CHIEF COMPLAINT: MVC

PRESENT ILLNESS: 74 y/o male brought to [**Hospital1 18**] via EMS after MVC. Patient was
restrained driver. Per report patient ran into the back of an
[**Company 2318**] bus and continued on through an intersection with a red
light and then struck a parked car. The patient had no obvious
signs of head trauma, no LOC. He had no complaints of pain in
the trauma bay. Per report he was confused at the scene. He had
no recollection of the events.

MEDICAL HISTORY: 1.cad s/p cabg
2.CHF
3.hyperlipidemia
4.htn
5.gout
6.polymyalgia rheumatica
7. diabetes

MEDICATION ON ADMISSION: asa, plavix, lisinopril, lasix, lipitor, atenolol, prevacid

ALLERGIES: Diltiazem

PHYSICAL EXAM: in the trauma bay:

FAMILY HISTORY: Mother with CAD and stroke.

SOCIAL HISTORY: Drinks 1-3 beers/night, smokes 1ppd for "[**Age over 90 **] years... all my
life." no illicit drug use. Lives alone, no children, has
siblings in the area
Injury to liver without mention of open wound into cavity, hematoma and contusion,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Atrial flutter,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Polymyalgia rheumatica,Gout, unspecified,Other and unspecified hyperlipidemia,Aortocoronary bypass status,Other persistent mental disorders due to conditions classified elsewhere
Liver hematoma/contusion,CHF NOS,Urin tract infection NOS,Atrial flutter,Mv collision NOS-driver,Polymyalgia rheumatica,Gout NOS,Hyperlipidemia NEC/NOS,Aortocoronary bypass,Mental disor NEC oth dis
Admission Date:  [**2198-4-20**]              Discharge Date:   [**2198-4-24**]

Date of Birth:  [**2124-1-3**]             Sex:   M

Service: SURGERY

Allergies:
Diltiazem

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
MVC

Major Surgical or Invasive Procedure:
none

History of Present Illness:
74 y/o male brought to [**Hospital1 18**] via EMS after MVC. Patient was
restrained driver. Per report patient ran into the back of an
[**Company 2318**] bus and continued on through an intersection with a red
light and then struck a parked car. The patient had no obvious
signs of head trauma, no LOC. He had no complaints of pain in
the trauma bay. Per report he was confused at the scene. He had
no recollection of the events.

Past Medical History:
1.cad s/p cabg
2.CHF
3.hyperlipidemia
4.htn
5.gout
6.polymyalgia rheumatica
7. diabetes

Social History:
Drinks 1-3 beers/night, smokes 1ppd for "[**Age over 90 **] years... all my
life." no illicit drug use. Lives alone, no children, has
siblings in the area

Family History:
Mother with CAD and stroke.

Physical Exam:
in the trauma bay:

Vitals: Temp 100 rectal BP 158/70 HR 90 RR 16 sats 100% on NRB
GCS 14 FS 206
GEN: elderly male, NAD, lying supine on hard board, alert and
oriented x 4, slowed speech, does not appear to understand some
questions, unable to provide medical history
HEENT: NCAT, PERRL, EOMI, TM clear bilaterally, midface stable,
OP clear
NECK: in c-collar, NTTP
PULM: CTA bilaterally
CHEST: no crepitus or pain
CV: regular, ECG NSR
ABD: SNTND, FAST neg
RECTAL: normal tone, guiac negative
PELVIS: stable to AP/Lateral compression
EXT: atraumatic, WWP, no edema
BACK: NTTP, no step-off or deformity
NEURO: CN II-XII intact, no focal motor or sensory deficits.

Pertinent Results:
[**2198-4-20**] 01:00PM BLOOD WBC-7.6 RBC-3.67* Hgb-10.6* Hct-31.3*
MCV-86 MCH-29.0 MCHC-34.0 RDW-15.1 Plt Ct-350
[**2198-4-22**] 05:35AM BLOOD WBC-8.5 RBC-3.42* Hgb-9.8* Hct-29.3*
MCV-86 MCH-28.7 MCHC-33.4 RDW-15.1 Plt Ct-300
[**2198-4-20**] 01:00PM BLOOD Glucose-213* UreaN-33* Creat-2.2* Na-143
K-4.3 Cl-105 HCO3-24 AnGap-18
[**2198-4-22**] 05:35AM BLOOD Glucose-115* UreaN-31* Creat-1.9* Na-142
K-4.3 Cl-105 HCO3-24 AnGap-17
[**2198-4-20**] 01:00PM BLOOD CK(CPK)-36* Amylase-119*
[**2198-4-20**] 01:00PM BLOOD CK-MB-NotDone cTropnT-0.04*
[**2198-4-21**] 11:15AM BLOOD CK(CPK)-28*
[**2198-4-20**] 01:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2198-4-22**] 12:33PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.015
[**2198-4-22**] 12:33PM URINE Blood-LG Nitrite-POS Protein-30
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-MOD
URINE CULTURE (Final [**2198-4-24**]):
      ESCHERICHIA COLI.    >100,000 ORGANISMS/ML..
         PRESUMPTIVE IDENTIFICATION.
         Trimethoprim/sulfa sensitivity confirmed by
[**Doctor Last Name 3077**]-[**Doctor Last Name 3060**].

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------   <=2 S
AMPICILLIN/SULBACTAM--   <=2 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------     4 S
GENTAMICIN------------   <=1 S
IMIPENEM--------------   <=1 S
LEVOFLOXACIN----------<=0.25 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------  <=16 S
PIPERACILLIN----------   <=4 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S

Imaging
[**2198-4-20**] Head CT: IMPRESSION: No intracranial hemorrhage is
identified.
[**2198-4-20**] CT C-spine IMPRESSION: No fracture or dislocation is
identified within the cervical vertebrae. Degenerative changes
are seen at multiple levels, most pronounced at the C5-C6 level,
with moderate to severe spinal canal stenosis
CT of Abd/Pelvis IMPRESSION:
1. Small extracapsular hematoma adjacent to the right posterior
liver.
2. Small low attenuation left hepatic focus, which is too small
to be characterized. If the patient sustained trauma to this
area, this could represent a small contusion.
3. Small right pleural effusion.
4. Defect of right L3 lamina, which does not appear to be an
acute finding.
5. Extensive atherosclerotic disease involving the aorta,
mesenteric and renal vessels

EEG [**2198-4-23**] IMPRESSION: This is an abnormal routine EEG due to a
slowed background rhythm with intermittent generalized delta
frequency slowing. These findings suggest deep, midline
subcortical dysfunction and are
consistent with an encephalopathy. Common causes include
infection,
metabolic abnormalities, and medication affects. No lateralizing
or
epileptiform abnormalities were seen.


Brief Hospital Course:
TSICU [**Date range (3) 93066**]
After initial stabilization in the trauma bay, the patient was
taken to the CT scanner for imaging studies. His only
significant injury related to the trauma of the MVC was a small
subcapsular hematoma of his liver. However, the patient began to
develop shortness of breath in the trauma bay after obtaining
his CT scans. He had been supine for a considerable length of
time and was also under a significant stress [**1-3**] the MVC. At no
time did he complain of chest pain. A chest x-ray was obtained
showing possible CHF. An ECG did not show any ischemic changes.
The patient has severe underlying cardiac disease with a
depressed ejection fraction predisposing him to pulmonary edema.
The patients blood pressure climbed to 200/100 and he was
tachypneic and tachycardic. He was treated with IV lasix, oxygen
and started on a nitro drip. Cardiology was called and the CHF
team was consulted for optimal management. The patient quickly
improved, but was monitored overnight in the ICU.

[**Date range (3) 93067**]: The following day the patient was transferred
to the hospital floor and cardiology was consulted regarding his
outpatient heart failure/CV medications. He was continued on his
beta-blocker, ace, and statin, but his asa and plavix were held
[**1-3**] his hematoma. Throughout the [**Hospital 228**] hospital course,
serial HCTs were done and they remained stable indicating no
significant bleeding from the hematoma. The patient was
restarted on his asa and plavix on [**4-22**]. The patient has an
underlying severely compromised cerebral blood as evidenced by
prior MRI/MRA. He had no memory of the accident and neurology
was consulted at the request of cardiology to help optimize his
blood pressure to ensure adequate cerebral perfusion while not
putting extra stress on his heart. Neuro recommended a goal SBP
of >120. The patient also has a L subclavian stent that requires
coumadin dosing. The patient should not be restarted on his
coumadin until 1 week post injury which is Friday [**4-27**]. Once
the patient has a theraputic INR his plavix may be discontinued.
The patient had a urine sample checked and was discovered to
have a UTI. The culture is susceptible to E Coli and bactrim was
prescribed and should be taken for 5 days after discharge.

The patient was evaluated by Physical and Occupational therapy
who found him to have good strength and mobility but to be of
considerable safety risk to himself in that he was unable to
answer appropriately when asked the names/doses of his
medications, what he would do in an emergency and also was noted
to have difficulty in tasks with concentration and memory.
Therefore placement was arranged in a SNIF. On the day of
discharge the patient was tolerating PO, was afebrile, voiding
well, and was agreeable to placement. Cardiology and neurology
were both aware of the patient's discharge planning.

Medications on Admission:
asa, plavix, lisinopril, lasix, lipitor, atenolol, prevacid

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily): this should be continued until patient has an INR
of 2.0-3.0 range. Once INR is >2.0 please discontinue plavix.
3. Lisinopril 10 mg Tablet Sig: 1.5 Tablets PO once a day.
Tablet(s)
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Lansoprazole 15 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) as needed for UTI for 5 days.
8. Donepezil Hydrochloride 5 mg Tablet Sig: One (1) Tablet PO HS
(at bedtime).
9. Tamsulosin HCl 0.4 mg Capsule, Sust. Release 24HR Sig: One
(1) Capsule, Sust. Release 24HR PO DAILY (Daily).
10. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: 1.5
Tablet Sustained Release 24HRs PO once a day: hold if HR<60 or
SBP<100.
11. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
12. Coumadin 2 mg Tablet Sig: Two (2) Tablet PO at bedtime:
please start on Friday [**4-27**]. Check INR on daily for 1 week
until theraputic at INR [**1-4**]. Adjust dose as appropriate.
13. Glucophage 500 mg Tablet Sig: One (1) Tablet PO once a day.
Tablet(s)


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 537**]- [**Location (un) 538**]

Discharge Diagnosis:
Subcapsular hematoma of the liver

Secondary diagnoses:
1.cad s/p cabg
2.CHF
3.hyperlipidemia
4.htn
5.gout
6.polymyalgia rheumatica
7. diabetes


Discharge Condition:
good

Discharge Instructions:
You should take all of your medication as prescribed during this
admission. You will begin taking Coumadin on Friday of this
week. After your INR becomes theraputic you will stop taking
plavix.

You may continue regular activity as tolerated. Avoid heavy
lifting or straining. You should eat a cardiac low sodium diet.

Return to the emergency room if you develop fevers, chills,
chest pain or shortness of breath, nausea, vomiting, abdominal
pain, lightheadedness, black or bloody stools, weakness in your
arms or legs, changes in speech, inability to urinate or any
other concerning symptoms.

Followup Instructions:
Follow up with Behavioral Neurology with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **],
[**Telephone/Fax (1) 1690**] in [**12-3**] weeks after your discharge.

Follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in the stroke clinic in 1 month
after discharge. Call [**Telephone/Fax (1) 93068**] for an appointment.

Follow up with Cardiology, Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **], on [**5-29**] at
2:30PM. You may call [**Telephone/Fax (1) 4022**] if you need to change your
appointment.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]
{'Injury to liver without mention of open wound into cavity, hematoma and contusion,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Atrial flutter,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Polymyalgia rheumatica,Gout, unspecified,Other and unspecified hyperlipidemia,Aortocoronary bypass status,Other persistent mental disorders due to conditions classified elsewhere'}


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: MVC

PRESENT ILLNESS: 74 y/o male brought to [**Hospital1 18**] via EMS after MVC. Patient was
restrained driver. Per report patient ran into the back of an
[**Company 2318**] bus and continued on through an intersection with a red
light and then struck a parked car. The patient had no obvious
signs of head trauma, no LOC. He had no complaints of pain in
the trauma bay. Per report he was confused at the scene. He had
no recollection of the events.

MEDICAL HISTORY: 1.cad s/p cabg
2.CHF
3.hyperlipidemia
4.htn
5.gout
6.polymyalgia rheumatica
7. diabetes

MEDICATION ON ADMISSION: asa, plavix, lisinopril, lasix, lipitor, atenolol, prevacid

ALLERGIES: Diltiazem

PHYSICAL EXAM: in the trauma bay:

FAMILY HISTORY: Mother with CAD and stroke.

SOCIAL HISTORY: Drinks 1-3 beers/night, smokes 1ppd for "[**Age over 90 **] years... all my
life." no illicit drug use. Lives alone, no children, has
siblings in the area 

### Response:
{'Injury to liver without mention of open wound into cavity, hematoma and contusion,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Atrial flutter,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Polymyalgia rheumatica,Gout, unspecified,Other and unspecified hyperlipidemia,Aortocoronary bypass status,Other persistent mental disorders due to conditions classified elsewhere'}
