CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 22 year old female
passenger unrestrained in a head-on motor vehicle accident
with positive air bag deployed, questionable loss of
consciousness, positive ethanol on board and critically
injured patient in the car.  Upon presentation the patient
complained of left hand and left shoulder pain.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of clavicle, unspecified part,Open wound of hand except finger(s) alone, complicated,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle
Traumatic subdural hem,Traumatic brain hem NEC,Fx clavicle NOS-closed,Opn wound hand-complicat,Mv collision NOS-pasngr
Admission Date:  [**2105-8-30**]     Discharge Date:  [**2105-9-2**]

Date of Birth:   [**2083-2-27**]     Sex:  F

Service:  TRAUMA [**Last Name (un) **]

HISTORY OF PRESENT ILLNESS:  This is a 22 year old female
passenger unrestrained in a head-on motor vehicle accident
with positive air bag deployed, questionable loss of
consciousness, positive ethanol on board and critically
injured patient in the car.  Upon presentation the patient
complained of left hand and left shoulder pain.

PAST MEDICAL HISTORY:  None.

PAST SURGICAL HISTORY:  None.

MEDICATIONS:  None.

ALLERGIES:  None.

PHYSICAL EXAMINATION:  T-max on presentation was 100.8, pulse
82, blood pressure 137/80, respiratory rate 18, sating 100%.
On general physical exam in no acute distress.  The patient
was perseverating, repeating words over and over.  HEENT was
unremarkable.  Cardiovascular regular rate and rhythm.  Lungs
were clear to auscultation bilaterally.  No contusions or
deformity.  Abdomen was soft, nontender, nondistended.
Stable back to palpation, no stepoff.  On the extremities the
left hand had a small laceration on the dorsum of the hand
and a deformity with swelling and ecchymosis along the dorsum
of the hand.  Positive radial pulse.  The patient had
deformity and pain of the left shoulder.  Bilateral shin
contusions.  Good distal pulses in upper and lower
extremities.  Rectal was guaiac negative and normal tone.

LABORATORY DATA:  On presentation WBC count was 10.4,
hematocrit 35.3, platelets 259.  PT/PTT were 12.7/28.1,
fibrinogen 242.  Sodium was 141, K 3.5, BUN and creatinine 9
and 0.8 respectively, glucose 92.  Amylase was 44.  Ethanol
was 79.  Chest x-ray showed no pneumothorax, positive left
clavicle fracture.  C-spine was negative to C-6.  Pelvis was
negative for fracture.  Left hand films showed no fracture,
but a foreign body in the soft tissue overlying the third
metacarpal on the dorsum of the hand.  Left shoulder films
showed a clavicle fracture.  CT of the head showed a small
parenchymal hemorrhage inferior aspect of the left frontal
lobe.  CT of the abdomen was negative.

IMPRESSION:  On presentation this trauma patient was that of
a 22 year old female, unrestrained passenger in a head-on MVA
with left clavicle fracture, parenchymal and subarachnoid
bleed noted on CT scan of the head.

HOSPITAL COURSE:  She was admitted to the ICU for q.one hour
neuro checks.  She had a completion C-spine series done.
Removal of the foreign body of the left hand with primary
closure.  Tetanus prophylaxis.  Antibiotics given the foreign
body in the hand.  Neurosurgery was consulted and their
impression was that of a small parenchymal hemorrhage without
neurological issues except for motor exam which was limited
to pain in her left hand.  She was considered to be
neurologically stable, but considered in guarded condition
with neuro checks required q.one hour and followed by
neurosurgery on the ICU team.

Orthopaedics was consulted given the patient's clavicle
fracture.  Their impression and plan was to get clavicular
views which showed a displaced middle third clavicle fracture
with depression in a 1 cm region of the lateral clavicle.
This was a 22 year old woman with lateral third clavicle
fracture recommended for left arm sling to elevate the point
of the elbow.  Follow up in ortho trauma clinic in one week.

Plastics was consulted to remove the foreign body from the
hand which they did successfully.  Ancef was given.  Keflex
was given.  Hand clinic next week upon discharge which were
their discharge instructions as well as dry sterile
dressings.

In the surgical ICU the patient was hemodynamically stable as
well as neurologically stable.  The patient had her C-spine
cleared.  She also had bilateral tib/fib films which were
negative.  TLS films were cleared with Dr. [**Last Name (STitle) 34918**] as well.
She was taken off log roll precautions.  Her C-spine was
actually not cleared initially because she had a lot of pain.
She had completion C-spine films on hospital day two which
was Kefzol day two out of seven.  She had flexion extension
neck films and her C-spine was eventually cleared on
[**9-1**] which was hospital day three and the collar was
removed.

The patient was treated with oxycodone elixir, also given
Percocet and Keflex.  Her diet was advanced which she
tolerated.  She was ambulating.  She was seen by our
occupational therapist to help with the clavicle fracture and
her activities of daily living.  She was also seen by social
work with regard to the death of a friend in the same car
accident that she was involved in.  Repeat head CT done
during her hospitalization showed no extension of the
intraparenchymal hemorrhage.

DISCHARGE INSTRUCTIONS:  Follow up in ortho trauma clinic in
one week.  Follow up in plastics hand clinic in one week.
Follow up in trauma clinic in two weeks.  The patient will go
home on oral analgesics based on neurosurgery recommendations
to avoid NSAIDs given this patient's intraparenchymal
hemorrhage.  She will have a dry sterile dressing to her hand
which will be changed daily.  She will continue Keflex for a
total seven day course.  The patient only required
neurosurgical followup if there was a change in her mental
status or as needed.

DISCHARGE DIAGNOSIS:  Status post motor vehicle accident with
left clavicle fracture, multiple contusions, left hand
foreign body status post removal, on antibiotics.






                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3598**], MD  [**MD Number(1) 3599**]

Dictated By:[**Last Name (NamePattern1) 8344**]

MEDQUIST36

D:  [**2105-9-2**]  09:21
T:  [**2105-9-6**]  10:28
JOB#:  [**Job Number 34919**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of clavicle, unspecified part,Open wound of hand except finger(s) alone, complicated,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in 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 is a 22 year old female
passenger unrestrained in a head-on motor vehicle accident
with positive air bag deployed, questionable loss of
consciousness, positive ethanol on board and critically
injured patient in the car.  Upon presentation the patient
complained of left hand and left shoulder pain.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of clavicle, unspecified part,Open wound of hand except finger(s) alone, complicated,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle'}
