CHIEF COMPLAINT: Motor Vehicle Collision

PRESENT ILLNESS: 69 yM restrained driver in MVC with airbag depoloyment. The
damage to the vehicle is unknown. He was first seen at an
outside hospital where CT scan showed that he had a subdural
hemorrhage as well as a chest x-ray which showed multiple rib
fractures left 5, 6, 8, 9. The patient also had what appeared to
be an old t7 compression fracture.

MEDICAL HISTORY: HTN, CHF gout, cad, dm, crf, right leg bypass, CABG, penile
implant

MEDICATION ON ADMISSION: allopruinol 100mg'
amaryl/glimipeiridie 2mg'
ecotrin 325mg'
fisl oil 1200mg''
hectorol 0.5 mcg every other day
hydralazine 10 mg '''
imdor 30mg'
lasix 80mg''
plavix 75mg'
lopressor 25mg''
simvastatin 20 mg'
zolpidem 10'prn

ALLERGIES: Avandia

PHYSICAL EXAM: VS: 98.7   69   181/88   16   94 on 2L
AAOx3, NAD
EOMI, PERRL
no hemotypidum, no blood in mouth
soft, supple neck, no midline c-spine tenderness
LF CTA
RRR no GMR
soft, NT, ND, normal bowel sounds
normal TLS spine, no tenderness, step offs or deformities of
vertebrae, otherwise good rectal tone, no gross blood,
ecchymosis on L scapulae and flank
II-XII intact, moving all for extremities with symmetric
strength

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: No smoking, occasional alcohol, no IVDU
Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Pathologic fracture of vertebrae,Flail chest,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Street and highway accidents,Gout, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified
Subdural hemorr-coma NOS,Path fx vertebrae,Flail chest,Mv collision NOS-driver,Accid on street/highway,Gout NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS
Admission Date:  [**2106-11-18**]              Discharge Date:   [**2106-11-21**]

Date of Birth:  [**2037-10-2**]             Sex:   M

Service: SURGERY

Allergies:
Avandia

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
Motor Vehicle Collision

Major Surgical or Invasive Procedure:
none


History of Present Illness:
69 yM restrained driver in MVC with airbag depoloyment. The
damage to the vehicle is unknown. He was first seen at an
outside hospital where CT scan showed that he had a subdural
hemorrhage as well as a chest x-ray which showed multiple rib
fractures left 5, 6, 8, 9. The patient also had what appeared to
be an old t7 compression fracture.


Past Medical History:
HTN, CHF gout, cad, dm, crf, right leg bypass, CABG, penile
implant

Social History:
No smoking, occasional alcohol, no IVDU

Family History:
Non-contributory

Physical Exam:
VS: 98.7   69   181/88   16   94 on 2L
AAOx3, NAD
EOMI, PERRL
no hemotypidum, no blood in mouth
soft, supple neck, no midline c-spine tenderness
LF CTA
RRR no GMR
soft, NT, ND, normal bowel sounds
normal TLS spine, no tenderness, step offs or deformities of
vertebrae, otherwise good rectal tone, no gross blood,
ecchymosis on L scapulae and flank
II-XII intact, moving all for extremities with symmetric
strength

Pertinent Results:
[**2106-11-18**] 09:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2106-11-18**] 09:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-75
GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2106-11-18**] 09:30PM URINE  RBC-0-2 WBC-0-2 BACTERIA-RARE YEAST-NONE
EPI-0-2
[**2106-11-18**] 09:30PM URINE  HYALINE-[**4-16**]*
[**2106-11-18**] 09:10PM   COMMENTS-GREEN TOP
[**2106-11-18**] 09:00PM   UREA N-54* CREAT-1.6*
[**2106-11-18**] 09:10PM   GLUCOSE-187* LACTATE-2.0 NA+-143 K+-4.2
CL--101 TCO2-27
[**2106-11-18**] 09:00PM   estGFR-Using this
[**2106-11-18**] 09:00PM   LIPASE-56
[**2106-11-18**] 09:00PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2106-11-18**] 09:00PM   WBC-14.2* RBC-4.60 HGB-14.3 HCT-41.8 MCV-91
MCH-31.1 MCHC-34.3 RDW-14.5
[**2106-11-18**] 09:00PM   NEUTS-85.4* LYMPHS-10.5* MONOS-3.4 EOS-0.2
BASOS-0.5
[**2106-11-18**] 09:00PM   PT-12.1 PTT-25.8 INR(PT)-1.0
[**2106-11-18**] 09:00PM   PLT COUNT-182
[**2106-11-18**] 09:00PM   FIBRINOGE-402*

Brief Hospital Course:
The patient was admitted after being transferred. His hospital
course by systems is as follows.

Neuro- the patient had a small suddural hemorrhage which was
again seen on repeat head CT. Neurosurgery was consulted and
said that without shift or evidence of hernia this was a
non-operative situation. They recommended to give platelets for
reversing anticoagulation however this was not done as plavix
would render any blood product useless without first
plasmaphoresing the patient. Repeat CT imaging of the head did
not show any further progression of the suddural hemorrhage.
Clinically the patient had a normal neurologic exam and remained
unchanged during his hospital course.

Cards- the patient had his aspirin and plavix held as these were
through to potentially worsen the subdural hemorrhage. Upon
discharge the patient was instructed to hold these until follow
up in the acute care surgery clinic in [**2-13**] weeks. Otherwise the
patient did not have any chest pain throughout the admission.

Musculoskeletal- the patient's rib fracture did not present as
flail chest. Chest rise on inspiration was symmetric without any
discordant segments. The patient's pain was controlled at first
with IV pain medication which were then switched to PO pain
medication. He was given incentive spirometry and performed it
adequately at his bed side. He was discharged home with pain
meds and incentive spirometry. The T7 compression fracture was
felt by both the Truama surgery attending and the spine service
to be chronic in nature and thus not needing any acute
intervention.

GI- the patient was restarted on the diet and took it without
any issues.

Renal- no issues

GU- a foley was placed originally which was subsequently
discontinued neither with any complications or issues


Medications on Admission:
allopruinol 100mg'
amaryl/glimipeiridie 2mg'
ecotrin 325mg'
fisl oil 1200mg''
hectorol 0.5 mcg every other day
hydralazine 10 mg '''
imdor 30mg'
lasix 80mg''
plavix 75mg'
lopressor 25mg''
simvastatin 20 mg'
zolpidem 10'prn

Discharge Medications:
1. allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. omega-3 fatty acids     Capsule Sig: One (1) Capsule PO BID
(2 times a day).
3. doxercalciferol 2.5 mcg Capsule Sig: Two (2) Capsule PO
3X/WEEK ([**Doctor First Name **],TU,TH,SA).
4. isosorbide mononitrate 30 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
5. furosemide 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Lidoderm 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One
(1)  Topical once a day as needed for pain.
Disp:*12 patches* Refills:*0*
9. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
Disp:*25 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
S/P MVC
1. left rib fractures 5 thru 9
2. Right subdural hematoma


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
* You were admitted to the hospital after your motor vehicle
accident with rib fractures and a small area of bleeding in the
brain.

* Your second head CT shows the area of bleeding is even smaller
than on admission and you have not had any neurologic changes.

*  Your injury caused left rib fractures 5 thru 9 which can
cause severe pain and subsequently cause you to take shallow
breaths because of the pain.

*  You should take your pain medication as directed to stay
ahead of the pain otherwise you won't be able to take deep
breaths. If the pain medication is too sedating take half the
dose and notify your physician.

*  Pneumonia is a complication of rib fractures.  In order to
decrease your risk you must use your incentive spirometer 4
times every hour while awake.  This will help expand the small
airways in your lungs and assist in coughing up secretions that
pool in the lungs.

*  You will be more comfortable if you use a cough pillow to
hold against your chest and guard your rib cage while coughing
and deep breathing.

*  Symptomatic relief with ice packs or heating pads for short
periods may ease the pain.

*  Narcotic pain medication can cause constipation therefore you
should take a stool softener twice daily and increase your fluid
and fiber intake if possible.

*  Do NOT smoke

*  If your doctor allows, non steroidal antiinflammatory drugs
are very effective in controlling pain ( ie, Ibuprofen, Motrin,
Advil, Aleve, Naprosyn) but they have their own set of side
effects so make sure your doctor approves.

*  Return to the Emergency Room right away for any acute
shortness of breath, increased pain or crackling sensation
around your ribs ( crepitus ).

Followup Instructions:
Call the [**Hospital 2536**] Clinic at [**Telephone/Fax (1) 600**] for a follow up appointment
in [**3-17**] weeks.
{'Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Pathologic fracture of vertebrae,Flail chest,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Street and highway accidents,Gout, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified'}


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: Motor Vehicle Collision

PRESENT ILLNESS: 69 yM restrained driver in MVC with airbag depoloyment. The
damage to the vehicle is unknown. He was first seen at an
outside hospital where CT scan showed that he had a subdural
hemorrhage as well as a chest x-ray which showed multiple rib
fractures left 5, 6, 8, 9. The patient also had what appeared to
be an old t7 compression fracture.

MEDICAL HISTORY: HTN, CHF gout, cad, dm, crf, right leg bypass, CABG, penile
implant

MEDICATION ON ADMISSION: allopruinol 100mg'
amaryl/glimipeiridie 2mg'
ecotrin 325mg'
fisl oil 1200mg''
hectorol 0.5 mcg every other day
hydralazine 10 mg '''
imdor 30mg'
lasix 80mg''
plavix 75mg'
lopressor 25mg''
simvastatin 20 mg'
zolpidem 10'prn

ALLERGIES: Avandia

PHYSICAL EXAM: VS: 98.7   69   181/88   16   94 on 2L
AAOx3, NAD
EOMI, PERRL
no hemotypidum, no blood in mouth
soft, supple neck, no midline c-spine tenderness
LF CTA
RRR no GMR
soft, NT, ND, normal bowel sounds
normal TLS spine, no tenderness, step offs or deformities of
vertebrae, otherwise good rectal tone, no gross blood,
ecchymosis on L scapulae and flank
II-XII intact, moving all for extremities with symmetric
strength

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: No smoking, occasional alcohol, no IVDU 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Pathologic fracture of vertebrae,Flail chest,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Street and highway accidents,Gout, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified'}
