CHIEF COMPLAINT: T5 burst fracture.

PRESENT ILLNESS: Patient is a 56 y.o. restraint driver s/p rear-end collision.
Per EMS the back of the car was demolished and seat buckled.
Taken to hospital in NH where a CT torso demonstrated a thoracic
burst fracture.  Pt med-flighted to [**Hospital1 18**] for further
management.

MEDICAL HISTORY: PMH:Rheumatoid arthritis, neuropathy of feet, recurring
shingles.

MEDICATION ON ADMISSION: amlodipine 5 ?prn, amitriptyline 10', Famvir 500''', neurontin
300'', nexium 40', prednisone 6', premarin .3', orencia infusion
1/mo, VitD 2000IU

ALLERGIES: Shellfish / iodine / Sulfa(Sulfonamide Antibiotics) / Levaquin /
Toprol XL / Darvocet-N 100 / Demerol / Augmentin / Amoxicillin /
Avelox / Codeine / Diflucan / Percocet / Kineret / Methotrexate
/ Biaxin

PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION:
O: T:  BP: 125 / 88        HR: 115    14O2Sats
Gen: obese, laying flat on the stretcher c/o of pain
HEENT: atraumatic eyes: clear, ears: hearing intact, nose
patent,
Pupils: PERRL        EOMs - full
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

FAMILY HISTORY: NC

SOCIAL HISTORY: No tobacco.
Closed fracture of T1-T6 level with other specified spinal cord injury,Acute posthemorrhagic anemia,Unspecified pleural effusion,Rheumatoid arthritis,Myalgia and myositis, unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle
T1-t6 fx-cl/cord inj NEC,Ac posthemorrhag anemia,Pleural effusion NOS,Rheumatoid arthritis,Myalgia and myositis NOS,Mv collision NOS-driver
Admission Date:  [**2145-8-3**]              Discharge Date:   [**2145-8-9**]

Date of Birth:  [**2089-3-29**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Shellfish / iodine / Sulfa(Sulfonamide Antibiotics) / Levaquin /
Toprol XL / Darvocet-N 100 / Demerol / Augmentin / Amoxicillin /
Avelox / Codeine / Diflucan / Percocet / Kineret / Methotrexate
/ Biaxin

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
T5 burst fracture.

Major Surgical or Invasive Procedure:
[**8-4**] T3-T7 posterior fusion with instrumentation; T5
laminectomy.


History of Present Illness:
Patient is a 56 y.o. restraint driver s/p rear-end collision.
Per EMS the back of the car was demolished and seat buckled.
Taken to hospital in NH where a CT torso demonstrated a thoracic
burst fracture.  Pt med-flighted to [**Hospital1 18**] for further
management.

On arrival, patient was c/o of severe back pain with numbness in
her feet.  She denies rectal or urine incontinence.  She denies
saddle anesthesia.


Past Medical History:
PMH:Rheumatoid arthritis, neuropathy of feet, recurring
shingles.

PSH: Thrinoplasty, tubal ligation, hysterectomy/R
oopherectomy, L submandibular gland surgery, appy, L
oopherectomy, fractured L foot, torn R rotator cuff, fractured
right foot.


Social History:
No tobacco.


Family History:
NC


Physical Exam:
PHYSICAL EXAM ON ADMISSION:
O: T:  BP: 125 / 88        HR: 115    14O2Sats
Gen: obese, laying flat on the stretcher c/o of pain
HEENT: atraumatic eyes: clear, ears: hearing intact, nose
patent,
Pupils: PERRL        EOMs - full
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor: MAEs with good strength
Sensation: Diminished to light touch in bilateral LE and foot,
diminshed to pin prick.
Toes are mute
Rectal exam normal sphincter control

PHYSICAL EXAMINATION ON DISCHARGE:
AVSS, NAD, AxOx4
EOMI, CNII-XII grossly intact
Laying in bed c/o bilateral neuropathic pain @T10 sensory level
symmetric chest rise< breathing comfortably
lue with ecchymosis
5- grip/deltoids bilat [**1-21**] pain; otherwise full strength in
[**Hospital1 **]/tri bilat
4- TA/[**Last Name (un) 938**] bilat; 4+ GS; 4 Quads/Hams bilat.
dc sensation below knees bilat.
Toes mute
extrems wwp, 2+ cr

Pertinent Results:
[**2145-8-3**] 07:05PM   PT-10.5 PTT-26.1 INR(PT)-1.0
[**2145-8-3**] 07:05PM   PLT COUNT-339
[**2145-8-3**] 07:05PM   WBC-26.4* RBC-4.77 HGB-13.6 HCT-41.3 MCV-87
MCH-28.6 MCHC-33.0 RDW-15.2
[**2145-8-3**] 07:05PM   estGFR-Using this
[**2145-8-3**] 07:05PM   UREA N-16 CREAT-0.8
[**2145-8-3**] 07:16PM   GLUCOSE-131* NA+-143 K+-3.4 CL--104 TCO2-26
[**2145-8-3**] 07:35PM URINE  MUCOUS-MANY
[**2145-8-3**] 07:35PM URINE  HYALINE-3*
[**2145-8-3**] 07:35PM URINE  RBC-12* WBC-4 BACTERIA-FEW YEAST-NONE
EPI-1
[**2145-8-3**] 07:35PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-2* PH-5.5 LEUK-NEG
[**2145-8-3**] 07:35PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.020
[**2145-8-3**] 07:35PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2145-8-3**] 07:35PM URINE  HOURS-RANDOM

MRI Lumbar Spine - T5 burst fracture with extension into the
posterior elements with associated retropulsion and
moderate-to-severe spinal canal narrowing as well as cord edema.
 T6 superior endplate fracture.  Bone marrow edema at T4.

[**8-4**] Ct thoracic spine - 1.  T5 burst fracture as described with
retropulsion and narrowing of the canal up to 8 mm.  Please
correlate with report of MRI as cord edema at this level is seen
by MRI.
2.  Additional comminuted superior endplate fracture of T6
vertebral body and multiple multilevel transverse process
fractures as described.
3.  Bilateral pleural effusions.

[**8-6**] CXR - Post-sternotomy, the vertebral rods are in place.
Paraspinal hematoma is noted, seen on the prior study is being
post-surgical and currently the most likely reflect a
combination of surgical hematoma and substantial mediastinal
fat.  No pneumothorax is seen.  Left lower lobe opacity most
likely reflects atelectasis.


Brief Hospital Course:
Ms. [**Known lastname 13712**] was admitted to the trauma surgical ICU on [**2145-8-4**]
with a T5 burst fracture.  She underwent a CT of the thoracic
spine without contrast in anticipation for a T3-T7 posterior
fusion with instrumentation; T5 laminectomy.  She was fitted
with a TLSO brace.  On [**8-4**], patient underwent the above stated
procedure.  She tolerated the procedure well.  She was then
transferred back to ICU in stable condition.  Motor exam
worsened which was expected status post spinal cord injury.  She
was trasnferred to SDU on [**8-5**] in stable condition.  Her PCA was
discontinued and pain meds were uptitrated accordingly.
Dexamethasone was discontinued and she was continued on her
normal regimen of prednisone. She was seen by PT once TLSO brace
arrived and rehab was recommended. On [**8-7**], her motor exam
improved, but still with R side weakness > L. On [**8-8**], patient
had further improvement of her LE strength, nearly equal
bilateral. Foley was replaced for urinary retention and she
continued to work with PT. On evening of [**8-8**], patient began to
complain of neuropathic pain at the level of the nipples,
crossing midline bilaterally. She also complained of continued
tingling in the legs. Gabapentin was uptitrated with moderate
improvement. Patient was cleared for transfer to acute rehab
facility on [**8-9**]. She has a foley in place and will need to
undergo a repeat void trial.

Medications on Admission:
amlodipine 5 ?prn, amitriptyline 10', Famvir 500''', neurontin
300'', nexium 40', prednisone 6', premarin .3', orencia infusion
1/mo, VitD 2000IU

Discharge Medications:
1. Amitriptyline 10 mg PO HS
2. Bisacodyl 10 mg PO/PR DAILY
3. Diazepam 5 mg PO Q8H:PRN spasm
4. Docusate Sodium 100 mg PO BID
5. Estrogens Conjugated 0.3 mg PO DAILY
6. Famvir *NF* (famciclovir) 500 mg Oral TID Reason for
Ordering: Wish to maintain preadmission medication while
hospitalized, as there is no acceptable substitute drug product
available on formulary.
7. Gabapentin 300 mg PO TID
8. Heparin 5000 UNIT SC TID
9. HYDROmorphone (Dilaudid) 2-4 mg PO Q4H:PRN pain
10. Senna 1 TAB PO QHS
11. Sodium Chloride Nasal [**12-21**] SPRY NU QID:PRN dryness


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 **]

Discharge Diagnosis:
T5 burst fracture
Spinal cord injury T4-6 level
Post operative anemia
pleural effusion


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
??????	Your large dressing may be removed the second day after
surgery.
??????	**If you have staples, keep your wound clean and dry until
they are removed.
??????	You should wear your brace when out of bed or when your head
of bed is above 30 degrees.
??????	You may put the brace on at the edge of your bed.
??????	You may use a shower chair to bathe without the brace on.
??????	 No tub baths or pool swimming for two weeks from your date of
surgery.
??????	Do not smoke.
??????	No pulling up, lifting more than 10 lbs., or excessive bending
or twisting.
??????	Limit your use of stairs to 2-3 times per day.
??????	Have a friend or family member check your incision daily for
signs of infection.
??????	Take your pain medication as instructed; you may find it best
if taken in the morning when you wake-up for morning stiffness,
and before bed for sleeping discomfort. Pain medication should
be used as needed when you have pain. You do not need to take it
if you do not have pain.
??????	Do not take any anti-inflammatory medications such as Motrin,
Advil, Aspirin, and Ibuprofen etc. for two weeks.
??????	Increase your intake of fluids and fiber, as pain medicine
(narcotics) can cause constipation. We recommend taking an over
the counter stool softener, such as Docusate (Colace) while
taking narcotic pain medication.
??????	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:

??????	Pain that is continually increasing or not relieved by pain
medicine.
??????	Any weakness, numbness, tingling in your extremities.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, and drainage.
??????	Fever greater than or equal to 101.5?????? F.
??????	Loss of control of bowel or bladder functioning


Followup Instructions:
??????Please return to the office in [**6-29**] days (from date of surgery)
for removal of your staples. This appointment can be made with
the Physician Assistant or [**Name9 (PRE) **] Practitioner.  Please make this
appointment by calling [**Telephone/Fax (1) 1272**]. If you live quite a
distance from our office, please make arrangements for the same,
with your PCP.
??????Please call Paresa at ([**Telephone/Fax (1) 4676**] to schedule an appointment
with Dr. [**Last Name (STitle) 739**] to be seen in 4 weeks. You will need AP
and Lateral Lumbar Spine X-rays prior to your appointment.


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2145-8-11**]
{'Closed fracture of T1-T6 level with other specified spinal cord injury,Acute posthemorrhagic anemia,Unspecified pleural effusion,Rheumatoid arthritis,Myalgia and myositis, 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: T5 burst fracture.

PRESENT ILLNESS: Patient is a 56 y.o. restraint driver s/p rear-end collision.
Per EMS the back of the car was demolished and seat buckled.
Taken to hospital in NH where a CT torso demonstrated a thoracic
burst fracture.  Pt med-flighted to [**Hospital1 18**] for further
management.

MEDICAL HISTORY: PMH:Rheumatoid arthritis, neuropathy of feet, recurring
shingles.

MEDICATION ON ADMISSION: amlodipine 5 ?prn, amitriptyline 10', Famvir 500''', neurontin
300'', nexium 40', prednisone 6', premarin .3', orencia infusion
1/mo, VitD 2000IU

ALLERGIES: Shellfish / iodine / Sulfa(Sulfonamide Antibiotics) / Levaquin /
Toprol XL / Darvocet-N 100 / Demerol / Augmentin / Amoxicillin /
Avelox / Codeine / Diflucan / Percocet / Kineret / Methotrexate
/ Biaxin

PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION:
O: T:  BP: 125 / 88        HR: 115    14O2Sats
Gen: obese, laying flat on the stretcher c/o of pain
HEENT: atraumatic eyes: clear, ears: hearing intact, nose
patent,
Pupils: PERRL        EOMs - full
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.

FAMILY HISTORY: NC

SOCIAL HISTORY: No tobacco. 

### Response:
{'Closed fracture of T1-T6 level with other specified spinal cord injury,Acute posthemorrhagic anemia,Unspecified pleural effusion,Rheumatoid arthritis,Myalgia and myositis, unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}
