CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 21 yo male driver s/p high speed motor vehicle crash vs
telephone pole during the early morning. Upon EMS arrival at the
scene patient was awake and able to state his name and was
moving bilateral upper extremities; + passenger fatality; +
prolonged extrication. He was taken to an area hospital and was
later transferred to [**Hospital1 18**] because of his extensive injuries.

MEDICAL HISTORY: h/o Right tib-fib and ankle injury w/hardware in place

MEDICATION ON ADMISSION: None

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Upon admission:
T: 98.8  BP:141/70    HR:100   RR:17      O2Sats:100%
intubated/CMV
Gen: WD/WN, intubated at OSH on minimal propofol.
HEENT: normocephalic, +epistaxis, no hemotympanum noted, TM
appears to be intact
Pupils: PERRL    EOMs: unable to assess
Extrem: Warm and well-perfused.
Neuro/Mental status: Intubated, on minimal propofol with
spontaneous
movement of the right upper extremity and right lower
extremities
noted. Absent response to deep pain stimulus on the left. Toes
mute.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Open fracture of lower end of radius with ulna,Open fracture of unspecified part of femur,Injury to kidney without mention of open wound into cavity, laceration,Closed fracture of patella,Closed fracture of two ribs,Cerebral edema,Open wound of scrotum and testes, without mention of complication,Closed fracture of mandible, ramus, unspecified,Closed fracture of clavicle, unspecified part,Contusion of lung without mention of open wound into thorax,Open wound of hand except finger(s) alone, without mention of complication,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Conjunctival hemorrhage
Cl skull vlt fx-coma NOS,Fx low radius w ulna-opn,Fx femur NOS-open,Kidney laceration-closed,Fracture patella-closed,Fracture two ribs-closed,Cerebral edema,Opn wound scrotum/testes,Fx ramus NOS-closed,Fx clavicle NOS-closed,Lung contusion-closed,Open wound of hand,Loss control mv acc-driv,Conjunctival hemorrhage
Admission Date:  [**2145-7-18**]              Discharge Date:   [**2145-7-29**]

Date of Birth:  [**2123-8-30**]             Sex:   M

Service: SURGERY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
[**2145-7-18**] Repair of scrotal tear
Debridement open right femur fractures; intramedullary rod
fixation right femur fracture; debridement and closure of a
laceration of the hand.

[**2145-7-20**]
Washout and debridement, open femoral fracture wound down to
bone.
Repair patellar tendon disruption.
Open reduction, internal fixation right patella fracture
Open reduction, internal fixation right distal radius and ulnar
fractures

[**2145-7-27**]
Placement of arch bars and maxillomandibular fixation.
ORIF of right zygomatic fracture.
ORIF of right mandibular fracture.



History of Present Illness:
21 yo male driver s/p high speed motor vehicle crash vs
telephone pole during the early morning. Upon EMS arrival at the
scene patient was awake and able to state his name and was
moving bilateral upper extremities; + passenger fatality; +
prolonged extrication. He was taken to an area hospital and was
later transferred to [**Hospital1 18**] because of his extensive injuries.


Past Medical History:
h/o Right tib-fib and ankle injury w/hardware in place

Family History:
Noncontributory

Physical Exam:
Upon admission:
T: 98.8  BP:141/70    HR:100   RR:17      O2Sats:100%
intubated/CMV
Gen: WD/WN, intubated at OSH on minimal propofol.
HEENT: normocephalic, +epistaxis, no hemotympanum noted, TM
appears to be intact
Pupils: PERRL    EOMs: unable to assess
Extrem: Warm and well-perfused.
Neuro/Mental status: Intubated, on minimal propofol with
spontaneous
movement of the right upper extremity and right lower
extremities
noted. Absent response to deep pain stimulus on the left. Toes
mute.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 1.5mm to
1mm bilaterally.
III, IV, VI-XII: unable to assess due to intubated state.


Pertinent Results:
[**2145-7-18**] 05:27PM   GLUCOSE-138* UREA N-15 CREAT-0.8 SODIUM-138
POTASSIUM-4.3 CHLORIDE-107 TOTAL CO2-20* ANION GAP-15
[**2145-7-18**] 05:27PM   CALCIUM-6.4* PHOSPHATE-3.7 MAGNESIUM-1.3*
[**2145-7-18**] 05:27PM   WBC-7.8# RBC-4.15* HGB-12.2* HCT-33.6*
MCV-81*# MCH-29.3 MCHC-36.2* RDW-14.6
[**2145-7-18**] 05:27PM   PLT SMR-LOW PLT COUNT-89*
[**2145-7-18**] 05:27PM   PT-15.0* PTT-28.6 INR(PT)-1.3*
[**2145-7-18**] 09:50AM   ASA-NEG* ETHANOL-51* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

[**2145-7-18**]
CT-Head
IMPRESSION:
1. Left-sided frontal lobe epidural hematomas. Right-sided
frontal subdural
hematoma. There is associated pneumocephalus with these areas of
hemorrhage.
2. Surgical bolt in the right temporal lobe with a small focus
of associated
intraparenchymal hemorrhage and surrounding soft tissue edema.
3. Right frontal bone fracture which is depressed and
comminuted.
4. Left frontal bone fracture with extension through the
posterior wall of
the left frontal sinus.
5. Multiple fractures of bilateral orbits and nasal bones which
are better
characterized on facial CT.

[**2145-7-19**]
CT C-spine
IMPRESSION:
1. There is no cervical spine fracture and there is normal
alignment of
osseous structures.
2. There is a right mandibular fracture and fracture of the
right
temporomandibular joint, which is better visualized on sinus CT.

3. Right-sided first rib fracture and left-sided second rib
fracture.

[**2145-7-19**]
CT Chest/Abdomen
IMPRESSION:
1. No acute traumatic aortic injury is identified.
2. A linear filling defect on a single image within the left
subclavian
artery may represent a dissection flap.
3. Grade 1 left kidney injury.
4. Fracture of the left clavicle.
5. Segmental atelectasis of the left lung and consolidation
ground-glass
opacities at the lungs bilaterally, which may represent
contusion in the
setting of trauma.

[**2145-7-21**]
CT Head
IMPRESSION:
1. Unchanged left epidural hematomas, right subdural hematoma,
and right
frontal parenchymal hematoma.
2. No evidence of new cerebral edema.



[**2145-7-28**]
CT Sinus/Mandible

 IMPRESSION: Postoperative changes with internal fixation of
mandibular
fracture as well as the anterior wall right maxillary sinus
fractures.
Extensive sinus soft tissue changes and other fractures
involving the
bilateral frontal bone, right zygomatic arch, pterygoid plates
are again
visualized.








Brief Hospital Course:
He was admitted to the Trauma Service. Neurosurgery,
Orthopedics, Plastics and Urology were consulted given his
multiple injuries. He was taken to the operating room for
washout and repair of his scrotal tear and for repair of and
debridement open right femur fractures; intramedullary rod
fixation right femur fracture; debridement and closure of a
laceration of the hand. He was taken to the Trauma ICU
postoperatively where he remained for several days.

He was later taken back to the operating room by Orthopedics for
washout and debridement, open femoral fracture wound down to
bone, repair patellar tendon disruption, open reduction,
internal fixation right patella fracture and open reduction,
internal fixation right distal radius and ulnar fractures. There
were no intraoperative complications.

Eventually he was weaned and extubated and was transferred to
the regular nursing unit. He was taken to the operating by
Plastics on [**7-27**] for placement of arch bars and
maxillomandibular fixation, ORIF of right zygomatic fracture and
ORIF of right mandibular fracture. He has a Penrose drain which
will remain in place until follow up in [**Hospital 3595**] clinic in 1
week.

Because his jaws are wired a Nutrition consult was placed;
Ensure Plus supplements were started. He will need to adhere to
a soft/liquid diet and will be able to use straws to drink the
liquid.

Physical and Occupational therapy were consulted and have
recommended acute rehab after hospital stay.

Social work was consulted early during his hospital stay for
emotional support for patient and family.


Medications on Admission:
None

Discharge Medications:
1. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic PRN
(as needed).
2. Clonidine 0.2 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QTHUR (every Thursday).
3. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
4. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15)
ML's Mucous membrane QID (4 times a day): Rinse and spit.
5. Enoxaparin 30 mg/0.3 mL Syringe Sig: 0.3 ML's Subcutaneous
Q12H (every 12 hours).
6. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed for pain.
7. Ondansetron 4-8 mg IV Q8H:PRN nausea
8. Clindamycin Phosphate 150 mg/mL Solution Sig: Six Hundred
(600) MG Injection every eight (8) hours for 7 days.
9. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) ML's
PO twice a day as needed for constipation.
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 1293**] - [**Location (un) **]

Discharge Diagnosis:
s/p Motor vehicle crash
Injuries:
Open right femur fracture
Multiple facial fractures; Right orbital roof fracture
Depressed right frontal fracture
Subdural hemorrhage
Left clavicle fracture
Scrotal tear w/ testicular avulsion 6. L epidural hematoma
Right mandibular fracture
Right 1st rib & Left 2nd rib fractures
Right distal radius and ulnar fractures
Right patella fracture
Left renal laceration - Grade I


Discharge Condition:
Hemodynamically stable, pain adequately controlled


Discharge Instructions:
Continue with the Clindamycin for a total of 7 days.

Adhere to a soft/liquid diet only.

In the event of an emergency, shortness  of breath, nausea with
vomiting your jaw wires will need to be cut. If this occurs you
will need to return to the hospital immediately so that the
wires can be replaced.

Followup Instructions:
Follow up in Plastic Surgery clinic next Friday with Dr.
[**Last Name (STitle) 23606**]; call [**Telephone/Fax (1) 5343**] for an appointment.

Follow up in [**Hospital 5498**] clinic in 2 weeks with Dr. [**Last Name (STitle) **],
call [**Telephone/Fax (1) 1228**] for an appointment.

Follow up in Trauma clinic with Dr. [**Last Name (STitle) **] in 2 weeks, call
[**Telephone/Fax (1) 600**] for an appointment.

Follow up in [**Hospital 159**] clinic in 2 weeks, call [**Telephone/Fax (1) 164**] for an
appointment.



Completed by:[**2145-7-30**]
{'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Open fracture of lower end of radius with ulna,Open fracture of unspecified part of femur,Injury to kidney without mention of open wound into cavity, laceration,Closed fracture of patella,Closed fracture of two ribs,Cerebral edema,Open wound of scrotum and testes, without mention of complication,Closed fracture of mandible, ramus, unspecified,Closed fracture of clavicle, unspecified part,Contusion of lung without mention of open wound into thorax,Open wound of hand except finger(s) alone, without mention of complication,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Conjunctival hemorrhage'}


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/p Motor vehicle crash

PRESENT ILLNESS: 21 yo male driver s/p high speed motor vehicle crash vs
telephone pole during the early morning. Upon EMS arrival at the
scene patient was awake and able to state his name and was
moving bilateral upper extremities; + passenger fatality; +
prolonged extrication. He was taken to an area hospital and was
later transferred to [**Hospital1 18**] because of his extensive injuries.

MEDICAL HISTORY: h/o Right tib-fib and ankle injury w/hardware in place

MEDICATION ON ADMISSION: None

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Upon admission:
T: 98.8  BP:141/70    HR:100   RR:17      O2Sats:100%
intubated/CMV
Gen: WD/WN, intubated at OSH on minimal propofol.
HEENT: normocephalic, +epistaxis, no hemotympanum noted, TM
appears to be intact
Pupils: PERRL    EOMs: unable to assess
Extrem: Warm and well-perfused.
Neuro/Mental status: Intubated, on minimal propofol with
spontaneous
movement of the right upper extremity and right lower
extremities
noted. Absent response to deep pain stimulus on the left. Toes
mute.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Open fracture of lower end of radius with ulna,Open fracture of unspecified part of femur,Injury to kidney without mention of open wound into cavity, laceration,Closed fracture of patella,Closed fracture of two ribs,Cerebral edema,Open wound of scrotum and testes, without mention of complication,Closed fracture of mandible, ramus, unspecified,Closed fracture of clavicle, unspecified part,Contusion of lung without mention of open wound into thorax,Open wound of hand except finger(s) alone, without mention of complication,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Conjunctival hemorrhage'}
