chest (wall), without mention of complication,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Open wound of upper arm, without mention of complication,Assault by cutting and piercing instrument,Anemia, unspecified,Hypopotassemia,Hypothermia'}
