CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 67-year-old
Russian-speaking gentleman with a history of Parkinson
disease who was impaled in the right thigh after being struck
by a vehicle at low speed.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Open wound of hip and thigh, complicated,Injury to other specified blood vessels of lower extremity,Closed fracture of acetabulum,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Closed fracture of five ribs,Closed fracture of shaft of fibula alone
Open wnd hip/thigh-compl,Injury leg vessels NEC,Fracture acetabulum-clos,Kidney hematoma-closed,Peritoneum injury-closed,Fracture five ribs-close,Fx shaft fibula-closed
Admission Date:  [**2140-1-15**]       Discharge Date: [**2140-3-9**]

Date of Birth:   [**2071-10-30**]       Sex:  M

Service:  Trauma

ADMISSION DIAGNOSIS:  Pedestrian struck.

HISTORY OF PRESENT ILLNESS:  The patient is a 67-year-old
Russian-speaking gentleman with a history of Parkinson
disease who was impaled in the right thigh after being struck
by a vehicle at low speed.

His primary survey was significant for an intact airway and
respirations, but there was a right lower extremity deformity
with a long 3-inch laceration on his right side.  He was
hypotensive in the Trauma Bay and was transfused with packed
red blood cells.  A central line was placed.  An arterial
line was placed.

An echocardiogram showed intravascular volume depletion.  In
addition, his chest x-ray showed a questionable right
mediastinum and fracture of ribs two, three, four, five, and
seven.  His anterior/posterior pelvis film in the Trauma Bay
showed a right acetabular fracture.

CONCISE SUMMARY OF HOSPITAL COURSE:  He was taken emergently
to angiography where a branch of the right profunda femoral
artery was embolized.  He was stabilized, and further
evaluation with an abdominal computed tomography showed a
left perinephric hematoma with no free air or free fluid
within the abdomen.  Additionally, a computed tomography
angiogram of the chest was done which showed a small venous
bleed in the mediastinum and an anterior sternal fracture.

His other injuries included a right fibular fracture, right
acetabular fracture (as mentioned above), the left rib
fractures (as mentioned above), and the left perinephric
hematoma.

The patient was then transferred from computed tomography
angiogram to the Trauma Intensive Care Unit where he received
further resuscitation with blood products, and his acidosis
subsequently improved.  However, he was noted to have ongoing
bleeding with a further hematocrit drop.  His leg wound was
examined without additional bleeding.  However, a repeat
computed tomography scan showed extension of the
retroperitoneal hematoma and extensive intraperitoneal fluid.

The patient was taken to the operating room for an
exploratory laparotomy and was found to have a large amount
of bloody/ascitic fluid with a left retroperitoneal hematoma.
This was observed directly with no worsening, and the patient
was closed and transferred intubated back to the Trauma
Intensive Care Unit.

From there, the patient had a prolonged Intensive Care Unit
course.  Significantly, he had a left common femoral vein
deep venous thrombosis; for which a removable inferior vena
cava filter was placed on [**2140-1-25**].  His right leg
wound had been treated with packs and dressing changes;
however, the skin developed increasing necrosis and
cellulitis; for which he underwent extensive debridement on
[**2140-1-25**].  He subsequently had a Hemovac dressing
placed over that wound.

On [**2140-2-9**] he underwent a split-thickness skin graft
from the left lateral and posterior thigh to the right
posterior thigh with good results.  Currently, the patient
has a small area of granulation on his posteromedial thigh
with otherwise take of his skin graft.

His hospital course was otherwise significant for an ileus;
for which he had a nasogastric tube placed.  He eventually
was extubated and was transferred to the regular floor.
However, he developed increasing respiratory distress with
abdominal pain and was found to have elevated liver function
tests and pancreatitis.  He was taken for endoscopic
retrograde cholangiopancreatography.  However, on the first
attempt the patient desaturated and was transferred to the
Intensive Care Unit where he was again intubated.  Endoscopic
retrograde cholangiopancreatography and sphincterotomy were
performed with findings of nonocclusive sludge in the common
bile duct.  His pancreatitis resolved, and he was stabilized
from a gastroenterology standpoint.

Of note, during this time, the patient was septic with
copious respiratory secretions.  Sputum cultures subsequently
grew methicillin-resistant Staphylococcus aureus; for which
he was placed on vancomycin.  His initial wound had grown
Escherichia coli bacillus Corynebacterium enterococcus, and
he additionally had grown Serratia marcescens from his
sputum.  He was maintained on vancomycin and aztreonam for a
course, after which his antibiotics were stopped.  At the
time of redevelopment of his pancreatitis, he was empirically
placed on vancomycin (which he is currently on).

He was extubated again on [**3-3**] and transferred to the
regular floor.  At this time, the patient was alert and
mildly tachycardic with a stable blood pressure.

Respiratory wise, he continued to have coarse breath sounds
with right lower lobe collapse on his chest x-ray and
required chest physical therapy and nebulizers to help him
manage copious secretions.  His initial swallow study was
equivocal; however, subsequent swallow studies showed the
patient did not have signs of aspiration; however, he
fatigued easily.  He was able to tolerate a regular diet via
frequent intervals with small amounts.

On [**3-7**], the patient was noted to have increasing
respiratory distress and tachypnea.  He was again transferred
to the Intensive Care Unit where aggressive chest physical
therapy and suctioning were performed.  He subsequently
stabilized and was able to be weaned to a nasal cannula with
a return to his previous baseline respiratory status.  He
continued to have copious secretions but was able to manage
them well.

1.  NEUROLOGY ISSUES:  On brief review of systems, as above,
neurologic wise, the patient has Parkinson disease.  A
Neurology consultation was pending for further
recommendations.  He is continues on Sinemet.

2.  CARDIOVASCULAR ISSUES:  The patient has a history of
hypertension.  However, his blood pressure here has been
lower and his blood pressure medications have been held at
this time.

3.  GASTROINTESTINAL ISSUES:  The patient was tolerating a
regular diet; per Speech and Swallow recommendations, will
have small frequent meals with supervision.  He can drink
thin liquids through a straw with a calorie count currently
ongoing to determine if he is able to meet his nutritional
goals orally.

4.  GENITOURINARY ISSUES:  The patient has a history of
prostate cancer; status post prostatectomy.

5.  RENAL ISSUES:  The patient has an indwelling Foley
catheter due to his instability and requires this for wound
hygiene.  He is also on Protonix for ulceration prophylaxis.

6.  HEMATOLOGIC ISSUES:  The patient is currently on Lovenox
given his history of deep venous thrombosis for pulmonary
embolism prophylaxis.  His white blood cell count and
hematocrit have been stable.

7.  ENDOCRINE ISSUES:  The patient is on a regular insulin
sliding-scale given the multiple stressors and traumatic
nature of his injuries.  He is not a diabetic, and his
glucose levels have been stable in the 80s to low 100 range.

8.  RESPIRATORY ISSUES:  The patient has currently been
weaned to nasal cannula with respiratory rates varying in the
20s to 30s.  He is receiving frequent chest physiotherapy
with albuterol and Atrovent nebulizer treatments and
occasional nasogastric tube suctioning for retained
secretions.  Current chest x-rays show no infiltrate;
however, there was persistent collapse of the right lower and
middle lobes.

PHYSICAL EXAMINATION ON DISCHARGE:  The patient was afebrile,
heart rate was 100, his blood pressure was 140s/70s, his
respiratory rate was 30 to 40, and his oxygen saturation was
96% on 4 liters via nasal cannula.  The patient was alert and
tremulousness.  He followed commands and moved all
extremities.  The neck was supple and nontender.  Chest was
coarse bilaterally with decreased breath sounds at the right
base.  Heart was regular in rate and rhythm.  The abdomen was
soft and nondistended.  The incision was healing well.  The
pelvis was stable.  Extremities were warm with generalized
anasarca.  The medial thigh skin graft with good take.  There
was no evidence of cellulitis.  There was approximately a
1-cm area with granulation tissue.

DISCHARGE DISPOSITION:  The patient is currently awaiting
placement in an acute rehabilitation facility with special
attention to pulmonary toilet.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient is to receive aggressive and frequent chest
physiotherapy in addition to regular physiotherapy for severe
deconditioning.
2.  The patient's diet consists of frequent small meals given
fatigue on his recent swallow evaluation.  Thin liquids
should be administered via a straw with supervision.
3.  The patient is to have a nonadherent dressing to his
right medial thigh wound changed twice per day.
4.  The patient was instructed to follow up with Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] from Plastic Surgery one to two weeks after discharge.
5.  The patient was instructed to follow up with the
Orthopaedic Surgery Clinic in one week from discharge.
6.  The patient was instructed to follow up with the Trauma
Clinic two weeks from discharge.

MEDICATIONS ON DISCHARGE:
1.  Protonix 40 mg by mouth q.24h.
2.  Carbidopa/Levodopa 25/25-mg tablets one tablet by mouth
q.4h.
3.  Lovenox 40 mg subcutaneously q.12h.
4.  Albuterol nebulizers q.4h.
5.  Atrovent nebulizers q.4h.
6.  Combivent inhaler 1 to 2 puffs inhaled q.6h. as needed.
7.  Tylenol 325 mg to 650 mg by mouth q.4-6h. as needed.

Of note, during this hospitalization, the patient was noted
to have an allergic reaction to both Zosyn and levofloxacin.






                            [**Last Name (LF) 53704**],[**First Name3 (LF) **] E. M.D.  [**MD Number(1) 10637**]

Dictated By:[**Last Name (NamePattern1) 2682**]
MEDQUIST36

D:  [**2140-3-9**]  16:03
T:  [**2140-3-9**]  16:11
JOB#:  [**Job Number 53705**]


Name:  [**Known lastname 9966**], [**Known firstname 4794**]      Unit No:  [**Numeric Identifier 9967**]

Admission Date: [**2140-1-15**]        Discharge Date: [**2140-3-12**]

Date of Birth:                    Sex:  M

Service:


This is an addendum to the previous extensive Discharge
Summary available for this patient covering his period of
hospital admission from [**2140-1-15**] to [**2140-3-9**]. The actual
date of discharge was [**2140-3-12**]. The patient remained in the
hospital for an additional three days because of difficulty
in identifying a rehabilitation bed. There was absolutely no
change in his medical status during the additional three days
of hospitalization and all of the particulars of the earlier
Discharge Summary remain relevant.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 9968**]

Dictated By:[**Last Name (NamePattern4) 9969**]
MEDQUIST36
D:  [**2140-9-6**] 13:09:19
T:  [**2140-9-6**] 13:31:08
Job#:  [**Job Number 9970**]
{'Open wound of hip and thigh, complicated,Injury to other specified blood vessels of lower extremity,Closed fracture of acetabulum,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Closed fracture of five ribs,Closed fracture of shaft of fibula alone'}


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: The patient is a 67-year-old
Russian-speaking gentleman with a history of Parkinson
disease who was impaled in the right thigh after being struck
by a vehicle at low speed.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Open wound of hip and thigh, complicated,Injury to other specified blood vessels of lower extremity,Closed fracture of acetabulum,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Closed fracture of five ribs,Closed fracture of shaft of fibula alone'}
