CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 52 yo female unrestrianed driver s/p motor vehcile head on
collision with barrier; +LOC. She was transported to [**Hospital1 18**]; GCS
13 upon arrival. Complained of difficulty breathing and was
subsequently intubated in the ED. CT imaging revealed a large
subgaleal hematoma but no skull fracture and shearing injury at
left perimesencephalic subarachnoid hemorrhage, countrecoup
contusion on right parietal cortex.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T:  BP: 134/80   HR: 80   R 13 (Vented)   O2Sats 100% FIO2
60%
Gen: intubated and sedated, critically ill, large R supraorbital
hematoma. occasionally moving left arm spontaneously.
HEENT: R eye edematous and unable to open for exam. Pupil: L 5mm
unreactive to light, no corneal reflex         EOMs absent
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft,BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: GCS 8 (recently given etomidate, fentanyl for
intubation)

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of five ribs,Subendocardial infarction, initial episode of care,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Open wound of forehead, without mention of complication,Unspecified essential hypertension,Closed fracture of nasal bones
Brain lacer NEC-coma NOS,Fracture five ribs-close,Subendo infarct, initial,Mv coll w oth obj-driver,Open wnd knee/leg/ankle,Open wound of forehead,Hypertension NOS,Nasal bone fx-closed
Admission Date:  [**2137-7-4**]              Discharge Date:   [**2137-7-15**]

Date of Birth:  [**2085-1-21**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5880**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
None


History of Present Illness:
52 yo female unrestrianed driver s/p motor vehcile head on
collision with barrier; +LOC. She was transported to [**Hospital1 18**]; GCS
13 upon arrival. Complained of difficulty breathing and was
subsequently intubated in the ED. CT imaging revealed a large
subgaleal hematoma but no skull fracture and shearing injury at
left perimesencephalic subarachnoid hemorrhage, countrecoup
contusion on right parietal cortex.


Family History:
Noncontributory

Physical Exam:
O: T:  BP: 134/80   HR: 80   R 13 (Vented)   O2Sats 100% FIO2
60%
Gen: intubated and sedated, critically ill, large R supraorbital
hematoma. occasionally moving left arm spontaneously.
HEENT: R eye edematous and unable to open for exam. Pupil: L 5mm
unreactive to light, no corneal reflex         EOMs absent
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft,BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: GCS 8 (recently given etomidate, fentanyl for
intubation)

Cranial Nerves: unable to assess

Motor: no withdrawal to painful stimulus x 4.

Reflexes: B T Br Pa Ac
Right
Left

Toes upgoing bilaterally


Pertinent Results:
[**2137-7-4**] 04:36PM   GLUCOSE-89 LACTATE-1.6 NA+-140 K+-3.5 CL--109
TCO2-26
[**2137-7-4**] 04:20PM   UREA N-16 CREAT-0.8
[**2137-7-4**] 04:20PM   AMYLASE-31
[**2137-7-4**] 04:20PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2137-7-4**] 04:20PM   WBC-4.3 RBC-3.39* HGB-11.4* HCT-32.8* MCV-97
MCH-33.5* MCHC-34.7 RDW-13.5
[**2137-7-4**] 04:20PM   PT-14.5* PTT-26.6 INR(PT)-1.3*
[**2137-7-4**] 04:20PM   PLT COUNT-190

CT HEAD W/O CONTRAST

Reason: ? interval change in SAH

[**Hospital 93**] MEDICAL CONDITION:
52 year old woman with high speed MVA
REASON FOR THIS EXAMINATION:
? interval change in SAH
CONTRAINDICATIONS for IV CONTRAST: None.

CT OF THE HEAD WITHOUT CONTRAST:
IMPRESSION:
1. In comparison with the prior examination, the left
perimesencephalic subarachnoid hemorrhage has been decreased in
the interim without evidence of mass effect. No new intracranial
hemorrhages are visualized.
2. Unchanged scattered foci of low attenuation in the
periventricular white matter, likely consistent with
microvascular ischemic disease, please correlate.
3. There is decrease in the size of the right frontal convexity
subgaleal hematoma, unchanged right nasal bone fracture as well
as fracture of the nasal septum.

CT C-SPINE W/O CONTRAST
IMPRESSION: No traumatic injury to the cervical spine.
Orogastric tube coiled as above. Surgical team made aware.



Cardiology Report ECHO Study Date of [**2137-7-8**]
Indication: Left ventricular function. Abnormal EKG. Motor
vehicle accident.  ?cardiac contusion.
Height: (in) 65
Weight (lb): 144
BSA (m2): 1.72 m2
BP (mm Hg): 150/68
HR (bpm): 94
Status: Inpatient
Date/Time: [**2137-7-8**] at 12:12
Test: Portable TTE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007W027-0:50
Test Location: West SICU/CTIC/VICU
Technical Quality: Adequate
MEASUREMENTS:
Left Atrium - Long Axis Dimension: 3.7 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: 4.5 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: 3.7 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: 1.1 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: 1.0 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 4.3 cm (nl <= 5.6 cm)
Left Ventricle - Systolic Dimension: 2.4 cm
Left Ventricle - Fractional Shortening: 0.44 (nl >= 0.29)
Left Ventricle - Ejection Fraction: >= 60% (nl >=55%)
Aorta - Valve Level: 2.5 cm (nl <= 3.6 cm)
Aorta - Ascending: 3.1 cm (nl <= 3.4 cm)
Aorta - Descending Thoracic: 2.1 cm (nl <= 2.5 cm)
Aortic Valve - Peak Velocity: 1.7 m/sec (nl <= 2.0 m/sec)
Mitral Valve - E Wave: 1.0 m/sec
Mitral Valve - A Wave: 0.8 m/sec
Mitral Valve - E/A Ratio: 1.25
Mitral Valve - E Wave Deceleration Time: 133 msec
TR Gradient (+ RA = PASP): *28 mm Hg (nl <= 25 mm Hg)
IMPRESSION: Normal study. Normal biventricular cavity size and
regional/global
systolic function. No valvular pathology or pathologic flow
identified.

CLINICAL IMPLICATIONS:
Based on [**2136**] AHA endocarditis prophylaxis recommendations, the
echo findings
indicate prophylaxis is NOT recommended. Clinical decisions
regarding the need
for prophylaxis should be based on clinical and
echocardiographic data.





Brief Hospital Course:
She was admitted to the Trauma Service. Neurosurgery was
consulted because of her SAH; this injury was nonoperative; she
was loaded with Dilantin and serial head CT scans were performed
which were stable.

Cardiology was also consulted because of HTN and tachycardia,
she had already been receiving beta blockade and it was
recommended that the dose be increased. Her ACEI was also
increased from 10mg to 10mg.

Orthopedics was also consulted because of the right knee open
wound and laceration; she was taken to the operating room for
debridement open wound and medial arthrotomy. She will follow up
with Dr. [**Last Name (STitle) 1005**] in 2 weeks.

She was evaluated by Speech and Swallow because of her mental
status and dysphagia. A Dobbhoff tube was placed initially for
enteral feedings; once she passed her bed side swallow her diet
was upgraded. She self discontinued the Dobbhoff and continued
to tolerate her regular diet and was able to maintain an
adequate caloric intake.

Physical and Occupational therapy also evaluated her and have
recommended rehab stay after her acute hospitalization.


Discharge Medications:
1. Insulin Regular Human 100 unit/mL Solution Sig: One (1) dose
Injection ASDIR (AS DIRECTED) as needed for per sliding scale:
see attached.
2. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
neb rx Inhalation Q4H (every 4 hours) as needed for wheezing.
3. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ML
Injection TID (3 times a day).
4. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb rx
Inhalation Q6H (every 6 hours) as needed for shortness of breath
or wheezing.
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day): hold for HR <60; SBP <120.
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
8. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

9. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
hold for SBP <120.
10. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
11. Dulcolax 10 mg Suppository Sig: One (1)  Rectal twice a day
as needed for constipation.
12. 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:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
s/p Motor vehicle crash
Subaracnoid hemorrhage
Nasal bone fracture
Scalp laceration
Subgleal hematoma
Right rib fractures [**3-6**]
Right knee laceration


Discharge Condition:
Stable


Discharge Instructions:
Remove staples on [**7-18**].

Followup Instructions:
Follow up with Neurosurgery in 4 weeks, call [**Telephone/Fax (1) 1669**] for an
appointment. Inform the office that you will need a repeat head
CT scan.

Follow up in 2 weeks with Dr. [**Last Name (STitle) 1005**], Orthopedics. Call
[**Telephone/Fax (1) 1228**] for an appointment.

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



Completed by:[**2137-7-16**]
{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of five ribs,Subendocardial infarction, initial episode of care,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Open wound of forehead, without mention of complication,Unspecified essential hypertension,Closed fracture of nasal bones'}


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: 52 yo female unrestrianed driver s/p motor vehcile head on
collision with barrier; +LOC. She was transported to [**Hospital1 18**]; GCS
13 upon arrival. Complained of difficulty breathing and was
subsequently intubated in the ED. CT imaging revealed a large
subgaleal hematoma but no skull fracture and shearing injury at
left perimesencephalic subarachnoid hemorrhage, countrecoup
contusion on right parietal cortex.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T:  BP: 134/80   HR: 80   R 13 (Vented)   O2Sats 100% FIO2
60%
Gen: intubated and sedated, critically ill, large R supraorbital
hematoma. occasionally moving left arm spontaneously.
HEENT: R eye edematous and unable to open for exam. Pupil: L 5mm
unreactive to light, no corneal reflex         EOMs absent
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft,BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: GCS 8 (recently given etomidate, fentanyl for
intubation)

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with loss of consciousness of unspecified duration,Closed fracture of five ribs,Subendocardial infarction, initial episode of care,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Open wound of forehead, without mention of complication,Unspecified essential hypertension,Closed fracture of nasal bones'}
