CHIEF COMPLAINT: pedestrian struck by car

PRESENT ILLNESS: 56M was struck by car at 7pm, reportedly was tossed 20ft and
hit his head.  By report, GCS in the field was 13, on arrival to
the [**Hospital1 18**] ED, the patient was increasingly combative, moving all
extremities and became bradycardic to the 30's and was intubated
and sedated shortly after arrival to the ED.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION:
O: T: 97.1 BP: 117/88         HR: 68   R   19    O2Sats 100% 2L
Gen: WD/WN, NAD, intubated and sedated.
HEENT: Pupils: PERRL 4 to 3mm bilaterally, abrasion over L
eyebrow and abrasion L zygomatic arch.  R occipital hematoma
Neck: in C-collar
Lungs: breath sounds equal bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT
Extrem: Warm and well-perfused. abrasions on hands and knees
Neuro:
Mental status: arousable to voice, nods head yes in reponse to
some questions
Orientation: intubated and sedated
Recall: intubated and sedated
Language: intubated and sedated

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: married, lives with wife, college professor
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Contusion of lung without mention of open wound into thorax,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Closed fracture of malar and maxillary bones,Open wound of forehead, without mention of complication,Unspecified fall,Accidents occurring in residential institution
Cl skul base fx-coma NOS,Lung contusion-closed,Mv coll w pedest-pedest,Fx malar/maxillary-close,Open wound of forehead,Fall NOS,Accid in resident instit
Admission Date:  [**2143-1-3**]              Discharge Date:   [**2143-1-9**]

Date of Birth:  [**2085-5-2**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
pedestrian struck by car


Major Surgical or Invasive Procedure:
R craniotomy for evacuation of R SDH/ R EDH


History of Present Illness:
56M was struck by car at 7pm, reportedly was tossed 20ft and
hit his head.  By report, GCS in the field was 13, on arrival to
the [**Hospital1 18**] ED, the patient was increasingly combative, moving all
extremities and became bradycardic to the 30's and was intubated
and sedated shortly after arrival to the ED.


Past Medical History:
None

Social History:
married, lives with wife, college professor

Family History:
non-contributory

Physical Exam:
PHYSICAL EXAM ON ADMISSION:
O: T: 97.1 BP: 117/88         HR: 68   R   19    O2Sats 100% 2L
Gen: WD/WN, NAD, intubated and sedated.
HEENT: Pupils: PERRL 4 to 3mm bilaterally, abrasion over L
eyebrow and abrasion L zygomatic arch.  R occipital hematoma
Neck: in C-collar
Lungs: breath sounds equal bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT
Extrem: Warm and well-perfused. abrasions on hands and knees
Neuro:
Mental status: arousable to voice, nods head yes in reponse to
some questions
Orientation: intubated and sedated
Recall: intubated and sedated
Language: intubated and sedated

Cranial Nerves:
PERRL 4 to 3mm bilaterally, unable to assess CN

Motor:  moves all extremities symmetrically, R grip [**3-23**],


Pertinent Results:
[**2143-1-6**] 07:05AM BLOOD WBC-11.6* RBC-2.98* Hgb-9.9* Hct-27.1*
MCV-91 MCH-33.2* MCHC-36.5* RDW-13.1 Plt Ct-189
[**2143-1-5**] 01:45AM BLOOD WBC-12.9* RBC-2.99* Hgb-9.8* Hct-27.2*
MCV-91 MCH-32.6* MCHC-35.9* RDW-13.4 Plt Ct-169
[**2143-1-4**] 01:13AM BLOOD WBC-11.3*# RBC-3.65* Hgb-11.6* Hct-32.7*
MCV-90 MCH-31.7 MCHC-35.4* RDW-13.7 Plt Ct-230
[**2143-1-3**] 07:50PM BLOOD WBC-6.7 RBC-4.23* Hgb-13.4* Hct-39.6*
MCV-94 MCH-31.7 MCHC-33.8 RDW-13.1 Plt Ct-333
[**2143-1-6**] 07:05AM BLOOD Plt Ct-189
[**2143-1-4**] 01:13AM BLOOD Plt Ct-230
[**2143-1-4**] 01:13AM BLOOD PT-12.6 PTT-26.1 INR(PT)-1.1
[**2143-1-3**] 07:50PM BLOOD PT-12.2 PTT-23.6 INR(PT)-1.0
[**2143-1-6**] 07:05AM BLOOD Glucose-114* UreaN-11 Creat-0.6 Na-142
K-3.8 Cl-106 HCO3-27 AnGap-13
[**2143-1-5**] 01:45AM BLOOD Glucose-138* UreaN-10 Creat-0.7 Na-133
K-3.7 Cl-102 HCO3-25 AnGap-10
[**2143-1-4**] 01:13AM BLOOD Glucose-171* UreaN-20 Creat-0.7 Na-140
K-4.0 Cl-112* HCO3-22 AnGap-10
[**2143-1-6**] 07:05AM BLOOD Calcium-7.9* Phos-1.8* Mg-2.2
[**2143-1-5**] 01:45AM BLOOD Albumin-3.1* Calcium-7.5* Phos-2.2*
Mg-1.9
[**2143-1-4**] 01:28PM BLOOD Type-ART pO2-140* pCO2-36 pH-7.41
calTCO2-24 Base XS-0
[**2143-1-4**] 10:31AM BLOOD Type-ART pO2-198* pCO2-35 pH-7.42
calTCO2-23 Base XS-0
[**2143-1-3**] 11:37PM BLOOD Glucose-179* Lactate-1.3 Na-136 K-3.6
Cl-111
[**2143-1-3**] 10:40PM BLOOD Glucose-139* Lactate-1.0 Na-137 K-3.5
Cl-106
[**2143-1-3**] 11:37PM BLOOD Hgb-11.4* calcHCT-34
[**2143-1-4**] 10:31AM BLOOD freeCa-1.01*

CT HEAD W/O CONTRAST  [**2143-1-5**] 3:52 PM
IMPRESSION:

1. Overall decrease in amount of bilateral subarachnoid
hemorrhage.

2. Similar-sized 2 left frontal intraparenchymal hemorrhage with
slightly increased surrounding local edema.

3. More apparent are 2 small contusions involving the left
temporal lobe and the right frontal lobe.

4. No evidence of hydrocephalus or intraventricular blood.

CT HEAD W/O CONTRAST  [**2143-1-4**] 6:11 AM
IMPRESSION:

1) Evacuation of the large epidural hematoma on the right. Small
residual extra-axial blood in the right middle cranial fossa
anterolaterally which is unchanged in size compared to the prior
study, and is consistent with residual epidural blood.

2) Extensive bilateral subarachnoid hemorrhage and probable
subdural hemorrhage layering along the tentorium.

3) Resection of a portion of the squamosal right temporal bone,
where the previously noted fracture had been.

4. Non-displaced fracture of the right zygoma, unchanged.

CT HEAD W/O CONTRAST  [**2143-1-3**] 7:55 PM
FINDINGS/IMPRESSION:

1. Acute right-sided epidural hematoma, maximal width of 14 mm
with hyperacute component centrally.
2. Extensive subarachnoid hemorrhage predominantly over the
right cerebrum.
3. Nondepressed fracture of the squamosal part of the right
temporal bone.
4. Small, approximately 3-mm, left-sided subdural hematoma.
5. Pneumocephalus most notably in the suprasellar cistern and in
the left middle cranial fossa.
6. Large extracalvarial hematoma over the right parietal
convexity.
7. No intraventricular hemorrhage or herniation noted at this
time.

Brief Hospital Course:
Patient underwent emergent Right craniotomy and evacuation of R
subdural and epidural hematoma. Post-op CT showed improvement;
however postoperatively patient was combative and somewat
confused. On [**2143-1-5**] he climbed out of bed and hit his face,
which caused a laceration of R eyebrow, repeat CT showed
increased in left sided swelling.
Sitter was assigned, and safety was implemented. Patient exam
improved, he follows simple commands, his diet was advanced, and
able to tolerate regular diet without swallowing difficulties.
He is voiding without difficulties.
Pysical therapy was consulted, and they recommended rehab. The
patient had a low grade fever on [**12-8**]. When rechecked prior
to discharge it was 98.3. He had a CXR and a UA that were
negative. Blood and urine cultures are pending at the time of
discharge. He had lower extremity ultrasounds on [**1-9**] which
showed no evidence of DVTs. He was discharged to rehab on [**1-9**].

Medications on Admission:
None

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain or fever. Tablet(s)
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Bisacodyl 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
6. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
7. Levetiracetam 1,000 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
R craniotomy for evacuation of R SDH/ R EDH


Discharge Condition:
NEUROLOGICALLY STABLE


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY/HEAD INJURY

??????	Have a family member check your incision daily for signs of
infection
??????	Take your pain medicine as prescribed
??????	Exercise should be limited to walking; no lifting, straining,
excessive bending
??????	You may wash your hair only after sutures and/or staples have
been removed
??????	You may shower before this time with assistance and use of a
shower cap
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????	New onset of tremors or seizures
??????	Any confusion or change in mental status
??????	Any numbness, tingling, weakness in your extremities
??????	Pain or headache that is continually increasing or not
relieved by pain medication
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, drainage
??????	Fever greater than or equal to 101?????? F


Followup Instructions:
PLEASE HAVE YOUR STAPLES REMOVED ON [**2143-1-17**] BY REHABILITATION
STAFF.

PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.
[**First Name (STitle) **] TO BE SEEN IN 6 WEEKS.
YOU WILL NEED A CAT SCAN OF THE BRAIN WITHOUT CONTRAST



Completed by:[**2143-1-9**]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Contusion of lung without mention of open wound into thorax,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Closed fracture of malar and maxillary bones,Open wound of forehead, without mention of complication,Unspecified fall,Accidents occurring in residential institution'}


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: pedestrian struck by car

PRESENT ILLNESS: 56M was struck by car at 7pm, reportedly was tossed 20ft and
hit his head.  By report, GCS in the field was 13, on arrival to
the [**Hospital1 18**] ED, the patient was increasingly combative, moving all
extremities and became bradycardic to the 30's and was intubated
and sedated shortly after arrival to the ED.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION:
O: T: 97.1 BP: 117/88         HR: 68   R   19    O2Sats 100% 2L
Gen: WD/WN, NAD, intubated and sedated.
HEENT: Pupils: PERRL 4 to 3mm bilaterally, abrasion over L
eyebrow and abrasion L zygomatic arch.  R occipital hematoma
Neck: in C-collar
Lungs: breath sounds equal bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT
Extrem: Warm and well-perfused. abrasions on hands and knees
Neuro:
Mental status: arousable to voice, nods head yes in reponse to
some questions
Orientation: intubated and sedated
Recall: intubated and sedated
Language: intubated and sedated

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: married, lives with wife, college professor 

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Contusion of lung without mention of open wound into thorax,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Closed fracture of malar and maxillary bones,Open wound of forehead, without mention of complication,Unspecified fall,Accidents occurring in residential institution'}
