CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 44-year-old female who
was the unrestrained driver of a car that was hit at high
speed by a truck.  She had a positive loss of consciousness
with air bag deployment.  She was confused and combative at
the scene and en route to the Emergency Department.  When she
arrived in the trauma bay she was intubated for airway
protection and the trauma survey per protocol was carried
out.

MEDICAL HISTORY: Prior car accident with multiple
facial fractures.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No alcohol or tobacco.
Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of ilium,Closed fracture of C5-C7 level with unspecified spinal cord injury,Closed fracture of lumbar vertebra without mention of spinal cord injury,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Postconcussion syndrome
Brain lac NEC-brief coma,Fracture of ilium-closed,C5-c7 fx-cl/cord inj NOS,Fx lumbar vertebra-close,Mv collision NOS-driver,Postconcussion syndrome
Admission Date: [**2164-7-20**]        Discharge Date: [**2164-7-31**]

Date of Birth:  [**2120-3-18**]        Sex:  F

Service:  TRA


HISTORY OF PRESENT ILLNESS:  This is a 44-year-old female who
was the unrestrained driver of a car that was hit at high
speed by a truck.  She had a positive loss of consciousness
with air bag deployment.  She was confused and combative at
the scene and en route to the Emergency Department.  When she
arrived in the trauma bay she was intubated for airway
protection and the trauma survey per protocol was carried
out.

PAST MEDICAL HISTORY:  Prior car accident with multiple
facial fractures.

PAST SURGICAL HISTORY:  History of facial reconstructive
surgery.

MEDICATIONS:  Herbal medications.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  No alcohol or tobacco.

PHYSICAL EXAMINATION:  Temperature 97.8, heart rate 89, blood
pressure 120/palp, respirations 24, oxygen saturation 100
percent on a nonrebreather.  She moved all extremities but
was not following commands and was combative.  Pupils are
equal, round and reactive.  Extraocular movements intact.
She was regular rate and rhythm.  Chest was clear to
auscultation bilaterally with no deformities.  Abdomen was
soft, non-tender, non-distended.  Pelvis was stable.  There
were no flank deformities or back deformities.  She had some
oozing over her left thigh with palpable intact distal
pulses.  GCS was 8.

LABORATORY ON ADMISSION:  Hematocrit 33.4, BUN 14, creatinine
0.8, INR 1.0, amylase 20.  Arterial blood gas had a pH of
7.39, pCO2 41, pO2 175, bicarb 26 and a base excess of 0.  A
FAST examination in the Emergency Department was negative.

RADIOLOGY:  Chest x-ray negative.  Pelvis was negative.  CT
of the head showed a bifrontal contusion with inferior
frontal subarachnoid hemorrhage.  CT of the cervical spine
showed nondisplaced fracture of the right transverse process
C6-C7 and the left superior facet fracture of C7.  CT of the
abdomen showed no solid organ injury with a comminuted
fracture of the left ischium, a fracture of the left iliac
bone with widening of the sacroiliac joint and fracture of
the right transverse process of the lumbar spines 1 through
3.  Film of the left femur showed no fractures.  Film of the
right forearm showed no fractures.  Plain films of the
thoracolumbar spine showed mild L3 on L4 retrolisthesis with
mild degenerative changes at L4-5.

HOSPITAL COURSE:  Ms. [**Known lastname 17926**] was seen and evaluated in the
Emergency Department.  As stated above, she was combative and
was intubated in the trauma bay for airway protection.  A
primary survey, as above, showed a GCS of 8 with a
hemodynamically stable patient.  On secondary survey she had
some bruising and swelling of her left thigh.  She was taken
to the Intensive Care Unit for further monitoring.  She was
loaded with Dilantin and neurosurgical consultation was
obtained.  Recommendations were made for Dilantin, as stated
above, and a repeat head CT the following day.  Orthopedic
Surgery consulted for the pelvic fractures.  They deemed
these nonoperative and recommended touch down weightbearing
on the left lower extremity.  They were also on for spine and
consulted for the lumbar spinal fractures and recommended a
Warm 'n Form brace for comfort.  These were nonoperative
fractures as well.  Her mental status cleared and on hospital
day she had a repeat head CT that showed no change and no
increase in her intracranial hemorrhage.  She was started on
subcu heparin for deep venous thrombosis prophylaxis after
being cleared with Neurosurgery.  After discussion with
Orthopedic Surgery they expressed the need for the patient to
be anticoagulated; however, according to Neurosurgery,
limitations given her intracranial hemorrhage including the
contusion and the subarachnoid hemorrhage, this was held off
until five days after her injury.  She was then started on
Lovenox.  She was extubated on hospital day three; however,
she continued to be somewhat confused, intermittently
following commands but with impulses taking her collar off.
She continued to slowly clear.  At the time her hematocrit
had stabilized around 27 with an appropriate Dilantin level.
She was then transferred to the floor.  She was started on a
diet and was advanced; however, she was noted to have some
choking with thin liquids.  A Speech and Swallow consultation
was obtained and they recommended nectar of thickened liquids
and reevaluation in a week.  As stated, after five days she
was started on Lovenox.  She was seen by Physical Therapy and
Occupational Therapy who thought that the patient would not
be suitable for discharge to home due to the weightbearing
restrictions.  She continued throughout her hospital course
to demonstrate impulsivity with attempts to get out of bed
unassisted and take off her cervical collar.  She did,
however, slowly clear and she was seen by Neurobehavioral
Service who recommended trazodone minimizing sedation and
trying to reestablish her sleep-wake cycle.  She continued to
have difficulty with sleeping and her trazodone dose was
increased and given later at night.  Per Neurosurgery
recommendations, she had a repeat head CT before discharge
which showed some improvement in her contusions and some
resolution of the subarachnoid blood.  Based on Orthopedic
Surgery preference, her Lovenox was changed over to Coumadin
and her INR was 2.1 on the day of discharge.  Repeat Speech
and Swallow evaluation done before discharge showed that the
patient was tolerating thin liquids through a straw and her
diet was liberalized.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient will be discharged to a
rehabilitation facility.

DISCHARGE INSTRUCTIONS:  She is to keep her cervical collar
for six weeks post injury which would be from [**2164-7-20**].
She is to wear her Warm 'n Form brace for comfort.  Her
weightbearing status is to be touch down weightbearing on the
left lower extremity with full weightbearing on the right
lower extremity.  She will stay on Coumadin for six weeks
after injury from [**2164-7-20**], with a goal INR of 1.5 to
2.0.

DISCHARGE DIAGNOSES:  Subarachnoid hemorrhage with bifrontal
contusion.

Multiple pelvic fractures.

Cervical spine fractures.

Lumbar spine fractures.

Post-concussive syndrome.

DISCHARGE MEDICATIONS:
1. Percocet one to two p.o. q. 4-6h. p.r.n.
2. Tylenol p.r.n.
3. Dulcolax one p.r.n.
4. Maalox p.r.n.
5. Colace 150 mg p.o. b.i.d.
6. Trazodone 75 mg p.o. q. hs.
7. Coumadin 2.5 alternating with 5 mg p.o. q. day for goal
   INR of 1.5 to 2.0.


FOLLOW UP:  Follow up with the Trauma Clinic in two weeks at
[**Telephone/Fax (1) 2359**], with Dr. [**Last Name (STitle) **] from Orthopedic Surgery in ten
to twelve days after discharge at [**Telephone/Fax (1) 9118**], with [**First Name8 (NamePattern2) **]
[**Name8 (MD) 1022**], MD, of Orthopedics/Spine Surgery in ten to twelve days
at [**Telephone/Fax (1) 4301**].  Of note, patient is to get a
flexion/extension film before follow up with Dr. [**First Name (STitle) 1022**].  Next
appointment is with Behavioral Neurology at [**Telephone/Fax (1) 1690**] with
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5732**], [**MD Number(1) 5733**]

Dictated By:[**Last Name (NamePattern1) 13030**]
MEDQUIST36
D:  [**2164-7-31**] 13:19:15
T:  [**2164-7-31**] 13:57:32
Job#:  [**Job Number 56178**]
{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of ilium,Closed fracture of C5-C7 level with unspecified spinal cord injury,Closed fracture of lumbar vertebra without mention of spinal cord injury,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Postconcussion syndrome'}


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 44-year-old female who
was the unrestrained driver of a car that was hit at high
speed by a truck.  She had a positive loss of consciousness
with air bag deployment.  She was confused and combative at
the scene and en route to the Emergency Department.  When she
arrived in the trauma bay she was intubated for airway
protection and the trauma survey per protocol was carried
out.

MEDICAL HISTORY: Prior car accident with multiple
facial fractures.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No alcohol or tobacco. 

### Response:
{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of ilium,Closed fracture of C5-C7 level with unspecified spinal cord injury,Closed fracture of lumbar vertebra without mention of spinal cord injury,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Postconcussion syndrome'}
