CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: 22 y/o f s/p mvc transported from OSH, +LOC, unrestrained, Death
on scene. Pt noted to have liver lac, right upper lobe pulm
contusion, questionable aortic tear, non-displaced sternal fx,
+scalp lac. Pt. received tetanus at OSH.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Quetiapine

PHYSICAL EXAM: Exam on arrival to trauma bay:
108/56 117 18 100%RA 101.2R
Gen: lying on stretcher, not boarded, not collared
HEENT: lac sutured on forehead, PERRL, EOMI
Neck: Abrasion R lateral neck, no stepoffs
Pulm:CTAB
CVS: RRR +s1/s2
Abd: +RUQ tenderness
Back: T-spine tenderness at T4
GU: Good rectal tone, guiac neg
Ext: +pulses x4 ext
Neuro: GCS 4/4/6--14
Pelvis: Stable
Chest: +Rash (old) L anterior chest

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-contrib
Other injury to liver without mention of open wound into cavity,Contusion of lung without mention of open wound into thorax,Closed fracture of sternum,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Concussion with loss of consciousness of unspecified duration,Acute alcoholic intoxication in alcoholism, continuous,Open wound of forehead, without mention of complication,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Delusional disorder,Tobacco use disorder
Liver injury NEC-closed,Lung contusion-closed,Fracture of sternum-clos,Kidney hematoma-closed,Concussion w coma NOS,Ac alcohol intox-contin,Open wound of forehead,Mv coll w oth obj-driver,Delusional disorder,Tobacco use disorder
Admission Date:  [**2120-11-4**]              Discharge Date:   [**2120-11-8**]

Date of Birth:  [**2098-2-7**]             Sex:   F

Service: SURGERY

Allergies:
Quetiapine

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
none


History of Present Illness:
22 y/o f s/p mvc transported from OSH, +LOC, unrestrained, Death
on scene. Pt noted to have liver lac, right upper lobe pulm
contusion, questionable aortic tear, non-displaced sternal fx,
+scalp lac. Pt. received tetanus at OSH.

Past Medical History:
none

Social History:
non-contrib

Family History:
non-contributory


Physical Exam:
Exam on arrival to trauma bay:
108/56 117 18 100%RA 101.2R
Gen: lying on stretcher, not boarded, not collared
HEENT: lac sutured on forehead, PERRL, EOMI
Neck: Abrasion R lateral neck, no stepoffs
Pulm:CTAB
CVS: RRR +s1/s2
Abd: +RUQ tenderness
Back: T-spine tenderness at T4
GU: Good rectal tone, guiac neg
Ext: +pulses x4 ext
Neuro: GCS 4/4/6--14
Pelvis: Stable
Chest: +Rash (old) L anterior chest

Pertinent Results:
[**2120-11-4**] 12:05PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2120-11-4**] 12:05PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.039*
[**2120-11-4**] 12:05PM   PT-13.1 PTT-25.2 INR(PT)-1.1
[**2120-11-4**] 12:05PM   PLT COUNT-241
[**2120-11-4**] 12:05PM   WBC-9.2 RBC-3.89* HGB-12.5 HCT-34.7* MCV-89
MCH-32.1* MCHC-36.0* RDW-14.0
[**2120-11-4**] 12:05PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2120-11-4**] 12:05PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2120-11-4**] 12:05PM   AMYLASE-44
[**2120-11-4**] 12:05PM   UREA N-6 CREAT-0.6
[**2120-11-4**] 12:35PM   GLUCOSE-99 LACTATE-1.6 NA+-145 K+-3.9 CL--110
TCO2-25
[**2120-11-4**] 02:18PM   HCT-38.8
[**2120-11-4**] 05:56PM   HCT-38.7
[**2120-11-4**] 09:21PM   HCT-38.0

   RADIOLOGY  Final Report

CT RECONSTRUCTION  [**2120-11-4**] 12:15 PM

CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST

Reason: bleed? fx?
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
22 year old woman with mvc death on scene
REASON FOR THIS EXAMINATION:
bleed? fx?
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Motor vehicle accident.

TECHNIQUE: MDCT-acquired images of the abdomen and pelvis were
obtained after the administration of IV contrast.

CT OF THE ABDOMEN WITH IV CONTRAST: There are patchy peripheral
opacities in the right middle lobe that may represent contusion.
There is dependent atelectasis. No evidence of pneumothorax on
the imaged portions of the lungs. There is a complex liver
laceration. No definite subcapsular hemorrhage is seen. The
pancreas and spleen enhance homogeneously. There are multiple
punctate calcifications located within the spleen, possibly
representing sequelae of prior granulomatous infection. The
kidneys enhance and excrete contrast symmetrically with no
evidence of hydronephrosis or hydroureter. Multiple small
mesenteric and retroperitoneal lymph nodes that do not meet CT
criteria for pathologic enlargement are seen. The small and
large bowel, on limited non-contrast evaluation, are of normal
caliber with no evidence of wall thickening. No free air in the
abdomen is seen.

CT OF THE PELVIS WITH IV CONTRAST: A central venous catheter is
present within the right femoral vein. There is a Foley catheter
in the bladder. Air within the bladder is likely secondary to
catheter placement. The rectum and sigmoid colon appear grossly
unremarkable. There is pelvic free fluid. Uterus and adnexa are
grossly unremarkable. No pathologically enlarged inguinal or
deep pelvic nodes are seen.

Bone windows demonstrate no suspicious lytic or sclerotic
lesions. There is an apparent sternal fracture.

MULTIPLANAR REFORMATTED IMAGES: The alignment of the lumbar and
lower thoracic spine is normal. T8 through L5 are imaged. There
is no loss of vertebral body height. The disc spaces are
maintained.

IMPRESSION:
1. Patchy peripheral opacity in the right middle lobe that may
represent contusion.
2. Sternal fracture.
3. Complex liver laceration.
4. Pelvic free fluid, a nonspecific finding.

The above was immediately relayed to the ED dashboard and
flagged for urgent attention.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7832**]
Approved: TUE [**2120-11-5**] 8:42 AM

RADIOLOGY  Final Report

CT RECONSTRUCTION  [**2120-11-4**] 12:15 PM

CT C-SPINE W/O CONTRAST; CT RECONSTRUCTION

Reason: fx?

[**Hospital 93**] MEDICAL CONDITION:
22 year old woman with mvc death on scene
REASON FOR THIS EXAMINATION:
fx?
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 22-year-old female with motor vehicle collision and
death on seen. Evaluate for fracture.

TECHNIQUE: Axial noncontrast helical scanning of the cervical
spine was performed without IV contrast. Sagittal and coronal
reconstructions were obtained.

FINDINGS: No disk, vertebral, or paraspinal abnormality is seen.
There is no sign of fracture or abnormal alignment of the
component vertebrae. CT is not able to provide intrathecal
detail comparable to MRI. The visualized outline of the thecal
sac appears unremarkable.

IMPRESSION: Normal cervical spinal CT.

These findings were discussed with Dr. [**Last Name (STitle) **] at proximately 1
p.m. on [**2120-11-4**].

The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10270**]
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 9987**]
Approved: TUE [**2120-11-5**] 8:54 AM

   RADIOLOGY  Final Report (Revised)

CT HEAD W/O CONTRAST  [**2120-11-4**] 12:07 PM

CT HEAD W/O CONTRAST

Reason: bleed?
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
22 year old woman with mvc death on scene
REASON FOR THIS EXAMINATION:
bleed?
CONTRAINDICATIONS for IV CONTRAST: None.

There is moderately prominent soft tissue thickening in the
posterior superior nasopharyngeal region, most likely enlarged
adenoids, common in a patient of this age. INDICATION:
22-year-old female with motor vehicle collision in death on
scene. Evaluate for bleed.

TECHNIQUE: Non-contrast CT of the head.

CT HEAD WITHOUT CONTRAST: There is no evidence of intracranial
hemorrhage. No hydrocephalus, shift of normally midline
structures, mass effect, minor or major acute vascular
territorial infarct is apparent. The density values of the brain
parenchyma are within normal limits, aside from a questionable
slightly heterogeneously diminished absorption in the rostrum
and anterior body of the corpus callosum. There is mild mucosal
thickening of the ethmoid and maxillary sinuses bilaterally.
There is a 4mm rounded area of calcification, which likely
represents an osteoma, in the right ethmoid sinus.

IMPRESSION:

No evidence of intracranial hemorrhage. Questionable subtle
reduced density in the corpus callosum- ? shearing injury. Minor
paranasal sinus mucosal thickening with associated osteoma in
the right ethmoid sinus.

I (JK) discussed these findings with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], senior
trauma resident, on [**2120-11-5**] at 9AM. With regard to the corpus
callosum finding, we agreed that a follow-up MR (preferably) or
CT head study today would be helpful, as well as review of
outside hospital studies.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10270**]
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 9987**]
Approved: TUE [**2120-11-5**] 9:21 AM


Brief Hospital Course:
Upon arrival to [**Hospital1 18**] pt. was immediately evaluated by emergency
medicine and trauma surgery teams. The patient was initially
tachycardic and was transfused PRBC's followed by a good
hemodynamic response of a decrease of her heart rate. Imaging
was performed and pt. was noted to have a sternal fracture and a
severe liver laceration. The pt. was admitted to the TSICU under
the trauma surgery service where her liver laceration was
managed conservatively and non-operatively. Neurosurgery was
consulted for a decreased absorption of the corpus collosum on
CT scan and stated that this was a normal variation in anatomy.
The patient was monitored closely and remained stable. The pt.
was transferred to the floor with an uneventful course, was put
on a full diet, c-spine was cleared and soft collar was placed
for comfort only. Pt was evaluated by psychiatry and social
work, was given numbers for AA and drug/alc treatment was
discussed with pt and father. Pt. was cleared by both services
for discharge and father is to be dispensor of pt's medication
as well as to have low threshold to bring pt. to ED for any
evidence of suicidality.  Pt. will follow up with psychiatry in
[**Location (un) 3844**], and will follow up with the trauma surgery clinic
for follow up of liver lac. Pt. will be d/c'd to parents.

Medications on Admission:
none

Discharge Medications:
1. Risperidone 3 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 months.
Disp:*10 Tablet(s)* Refills:*0*
2. Escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 1 months.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Sternal fracture
Severe liver laceration


Discharge Condition:
stable


Discharge Instructions:
-Keep your soft collar on as you need for comfort
-Take your medications as perscribed

-Do not take part in any contact sports, or any activity that
may lead to impact to your abdomen as this could lead to brisk
bleeding of your known liver injury. If you experience any
symptoms of bleeding such as dizziness, sudden extreme fatigue,
fast heat rate, blood in your urine or stool, or feeling as if
you are going to pass out, proceed to the nearest emergency room
immediately.

-Follow up with trauma surgery and psychiatry as noted below

Followup Instructions:
1) Please call to make an appointment in [**2-4**] weeks for follow up
with the trauma surgery service: [**Telephone/Fax (1) 6439**]
2) You have an appointment for psychiatric follow up at:
     Date: [**2120-11-11**]
     Time: 1pm
     [**Location (un) 34004**] Counseling Center
     [**Location (un) 63059**]
     [**Location (un) 12017**] [**Telephone/Fax (1) 63060**]
     Contact [**Name (NI) 19447**]: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]
{'Other injury to liver without mention of open wound into cavity,Contusion of lung without mention of open wound into thorax,Closed fracture of sternum,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Concussion with loss of consciousness of unspecified duration,Acute alcoholic intoxication in alcoholism, continuous,Open wound of forehead, without mention of complication,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Delusional disorder,Tobacco use disorder'}


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: abdominal pain

PRESENT ILLNESS: 22 y/o f s/p mvc transported from OSH, +LOC, unrestrained, Death
on scene. Pt noted to have liver lac, right upper lobe pulm
contusion, questionable aortic tear, non-displaced sternal fx,
+scalp lac. Pt. received tetanus at OSH.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Quetiapine

PHYSICAL EXAM: Exam on arrival to trauma bay:
108/56 117 18 100%RA 101.2R
Gen: lying on stretcher, not boarded, not collared
HEENT: lac sutured on forehead, PERRL, EOMI
Neck: Abrasion R lateral neck, no stepoffs
Pulm:CTAB
CVS: RRR +s1/s2
Abd: +RUQ tenderness
Back: T-spine tenderness at T4
GU: Good rectal tone, guiac neg
Ext: +pulses x4 ext
Neuro: GCS 4/4/6--14
Pelvis: Stable
Chest: +Rash (old) L anterior chest

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-contrib 

### Response:
{'Other injury to liver without mention of open wound into cavity,Contusion of lung without mention of open wound into thorax,Closed fracture of sternum,Injury to kidney without mention of open wound into cavity, hematoma without rupture of capsule,Concussion with loss of consciousness of unspecified duration,Acute alcoholic intoxication in alcoholism, continuous,Open wound of forehead, without mention of complication,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Delusional disorder,Tobacco use disorder'}
