CHIEF COMPLAINT: traumatic accident - bicycle vs auto

PRESENT ILLNESS: 46yo M bicyclist s/p bike vs auto, hit at 30-35mph & thrown
30-40ft into air, landed on head. No helmet. LOC x5min.
+confusion

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: afebrile hemodynamically

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: married, occasional alcohol, unknown tobacco. employed
Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Closed fracture of eight or more ribs,Open wound of scalp, without mention of complication,Other specified disorders of liver,Esophageal reflux,Arthrodesis status,Motor vehicle traffic accident involving collision with other vehicle injuring pedal cyclist
Brain hem NEC-brief coma,Traum pneumohemothor-cl,Traum subcutan emphysema,Fx eight/more rib-closed,Open wound of scalp,Liver disorders NEC,Esophageal reflux,Arthrodesis status,Mv-oth veh coll-ped cycl
Admission Date:  [**2170-6-17**]              Discharge Date:   [**2170-6-21**]

Date of Birth:  [**2124-1-4**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
traumatic accident - bicycle vs auto

Major Surgical or Invasive Procedure:
none


History of Present Illness:
46yo M bicyclist s/p bike vs auto, hit at 30-35mph & thrown
30-40ft into air, landed on head. No helmet. LOC x5min.
+confusion

Past Medical History:
none

Social History:
married, occasional alcohol, unknown tobacco. employed

Family History:
non-contributory

Physical Exam:
afebrile hemodynamically

3mm R parietal hemorrhage
2cm lac R parietal (stapled)
subgaleal hematoma
R rib fx mildly displaced [**3-20**] except 6
subcutaneous emphysema on R
small R PTX
hypodensity in dome of liver

CTAB but painful  breathing
RRR no mrg
S NT ND no HSM
MAE [**6-11**] B LE and UE
A+O x 3

Pertinent Results:
[**2170-6-18**] 01:52AM BLOOD WBC-12.2* RBC-4.70 Hgb-15.4 Hct-42.5
MCV-90 MCH-32.6* MCHC-36.1* RDW-12.7 Plt Ct-341
[**2170-6-17**] 11:15AM BLOOD WBC-14.0* RBC-4.75 Hgb-15.9 Hct-42.5
MCV-90 MCH-33.5* MCHC-37.4* RDW-12.5 Plt Ct-418
[**2170-6-18**] 01:52AM BLOOD Plt Ct-341
[**2170-6-18**] 01:52AM BLOOD PT-12.8 PTT-25.3 INR(PT)-1.1
[**2170-6-17**] 11:15AM BLOOD PT-11.7 PTT-22.9 INR(PT)-1.0
[**2170-6-17**] 11:15AM BLOOD Plt Ct-418
[**2170-6-17**] 11:15AM BLOOD Fibrino-208
[**2170-6-18**] 01:52AM BLOOD Glucose-166* UreaN-16 Creat-1.2 Na-140
K-4.6 Cl-103 HCO3-26 AnGap-16
[**2170-6-17**] 11:15AM BLOOD UreaN-17 Creat-1.1
[**2170-6-17**] 11:15AM BLOOD Amylase-60
[**2170-6-18**] 01:52AM BLOOD Calcium-9.4 Phos-3.9 Mg-2.1
[**2170-6-17**] 11:15AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2170-6-17**] 11:15AM BLOOD GreenHd-HOLD
[**2170-6-17**] 11:29AM BLOOD pH-7.41 Comment-GREEN TOP
[**2170-6-17**] 11:29AM BLOOD Glucose-147* Lactate-3.5* Na-139 K-3.9
Cl-104 calHCO3-20*
[**2170-6-17**] 11:29AM BLOOD freeCa-1.02*

Brief Hospital Course:
46yo M bicyclist s/p bike vs auto, hit at 30-35mph & thrown
30-40ft into air, landed on head. No helmet. LOC x5min.
+confusion

Injuries incurred:
3mm R parietal hemorrhage
2cm lac R parietal (stapled)
subgaleal hematoma
R rib fx mildly displaced [**3-20**] except 6
subcutaneous emphysema on R
small R PTX
hypodensity in dome of liver
maging:
[**6-17**] CT Head: 3mm R parietal IPH
[**6-17**] CT Torso: Multiple R sided rib fractures, R ptx
[**6-17**] CXR: R sided ptx w/subcutaneous ai

Chest tube placed, pain service consulted for epidural and pain
management.
Was admitted to TSICU for 24 hours for neuro monitoring and
exams.
Patient transferred to floor without difficulty, chest tube able
to be d/c'ed with decreasing output.  Epidural discontinued with
good oral pain regimen transition.
Left tib-fib fracture found during hospital course, and
ORTHOPAEDICS was consulted.
Air walking boot/cast was placed, and the patient was stable for
discharge by Physical therapy with appropriate trauma and
orthopaedic follow-up appointments.

Medications on Admission:
none

Discharge Medications:
1. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3-4H () as needed
for pain.
Disp:*20 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
multiple traumatic injuries:
3mm R parietal hemorrhage
2cm lac R parietal (stapled)
subgaleal hematoma
R rib fx mildly displaced [**3-20**] except 6
subcutaneous emphysema on R
small R PTX
hypodensity in dome of liver


Discharge Condition:
stable, weight bearing as tolerated to bilateral lower
extremities, tolerating usual diet, ambulating independently
without difficulty


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting, diarrhea
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or becoming
progressively worse, or inadequately controlled with the
prescribed pain medication.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.

Incision Care:
*You may shower. Pat incision dry.
*Avoid swimming and baths until further instruction at your
followup appointment.
*Leave the steri-strips on. They will fall off on their own, or
be removed during your followup.
*Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
You are to call Dr.[**Name (NI) 12389**] office ASAP for a follow-up
appointment in the trauma clinic.
You are to call Dr.[**Name (NI) 4016**] office ASAP for a follow-up
appointment IN ONE WEEK in the Orthopaedic surgery clinic
You are to call your primary care physician [**Name9 (PRE) 2678**] for [**Name Initial (PRE) **]
post-hospitalization follow-up appointment.
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Closed fracture of eight or more ribs,Open wound of scalp, without mention of complication,Other specified disorders of liver,Esophageal reflux,Arthrodesis status,Motor vehicle traffic accident involving collision with other vehicle injuring pedal cyclist'}


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: traumatic accident - bicycle vs auto

PRESENT ILLNESS: 46yo M bicyclist s/p bike vs auto, hit at 30-35mph & thrown
30-40ft into air, landed on head. No helmet. LOC x5min.
+confusion

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: afebrile hemodynamically

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: married, occasional alcohol, unknown tobacco. employed 

### Response:
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Traumatic pneumohemothorax without mention of open wound into thorax,Traumatic subcutaneous emphysema,Closed fracture of eight or more ribs,Open wound of scalp, without mention of complication,Other specified disorders of liver,Esophageal reflux,Arthrodesis status,Motor vehicle traffic accident involving collision with other vehicle injuring pedal cyclist'}
