CHIEF COMPLAINT: Fall from ladder 20 feet after sustaining a seizure

PRESENT ILLNESS: 31 M fell from 20 foot ladder after a questionable seizure,
GCS15, combative at scene, hemodynamically stable,
neurologically intact.

MEDICAL HISTORY: Seizure disorder

MEDICATION ON ADMISSION: Depakote

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T= 100.4 HR=120 BP=125/89 saO2=100% 2L
GEN: GCS15, combative, following commands
HEENT: blood around face, abrasion R. cheek, blood from nose, TM
clear, tenderness of midface, L. mandible
NECK: c-collar, trachea midline
CHEST: CTA B/L
HEART: RRR
ABD: soft, NT, ND, FAST -
RECTAL: good tone, guaic -
BACK: logroll with tenderness over T/L spine, no bruises
EXT: B/L knees with bruises, - swelling, l. wrist
tender/swelling
NEURO: MOEx4 sensation intact x4, all peripheral pulses palpable

FAMILY HISTORY: n/a

SOCIAL HISTORY: +tobacco, +EtOH, -drugs
Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Other closed fractures of distal end of radius (alone),Closed fracture of mandible, unspecified site,Closed fracture of base of other metacarpal bone(s),Accidental fall from ladder,Epilepsy, unspecified, without mention of intractable epilepsy,Personal history of noncompliance with medical treatment, presenting hazards to health
Clos skull base fracture,Fx distal radius NEC-cl,Mandible fx NOS-closed,Fx metacarp base NEC-cl,Fall from ladder,Epilep NOS w/o intr epil,Hx of past noncompliance
Admission Date:  [**2132-8-14**]              Discharge Date:   [**2132-8-28**]

Date of Birth:  [**2101-6-3**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
Fall from ladder 20 feet after sustaining a seizure

Major Surgical or Invasive Procedure:
Open reduction internal fixation distal radial fracture,
multiple facial fracture, and mandibular fracture with
fiberoptic nasotracheal intubation.


History of Present Illness:
31 M fell from 20 foot ladder after a questionable seizure,
GCS15, combative at scene, hemodynamically stable,
neurologically intact.

Past Medical History:
Seizure disorder

Social History:
+tobacco, +EtOH, -drugs

Family History:
n/a

Physical Exam:
T= 100.4 HR=120 BP=125/89 saO2=100% 2L
GEN: GCS15, combative, following commands
HEENT: blood around face, abrasion R. cheek, blood from nose, TM
clear, tenderness of midface, L. mandible
NECK: c-collar, trachea midline
CHEST: CTA B/L
HEART: RRR
ABD: soft, NT, ND, FAST -
RECTAL: good tone, guaic -
BACK: logroll with tenderness over T/L spine, no bruises
EXT: B/L knees with bruises, - swelling, l. wrist
tender/swelling
NEURO: MOEx4 sensation intact x4, all peripheral pulses palpable

Pertinent Results:
[**2132-8-14**] 07:15PM   FIBRINOGE-178
[**2132-8-14**] 07:15PM   PLT COUNT-333
[**2132-8-14**] 07:15PM   PT-12.0 PTT-19.7* INR(PT)-1.0
[**2132-8-14**] 07:15PM   WBC-10.9 RBC-4.51* HGB-14.0 HCT-37.0* MCV-82
MCH-31.0 MCHC-37.8* RDW-13.5
[**2132-8-14**] 07:15PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2132-8-14**] 07:15PM   VALPROATE-93
[**2132-8-14**] 07:15PM   AMYLASE-49
[**2132-8-14**] 07:15PM   UREA N-11 CREAT-1.1
[**2132-8-14**] 07:17PM   GLUCOSE-127* LACTATE-5.7* NA+-144 K+-3.5
CL--107 TCO2-21
[**2132-8-14**] 10:25PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG

FOREARM (AP & LAT) LEFT  [**2132-8-14**] 7:59 PM
IMPRESSION: Intra-articular impacted radial head fracture with 5
to 6 mm of positive ulnar variance. Minimally displaced fracture
of the base of the third metacarpal.

KNEE (2 VIEWS) BILAT  [**2132-8-14**] 7:58 PM
IMPRESSION: No fracture.

CT Torso
IMPRESSION:
1. No evidence of acute intrathoracic or intra-abdominal solid
organ injury.
2. Focal hypodensity within the posterior aspect of the spleen
likely representing asymmetric perfusion.
3. There are several loops of proximal small bowel within the
left upper quadrant, which demonstrate prominant walls. Given
the lack of oral contrast, and the mechanism of injury, this
likely reflects a combination of underdistention and ingested
contents.
4. Bilateral L5 spondylolysis.

CT Maxillofacial
CT FACIAL BONES: There are fractures involving the lateral walls
of the orbits bilaterally, with two fracture lines noted on the
right. Additionally, there are comminuted fractures involving
the medial and lateral walls of the maxillary sinuses, the
ethmoid bone, and the medial and lateral pterygoid plates on the
right. There is a fracture line extending through the left side
of the hard palate. The comminuted fracture in the
posterolateral wall of the right maxillary sinus also extends to
involve the posterior inferior orbital floor at that location.
There is prolapse of muscle and fat into the right maxillary
sinus. There is a fracture through the anterior aspect of the
lesser [**Doctor First Name 362**] of the sphenoid. The ethmoid and frontal air cells
are well aerated. There are fractures through the angle of the
mandible bilaterally (comminuted on the left), with leftward
displacement of the body mandible.
Blood and fluid can be seen within both maxillary sinuses.
Additionally, there is soft tissue air adjacent to the left
lateral maxillary wall.
IMPRESSION: There are multiple facial fractures, as described
above.
NOTE ADDED AT ATTENDING REVIEW: There are bilateral zygomatic
arch fractures.

CT C-Spine:
IMPRESSION:
1. No fracture or spondylolisthesis of the cervical vertebral
bodies is identified.
2. Bilateral mandibular rami fracture.

CT HEAD WITHOUT IV CONTRAST:
IMPRESSION:
1. No intracranial hemorrhage is identified.
2. Multiple facial fractures are seen, as described above. These
are better evaluated on the dedicated CT scan of the facial
bones, performed on the same day.

AP CHEST AND AP PELVIS:
IMPRESSION: No fracture or pneumothorax identified.

Brief Hospital Course:
Patient admitted to the trauma service from the ED with multiple
facial fractures, B/L mandibular fractured, and L. distal radius
fracture. Patient admitted to trauma step-down with telemetry. A
daubhoff tube was placed on [**8-16**] for tubefeeds.  Patient was
followed by orthopedics, plastics, OMFS, and neurology. On [**8-17**],
patient had 3 episodes of asymptomatic skipped heartbeats. On
[**8-22**], patient was brought to OR for ORIF of L. distal radial
fracture and ORIF of facial and mandibular fractures. Patient
was intubated via fiberoptic nasotracheal approach. There were
no complications.  Patient was transferred to the TSICU post-op.
 Given extensive facial swelling, he was intubated until [**8-25**]
when chest XRay indicated improved aeration.  He was extubated
uneventfully.  Patient was transferred to the floor on [**8-26**]. On
[**8-27**] tube feeds were stopped as he was able to take sufficient PO
intake via a straw.

He did not have witnessed seizure activity during this
hospitalization.

Medications on Admission:
Depakote

Discharge Medications:
1. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15) ML
Mucous membrane  QID (4 times a day).
Disp:*1800 ML(s)* Refills:*2*
2. Colace 150 mg/15 mL Liquid Sig: Ten (10) mL PO twice a day as
needed for constipation: take colace while taking codeine to
prevent constipation.
Disp:*200 mL* Refills:*0*
3. Acetaminophen-Codeine 120-12 mg/5 mL Elixir Sig: Ten (10) mL
PO every 4-6 hours as needed for pain.
Disp:*200 mL* Refills:*0*
4. Ibuprofen 100 mg/5 mL Suspension Sig: Twenty (20) mL PO three
times a day as needed for pain.
Disp:*200 mL* Refills:*0*
5. Erythromycin 5 mg/g Ointment Sig: 0.5 cm Ophthalmic  four
times a day: QID in OU; [**Hospital1 **] to incision sites.
Disp:*1 tube* Refills:*0*
6. Valproic Acid 250 mg/5 mL Syrup Sig: Ten (10) mL PO three
times a day.
Disp:*500 mL* Refills:*2*
7. Keppra 100 mg/mL Solution Sig: Five (5) mL PO twice a day.
Disp:*350 mL* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Multiple facial fractures including B/L mandibular fracture
with displacement, B/L orbital wall fracture, fracture of hard
palate.
2. Left distal radial fracture.


Discharge Condition:
Good


Discharge Instructions:
You were hospitalized at [**Hospital1 18**] after a fall.  From the fall, you
had multiple facial and jaw fractures, and a fracture of your
left wrist.

To treat your jaw fracture, your jaw has been wired.  You will
only be able to drink liquids until the wires are removed.  You
should try to drink 5 cans or BOOST or ENSURE (liquid
nutritional supplement) each day to make sure that you get
enough nutrition.

You have been given a pair of wire cutters.  If you develop any
difficulty breathing, start vomiting or choke, you should use
the wirecutters to cut the wires keeping your jaw shut.  You
should then go immediately to an Emergency Department.

You should continue to wear the splint on your wrist until
otherwise notified by orthopedics.

Please call doctor or go to the emergency department for:
*fever greater than 101
*nausea/vomiting
*inability to eat
*wound redness/warmth/swelling/foul smelling drainage
*difficulty breathing
*pain not controlled by pain medications
*numbness or weakness in your left hand/fingers
*increased swelling or increased pain in your left hand/fingers
*if your left hand/fingers turn blue or cold
*seizures
*if you have to clip the wires on your jaw
*if you develop confusion, are excessively drowsy/difficult to
awaken
*any other symptoms that concern you.

Please resume taking all medications as taken prior to this
surgery and pain medications and stool softener as prescribed.
For your seizures, you have been prescribed dilantin (valproic
acid) and keppra.

Please follow-up as directed.

Followup Instructions:
You will follow-up weekly at the [**Hospital 40530**] clinic (Friday afternoons)
with Dr. [**First Name (STitle) **] until further notice.  Please call [**Telephone/Fax (1) 274**]
to make an appointment.

You should follow-up with Plastic Surgery on Friday [**2132-9-5**] (call [**Telephone/Fax (1) 5343**] to make an appointment).

You should follow-up with orthopedics with Dr. [**Last Name (STitle) **] 10 days
after your surgery (i.e. around [**8-31**]).  Call [**Telephone/Fax (1) 1228**]
to make an appointment.

We have schedule a follow-up appointment with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] (Neurology) on [**2132-9-18**] at 12:00.  Call
[**Telephone/Fax (1) 5285**] for directions or if you need to change this
appointment. Provider: [**Name Initial (NameIs) 1220**]. [**Name5 (PTitle) **] & [**Doctor Last Name **]
Phone:[**Telephone/Fax (1) 5285**] Date/Time:[**2132-9-18**] 12:00

You should follow-up with your primary care physician [**Last Name (NamePattern4) **] [**1-21**]
weeks.

You should contact [**Name (NI) **] at [**Telephone/Fax (1) 253**] to make a
follow-up appointment.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2132-8-28**]
{'Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Other closed fractures of distal end of radius (alone),Closed fracture of mandible, unspecified site,Closed fracture of base of other metacarpal bone(s),Accidental fall from ladder,Epilepsy, unspecified, without mention of intractable epilepsy,Personal history of noncompliance with medical treatment, presenting hazards to health'}


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: Fall from ladder 20 feet after sustaining a seizure

PRESENT ILLNESS: 31 M fell from 20 foot ladder after a questionable seizure,
GCS15, combative at scene, hemodynamically stable,
neurologically intact.

MEDICAL HISTORY: Seizure disorder

MEDICATION ON ADMISSION: Depakote

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T= 100.4 HR=120 BP=125/89 saO2=100% 2L
GEN: GCS15, combative, following commands
HEENT: blood around face, abrasion R. cheek, blood from nose, TM
clear, tenderness of midface, L. mandible
NECK: c-collar, trachea midline
CHEST: CTA B/L
HEART: RRR
ABD: soft, NT, ND, FAST -
RECTAL: good tone, guaic -
BACK: logroll with tenderness over T/L spine, no bruises
EXT: B/L knees with bruises, - swelling, l. wrist
tender/swelling
NEURO: MOEx4 sensation intact x4, all peripheral pulses palpable

FAMILY HISTORY: n/a

SOCIAL HISTORY: +tobacco, +EtOH, -drugs 

### Response:
{'Closed fracture of base of skull without mention of intra cranial injury, unspecified state of consciousness,Other closed fractures of distal end of radius (alone),Closed fracture of mandible, unspecified site,Closed fracture of base of other metacarpal bone(s),Accidental fall from ladder,Epilepsy, unspecified, without mention of intractable epilepsy,Personal history of noncompliance with medical treatment, presenting hazards to health'}
