CHIEF COMPLAINT: s/p ATV crash

PRESENT ILLNESS: 32M + EtOH s/p high speed ATV collision this. Friends report
found patient beside a tree, disoriented and unconscious. Upon
EMS arrival he was intubated at scene and evaluated at [**Hospital3 **]
hospital. CT head showing frontal and temporal IPH; he was
transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: ADHD per family report (not treated with medication)

MEDICATION ON ADMISSION: Denies

ALLERGIES: Penicillins

PHYSICAL EXAM: Upon presentation to [**Hospital1 18**]:
O: T:98.5  BP: 133/ 72    HR: 68   R:20       O2Sats
99%ventilated Cpap
Gen:intubated off propofol for exam
HEENT: Pupils: 3.5-3mm        EOMs;pt does not comply
Neck: hard cervical collar in place
Extrem:left lower leg in traction
Neuro:
Mental status: intubated, no eye opening to noxious stimuli, but
facial grimaces, pt does not follow commands
Orientation:not opening eye or verbal
Recall,Language:pt unable to perform at this time

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: +EtOH
Cerebellar or brain stem contusion without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of lower end of femur, unspecified part,Cerebral edema,Pneumonia due to other gram-negative bacteria,Acute respiratory failure,Closed fracture of sixth cervical vertebra,Alkalosis,Closed fracture of two ribs,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle,Contusion of lung without mention of open wound into thorax,Closed fracture of clavicle, unspecified part,Attention deficit disorder with hyperactivity
Cerebell contus-coma NOS,Fx low end femur NOS-cl,Cerebral edema,Pneumo oth grm-neg bact,Acute respiratry failure,Fx c6 vertebra-closed,Alkalosis,Fracture two ribs-closed,Oth coll stndng obj-driv,Lung contusion-closed,Fx clavicle NOS-closed,Attn deficit w hyperact
Admission Date:  [**2111-3-1**]              Discharge Date:   [**2111-3-24**]

Date of Birth:  [**2078-3-4**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
s/p ATV crash

Major Surgical or Invasive Procedure:
[**2111-3-1**]
Closed treatment right femoral shaft fracture with traction and
placement of traction pin

[**2111-3-4**]
IM nail right femur


History of Present Illness:
32M + EtOH s/p high speed ATV collision this. Friends report
found patient beside a tree, disoriented and unconscious. Upon
EMS arrival he was intubated at scene and evaluated at [**Hospital3 **]
hospital. CT head showing frontal and temporal IPH; he was
transferred to [**Hospital1 18**] for further care.

Past Medical History:
ADHD per family report (not treated with medication)

Social History:
+EtOH

Family History:
Noncontributory

Physical Exam:
Upon presentation to [**Hospital1 18**]:
O: T:98.5  BP: 133/ 72    HR: 68   R:20       O2Sats
99%ventilated Cpap
Gen:intubated off propofol for exam
HEENT: Pupils: 3.5-3mm        EOMs;pt does not comply
Neck: hard cervical collar in place
Extrem:left lower leg in traction
Neuro:
Mental status: intubated, no eye opening to noxious stimuli, but
facial grimaces, pt does not follow commands
Orientation:not opening eye or verbal
Recall,Language:pt unable to perform at this time

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3.5 to 3
mm bilaterally. Visual fields unable to test
III, IV, VI: Extraocular movements unable to test
V, VII: Facial strength grossly symmetric.
VIII: Hearing-unable to test
IX, X: Palatal elevation unable to test
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius unable to test
XII: Tongue midline unable to test

Motor: patient briskly localizes to painful stimuli with
bilateral upper extremities.  Left leg moves up off bed to pain,
right lower leg appears in traction and right foot flexes and
withdraws to pain.  Patient does not follow commands

Sensation: unable to test

Toes downgoing bilaterally

Coordination: unable to test


Pertinent Results:
[**2111-3-1**] 11:19AM   GLUCOSE-142* UREA N-18 CREAT-0.7 SODIUM-141
POTASSIUM-4.5 CHLORIDE-108 TOTAL CO2-25 ANION GAP-13
[**2111-3-1**] 11:19AM   ALT(SGPT)-61* AST(SGOT)-128* CK(CPK)-4588*
AMYLASE-109*
[**2111-3-1**] 11:19AM   WBC-14.2* RBC-3.75* HGB-12.3* HCT-36.2*
MCV-96 MCH-32.8* MCHC-34.0 RDW-12.7
[**2111-3-1**] 11:19AM   PLT COUNT-324
[**2111-3-1**] 08:35AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

[**2111-3-16**] ECG QTC 386
[**2111-3-11**] ECG QTC 390
[**2111-3-10**] ECG QTC 405
[**2111-3-7**] LENIS No evidence of DVT
[**2111-3-5**] miniBAL no PMNs, no orgs, NG
[**2111-3-5**] CATH tip NG
[**2111-3-5**] CXR unchanged b/l LL opacities, atelectasis R>L, no new
opacities
[**2111-3-4**] BCx neg
[**2111-3-4**] UCX neg
[**2111-3-4**] CT chest bibasilar consolidation new/unchanged, ? pna
vs. aspiration
[**2111-3-4**] CT head stable hemorrh foci, no acute hemorrhage, bolt
in R front lobe
[**2111-3-4**] LENIS No evidence of DVT in bilateral lower
extremities.
[**2111-3-3**] CXR Improving R middle and LL atelectasis,
consolidation LLL
[**2111-3-3**] CT head No evidence of infarction or significant mass
effect, no herniation
[**2111-3-3**] BCX neg
[**2111-3-3**] MRSA neg
[**2111-3-2**] CT head Unchanged bilateral scattered punctate
hemorrhagic foci
[**2111-3-2**] CXR New right lower and middle lobe collapse, likely
bronchus plug
[**2111-3-2**] BCX NGTD
[**2111-3-2**] UCX NG
[**2111-3-2**] miniBAL 4+ PMNs, 4+ GPdiplos, MORAXELLA CATARRHALIS
>100,000 orgs
[**2111-3-1**] CT head b/l temporal petechial hemorrhage
[**2111-3-1**] CT spine C6/C7 transverse processes frx
[**2111-3-1**] CT torso R distal clavicle fx, b/l 1st rib fxs, pulm
contusions
[**2111-3-1**] CXR Comminuted fracture of right clavicle
[**2111-3-1**] CT head [**Hospital1 **] punctate foci of hemorrhage ? diffuse axonal
injury
[**2111-3-1**] R shoulder right clavicular fracture
[**2111-3-1**] R femur No acute pelvic frx, frx R femoral diaphysis
[**2111-3-1**] pelvis XR No acute pelvic frx, frx R femoral diaphysis

[**2111-3-1**] R knee No acute pelvic frx, frx R femoral diaphysis


Brief Hospital Course:
He was admitted to the trauma service and transferred to the
Trauma ICU where he remained sedated and vented. Neurosurgery
was consulted; his head CT scan revealed  multiple bilateral
scattered punctate hemorrhagic foci with pattern compatible with
diffuse axonal injury. Serial exams and head CT scans were
followed closely, his head CT scans remained stable with no new
areas of bleeding. His sedation was eventually weaned and he was
extubated. His mental status was intermittently agitated and
disoriented. He required antipsychotic to manage his behaviors.

He was taken to the operating room by Orthopedics for closed
treatment right femoral shaft fracture with traction and
placement of traction pin and again taken back on [**3-4**] for
intramedullary nail of the right femur.

Psychiatry and Cognitive Neurology were consulted once patient
was transferred to the regular nursing unit. Adjustments to his
antipsychotic were made; he was also started on Depakote as a
mood stabilizer.

He was followed by Physical and Occupational therapy who worked
closely with him given that he was not able to go to a rehab
facility due to lack of insurance. The Masshealth application
process was initiated.

At time of discharge his mental status had improved
significantly although he did continued short term memory
problems. [**Name (NI) **] will follow up with Cognitive Neurology as an
outpatient.


Medications on Admission:
Denies

Discharge Medications:
1. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
2. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO once a day.
Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*2*
3. Olanzapine 15 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO at bedtime.
Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*2*
4. Divalproex 500 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO HS (at bedtime).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed for insomnia.
Disp:*60 Tablet(s)* Refills:*0*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
7. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) ML's
PO twice a day as needed for constipation.
8. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every [**2-24**]
hours as needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
s/p ATV crash vs. tree
C6, C7 transverse process fracture
Bifrontal diffuse axonal injury
Right clavicle fracture
Right distal femur fracture
Bilateral 1st rib fracture



Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
You were hospitalized following a trauamtic event where you
sustained a brain injury, right femur fracture, right clavicle
fracture and rib fractures. Your femur fracture was repaired in
the operating room; your staples have been removed. It is common
to have pain from time to time from your injuries. You have been
prescribed a pain medication called Dilaudid which you should
take only as needed.

Your brain injury has left you with some memory deficits and at
times you act impulsively. It is important that you listen to
your care providers and take your medications as prescribed.

Followup Instructions:
Follow up in 2 weeks with Dr. [**Last Name (STitle) 86496**] [**Name (STitle) **], Cognitive
Neurology for ongoing evaluation of your traumatic brain injury;
call [**Telephone/Fax (1) 6335**] for an appointment.

Follow up in 4 weeks with CT of brain with Dr. [**First Name (STitle) **],
Neurosurgery; call [**Telephone/Fax (1) 1669**] for an appointment.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2111-4-15**]
{'Cerebellar or brain stem contusion without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of lower end of femur, unspecified part,Cerebral edema,Pneumonia due to other gram-negative bacteria,Acute respiratory failure,Closed fracture of sixth cervical vertebra,Alkalosis,Closed fracture of two ribs,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle,Contusion of lung without mention of open wound into thorax,Closed fracture of clavicle, unspecified part,Attention deficit disorder with hyperactivity'}


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 ATV crash

PRESENT ILLNESS: 32M + EtOH s/p high speed ATV collision this. Friends report
found patient beside a tree, disoriented and unconscious. Upon
EMS arrival he was intubated at scene and evaluated at [**Hospital3 **]
hospital. CT head showing frontal and temporal IPH; he was
transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: ADHD per family report (not treated with medication)

MEDICATION ON ADMISSION: Denies

ALLERGIES: Penicillins

PHYSICAL EXAM: Upon presentation to [**Hospital1 18**]:
O: T:98.5  BP: 133/ 72    HR: 68   R:20       O2Sats
99%ventilated Cpap
Gen:intubated off propofol for exam
HEENT: Pupils: 3.5-3mm        EOMs;pt does not comply
Neck: hard cervical collar in place
Extrem:left lower leg in traction
Neuro:
Mental status: intubated, no eye opening to noxious stimuli, but
facial grimaces, pt does not follow commands
Orientation:not opening eye or verbal
Recall,Language:pt unable to perform at this time

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: +EtOH 

### Response:
{'Cerebellar or brain stem contusion without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of lower end of femur, unspecified part,Cerebral edema,Pneumonia due to other gram-negative bacteria,Acute respiratory failure,Closed fracture of sixth cervical vertebra,Alkalosis,Closed fracture of two ribs,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle,Contusion of lung without mention of open wound into thorax,Closed fracture of clavicle, unspecified part,Attention deficit disorder with hyperactivity'}
