CHIEF COMPLAINT: s/ Pedestrian struck by auto

PRESENT ILLNESS: 45 yo male pedestrina who was struck by auto reportedly @ 45
MPH, was thrown over [**Doctor Last Name **] of car; + windshiled damage;
questionable LOC. Noted with bilateral lower extremity
deformities and decreased pulses. he was initially taken to an
area hospital and was later transferred to [**Hospital1 18**] for ongoing
trauma care.

MEDICAL HISTORY: Schizophrenia

MEDICATION ON ADMISSION: Seroquel 50 [**Hospital1 **] & 220 qhs
Clozapine 100 qd

ALLERGIES: Haloperidol

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Resides in a group home
Has a guardian: [**Name (NI) **] [**Name (NI) 68296**]
Closed fracture of multiple cervical vertebrae,Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Iron deficiency anemia secondary to blood loss (chronic),Closed fracture of shaft of fibula with tibia,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian
Fx mult cervical vert-cl,Clos skull base fracture,Chr blood loss anemia,Fx shaft fib w tib-clos,Mv coll w pedest-pedest
Admission Date:  [**2183-11-14**]              Discharge Date:   [**2183-11-28**]

Date of Birth:  [**2137-1-24**]             Sex:   M

Service: SURGERY

Allergies:
Haloperidol

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
s/ Pedestrian struck by auto

Major Surgical or Invasive Procedure:
[**2183-11-16**] L1-L4 fusion; laminectomy L1,2,3
[**2183-11-15**] Bilateral tibia nailing (ORIF)


History of Present Illness:
45 yo male pedestrina who was struck by auto reportedly @ 45
MPH, was thrown over [**Doctor Last Name **] of car; + windshiled damage;
questionable LOC. Noted with bilateral lower extremity
deformities and decreased pulses. he was initially taken to an
area hospital and was later transferred to [**Hospital1 18**] for ongoing
trauma care.

Past Medical History:
Schizophrenia

Social History:
Resides in a group home
Has a guardian: [**Name (NI) **] [**Name (NI) 68296**]

Family History:
Noncontributory

Pertinent Results:
[**2183-11-14**] 09:37PM   GLUCOSE-61* LACTATE-1.8 NA+-137 K+-4.2
CL--106 TCO2-14*
[**2183-11-14**] 09:37PM   HGB-13.5* calcHCT-41 O2 SAT-74
[**2183-11-14**] 09:30PM   UREA N-23* CREAT-1.0
[**2183-11-14**] 09:30PM   AMYLASE-63
[**2183-11-14**] 09:30PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2183-11-14**] 09:30PM URINE  bnzodzpn-POS barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2183-11-14**] 09:30PM   WBC-24.0* RBC-4.42* HGB-13.0* HCT-37.7*
MCV-85 MCH-29.5 MCHC-34.5 RDW-15.7*
[**2183-11-14**] 09:30PM   PLT COUNT-216
[**2183-11-14**] 09:30PM   PT-13.0 PTT-30.0 INR(PT)-1.1
[**2183-11-14**] 09:30PM   FIBRINOGE-279

CT C-SPINE W/O CONTRAST

Reason: PED STRUCK BY CAR.R/O FX

[**Hospital 93**] MEDICAL CONDITION:
40 year old man ped vs. car, high speed, ? LOC
REASON FOR THIS EXAMINATION:
eval for fracture
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Trauma.

TECHNIQUE: Non-contrast axial CT imaging of the cervical spine
with sagittal and coronal reformations was reviewed.

FINDINGS: The study is markedly limited secondary to patient
motion. Given these limitations, however, there is evidence for
a slightly displaced right occipital condyle fracture. The dens
is also mildly offset within the C1 body with 1.5 mm distance on
the right versus 3 mm on the left. A displaced fracture is also
present extending from the C4 spinous process through the right
lamina. Fracture line does not disrupt the spinal canal. No
other fractures are identified, but again, study is limited by
patient motion. Vertebral body alignment is anatomic.
Degenerative changes are also noted throughout the spine.
Evaluation of the soft tissues of the spinal canal is limited by
CT, but there is no evidence for acute cord disruption. Mastoid
air cells are clear. The lung apices are clear.

IMPRESSION: Markedly limited scan secondary to patient motion,
but right occipital condyle and C4 right laminar/spinous process
fracture identified. The possibility of other fracture is not
identified given patient motion, repeat imaging is recommended.

Findings and recommendations discussed with Dr [**First Name8 (NamePattern2) **] [**Name (STitle) 1022**] at time
of interpretation.

CT HEAD W/O CONTRAST

Reason: PED STRUCK BY CAR.R/O BLEED

[**Hospital 93**] MEDICAL CONDITION:
40 year old man ped vs. car, high speed, ? LOC
REASON FOR THIS EXAMINATION:
eval for bleed
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Pedestrian struck by car.

TECHNIQUE: Non-contrast head CT.

FINDINGS: No priors for comparison. The study is markedly
limited by motion, despite multiple attempts. Within the limits
of this examination, no hydrocephalus, shift of normally midline
structures, large extra-axial or intraparenchymal hemorrhage, or
large major vascular territorial infarct is identified. No
displaced skull fractures are seen. Minor mucosal thickening of
the ethmoid air cells. Petrous apices are both pneumatized and
aerated.

IMPRESSION: Within the limits of this motion-marred study, no
large intraparenchymal hemorrhage, large extra-axial hemorrhage,
or displaced skull fracture identified.

CTA NECK W&W/OC & RECONS

Reason: assess for vertebral art injury
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
40 year old man s/p mva w/ C$ fx
REASON FOR THIS EXAMINATION:
assess for vertebral art injury
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Previous CT cervical spine limited by motion.
Patient has a history of being struck by a motor vehicle.

TECHNIQUE: Multidetector CT images with IV contrast from the
aortic arch to the vertex of the skull, with multiplanar
reformats.

Comparison with CT cervical spine, [**2183-11-14**] at 21:58.

CT CERVICAL SPINE: Right occipital condyle fracture, minimally
displaced. C4 spinous process fracture, without extension to
lamina. Fracture through right C7 lamina. Fracture of right
lateral mass. Non-displaced sternal fracture. Vertebral body
alignment is maintained. The patient is intubated, therefore,
prevertebral soft tissue swelling cannot be assessed.

CT ANGIO NECK: Both common carotid arteries are normal in
appearance, without significant atherosclerotic narrowing or
evidence of dissection. Both vertebral arteries are patent,
without evidence of dissection. Emphysematous changes seen in
the lungs. No pericardial effusion.

Incidentally noted is 17-mm sebaceous cyst in right upper back
midline. 9-mm left soft tissue density just deep to the
clavicle, probably representing a lymph node. Retention cyst
seen in the right maxillary sinus. Scattered opacification of
ethmoid air cells. Imaged sinuses are otherwise clear.Lung
apices are pneumatized and well aerated.

Calcified granuloma in right lung apex.

IMPRESSION:
1. Right occipital condyle fracture.

2. C4 spinous process fracture and C7 spinous process fracture.
Right C7 lateral mass fracture.

3. No evidence of vertebral artery dissection. No evidence of
carotid artery dissection.

4. Emphysema.

5. Calcified granuloma in right upper lobe apex.

MR CERVICAL SPINE W/O CONTRAST

Reason: r/o cord injury

[**Hospital 93**] MEDICAL CONDITION:
40 year old man with cervical spine fractures
REASON FOR THIS EXAMINATION:
r/o cord injury
MRI CERVICAL SPINE

CLINICAL INFORMATION: Patient with cervical spine fracture, rule
out cord injury.

TECHNIQUE: T1, T2 and inversion recovery sagittal, gradient echo
sagittal and T2 axial images of the cervical spine were
acquired. Correlation was made with the cervical spine CT of
[**2183-11-14**].

FINDINGS: From skull base to T3 level, the spinal cord
demonstrates normal intrinsic signal without extrinsic
compression or intraspinal hematoma.

There is increased signal seen on the inversion recovery images
within the right occipital condyle at the site of fracture seen
on the CT. There is no evidence of disruption of the anterior or
posterior longitudinal ligaments or ligamentum flavum. There is
increased signal seen in the interspinous region of C2-C4
indicating trauma in this region. There is also prevertebral
soft tissue edema seen identified from C1-C4.

There is fluid seen within the right C6-7 facet joint, which
could be related to the lamina fracture seen on CT. There is
minimal anterolisthesis of C6 over C7 identified.

There is increased signal seen in the T3 vertebral body in its
upper portion indicating trauma and probable nondisplaced
fracture. No significant compression or retropulsion is seen.

There is fluid seen within the nasopharynx which appears to be
secondary to intubation. A 1.5-cm cystic area is identified
projected over the upper thoracic posterior subcutaneous region
which could be due to an incidental sebaceous cyst. Mild mucosal
thickening is seen in this visualized sphenoid sinus.

IMPRESSION:
1. Marrow edema in the right occipital condyle indicating
fracture.
2. Fluid in the right C6-7 facet joint could be related to the
lamina fracture seen on CT. Mild anterolisthesis of C6 over C7
is seen. No obvious ligamentous disruption is identified.
3. Increased signal in the interspinous region indicating trauma
in the upper cervical region.
4. Mild prevertebral soft tissue edema from C1-C4.
5. Increased signal in the T3 vertebra indicating trauma.
6. No evidence of spinal cord compression or intrinsic spinal
cord signal abnormalities.

MR L SPINE W/O CONTRAST

Reason: fracture evaluation

[**Hospital 93**] MEDICAL CONDITION:
40 year old man with cervical spine fractures
REASON FOR THIS EXAMINATION:
fracture evaluation
MRI OF THE LUMBAR SPINE.

CLINICAL INFORMATION: Patient with fracture of L2 for further
evaluation.

TECHNIQUE: T1, T2 and inversion recovery sagittal and T1 and T2
axial images of the lumbar spine were obtained. Correlation was
made with the abdominal CT of [**2183-11-14**].

FINDINGS: As seen on the abdominal CT of [**2183-11-14**], there is
fracture of the L2 vertebral body identified. There is evidence
of disruption of the anterior spinous and posterior spinal
ligaments at this level. There is mild retrolisthesis of L2 over
L3. As seen on the CT, there is fracture through the posterior
elements. There is also increased signal seen within the
intraspinous region of L2 and L3 indicative of trauma to the
intraspinous ligaments. There is buckling of the ligamentum
flavum indicating trauma. There is no evidence of high-grade
spinal stenosis seen or evidence of intraspinal hematoma
identified. The distal spinal cord shows normal signal
intensities. Extensive increased signal is seen in the posterior
muscular structures in the upper lumbar region indicating
trauma.

IMPRESSION: Fracture of L2 vertebra with disruption of
ligamentous structures at L2-3 level as described above. The
fracture extends through the posterior elements as seen on the
CT of [**2183-11-14**]. No intraspinal hematoma is seen. No evidence of
high-grade thecal sac compression is noted. Other changes as
described above.

ECG: [**2183-11-17**]
Sinus tachycardia
Early precordial QRS transition - is nonspecific
Diffuse nonspecific ST-T wave abnormalities
Since previous tracing of [**2183-11-16**], sinus tachycardia rate
faster and further
ST-T wave changes present
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
116 102 90 302/371 74 47 130




Brief Hospital Course:
He was admitted to the Trauma service. Orthopedic spine and
Orthopedics were immediately consulted because of his injuries.
He was taken to the operating room on [**11-15**] for bilateral ORIF
of his tibial fractures; he is WBAT on his LLE and PWB on his
RLE. He will need to follow up with Dr. [**Last Name (STitle) 1005**] in 2 weeks.

He was taken to the operating room on [**11-16**] for repair of his
lumbar spine injuries; his cervical spine injuries were
nonoperative; he will need to remain in a hard collar for 4 more
weeks. Follow up with Dr. [**Last Name (STitle) 363**] in 4 weeks for repeat spine
injuries. He was also fitted for a TLSO brace which must be worn
at all times when out of bed.

Psychiatry was also consulted given his history of
schizophrenia. His home meds were restarted which include
Clozapine and Seroquel. There were no behavioral issues
throughout his hospital stay.

Physical therapy was also consulted and have recommended a short
rehab stay to improve functional ability.

Medications on Admission:
Seroquel 50 [**Hospital1 **] & 220 qhs
Clozapine 100 qd

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
2. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Dose
Injection TID (3 times a day).
3. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
4. Quetiapine 200 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. Clozapine 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day) as needed for Agitation.
7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H as needed for
pain.
9. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
10. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30)
ML's PO twice a day as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
st. JosephConcord - [**Location (un) 1514**], NH

Discharge Diagnosis:
s/p pedestrian struck by auto
Right occipital skull fracture
C4 laminar fracture
C4 foramen fracture
C7 lateral mass fracture
L2 compression fracture and bilat facet fracture
Bilateral tibia/fibula fracture

Secondary diagnosis:
Acute blood loss anemia


Discharge Condition:
Good


Discharge Instructions:
You may partially weight bear on your right lower extremity and
weight bear as tolerated on your left lowere extremity.

You must continue to wear your hard collar for the next 4 weeks.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) 363**], Orthopedic Spine surgery in 4 weeks,
call [**Telephone/Fax (1) 3573**] for an appointment.

Follow up with Orthopedics in 2 weeks, call the clinic to
schedule an appointment, [**Telephone/Fax (1) 1228**].



Completed by:[**2183-11-28**]
{'Closed fracture of multiple cervical vertebrae,Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Iron deficiency anemia secondary to blood loss (chronic),Closed fracture of shaft of fibula with tibia,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian'}


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: s/ Pedestrian struck by auto

PRESENT ILLNESS: 45 yo male pedestrina who was struck by auto reportedly @ 45
MPH, was thrown over [**Doctor Last Name **] of car; + windshiled damage;
questionable LOC. Noted with bilateral lower extremity
deformities and decreased pulses. he was initially taken to an
area hospital and was later transferred to [**Hospital1 18**] for ongoing
trauma care.

MEDICAL HISTORY: Schizophrenia

MEDICATION ON ADMISSION: Seroquel 50 [**Hospital1 **] & 220 qhs
Clozapine 100 qd

ALLERGIES: Haloperidol

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Resides in a group home
Has a guardian: [**Name (NI) **] [**Name (NI) 68296**] 

### Response:
{'Closed fracture of multiple cervical vertebrae,Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Iron deficiency anemia secondary to blood loss (chronic),Closed fracture of shaft of fibula with tibia,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian'}
