CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 51 yo male unrestrained driver s/p motor vehicle crash vs oil
tanker. He was taken to an area hospital and intubated. Head
imaging revealed intracranial hemorrhage; he was then
transferred to [**Hospital1 18**] for furthe care. Upon arrival he was
pulseless, once chest decompressed his pulse returned.

MEDICAL HISTORY: ?Psychiatric history

MEDICATION ON ADMISSION: Seroquel

ALLERGIES: Penicillins

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Traumatic pneumothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Other and unspecified alcohol dependence, unspecified,Drug-induced delirium,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use
Brain hem NEC-coma NOS,Traum pneumothorax-close,Traum subcutan emphysema,Alcoh dep NEC/NOS-unspec,Drug-induced delirium,Mv collision NOS-driver,Adv eff benzodiaz tranq
Admission Date:  [**2179-12-18**]              Discharge Date:   [**2179-12-24**]

Date of Birth:  [**2128-11-6**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

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

Major Surgical or Invasive Procedure:
Bilateral chest tube thoracostomies


History of Present Illness:
51 yo male unrestrained driver s/p motor vehicle crash vs oil
tanker. He was taken to an area hospital and intubated. Head
imaging revealed intracranial hemorrhage; he was then
transferred to [**Hospital1 18**] for furthe care. Upon arrival he was
pulseless, once chest decompressed his pulse returned.

Past Medical History:
?Psychiatric history

Family History:
Noncontributory

Pertinent Results:
[**2179-12-18**] 06:58PM   GLUCOSE-102 UREA N-13 CREAT-0.7 SODIUM-143
POTASSIUM-4.2 CHLORIDE-107 TOTAL CO2-25 ANION GAP-15
[**2179-12-18**] 06:58PM   WBC-11.3* RBC-3.97* HGB-13.7* HCT-39.9*
MCV-100* MCH-34.4* MCHC-34.3 RDW-12.6
[**2179-12-18**] 06:58PM   PLT COUNT-115*
[**2179-12-18**] 06:58PM   PT-12.8 PTT-27.6 INR(PT)-1.1

CHEST (PORTABLE AP)

Reason: Eval for recurrent ptx

[**Hospital 93**] MEDICAL CONDITION:
40 year old man with B PTX, B chest tubes. L Chest tube pulled
yesterday AM, R Chest tube pulled this AM
REASON FOR THIS EXAMINATION:
Eval for recurrent ptx
INDICATION: Removal of right chest tube.

COMPARISON: [**2179-12-21**].

AP UPRIGHT CHEST: The heart size, mediastinal and hilar contours
are normal. There has been interval removal of the right-sided
chest tube. There is no pneumothorax. Subcutaneous emphysema is
again visualized along the right lateral thoracic wall. The
lungs are grossly clear. No pleural effusions are identified.

IMPRESSION: No pneumothorax. Interval removal of right chest
tube.

CT HEAD W/O CONTRAST

Reason: eval for bleeding

[**Hospital 93**] MEDICAL CONDITION:
40 year old man s/p MVA
REASON FOR THIS EXAMINATION:
eval for bleeding
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: MVA.

NON-CONTRAST HEAD CT: No hydrocephalus, shift of normally
midline structures, or acute major vascular territorial infarct
is identified. Several foci of intraparenchymal hemorrhage are
identified in the frontal lobes. For example, in the left
frontal lobe, there is an 8-mm focus of blood. In the right
frontal lobe near the vertex, there is a 6-mm focus, a 4-mm
focus, and a 5-mm focus. No other foci of intraparenchymal
hemorrhage are seen. High density material in the occipital [**Doctor Last Name 534**]
of the right lateral ventricle is not likely to be blood. There
is opacification of the dependent portion of the nasal cavity.
Air is seen dissecting along the soft tissues overlying the
right posterior fossa, though no soft tissue defect is seen in
the imaged portion. No fractures are seen. Other imaged sinuses
including the mastoid air cells, maxillary sinuses, and ethmoid
and sphenoid sinuses appear clear.

High density indicating blood is seen in right occipital [**Doctor Last Name 534**].

IMPRESSION: Bifrontal traumatic small intraparenchymal
hemorrhages. Air in subcutaneous tissues of right occipital
region originates from right chest tube. Intraventricular blood
in the occipital [**Doctor Last Name 534**] of right lateral ventricle.

Findings discussed with trauma surgery team at time of
interpretation.

CT C-SPINE W/O CONTRAST

Reason: r/o fracture, dislocation

[**Hospital 93**] MEDICAL CONDITION:
40 year old man s/p MVA
REASON FOR THIS EXAMINATION:
r/o fracture, dislocation
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: MVA.

CT CERVICAL SPINE: No prior for comparison. Slight kyphosis of
the C-spine centered at C5, probably degenerative in nature;
there is loss of disc height at C4-5 through C6-7. There is
grade I anterolisthesis of C4 on C5. A large amount of
retropharyngeal and paravertebral subcutaneous emphysema is seen
dissecting along the retropharyngeal space and posterior to both
sternocleidomastoid muscles into the mediastinum. Endotracheal
tube is noted, as is a nasogastric tube. The tube cuff is
slightly over-distended. Some dependent opacity in the left lung
apex is seen, and there is a small left pneumothorax.
Incidentally noted is surgical fusion of the right facet joints
of C4-5, with a cerclage wire encircling the spinous processes
of C4-5.

IMPRESSION: 1. Degenerative changes of the spine. No acute
fractures seen.

2. Slight overdistention of the ETT cuff.

For details regarding the traumatic injuries to the chest,
please see CT torso of the same day.


Brief Hospital Course:
He was admitted to the trauma Service under the care of Dr.
[**Last Name (STitle) **]. Neurosurgery was immediately consulted. An ICP bolt was
placed, he was loaded with Dilantin and remained on a stable
dose for 7 days.  He underwent serial head imaging which
revealed stable ICH. This injury was nonoperative.

Psychiatry was consulted because of behavioral issues; he
initially required Ativan for extreme agitation and required
sitters for safety. The Ativan appeared to have contributed to a
delirium and so this was stopped; he was placed on Haldol which
he did require for subsequent agitated episodes. Over the next
several days his behavior improved considerably, he was less
agitated and more cooperative with his care. The Haldol was
eventually stopped.

Behavioral Neurology was consulted because of his traumatic
brain injury and made several recommendations; Ambien was
initiated to help regulate his sleep/wake cycle.
He will need to follow up with Dr. [**Last Name (STitle) 8012**] in [**1-8**] weeks.

Physical and Occupational therapy were consulted and have
recommended home with outpatient Occupational therapy for
ongoing cognitive rehab.






Medications on Admission:
Seroquel

Discharge Medications:
1. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
2. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6
hours) as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
4. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) ML's
PO once a day as needed for constipation.
5. Phenytoin 50 mg Tablet, Chewable Sig: Three (3) Tablet,
Chewable PO TID (3 times a day) for 2 days.
Disp:*18 Tablet, Chewable(s)* Refills:*0*
6. Outpatient Occupational Therapy
DX: Traumatic Brain Injury - Subdural hematoma


Discharge Disposition:
Home

Discharge Diagnosis:
s/p Motor vehicle crash
Intraparenchymal hemorrhage (bifrontal)
Bilateral pneumothorax
Pneumomediastinum


Discharge Condition:
Stable


Discharge Instructions:
Return to the Emergency  room if you develop any fevers, chills,
severe headaches, dizziness, visual distubances, chest pai,
shortness of breath, nausea, vomiting, diarrhea and/or any other
symptoms that are concerning to you.

Followup Instructions:
Follow up as needed in the Trauma Clinic, call [**Telephone/Fax (1) 6429**] for
an appointment.

Follow up in [**1-8**] weeks with Dr. [**Last Name (STitle) 71066**], Behavioral Neurology,
call [**Telephone/Fax (1) 1690**] for an appointment.

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

Follow up in [**2-6**] weeks in Trauma Clinic, call [**Telephone/Fax (1) 6429**] for
an appointment.



Completed by:[**2179-12-24**]

Name:  [**Known lastname 3992**],[**Known firstname **]                   Unit No:   [**Numeric Identifier 11975**]

Admission Date:  [**2179-12-18**]              Discharge Date:   [**2179-12-24**]

Date of Birth:  [**2128-11-6**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 813**]
Addendum:
Pt. was offered substance-abuse counseling/tx and declined. He
is tied in with AA and says he will resume with that program.

Discharge Disposition:
Home

                             [**First Name11 (Name Pattern1) 801**] [**Last Name (NamePattern4) 815**] MD [**MD Number(2) 816**]

Completed by:[**2179-12-24**]
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Traumatic pneumothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Other and unspecified alcohol dependence, unspecified,Drug-induced delirium,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use'}


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: 51 yo male unrestrained driver s/p motor vehicle crash vs oil
tanker. He was taken to an area hospital and intubated. Head
imaging revealed intracranial hemorrhage; he was then
transferred to [**Hospital1 18**] for furthe care. Upon arrival he was
pulseless, once chest decompressed his pulse returned.

MEDICAL HISTORY: ?Psychiatric history

MEDICATION ON ADMISSION: Seroquel

ALLERGIES: Penicillins

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Traumatic pneumothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Other and unspecified alcohol dependence, unspecified,Drug-induced delirium,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use'}
