CHIEF COMPLAINT: s/p MVC vs tree

PRESENT ILLNESS: 29 year-old male, unrestrained driver, who was brought in by EMS
after his car collided with a tree; questionable LOC. Positive
for ETOH.  Airbags were activated and windshield was starred. He
was positive for ETOH.  He was extricated and transported to
[**Hospital1 18**].

MEDICAL HISTORY: Pectus excavatum
ADD
Depression
Anxiety

MEDICATION ON ADMISSION: Xanax 0.5mg [**Hospital1 **]
Celexa 40mg qd
Valtrex 400mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: on admission to trauma bay: T 98.8  HR 78  BP 109/52  RR 18
Sat 97%
GCS 15
Gen: Smells of EtOH, intoxicated
HEENT: NC/AT, EOM intact, PERRLA.
Neck:C-collar present, trachea midline.
Chest: CTA bilaterally. Equal breath sounds  Pectus excavatum.
Well-healed transverse lower sternal scar.
CV: RRR, S1, S2
Abd: Soft BS, slightly distended.  Mild TTP. No guarding  No
rebound
Rectum: Normal tone, guaiac negative
Back: No stepoffs, no tenderness
Motor: 5/5 strength
Neuro: A & O x3

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Consumes about 5 beers/week.  Smokes tobacco occasionally, for
past 13 years.  Occasionally smokes marijuana.
Injury to spleen without mention of open wound into cavity, laceration extending into parenchyma,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Dysthymic disorder,Attention deficit disorder without mention of hyperactivity
Spleen parenchyma lacer,Peritoneum injury-closed,Loss control mv acc-driv,Dysthymic disorder,Attn defic nonhyperact
Admission Date:  [**2179-10-16**]              Discharge Date:   [**2179-10-21**]

Date of Birth:  [**2150-5-14**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
s/p MVC vs tree

Major Surgical or Invasive Procedure:
None

History of Present Illness:
29 year-old male, unrestrained driver, who was brought in by EMS
after his car collided with a tree; questionable LOC. Positive
for ETOH.  Airbags were activated and windshield was starred. He
was positive for ETOH.  He was extricated and transported to
[**Hospital1 18**].

Past Medical History:
Pectus excavatum
ADD
Depression
Anxiety

Social History:
Consumes about 5 beers/week.  Smokes tobacco occasionally, for
past 13 years.  Occasionally smokes marijuana.

Family History:
Non-contributory

Physical Exam:
VS: on admission to trauma bay: T 98.8  HR 78  BP 109/52  RR 18
Sat 97%
GCS 15
Gen: Smells of EtOH, intoxicated
HEENT: NC/AT, EOM intact, PERRLA.
Neck:C-collar present, trachea midline.
Chest: CTA bilaterally. Equal breath sounds  Pectus excavatum.
Well-healed transverse lower sternal scar.
CV: RRR, S1, S2
Abd: Soft BS, slightly distended.  Mild TTP. No guarding  No
rebound
Rectum: Normal tone, guaiac negative
Back: No stepoffs, no tenderness
Motor: 5/5 strength
Neuro: A & O x3


Pertinent Results:
[**2179-10-16**] 10:13PM   HCT-33.6*
[**2179-10-16**] 04:22PM   GLUCOSE-108* UREA N-8 CREAT-1.0 SODIUM-142
POTASSIUM-4.1 CHLORIDE-106 TOTAL CO2-29 ANION GAP-11
[**2179-10-16**] 04:22PM   CALCIUM-8.9 PHOSPHATE-4.6*# MAGNESIUM-2.1
[**2179-10-16**] 04:22PM   HCT-35.7*
[**2179-10-16**] 10:24AM   HCT-37.9*
[**2179-10-16**] 05:15AM   CALCIUM-9.3 PHOSPHATE-2.4* MAGNESIUM-1.6
[**2179-10-16**] 05:15AM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2179-10-16**] 05:15AM   WBC-17.5*# RBC-4.28* HGB-13.4* HCT-38.4*
MCV-90 MCH-31.3 MCHC-34.9 RDW-12.3
[**2179-10-16**] 05:15AM   PLT COUNT-334
[**2179-10-16**] 02:31AM   PH-7.37 COMMENTS-GREEN TOP
[**2179-10-16**] 02:31AM   LACTATE-2.1* NA+-140 K+-3.5 CL--101 TCO2-26
[**2179-10-16**] 02:31AM   freeCa-1.19
[**2179-10-16**] 02:29AM   AMYLASE-28
[**2179-10-16**] 02:29AM   ASA-NEG ETHANOL-32* ACETMNPHN-NEG
bnzodzpn-POS barbitrt-NEG tricyclic-NEG
[**2179-10-16**] 02:29AM   WBC-7.7 RBC-4.63 HGB-15.3 HCT-41.4 MCV-90
MCH-33.0* MCHC-36.9* RDW-12.5
[**2179-10-16**] 02:29AM   PLT COUNT-308
[**2179-10-16**] 02:29AM   PT-13.1 PTT-23.3 INR(PT)-1.1
[**2179-10-16**] 02:29AM   FIBRINOGE-190

CT ABDOMEN W/CONTRAST  [**2179-10-16**] 2:37 AM

CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST

Reason: injury
Field of view: 38 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
29 year old man with trauma
REASON FOR THIS EXAMINATION:
injury
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Trauma.

No prior studies are available for comparison.

TECHNIQUE: Multidetector CT scanning of the abdomen and pelvis
was performed following intravenous administration of 150 cc of
Optiray contrast. Coronal and sagittal reformations were also
obtained.

CT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST: The visualized lung
bases demonstrate minor linear atelectatic changes. There is
noted of a large amount of gas within the right ventricles,
estimated at 10-20 cc. Note is made of a pectus deformity. There
is a large laceration involving the superior aspect of the
spleen, with adjacent acute extravasation of contrast. There is
adjacent high-density free fluid extending along the left
paracolic gutter into the pelvis consistent with hemoperitoneum.
A small amount of high- density free fluid is also seen in the
deep pelvis and in the right lower quadrant. There is also note
of small focal area of fluid, with a triangular configuration,
within the mesentery adjacent to a loop of jejunum in the left
mid abdomen (best appreciated series 3, image 43). No associated
bowel wall thickening is identified. The liver, gallbladder,
adrenals, pancreas, and opacified loops of large are otherwise
within normal limits. There is no free intraperitoneal air.

CT OF THE PELVIS WITH INTRAVENOUS CONTRAST: The distal ureters,
urinary bladder, rectum, prostate, and seminal vesicles are
within normal limits. The bladder is distended with urine. There
is no pelvic or deep inguinal lymphadenopathy.

BONE WINDOWS: There are no fractures identified. Note is again
made of a pectus deformity. No suspicious lytic or sclerotic
lesions are identified.

CT RECONSTRUCTIONS: The above findings were confirmed with
coronal and sagittal reformations.

IMPRESSION:

1. Large laceration involving the superior aspect of the spleen
with associated active extravasation of contrast material and
hemoperitoneum.

2. Small triangular focus of fluid tracking along the mesentery
associated with loops of jejunum in the left mid abdomen. This
finding is unusual despite the associated hemoperitoneum and
raises concern for a mesenteric or small bowel injury.

3. Air within the right ventricle, estimated around 10-20 cc.
This was likely introduced through a venous line, as it was also
evident in the neck veins on the non-contrast CT scan of the
c-spine. Precautionary positioning would be advised.


Brief Hospital Course:
On arrival at [**Hospital1 18**], the patient was hemodynamically stable,
with complaints of epigatsric tenderness. He was admitted under
the trauma service to the Trauma intensive care unit.  His
intitial evaluation revealed a large splenic laceration and
thickened small bowel with free abdominal fluid. He was admitted
under the trauma service to the Trauma Intensive Care Unit for
monitoring of the splenic laceration and serial hematocrits. His
hematocrit remained stable during his hospital course His Hct on
[**2179-10-21**] was 33.  He was kept on bedrest at first and physical
activities were advanced slowly, along with his diet. Social
work was consulted for his ETOH use.

Medications on Admission:
Xanax 0.5mg [**Hospital1 **]
Celexa 40mg qd
Valtrex 400mg [**Hospital1 **]

Discharge Medications:
1. Citalopram Hydrobromide 20 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
2. Valacyclovir 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) as needed for unknown (prior medication).
3. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed for breakthrough pain.
Disp:*45 Tablet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Oxycodone 10 mg Tablet Sustained Release 12HR Sig: One (1)
Tablet Sustained Release 12HR PO Q12H (every 12 hours) as needed
for pain.
Disp:*60 Tablet Sustained Release 12HR(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
status-post motor vehicle collision
Splenic laceration


Discharge Condition:
Stable

Discharge Instructions:
It is important you complete all the medications as directed.
You [**Known lastname **] continue to take your pre-admission medications.  You
should not drive or operate heavy machinery while on any
narcotic pain medication such as oxycodone as it can be
sedating.  You [**Known lastname **] take colace to soften the stool as needed for
constipation, which can be caused by narcotic pain medication.

AVOID any physical/contact sports for next 6-8weeks to not cause
injury to your spleen.

You should call a physician or come to ER if you have worsening
pains, fevers, chills, nausea, vomiting, shortness of breath,
chest pain, redness or drainage about the wounds, or if you have
any questions or concerns.



Followup Instructions:
Follow up in Trauma Clinic in 2 weeks, call [**Telephone/Fax (1) 6439**] for an
appointment.



Completed by:[**2179-10-21**]
{'Injury to spleen without mention of open wound into cavity, laceration extending into parenchyma,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Dysthymic disorder,Attention deficit disorder without mention of 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 MVC vs tree

PRESENT ILLNESS: 29 year-old male, unrestrained driver, who was brought in by EMS
after his car collided with a tree; questionable LOC. Positive
for ETOH.  Airbags were activated and windshield was starred. He
was positive for ETOH.  He was extricated and transported to
[**Hospital1 18**].

MEDICAL HISTORY: Pectus excavatum
ADD
Depression
Anxiety

MEDICATION ON ADMISSION: Xanax 0.5mg [**Hospital1 **]
Celexa 40mg qd
Valtrex 400mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: on admission to trauma bay: T 98.8  HR 78  BP 109/52  RR 18
Sat 97%
GCS 15
Gen: Smells of EtOH, intoxicated
HEENT: NC/AT, EOM intact, PERRLA.
Neck:C-collar present, trachea midline.
Chest: CTA bilaterally. Equal breath sounds  Pectus excavatum.
Well-healed transverse lower sternal scar.
CV: RRR, S1, S2
Abd: Soft BS, slightly distended.  Mild TTP. No guarding  No
rebound
Rectum: Normal tone, guaiac negative
Back: No stepoffs, no tenderness
Motor: 5/5 strength
Neuro: A & O x3

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Consumes about 5 beers/week.  Smokes tobacco occasionally, for
past 13 years.  Occasionally smokes marijuana. 

### Response:
{'Injury to spleen without mention of open wound into cavity, laceration extending into parenchyma,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Dysthymic disorder,Attention deficit disorder without mention of hyperactivity'}
