CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 33 year old female s/p MVC, single driver collision with pole,
transfered from [**Hospital3 **] Hospital.

MEDICAL HISTORY: Facial lacerations from surfing accidents
Herpes Simplex

MEDICATION ON ADMISSION: Valtrex

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Injury to spleen with open wound into cavity, laceration extending into parenchyma,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Street and highway accidents,Closed fracture of mandible, ramus, unspecified,Open wound of jaw, without mention of complication,Cracked tooth,Alcohol abuse, continuous,Contusion of lung with open wound into thorax,Traumatic pneumothorax with open wound into thorax,Cannabis dependence, continuous,Hemangioma of intra-abdominal structures
Cl skul base fx-coma NOS,Spleen parnchym lac-opn,Loss control mv acc-driv,Accid on street/highway,Fx ramus NOS-closed,Open wound of jaw,Cracked tooth,Alcohol abuse-continuous,Lung contusion-open,Traum pneumothorax-open,Cannabis depend-contin,Hemangioma intra-abdom
Admission Date:  [**2194-9-8**]              Discharge Date:   [**2194-9-11**]

Date of Birth:  [**2161-4-14**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2194-9-8**] Suture chin lacertion
[**2194-9-9**] Closed reduction mandible and intermedullary fixation

History of Present Illness:
33 year old female s/p MVC, single driver collision with pole,
transfered from [**Hospital3 **] Hospital.

Past Medical History:
Facial lacerations from surfing accidents
Herpes Simplex

Family History:
Noncontributory

Physical Exam:
Upon admission:

O: T: afeb  BP:118 / 68        HR:95    R 17      O2Sats 97 RA
Gen: Lying in bed in supine, un cooperative with exam
HEENT: Pupils: [**1-27**] BL symmetric and reactive        EOMs full
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

Neuro:
Mental status: Awake and alert, UNcooperative with exam,
withdrawn affect.
Orientation: did not answer these questions . said - I dont know

Recall: Refused for this part of exam
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, to
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**4-1**] throughout. No pronator drift

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Reflexes: B T Br Pa Ac
Right     2 2 2  2  2
Left      2 2 2  2  2

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin


Pertinent Results:
[**2194-9-8**] 08:35AM   ASA-NEG ETHANOL-67* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2194-9-8**] 08:35AM   WBC-13.3* RBC-3.73* HGB-11.0* HCT-33.2*
MCV-89 MCH-29.6 MCHC-33.3 RDW-13.0
[**2194-9-8**] 08:35AM   PT-13.4 PTT-28.4 INR(PT)-1.1
[**2194-9-8**] 08:35AM   PLT COUNT-253


  RENAL & GLUCOSE    Glucose UreaN Creat Na  K   Cl  HCO3 AnGap
[**2194-9-9**] 01:59AM    107*   10    0.7 137 4.1  105 25  11

Micro/Imaging:
[**2194-9-10**] MR [**Name13 (STitle) 2853**] no cord compression, no ligamentous injury.
limited by motion.
[**2194-9-10**] mandible series no significant change to L mandibular
fracture
[**2194-9-9**] CT Head No changes. sm subarach. hemorr. L vertex, no
subdural hematoma.
[**2194-9-9**] CT fac complex fx ramus L mandible
[**2194-9-9**] R ankle no fx
[**2194-9-8**] CT head SAH L parietal, intraparench H R frontal, ? L
frontal SAH. No shift.
[**2194-9-8**] CT head L mandibular fracture
[**2194-9-8**] CT spine no fractures or malalignment
[**2194-9-8**] CT torso no splenic lac seen, as reported from OSH
[**2194-9-8**] R Shoulder no fx


Brief Hospital Course:
She was admitted to the Trauma service. Because of her traumatic
brain injury=y and mandible fracture she was evaluated n=by
neurosurgery and OMFS. Her subarachnoid hemorrhage was managed
non operatively; she was monitored closely in the Trauma ICU
with frequent neurologic checks and serial head CT scan which
remained stable. Dilantin was initiated and it was recommended
that she remain on this for a total of 10 days. There were no
reported or observed seizure activity during her hospital stay.

On [**9-9**] she was taking to the operating room by OMFS for closed
reduction with intermaxillary fixation; her jaws were wired
closed. There were no intraoperative complications.
Postoperatively she did have some pain control issues initially
requiring IV narcotics and was later changed to oral pain
medications with adequate relief. She was also started on a
bowel regimen. Her diet was advanced so that at time of
discharge she was tolerating a soft diet; dietary supplements
were also added to her nutritional program.

As her mental status improved and remained stable she was
transferred to the regular nursing unit where she continued to
progress. She was evaluated by Physical therapy for balance
issues and was eventually cleared for home.

Her chin laceration sutures were removed on day of her
discharge; steri-strips were applied.


Medications on Admission:
Valtrex

Discharge Medications:
1. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15) ML
Mucous membrane [**Hospital1 **] (2 times a day).
Disp:*900 ML(s)* Refills:*2*
2. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed for pain.
Disp:*450 ML(s)* Refills:*0*
3. Phenytoin 125 mg/5 mL Suspension Sig: One Hundred (100) MG PO
Q8H (every 8 hours) for 6 days.
Disp:*qs ML's* Refills:*0*
4. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) MG
PO BID (2 times a day).
5. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) ML's
PO twice a day as needed for constipation.


Discharge Disposition:
Home

Discharge Diagnosis:
s/p Motor vehicle crash
Subarachnoid hemorrhage left parietal
Intrapaernchymal hemorrhage right frontal region
Left mandible fracture
Chin laceration

Discharge Condition:
Hemodynamically stable, tolerating a regular diet, pain
adequately controlled.

Discharge Instructions:
Return to the Emergency room if you develop any fevers, chills,
increased jaw pain, headache, dizziness, shortness of breath,
chest pain, nausea, vomiting, diarrhea and/or any other symptoms
that are concerning to you.

You have been given wire cutters to use in the event of an
emergency such as shortness of breath, nausea with vomiting; you
should cut the wires on both sides to release them. Return to
the Emergency room immediately if need to cut the wires.

Adhere to a soft diet. Drink Carnation Instant breakfast of
Ensure/Boost Plus at least 3x/day to help supplement your diet.

Continue the Dilantin for 6 more days.


Followup Instructions:
Follow up with Dr. [**First Name (STitle) **] in [**Hospital 40530**] clinic on Friday [**9-12**]; you
will need to call [**Telephone/Fax (1) 55393**] for an appointment time.

For any concerns related to your head injury you should follow
up with Neurosurgery by calling [**Telephone/Fax (1) 1669**] for an appointment
if one is needed.

If you are noticing that you are having ongoing problems with
your memory as a result of your head injury you should call for
an appointment in the Cognitive Neurology Unit at [**Hospital1 771**] with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] by calling
[**Telephone/Fax (1) 1690**].

Follow up with your primary care doctor in [**11-29**] weeks for a
general physical exam. You will need to call for an appointment.


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

Completed by:[**2194-10-15**]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Injury to spleen with open wound into cavity, laceration extending into parenchyma,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Street and highway accidents,Closed fracture of mandible, ramus, unspecified,Open wound of jaw, without mention of complication,Cracked tooth,Alcohol abuse, continuous,Contusion of lung with open wound into thorax,Traumatic pneumothorax with open wound into thorax,Cannabis dependence, continuous,Hemangioma of intra-abdominal structures'}


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: 33 year old female s/p MVC, single driver collision with pole,
transfered from [**Hospital3 **] Hospital.

MEDICAL HISTORY: Facial lacerations from surfing accidents
Herpes Simplex

MEDICATION ON ADMISSION: Valtrex

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Injury to spleen with open wound into cavity, laceration extending into parenchyma,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Street and highway accidents,Closed fracture of mandible, ramus, unspecified,Open wound of jaw, without mention of complication,Cracked tooth,Alcohol abuse, continuous,Contusion of lung with open wound into thorax,Traumatic pneumothorax with open wound into thorax,Cannabis dependence, continuous,Hemangioma of intra-abdominal structures'}
