CHIEF COMPLAINT: s/p Pedestrian struck by auto

PRESENT ILLNESS: 64 year old male pedestrian who was crushed under his car at low
speed. No reported LOC. He was transported from the scene
directly to the [**Hospital1 18**] emergency room.

MEDICAL HISTORY: 1. Coronary artery disease
2. CABGx4 15 years ago
3. History of myocardial infarction
4. Gout
5. Hypercholesterolemia
6. s/p melanoma resection

MEDICATION ON ADMISSION: [**Last Name (LF) **], [**First Name3 (LF) **], toprol, statin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On discharge:
Gen: NAD, resting comfortably
HEENT: PERRL, IOMs intact
Chest: CTAB
CV: RRR, S1,S2, no murmurs
Abd: S/ND/NT, +BS, no masses
Extremities: WWP, no edema, 2+ pulses, incisions CDI, ROM
limited by pain in lower extremities, non-weight bearing.  RUE
with splint in place.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married, lives with supportive wife, and has a daughter-in-law
who is an internist at [**Hospital6 **]. Non-smoker.
Occasional EtOH.  No drug use.
Multiple closed pelvic fractures with disruption of pelvic circle,Injury to other specified blood vessels of abdomen and pelvis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Traumatic shock,Paralytic ileus,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Acute posthemorrhagic anemia,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Other pulmonary insufficiency, not elsewhere classified,Closed fracture of unspecified part of ulna (alone),Contusion of unspecified site,Pure hypercholesterolemia,Gout, unspecified,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Old myocardial infarction
Pelv fx-clos/pelv disrup,Inj abdominal vessel NEC,Fx lumbar vertebra-close,Traumatic shock,Paralytic ileus,Mv coll w pedest-pedest,Ac posthemorrhag anemia,SIRS-noninf w/o ac or ds,Other pulmonary insuff,Fracture ulna NOS-closed,Contusion NOS,Pure hypercholesterolem,Gout NOS,Crnry athrscl natve vssl,Aortocoronary bypass,Old myocardial infarct
Admission Date:  [**2163-9-17**]              Discharge Date:   [**2163-9-28**]

Date of Birth:  [**2099-6-21**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
s/p Pedestrian struck by auto

Major Surgical or Invasive Procedure:
1. Pelvic angiography and embolization of distal branch
pseudoaneurysm site of active bleeding from left internal
pudendal (coils and gelfoam).
2. Open reduction and internal fixation, right sacroiliac joint.
3. Open reduction and internal fixation, left sacroiliac joint.
4. Open reduction and internal fixation, anterior column
fracture, with retrograde columnar screw.
5. Placement of Right femoral [**Location (un) 260**] filter (Bard G2 type).


History of Present Illness:
64 year old male pedestrian who was crushed under his car at low
speed. No reported LOC. He was transported from the scene
directly to the [**Hospital1 18**] emergency room.

Past Medical History:
1. Coronary artery disease
2. CABGx4 15 years ago
3. History of myocardial infarction
4. Gout
5. Hypercholesterolemia
6. s/p melanoma resection


Social History:
Married, lives with supportive wife, and has a daughter-in-law
who is an internist at [**Hospital6 **]. Non-smoker.
Occasional EtOH.  No drug use.

Family History:
Non-contributory

Physical Exam:
On discharge:
Gen: NAD, resting comfortably
HEENT: PERRL, IOMs intact
Chest: CTAB
CV: RRR, S1,S2, no murmurs
Abd: S/ND/NT, +BS, no masses
Extremities: WWP, no edema, 2+ pulses, incisions CDI, ROM
limited by pain in lower extremities, non-weight bearing.  RUE
with splint in place.


Pertinent Results:
CT chest/abdomen/pelvis ([**2163-9-18**]): IMPRESSION:
1. Extensively comminuted displaced fractures of the left
superior and
inferior pubic rami. The fracture of the superior pubic ramus
extends into the the acetabulum and is associated with small
active extravasation and contrast pooling at this site, most
likely related to injury of the external pudendal artery.
2. Innumerable fractures of both sacral alae, extending into the
sacroiliac joints, with marked diastasis and off-set on the left
("open book" fracture of the left hemipelvis), with associated
moderate hematoma anterior to the right sacral ala, likely
related to venous hemorrhage.
3. Hematoma in the right psoas muscle, which may relate to
lumbar transverse process fractures.
4. Small amount of free fluid is noted within the pelvis,
consistent with
hematoma. Small amount of fluid is also noted within the
posterior pararenal spaces bilaterally. However, there is no
evidence of visceral injury in the abdomen or pelvis.
5. Fractures L5 bilateral and L4 right transverse processes.
6. Small bilateral pleural effusion.
7. Small axial hiatal hernia.
.
AP pelvis ([**9-18**]):
PELVIS: Single AP view of the pelvis demonstrates markedly
displaced and
extensively comminuted fractures of the left superior and
inferior pubic rami, with apparent involvement of the ischium
but no definite acetabular
involvement in this limited view. There is a so-called "open
book" fracture of the left hemipelvis with marked diastasis of
the left sacroiliac joint with significant, roughly 15-mm
superior offset of the left iliac [**Doctor First Name 362**]. There is poor
visualization of the known multiple bilateral sacral alar
fractures. The right hemipelvis appears, otherwise, intact.
.
CT abdomen/pelvis ([**9-18**]):
IMPRESSION:
1. Slight interval increase in size of intra-abdominal and
pelvic hematomas. It is unclear if this increase represents
hemorrhage formed from the time of the prior CT until the
embolization versus more acute hemorrhage. If the hematocrit
continues to drop, a repeat CT angiogram could be performed
using the current study has a new baseline post-embolization.
2. Open-book fracture of the left hemipelvis with sacral alar
and left
inferior and superior pubic rami fractures. Alignment appears
relatively
unchanged from the prior study.
3. Fractures of L5 lateral and L4 right transverse processes.
.

[**2163-9-28**] 07:50AM BLOOD WBC-14.8* RBC-3.38* Hgb-10.6* Hct-31.3*
MCV-92 MCH-31.2 MCHC-33.8 RDW-15.0 Plt Ct-405
[**2163-9-28**] 07:50AM BLOOD Plt Ct-405
[**2163-9-28**] 07:50AM BLOOD Glucose-99 UreaN-26* Creat-0.7 Na-141
K-3.9 Cl-106 HCO3-28 AnGap-11
[**2163-9-28**] 07:50AM BLOOD Calcium-8.5 Phos-3.6 Mg-2.3

Brief Hospital Course:
Pt is a 64 year old male pedestrian who was crushed under his
car at low speed. No reported LOC. He was transported from the
scene directly to the [**Hospital1 18**] emergency room.  He was admitted to
the Trauma Service.
Due to the mechanism of his injury and the fact that he began to
have a decreasing blood pressure an emergent
chest/abdomen/pelvis CT was performed which showed small active
extravasation and contrast pooling at this site, most likely
related to injury of the external pudendal artery. He was taken
emergently to angiography where he underwent embolization of
distal branch pseudoaneurysm site of active bleeding from left
internal pudendal (coils and gelfoam).  He tolerated this well.
He had a total of 4 units of PRBCs in before transfer to the ICU
in hemodynamically stable condition.

His ICU course was without significant events. On hospital day
number four ([**9-20**]) he underwent open reduction, internal fixation
of his pelvic fractures.  This was complicated post-operatively
by a SIRS response in his lungs with desaturation to 85% SpO2,
and RR in the 30s, fever=102, pulmonary edema on CXR. He was
reintubated. This was followed by supportive care and his
respiratory status improved to baseline.
.
On hospital day 7, ([**2163-9-23**]) the patient underwent percutaneous
placement of an IVC filter to reduce his risk of pulmonary
embolis.  he tolerated this procedure well.
.
Neurosurgery was consulted because of fractures of both
transverse processes of L5 and L4.  The neurosurgical service
felt that no neurosurgical intervention was required, based on
the physical examination and the images provided. It was
recommended to have him fitted for a lumbar brace, provide
adequate pain control and follow-up in [**5-20**] weeks with new X-rays
in the [**Hospital 4695**] clinic.  He was instructed to wear his TLSO
brace when he was >30 degrees upright. My feeling is that the of
L4 and L5 transverse processes fractures are part of the pelvic
fracture construct, and their treatment is that of the pelvic
fracture.
.
Of note, the patient had his troponin enzymes cycledx3 and were
negative.  It was not felt that he had any acute coronary event.
.
His pulmonary symptoms had resolved and he was discharged with
SpO2>95% without respiratory symptoms. The patient was felt to
be at very high VTE risk because he would likely be bed bound
for >6 months. A removable IVC (Bard G2) filter was placed.
.
On the days preceeding discharge, he was unable to urinate
without a foley catheter and was discharged with a foley in
place.
.
The patient suffered a brief post-operative ileus.  An NG tube
was placed briefly.  On the day of discharge he was tolerated a
regular diet and passing stool.  Of note, the patient reported
frequent bowel movements on hospital days 9 and 10.  His c-diff
studies were negative but the clinical suspicion was high and
thus he was started on a one-week course of oral flagyl.
.
The patient was discharged on hospital day 12 in stable
condition.  On the day of discharge his HCT was 31.3 which was
stable.  He was provided with plans for follow-up with
orthopaedic surgery and spine surgery.

Medications on Admission:
[**Last Name (LF) **], [**First Name3 (LF) **], toprol, statin


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for fever/pain.
2. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime.
3. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
4. Enoxaparin 30 mg/0.3 mL Syringe Sig: 0.3 ML's Subcutaneous
Q12H (every 12 hours).
5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
6. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
7. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
8. Morphine 15 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
10. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
11. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed for possible c-diff for 5 days.
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
13. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed for indigestion.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**]

Discharge Diagnosis:
s/p Pedestrian struck by auto
1.Pelvic fracture - comminuted displaced fractures of the left
superior and inferior pubic rami; innumerable fractures of both
sacral alae, extending into the sacroiliac joints, with marked
diastasis and off-set on the left ("open book" fracture of the
left hemipelvis).
3. Traumatic injury of the external pudendal artery.
4. Hematoma in the right psoas muscle
5. Fractures L5 bilateral
6. Fracture of L4 right transverse processes
7. Small bilateral pleural effusion
8. Small axial hiatal hernia


Discharge Condition:
Good


Discharge Instructions:
DO NOT  bear any weight on either lower extremity for the next
6-8 weeks.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 1005**] in Orthopaedic surgery.
Please call to make an appointment [**Telephone/Fax (1) 1228**].
Please follow-up with Dr. [**Last Name (STitle) **] in Trauma surgery.  Please call
to make an appointment: [**Telephone/Fax (1) 6429**]
Please follow-up with Dr. [**Last Name (STitle) **], in [**Hospital 4695**] Clinic.
Please call to make an appointment: [**Telephone/Fax (1) 1669**]
{'Multiple closed pelvic fractures with disruption of pelvic circle,Injury to other specified blood vessels of abdomen and pelvis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Traumatic shock,Paralytic ileus,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Acute posthemorrhagic anemia,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Other pulmonary insufficiency, not elsewhere classified,Closed fracture of unspecified part of ulna (alone),Contusion of unspecified site,Pure hypercholesterolemia,Gout, unspecified,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Old myocardial infarction'}


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 Pedestrian struck by auto

PRESENT ILLNESS: 64 year old male pedestrian who was crushed under his car at low
speed. No reported LOC. He was transported from the scene
directly to the [**Hospital1 18**] emergency room.

MEDICAL HISTORY: 1. Coronary artery disease
2. CABGx4 15 years ago
3. History of myocardial infarction
4. Gout
5. Hypercholesterolemia
6. s/p melanoma resection

MEDICATION ON ADMISSION: [**Last Name (LF) **], [**First Name3 (LF) **], toprol, statin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On discharge:
Gen: NAD, resting comfortably
HEENT: PERRL, IOMs intact
Chest: CTAB
CV: RRR, S1,S2, no murmurs
Abd: S/ND/NT, +BS, no masses
Extremities: WWP, no edema, 2+ pulses, incisions CDI, ROM
limited by pain in lower extremities, non-weight bearing.  RUE
with splint in place.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married, lives with supportive wife, and has a daughter-in-law
who is an internist at [**Hospital6 **]. Non-smoker.
Occasional EtOH.  No drug use. 

### Response:
{'Multiple closed pelvic fractures with disruption of pelvic circle,Injury to other specified blood vessels of abdomen and pelvis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Traumatic shock,Paralytic ileus,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Acute posthemorrhagic anemia,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Other pulmonary insufficiency, not elsewhere classified,Closed fracture of unspecified part of ulna (alone),Contusion of unspecified site,Pure hypercholesterolemia,Gout, unspecified,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Old myocardial infarction'}
