CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 50 year old female who
was brought in by EMS after a syncopal episode leading to a
head-on collision against a tree at approximately 30 mph.
The patient was restrained and the airbag deployed.  The
patient was hemodynamically stable with a GCS of 15 in the
Emergency Department.  In the Emergency Department, she was
complaining of left chest pain, shortness of breath, and in
the field left crepitus was noted as well.  In the trauma
bay, the patient was hemodynamically stable with a GCS of 15,
however, her oxygen saturation rate initially was between 80
and 90%.  It was also noted at that time that her breath
sounds on the left side were markedly decreased.  A tube
thoracostomy was then performed on the left side without
complications.  After the placement of the tube thoracostomy,
the patient's oxygen saturation rate improved to 97%, her
shortness of breath improved, and lung sounds improved on the
left side as well.  She remained hemodynamically stable
throughout the procedure and tolerated it well.  As far as
her syncopal episode that led to the accident, the patient
reports feeling lightheaded and then blacked out and woke up
immediately after her motor vehicle collision without any
confusion, no loss of continence, and denied symptoms of
chest pain, palpitations, diaphoresis, or headache.  She also
notes the use of cocaine three days prior to the accident,
and previously, one year ago without any sequelae at that
time.  She had one previous episode of syncope during
pregnancy.  There is no history of syncope in her family, but
there is a significant history of myocardial infarction, both
in her father and mother at an early age.

MEDICAL HISTORY: Consistent bilateral pyelonephritis.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine which causes nausea and vomiting.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for her mother having a
myocardial infarction around age 50 and her father dieing of
a myocardial infarction in the [**2114**]'s.

SOCIAL HISTORY: Consists of occasional alcohol as well as
occasional cocaine ingestion, last was three days prior to
the accident, and previously was one year ago.
Open fracture of lower end of radius with ulna,Traumatic pneumothorax without mention of open wound into thorax,Cocaine abuse, unspecified,Closed fracture of clavicle, unspecified part,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Closed fracture of two ribs,Syncope and collapse
Fx low radius w ulna-opn,Traum pneumothorax-close,Cocaine abuse-unspec,Fx clavicle NOS-closed,Mv coll w oth obj-driver,Fracture two ribs-closed,Syncope and collapse
Admission Date:  [**2147-8-28**]     Discharge Date:  [**2147-9-3**]

Date of Birth:   [**2097-5-8**]     Sex:  F

Service:  TRAUMA SURGERY

HISTORY OF PRESENT ILLNESS:  This is a 50 year old female who
was brought in by EMS after a syncopal episode leading to a
head-on collision against a tree at approximately 30 mph.
The patient was restrained and the airbag deployed.  The
patient was hemodynamically stable with a GCS of 15 in the
Emergency Department.  In the Emergency Department, she was
complaining of left chest pain, shortness of breath, and in
the field left crepitus was noted as well.  In the trauma
bay, the patient was hemodynamically stable with a GCS of 15,
however, her oxygen saturation rate initially was between 80
and 90%.  It was also noted at that time that her breath
sounds on the left side were markedly decreased.  A tube
thoracostomy was then performed on the left side without
complications.  After the placement of the tube thoracostomy,
the patient's oxygen saturation rate improved to 97%, her
shortness of breath improved, and lung sounds improved on the
left side as well.  She remained hemodynamically stable
throughout the procedure and tolerated it well.  As far as
her syncopal episode that led to the accident, the patient
reports feeling lightheaded and then blacked out and woke up
immediately after her motor vehicle collision without any
confusion, no loss of continence, and denied symptoms of
chest pain, palpitations, diaphoresis, or headache.  She also
notes the use of cocaine three days prior to the accident,
and previously, one year ago without any sequelae at that
time.  She had one previous episode of syncope during
pregnancy.  There is no history of syncope in her family, but
there is a significant history of myocardial infarction, both
in her father and mother at an early age.

PAST MEDICAL HISTORY:  Consistent bilateral pyelonephritis.

PAST SURGICAL HISTORY:  None.

MEDICATIONS:  None.

ALLERGIES:  Codeine which causes nausea and vomiting.

SOCIAL HISTORY:  Consists of occasional alcohol as well as
occasional cocaine ingestion, last was three days prior to
the accident, and previously was one year ago.

FAMILY HISTORY:  Significant for her mother having a
myocardial infarction around age 50 and her father dieing of
a myocardial infarction in the [**2114**]'s.

PHYSICAL EXAMINATION:  GCS 15; vital signs 105/palp; heart
rate 105; respiratory rate 22; oxygen saturation rate 85%
which then improved to 97% after chest tube placement.  Head
eyes, ears, nose and throat:  pupils were equally round and
reactive to light, extraocular movements intact.  TM's were
clear.  Face stable.  Neck:  trachea was midline.  Chest:
decreased breath sounds to the left chest, no crepitus noted.
Cardiovascular:  slightly tachy, 2 out of 6 systolic murmur
noted, loudest at the apex.  Abdomen:  soft, no tenderness to
palpation, rectal tone normal with no gross blood, guaiac
negative.  Back:  no tenderness to palpation, no step-offs
noted.  Extremities:  there was an open fracture noted to the
right wrist, otherwise she was moving extremities freely,
sensation and capillary refill to the right hand and fingers
was completely intact.  Neurological examination:  non-focal,
strength and sensation grossly intact.  Her EKG was sinus at
106 beats per minute with normal axis intervals, showing some
[**Hospital1 **]-atrial abnormalities, poor R-wave progression, no acute
STT wave changes.


LABS:  Initial blood gas 7.38; CO2 46; oxygen 35; bicarbonate
28;
base deficit 0.  After the chest tube this improved to 7.40, 4
1, 382,
26, 0.  Other notable laboratory findings was positive urine c
ocaine.
Also, three sets of enzymes were obtained for the syncopal epi
[**Last Name (un) **]
which were all within normal limits.

RADIOLOGY:  Chest x-ray showed small apical pneumothorax and
proper placement of chest tube.  Pelvis showed no fracture.
Head CT showed no bleed, no fracture.  Spine CT showed no
fracture.  Follow-up flexion extension films showed
subluxation of C2 to C3 and C3 C4 likely consistent with
degenerative changes as improved on extension.  Chest CTA
showed no great vessel injury, a left upper lobe contusion.
Abdominal CT was normal.  Right arm and wrist plain film
showed a distal, radial, and ulnar fracture with 100%
displacement.

HOSPITAL COURSE:  Given the normal spine CT and the flexion
extension films which were most likely considered to be
associated with degenerative changes of the spine, we opted
to clear the patient clinically as she had no pain in the
spine at the time.  On examination of the spine, she had no
tenderness and had free range of motion.  Thus, the hard
cervical collar was removed.  The patient has tolerated this
well.

The left tube thoracostomy that was placed was followed with
serial chest x-rays showing stabilization and eventually full
improvement of the apical pneumothorax, thus the chest tube
was removed on hospital day four.  The patient has tolerated
this well and the chest tube has remained out.

Plastic Surgery was consulted for the right wrist fracture.
They opted to take the patient to the Operating Room for a
full examination and repair of the wound.  The patient was
taken to the Operating Room on hospital day one and underwent
a right open reduction and internal fixation of the radius
and ulna.  The patient tolerated the surgery well.  She was
then started on Kefzol 1 gram q8 hours and gentamycin 100 mg
q8 hours for prophylaxis.  Plastic Surgery has followed her
throughout the hospital course, remarking that the wound was
intact and the hand vasculature and nerves were intact.  They
recommended follow-up in two weeks with Dr. [**Last Name (STitle) **].

Status post removal of the chest tube, there was a chest
x-ray done that showed a not previously seen fracture of the
left clavicle that was non-displaced.  For this, Orthopedics
was consulted who recommended that a sling and swathe was not
necessary due to the desire to keep one arm slightly
mobilized.  Thus a sling was provided for comfort and
recommendations were given for follow-up in three weeks.

For the syncopal episode, Cardiology was initially consulted
given the patient's significant family history.  Cardiology,
after being consulted, decided to place the patient back on
continuous telemetry monitoring and ordered an
echocardiogram, the results of which showed one plus aortic
regurgitation, trivial mitral regurgitation, and a small
pericardial effusion which was noted to most likely be due to
trauma and not leading to any signs of tamponade.  Cardiology
also suggested a consultation of the Electrophysiology
Service which was then done.  Electrophysiology, after seeing
the patient, suggested the following course of action which
took place during the hospital stay:

1.  There was a Persantine sestamibi test performed on
hospital day four.  The sestamibi showed normal profusion of
the myocardium as well as normal wall motion and an ejection
fraction of 78%, considered to be a normal examination.  They
also recommended a carotid ultrasound study which showed
normal flow of the carotid bilaterally.  On hospital day
five, they took the patient for an electrophysiology study
which, per the attending electrophysiologist was also normal.
They decided at that time to place an implantable monitor
called a Reveal monitor which was placed during the
electrophysiology study which the patient tolerated well.
They also provided recommendations for follow-up on the
implantable monitor which will stay in for at least one year
in all likelihood.

The final consult was a physical therapy consult to improve
the patient's ability to ambulate and provide exercises for
both upper extremities as well as restrictions in activity
for her bilateral upper extremity fractures.

A final consult was done for social work regarding the
patient's history of cocaine use.  The patient acknowledged
her use of cocaine and acknowledged that it was not a
problem, that she had only used it twice in the past.  The
first time without sequelae and that she "did not even like
using it."  The patient refused any further social work
follow-up or substance abuse assistance outside of the
hospital.

The patient remained stable throughout the hospital course.
She was then determined to be suitable for discharge on
hospital day seven.

DISCHARGE DIAGNOSIS:
1.  Syncope, etiology undefined.  In all likelihood, the
syncope was due to either a vasovagal reaction, some relation
to her cocaine use, although less likely given that it was
three days prior to the syncopal episode, or some cardiac
etiology which cannot be defined by the studies performed in
the hospital such as a prolonged QT leading to ventricular
tachycardia.  It was considered unlikely that there was a
neurologic etiology such as seizure leading to the syncopal
episode.  Given the normal cardiac work-up and the implanted
monitor placed, the patient was discharged with plans for
follow-up with Cardiology and Electrophysiology.

2.  Traumatic left pneumothorax improved status post
placement of tube thoracostomy.

3.  Right radial and ulnar fracture with complete
dislocation, status post open reduction and internal
fixation.

4.  Left clavicle fracture treated with a sling and activity
restriction.

5.  Tox screen positive for cocaine use.

DISCHARGE MEDICATIONS:
1.  Augmentin 500 by mouth twice a day times seven days.
2.  Percocet 5 mg 1 to 2 tablets by mouth q4-6 hours as
needed pain.
3.  Oxycodone 10 mg by mouth q4-6 hours as needed
breakthrough pain.
4.  Ibuprofen 600 mg q8 hours as needed pain.
5.  Docusate 100 mg twice a day as needed constipation.

DISCHARGE INSTRUCTIONS:
1.  Follow-up plans were scheduled with Dr. [**Last Name (STitle) **] of Plastic
Surgery in two weeks for re-evaluation of the right radial
and ulnar fracture.

2.  Follow-up with Orthopedics was scheduled in three weeks
for follow-up on the left clavicle fracture.  A sling was
provided for comfort and instructions were given to restrict
motion to no greater than 90 degrees and no heavy weight
bearing on the left side.

3.  Follow-up with trauma clinic was provided for two weeks
from date of discharge from hospital.

4.  Electrophysiology follow-up was provided for one week
from date of discharge.  The patient will make an appointment
to be seen in the pacemaker center and further follow-up will
be decided on at that time.

5.  Other instructions include that the patient should be
closely monitored over the next several days after discharge
and should refrain from driving a car for one to two months
given the syncopal episode.  The patient also will receive
instructions to limit weight bearing to the right and left
upper extremities and to continue ambulation as much as
possible.



                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  2923

Dictated By:[**Last Name (NamePattern1) 50087**]

MEDQUIST36

D:  [**2147-9-1**]  14:00
T:  [**2147-9-4**]  21:17
JOB#:  [**Job Number 51576**]


Name:  [**Known lastname 9598**], [**Known firstname 4193**]              Unit No:  [**Numeric Identifier 9599**]

Admission Date:  [**2147-8-29**]     Discharge Date:  [**2147-9-6**]

Date of Birth:   [**2097-5-8**]     Sex:  F

Service:  Trauma Surgery

ADDENDUM:  During the hospital course the patient was changed
from Kefzol and gentamicin intravenously to oral antibiotics
in preparation for discharge.  The antibiotic given was
Augmentin which was given on hospital day six.  Thirty
minutes after the Augmentin the patient experienced an
episode of hypoxia as well as hypotension witnessed by Dr.
[**Last Name (STitle) **] and Dr. [**Last Name (STitle) **].

The patient responded to fluid boluses and oxygen via nasal
cannula and was transferred to the Medical Intensive Care
Unit where she responded without further resuscitative
measures.

To rule out other causes, the patient had a chest computed
tomography angiogram, a repeat echocardiogram, and an
investigation of her implantable cardiac monitor.  The chest
computed tomography angiogram was normal.  The echocardiogram
showed no changes from the prior study.  The investigation of
the intracardiac monitor revealed no abnormal cardiac
activity.

Given the association with the Augmentin, it was decided that
the episode of hypotension and hypoxia was due to an
anaphylactic reaction to the Augmentin.

The patient remained stable throughout the one day in the
Medical Intensive Care Unit and was transferred back to floor
where she remained stable and experienced no further issues.
The patient was started on clindamycin 300 mg by mouth four
times per day and experienced no side effects to this
medication.

The patient did well throughout the rest of her hospital
stay.  The patient was suitable for discharge on hospital day
nine.

The rest of the hospital course and follow-up plans are the
same as the previous dictation.  The patient was to follow up
with Orthopaedics as well as Trauma in the clinic within two
weeks.






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

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

MEDQUIST36

D:  [**2147-9-5**]  15:40
T:  [**2147-9-5**]  16:05
JOB#:  [**Job Number 9600**]
{'Open fracture of lower end of radius with ulna,Traumatic pneumothorax without mention of open wound into thorax,Cocaine abuse, unspecified,Closed fracture of clavicle, unspecified part,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Closed fracture of two ribs,Syncope and collapse'}


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: This is a 50 year old female who
was brought in by EMS after a syncopal episode leading to a
head-on collision against a tree at approximately 30 mph.
The patient was restrained and the airbag deployed.  The
patient was hemodynamically stable with a GCS of 15 in the
Emergency Department.  In the Emergency Department, she was
complaining of left chest pain, shortness of breath, and in
the field left crepitus was noted as well.  In the trauma
bay, the patient was hemodynamically stable with a GCS of 15,
however, her oxygen saturation rate initially was between 80
and 90%.  It was also noted at that time that her breath
sounds on the left side were markedly decreased.  A tube
thoracostomy was then performed on the left side without
complications.  After the placement of the tube thoracostomy,
the patient's oxygen saturation rate improved to 97%, her
shortness of breath improved, and lung sounds improved on the
left side as well.  She remained hemodynamically stable
throughout the procedure and tolerated it well.  As far as
her syncopal episode that led to the accident, the patient
reports feeling lightheaded and then blacked out and woke up
immediately after her motor vehicle collision without any
confusion, no loss of continence, and denied symptoms of
chest pain, palpitations, diaphoresis, or headache.  She also
notes the use of cocaine three days prior to the accident,
and previously, one year ago without any sequelae at that
time.  She had one previous episode of syncope during
pregnancy.  There is no history of syncope in her family, but
there is a significant history of myocardial infarction, both
in her father and mother at an early age.

MEDICAL HISTORY: Consistent bilateral pyelonephritis.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine which causes nausea and vomiting.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for her mother having a
myocardial infarction around age 50 and her father dieing of
a myocardial infarction in the [**2114**]'s.

SOCIAL HISTORY: Consists of occasional alcohol as well as
occasional cocaine ingestion, last was three days prior to
the accident, and previously was one year ago. 

### Response:
{'Open fracture of lower end of radius with ulna,Traumatic pneumothorax without mention of open wound into thorax,Cocaine abuse, unspecified,Closed fracture of clavicle, unspecified part,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Closed fracture of two ribs,Syncope and collapse'}
