CHIEF COMPLAINT: 

PRESENT ILLNESS: This patient was admitted on
[**2148-5-22**] after having been in a roll-over car accident with
loss of consciousness.  She was the restrained driver in this
accident.  There was no air bag deployment.  She was alert
and oriented on transfer, but had systolic blood pressure in
the 70s to 80s and she was complaining of both left chest and
neck pain.

MEDICAL HISTORY: None.  No known medications.  No
surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for being a nurse manager in [**Location (un) 7498**].
Bimalleolar fracture, closed,Closed fracture of multiple ribs, unspecified,Injury to tibial vessel(s), unspecified,Other injury into spleen without mention of open wound into cavity,Dislocation of knee, unspecified, open,Alcohol abuse, unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle
Fx bimalleolar-closed,Fx mult ribs NOS-closed,Injury tibial vessel NOS,Spleen injury NEC-closed,Dislocat knee NOS-open,Alcohol abuse-unspec,Mv collision NOS-driver
Admission Date:  [**2148-5-22**]       Discharge Date:

Date of Birth:   [**2098-9-16**]       Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  This patient was admitted on
[**2148-5-22**] after having been in a roll-over car accident with
loss of consciousness.  She was the restrained driver in this
accident.  There was no air bag deployment.  She was alert
and oriented on transfer, but had systolic blood pressure in
the 70s to 80s and she was complaining of both left chest and
neck pain.

PAST MEDICAL HISTORY:  None.  No known medications.  No
surgery.

SOCIAL HISTORY:  Significant for being a nurse manager in [**Location (un) 7498**].

PHYSICAL EXAMINATION:  The patient was triaged in the trauma
bay and was intubated for change in mental status in the
emergency room.  She was boarded and collared and talking
initially on arrival though.  Temperature was 97.  Vitals
were significant for heart rate of 120 and blood pressure of
80/60 which improved to 120/60 with IV fluids.  Sat was 100%.
Pupils were equal and reactive.  She did have an abrasion in
the left neck.  She also had C-spine tenderness.  Heart was
regular rate and rhythm, but tachycardic.  She did have some
left shoulder instability.  She was noted to have slightly
decreased breath sounds on the left.  Abdomen was soft and
was tender in the left upper abdomen especially in the lower
rib area.  There were no masses felt.  Pelvis was stable.
She was guaiac negative from below.  Extremity exam was
significant for an open left popliteal fossa.  There was an
avulsion there of muscle and there were no pulses in the left
foot along with a cool foot.  She did seem to have some
arterial bleeding which was tamponaded with gauze and a tight
dressing.  Motor-wise she seemed to be intact.  The right
lower extremity had a medial laceration in the right tibial
area with exposed bone.  The right lower extremity did have
dopplerable pulses.  Back was stable with no stepoff.

LABORATORY DATA:  She did receive an ultrasound in the trauma
bay with no fluid noted.  She had a chest x-ray that showed
no pneumothorax status post chest tube which was placed for
decreased breath sounds.  Labs were significant for
hematocrit of 30.  Coags were INR of 1.2, PTT 25.  Chem-7 was
normal save for K of 3.6.  Amylase was 37.  She received
initial screening films including trauma series.  Head CT
showed no lesion and no bleed.  Neck CT showed a C-1 body
fracture.  Chest CT showed multiple bilateral rib fractures.
Abdomen and pelvis CT showed a small splenic laceration,
maybe grade 1.

HOSPITAL COURSE:  The patient was a 48 year old woman who had
basically been evaluated except for the significant left
lower extremity injuries.  Vascular surgery was then called
for an extensive evaluation given that the patient did not
have any other life threatening injuries.  She was evaluated
and then taken to the operating room by both vascular surgery
and orthopaedic surgery in tandem for left saphenous vein to
posterior tibial bypass graft with reversed right saphenous
vein done by Dr. [**Last Name (STitle) 18835**] of the vascular surgery service.  The
patient also had ligation of the inherent popliteal artery
and vein which were disrupted and posterior compartment
fasciotomy.  Estimated blood loss was approximately 600 cc.
The findings were significant for the aforementioned
transected/macerated artery and vein with an intact tibial
nerve.  The patient then went on to be evaluated by
orthopaedics who performed stabilization of left bimalleolar
ankle fracture, irrigation and drainage of the left open knee
joint and anterior and lateral fasciotomies of the lower
extremity.  They also applied a V.A.C. dressing to help clean
the wound.  The patient was returned to the ICU for close
monitoring.

The patient was then consulted by plastic surgery for
assistance with the significant lower extremity wound.
Neither general surgery or orthopaedic surgery really felt
comfortable with primary closure and plastic surgery
proceeded to perform a flap for coverage of the wound with
split thickness skin graft for external coverage.  There were
multiple services playing a role in this patient's care
including orthopaedics, plastic surgery, vascular surgery
along with trauma service.  She was monitored closely.
Orthopaedic spine surgery service also evaluated her for the
C-1 fracture and prescribed that she have a hard collar that
should be worn for three or four months and Dr. [**Last Name (STitle) 363**] would
follow up with her for this.

She did well in the ICU and when it was safe for transfer,
she was transferred to the floor.  Once she was on the floor,
her issues became pulmonary toilet and deep breathing with
pain management given the patient's multiple rib fractures.
For this pain service was consulted who recommended a series
of medications which began to be beneficial to the patient.
She was working with physical therapy on pivoting, etc.,
given her wounds and mobility challenges from the accident.
When it was deemed that the patient had recovered
sufficiently from these injuries and her pain was under good
p.o. management, she was discharged to an acute rehab
facility.

Followup included followup with plastic surgery for continued
monitoring of her skin graft.  She also had followup with
orthopaedic surgery for the bimalleolar fracture which had
been repaired.  Orthopaedic surgery also wanted her to wear [**Initials (NamePattern4) **]
[**Last Name (NamePattern4) **] brace at 40 degrees of flexion and locked in this
area and to be nonweight bearing on the left lower extremity
for some time.  She was to follow up with orthopaedic surgery
approximately two weeks post discharge.

It should be noted the patient was seen by the psychiatric
consult service while an inpatient to help to screen her for
potential suicidal behavior given that she had been
intoxicated during the accident and there was some question
as to whether she had accidents of this nature before and her
social stability.  Psychiatry also thought this was not a
suicidal attempt nor did the patient have any suicidal
ideation.  They thought that there was no indication for any
kind of psychiatric hospitalization stay and the patient
stated that she was not interested in outpatient followup.
So the psychiatric service also signed off on the patient
without any apprehensions.

The patient was discharged on the following medications.  She
was on Coumadin for a goal INR of approximately 2 to 2.5.
She was on Zantac which would actually be discontinued as the
patient had transitioned and was tolerating a p.o. diet for
some time.  She was on Neurontin 300 mg p.o. t.i.d. for
neurogenic pain.  She was on OxyContin 30 mg p.o. t.i.d.
along with oxycodone 10 to 20 mg p.o. q.three hours p.r.n.
for break through pain.  She was on Zanaflex as well, a
muscle relaxant, 4 to 6 mg p.o. q.eight for muscle spasm
associated with rib pain.  She was on Ativan 0.5 to 1 mg p.o.
q.four hours for excessive anxiety.  The patient was also
discharged on a bowel regimen of Colace taken 100 mg p.o.
b.i.d. and Dulcolax tabs one to two 5 mg tabs p.o. q.day
p.r.n.

The patient was content with her discharge plan and was
discharged safely to rehab with the previously noted
followup.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

Dictated By:[**Name8 (MD) 15477**]
MEDQUIST36

D:  [**2148-6-10**]  17:07
T:  [**2148-6-10**]  20:18
JOB#:  [**Job Number 34201**]
{'Bimalleolar fracture, closed,Closed fracture of multiple ribs, unspecified,Injury to tibial vessel(s), unspecified,Other injury into spleen without mention of open wound into cavity,Dislocation of knee, unspecified, open,Alcohol abuse, unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}


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 patient was admitted on
[**2148-5-22**] after having been in a roll-over car accident with
loss of consciousness.  She was the restrained driver in this
accident.  There was no air bag deployment.  She was alert
and oriented on transfer, but had systolic blood pressure in
the 70s to 80s and she was complaining of both left chest and
neck pain.

MEDICAL HISTORY: None.  No known medications.  No
surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for being a nurse manager in [**Location (un) 7498**]. 

### Response:
{'Bimalleolar fracture, closed,Closed fracture of multiple ribs, unspecified,Injury to tibial vessel(s), unspecified,Other injury into spleen without mention of open wound into cavity,Dislocation of knee, unspecified, open,Alcohol abuse, unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}
