CHIEF COMPLAINT: 

PRESENT ILLNESS: A 28-year-old black male in a
car crash with extraction time of one hour, combative at the
scene, positive loss of consciousness.

MEDICAL HISTORY: The patient has a past medical history
of asthma.

MEDICATION ON ADMISSION: No known medications currently.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of C5-C7 level with unspecified spinal cord injury,Alcohol abuse, unspecified,Occlusion and stenosis of vertebral artery without mention of cerebral infarction,Other alteration of consciousness,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Open wound of forehead, without mention of complication,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle
C5-c7 fx-cl/cord inj NOS,Alcohol abuse-unspec,Ocl vrtb art wo infrct,Other alter consciousnes,Fx clavicle NOS-closed,Fracture one rib-closed,Open wound of forehead,Open wnd knee/leg/ankle,Mv collision NOS-driver
Admission Date:  [**2143-8-16**]     Discharge Date:  [**2143-8-23**]

Date of Birth:   [**2114-7-27**]     Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  A 28-year-old black male in a
car crash with extraction time of one hour, combative at the
scene, positive loss of consciousness.

PAST MEDICAL HISTORY:  The patient has a past medical history
of asthma.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  No known medications currently.

PHYSICAL EXAMINATION ON ADMISSION:  On initial examination
revealed he was a unrestrained driver. The patient was
complaining of numbness in his right upper extremity on
presentation.  Positive alcohol on board.  Generally, alert,
awake, and oriented.  Pupils were equal and reactive to
light.  A small superficial laceration on his forehead.
Tenderness in his left clavicle.  A regular rate and rhythm
on cardiovascular.  Breath sounds were good bilaterally.  The
abdomen was soft.  The back was without stepoff.  His pelvis
was stable.  There was a small puncture wound in his left
lower extremity.  No deformities.  Neurologically wise, the
patient was not cooperative with the examination.

LABORATORY DATA ON ADMISSION:  Laboratories on arrival were
white blood cell count of 9.2, hematocrit of 34,
platelets 234.  Coagulations were PT 13.1, PTT was 24.4, INR
was 1.1.  Fibrinogen was 283.  Ethanol was 149.  Chemistry
revealed a sodium of 143, potassium 3.5, chloride 107,
bicarbonate 21, BUN 13, creatinine 1.1, glucose of 133.
Amylase was 48.

RADIOLOGY/IMAGING:   Initial trauma series showed a cervical
spine that was negative to C5.

A chest x-ray which showed a fracture of the left clavicle
which was nondisplaced and of the right first rib.

Pelvis x-ray was negative.

HOSPITAL COURSE:   The plan was to admit this gentleman.  He
had a CT of the neck which showed a transverse process
fracture of C5 and C6, and the C6 extended into the vertebral
artery foramen.  CT also showed a left clavicle fracture and
a right first rib fracture.  CT of the abdomen was negative.
CT of the head was negative. There was no extravasation of
fluid, blood or contrast in the chest CT.

So, the initial assessment of this gentleman was that of a
28-year-old man with a transverse process fracture of C5-C6
extending into the vertebral artery foramen with questionable
mental status given his uncooperativeness and combative
examination.  Positive alcohol.  Cervical spine precautions,
cervical collar, logroll precautions.  Orthopaedics
consultation for spine and pain control, and admission to
Surgical Intensive Care Unit for frequent neurologic checks.

Orthopaedics was involved and given the fact that there was a
question about extension of the fracture into the vertebral
artery foramen, Neurosurgery was consulted.  A MRA was done,
per Neurosurgery, which showed a right vertebral artery
thrombosis and positive anterior longitudinal ligament
injury.  Chest x-ray was repeated as well without change.
So, the patient was kept on cervical spine precautions in a
hard collar, and Neurosurgery advised anticoagulation which
was done, and an angiogram as well.  The MRA could not rule
out a dissection which was another reason why the angiogram
was done for dissection of the vertebral artery.  The patient
had some weakness in his right upper extremity, but the
sensation was normal to light touch and pinprick in the
bilateral upper extremities and lower extremities.  The
patient was anticoagulated on heparin.  Neurosurgery and
Orthopaedics was following.  Orthopaedics' evaluation
resulted in agreement with the hard collar as well as a
follow-up evaluation in two weeks at the office of Dr. [**Last Name (STitle) 34920**].
They also put him in a sling for his clavicular fracture.

The angiogram showed the right vertebral artery with a low
flow state with good collateral flow and left dominant, and
heparin was continued, and eventually Coumadin was begun.
The patient was then transferred out of the unit, and his
neurologic checks were given less frequently, and the patient
was continued on Coumadin.  He was also on Percocet and
Zantac.  The goal of the INR per the Neurosurgery team was an
INR of 2 to 3.  There were no neurologic deficits during his
hospitalization.  His arm strength completely improved and
was equal bilaterally.

On hospital day eight, this was the patient's second day of
anticoagulation with an INR above 2.  The patient was to be
going home with his cervical collar in place.  He had
appropriate follow-up appointments.  He was tolerating a
regular diet, having bowel movements, and ambulating without
difficulty.  He was seen and cleared by Physical Therapy to
go home.  He was to go home on Coumadin 5, Percocet, and
Colace.

DISCHARGE DIAGNOSES:
1.  C5-C6 transverse process fractures.
2.  Anterior longitudinal ligament injury of his neck.
3.  Right vertebral artery thrombosis.
4.  Status post motor vehicle crash.
5.  Right clavicular fracture.
6.  Right first rib fracture.

DISCHARGE INSTRUCTIONS:  Continue anticoagulation with
Coumadin.  Follow up with primary care physician appointment
that was arranged.  Follow up with Orthopaedics.  Follow up
with Neurosurgery.  Follow up in the Trauma Clinic.  Ambulate
and call if there were any problems.

CONDITION AT DISCHARGE:  Discharge condition was stable and
improved.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D.  [**MD Number(1) 2214**]

Dictated By:[**Last Name (NamePattern1) 8344**]

MEDQUIST36

D:  [**2143-8-23**]  12:34
T:  [**2143-8-27**]  13:33
JOB#:  [**Job Number 34921**]
{'Closed fracture of C5-C7 level with unspecified spinal cord injury,Alcohol abuse, unspecified,Occlusion and stenosis of vertebral artery without mention of cerebral infarction,Other alteration of consciousness,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Open wound of forehead, without mention of complication,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}


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: 

PRESENT ILLNESS: A 28-year-old black male in a
car crash with extraction time of one hour, combative at the
scene, positive loss of consciousness.

MEDICAL HISTORY: The patient has a past medical history
of asthma.

MEDICATION ON ADMISSION: No known medications currently.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of C5-C7 level with unspecified spinal cord injury,Alcohol abuse, unspecified,Occlusion and stenosis of vertebral artery without mention of cerebral infarction,Other alteration of consciousness,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Open wound of forehead, without mention of complication,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}
