CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 50-year-old male
pedestrian, struck by a car going approximately 35 miles an
hour, with loss of consciousness, obvious deformity of the
right lower extremity which was splinted.  On transport, his
systolic blood pressure was reported to be in the 80s.  On
presentation, he was awake and following commands, GCS of 12.
The patient was intubated in the field.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: History of alcohol abuse.  The patient is
homeless.
Injury to spleen without mention of open wound into cavity, unspecified injury,Closed fracture of pubis,Injury to liver without mention of open wound into cavity laceration, unspecified,Cirrhosis of liver without mention of alcohol,Alcohol abuse, unspecified,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Closed fracture of metacarpal bone(s), site unspecified,Closed fracture of upper end of tibia alone,Lack of housing
Spleen injury NOS-closed,Fracture of pubis-closed,Liver lacerat unspcf cls,Cirrhosis of liver NOS,Alcohol abuse-unspec,Mv coll w pedest-pedest,Fx metacarpal NOS-closed,Fx upper end tibia-close,Lack of housing
Admission Date:  [**2161-9-29**]     Discharge Date:  [**2161-10-12**]

Date of Birth:   [**2111-9-22**]     Sex:  M

Service:  TRAUMA

HISTORY OF PRESENT ILLNESS: This is a 50-year-old male
pedestrian, struck by a car going approximately 35 miles an
hour, with loss of consciousness, obvious deformity of the
right lower extremity which was splinted.  On transport, his
systolic blood pressure was reported to be in the 80s.  On
presentation, he was awake and following commands, GCS of 12.
The patient was intubated in the field.

PAST MEDICAL HISTORY: None.

MEDICATIONS:  None.

ALLERGIES:  None.

SOCIAL HISTORY:  History of alcohol abuse.  The patient is
homeless.

EXAMINATION:  VITALS:  98.1??????, 130, 80/palp, which increased
to 160/130 and then returned to 80/palp, satting 100%,
intubated.  HEENT:  Pupils were equal, round, reactive to
light bilaterally.  TMs were clear bilaterally.  HEART:
Regular.  LUNGS:  Clear.  ABDOMEN:  Soft, nontender,
nondistended, but 15 minutes later became distended.  Rectal
tone was normal with guaiac negative.  Pelvis was stable.
EXTREMITIES:  In the right lower extremity there is an
obvious tib-fib fracture with 2+ dorsalis pedis and posterior
tibial pulses, otherwise no deformities.  BACK:  There were
abrasions over the lumbar spine but no step-off.

LABS ON ADMISSION:  White count 5.1, hematocrit 42.8,
platelets 76, PT 12.1, PTT 29.3, INR 1, fibrinogen 262,
sodium 141, potassium 3.8, chloride 114, bicarb 22, BUN 7,
creatinine 0.9, glucose 199, lactate was 6.  UA showed 750
red blood cells.  Tox screen:  alcohol 192, positive for
opiates and benzo.  ABGs:  7.44, 36.2, 25.  Chest x-ray was
negative.  Pelvic exam shows a right inferior and superior
pubic rami fracture.  Patient's back exam was negative.

The patient had a left subclavian Cordis placed in the trauma
bay.  The patient's pelvis was wrapped tightly and the
patient had a grossly positive CPL.  The patient went to the
O.R. for exploratory laparotomy.

HOSPITAL COURSE: The patient went to the O.R. for exploratory
laparotomy, was found to have a ruptured spleen with
splenectomy performed.  Then the patient was admitted to the
Trauma ICU.  Post-op, the patient had a head CT which showed
a left maxillary sinus fracture with no intracranial
hemorrhage.  A CT of the C-spine showed no fracture.  A CT of
the abdomen showed right inferior-superior pubic rami
fracture, normal kidneys.  A CT cystogram showed no
extravasation of the contrast.

In Trauma ICU, ortho was consulted for the right tib-fib
fracture and also for increased compartment pressure in the
right lower extremity. Decision was made to take the patient
to the operating room on [**2161-9-30**] in the morning for
fasciotomy and external fixation of the right tib-fib
fracture.  On the following day, the patient returned to the
O.R. for ORIF of the right lower extremity.  The patient
remained in the Trauma ICU for three days and was weaned off
of pressors and drips.

Oral maxillofacial surgery was consulted for the left
maxillary sinus fracture seen on facial CT, and the decision
was made that the findings were consistent with an old
fracture with no intervention needed at this time.

Urology was consulted for hematuria with a hematoma at the
base of the penis.  There was no extravasation of contrast on
cystogram.  The patient was to go for a retrograde
urethrogram, however patient was not cooperative.  The
patient self DC'd his Foley and was urinating without
difficulty.

Plastic Surgery was consulted for closure of a defect on the
right tibia.  A vac was placed and a split thickness skin
graft was performed to the right lower extremity on
[**2161-10-7**].  The patient was also found to have a fracture of
the left second metacarpal, which was also repaired by
Plastic Surgery on [**2161-10-7**].

For nutrition, the patient was started on TPN in ICU and
changed to tube feeds, then tolerating p.o. with adequate
calorie counts.

The patient was given prophylactic immunizations while in
hospital:  Pneumovax, HIB, meningococcal vaccination.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  The patient is DC'd to rehab.

DISCHARGE DIAGNOSES:
1.  Pedestrian struck by motor vehicle with a splenectomy,
right tib-fib fractures with external fixation, with
fasciotomy; then open reduction, internal fixation followed
by split thickness skin graft on the right lower extremity.
2.  Right inferior-superior pubic rami fracture.
3.  Left maxillary fracture, which is old.

DISCHARGE MEDICATIONS:
1.  Levaquin 500 mg p.o. q.d. to be given his last dose on
[**2161-10-13**].
2.  Pantoprazole 40 mg p.o. q.d.
3.  Nicotine patch 7 mg transdermal q.d.
4.  Heparin 5000 units subcu twice a day.
5.  Haldol 5 mg I.V. q.4h. p.r.n.
6.  Colace 100 mg p.o. b.i.d. p.r.n.
7.  Percocet 2 tablets p.o. q.4h. p.r.n.

The patient will also need a repeat HIB, Pneumovax and
meningococcal vaccination to be given in 6 to 12 weeks.

The patient is nonweightbearing until seen by Plastic
Surgery.  He is to keep his left upper extremity elevated.
Once weightbearing status is cleared by Plastic Surgery, the
goal is for 50% partial weightbearing on the right lower
extremity.  The patient is to followup with Trauma Clinic
[**Telephone/Fax (1) 274**] in one to two weeks, with Plastic Clinic
[**Telephone/Fax (1) 274**] on [**2161-10-16**], the patient is to call for an
appointment.  The patient is to follow up with Dr. [**First Name (STitle) 1022**] of
Ortho [**Telephone/Fax (1) 4301**] in three weeks.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 18153**], M.D.  [**MD Number(1) 18154**]

Dictated By:[**Last Name (NamePattern1) 13577**]

MEDQUIST36

D:  [**2161-10-11**]  11:32
T:  [**2161-10-11**]  11:41
JOB#:  [**Job Number 27693**]


Name:  [**Known lastname 4411**], [**Known firstname 651**]                      Unit No:  [**Numeric Identifier 8335**]

Admission Date:  [**2161-9-29**]     Discharge Date:  [**2161-10-14**]

Date of Birth:   [**2111-9-22**]     Sex:  M

Service:

ADDENDUM:  On [**10-14**] the patient wanted to sign out
against medical advice.  Despite counseling the patient to
the fact that he should remain in the hospital the patient
refused and signed the form.  The patient also refused his
follow up urologic retrograde urethrogram, although follow up
appointments were called and made appropriately for the
patient.






                          [**First Name11 (Name Pattern1) 184**] [**Last Name (NamePattern4) 2931**], M.D.  [**MD Number(1) 2932**]

Dictated By:[**Name8 (MD) 1561**]

MEDQUIST36

D:  [**2161-10-14**]  09:50
T:  [**2161-10-21**]  10:25
JOB#:  [**Job Number 8336**]
{'Injury to spleen without mention of open wound into cavity, unspecified injury,Closed fracture of pubis,Injury to liver without mention of open wound into cavity laceration, unspecified,Cirrhosis of liver without mention of alcohol,Alcohol abuse, unspecified,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Closed fracture of metacarpal bone(s), site unspecified,Closed fracture of upper end of tibia alone,Lack of housing'}


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: This is a 50-year-old male
pedestrian, struck by a car going approximately 35 miles an
hour, with loss of consciousness, obvious deformity of the
right lower extremity which was splinted.  On transport, his
systolic blood pressure was reported to be in the 80s.  On
presentation, he was awake and following commands, GCS of 12.
The patient was intubated in the field.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: History of alcohol abuse.  The patient is
homeless. 

### Response:
{'Injury to spleen without mention of open wound into cavity, unspecified injury,Closed fracture of pubis,Injury to liver without mention of open wound into cavity laceration, unspecified,Cirrhosis of liver without mention of alcohol,Alcohol abuse, unspecified,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Closed fracture of metacarpal bone(s), site unspecified,Closed fracture of upper end of tibia alone,Lack of housing'}
