CHIEF COMPLAINT: s/p Stab wound to abdomen

PRESENT ILLNESS: 36 yo male with PMHx of depression, EtOH abuse, manic
disorder admittted s/p assault with multiple stab wounds to
abdomen and left shoulder. Pt relates that that he had been
attacked by an associate  of his friend on [**7-4**] in
[**Hospital1 **]. Pt had been drinking and was involved in an argument
with his friend. [**Name (NI) **] was stabbed multiple times following a
scuffle. Pt was taken to the OR upon admission for exploratory
laparotomy and incision and drainage of back stab wounds.

MEDICAL HISTORY: Bipolar disorder

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillins

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: h/o substance abuse
Reportedly homeless
Injury to stomach, with open wound into cavity,Pneumonitis due to inhalation of food or vomitus,Injury to liver with open wound into cavity, laceration, unspecified,Open wound of chest (wall), without mention of complication,Seroma complicating a procedure,Assault by cutting and piercing instrument,Tobacco use disorder,Atypical manic disorder,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Stomach injury-open,Food/vomit pneumonitis,Liver lacerat unspcf opn,Open wound of chest,Seroma complicting proc,Assault-cutting instr,Tobacco use disorder,Atypical manic disorder,Abn react-surg proc NEC
Admission Date:  [**2139-7-3**]              Discharge Date:   [**2139-7-15**]

Date of Birth:  [**2102-9-23**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
s/p Stab wound to abdomen

Major Surgical or Invasive Procedure:
[**2139-7-3**] Exploratory laparotomy

History of Present Illness:
36 yo male with PMHx of depression, EtOH abuse, manic
disorder admittted s/p assault with multiple stab wounds to
abdomen and left shoulder. Pt relates that that he had been
attacked by an associate  of his friend on [**7-4**] in
[**Hospital1 **]. Pt had been drinking and was involved in an argument
with his friend. [**Name (NI) **] was stabbed multiple times following a
scuffle. Pt was taken to the OR upon admission for exploratory
laparotomy and incision and drainage of back stab wounds.

Past Medical History:
Bipolar disorder

Social History:
h/o substance abuse
Reportedly homeless

Family History:
Noncontributory

Pertinent Results:
[**2139-7-3**] 10:11PM   GLUCOSE-120* UREA N-8 CREAT-0.6 SODIUM-145
POTASSIUM-4.1 CHLORIDE-114* TOTAL CO2-22 ANION GAP-13
[**2139-7-3**] 10:11PM   CALCIUM-8.0* PHOSPHATE-4.1 MAGNESIUM-1.5*
[**2139-7-3**] 10:11PM   WBC-14.0*# RBC-3.46* HGB-10.7* HCT-32.5*
MCV-94 MCH-31.1 MCHC-33.1 RDW-12.9
[**2139-7-3**] 10:11PM   PLT COUNT-251
[**2139-7-3**] 06:30PM   ASA-NEG ETHANOL-288* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

CTA CHEST W&W/O C&RECONS, NON-CORONARY  [**2139-7-7**] 6:43 AM

No prior CTs available for comparison.

FINDINGS:

The heart is normal in size. There is no pericardial effusion.

The tracheobronchial tree is patent. There are multiple mildly
enlarged mediastinal lymph nodes. For the example, the largest
lymph node in the pretracheal region measures 0.9 cm in short
axis and 1.8 cm in long axis. There is an enlarged right hilar
lymph node that measures 1.0 cm in short axis and 2.0 cm in long
axis. Numerous prevascular, subcarinal and paratracheal lymph
nodes are noted that measure less than 1 cm in greatest
dimension.

Several small bilateral axillary lymph nodes are seen. Most of
these lymph nodes, however, contain fatty hila, small part of
normal internal architecture. The largest lymph node is seen in
the right axilla measures 0.8 x 1.2 cm.

The heart is normal in size. There is no pericardial effusion.
The tracheobronchial tree is patent. The aorta and pulmonary
arteries are normal in caliber. There is no evidence of
pulmonary embolism.

Examination of the lung windows demonstrate several bullae in
paraseptal location at both lung apices.

There are scattered bilateral patchy opacities in both upper and
lower lobes as well as bibasilar patchy consolidations involving
short aspects of both lower lobes. This may be of either
infectious or inflammatory in etiology.

There are several pockets of gas in the left axilla. This may be
either iatrogenic or related to recent stab wound.

There is no evidence of pneumothorax.

BONE WINDOWS: No suspicious lytic or sclerotic lesions are
identified. There is a small, somewhat rounded 6 mm lucency in
the sternum (series 3, image 48), which most likely reflects a
focal area of rarefaction in a patient without known malignancy.

IMPRESSION:

1. No evidence of pulmonary embolism.

2. Bilateral patchy opacities in both upper and lower lobes,
which may be either infectious or inflammatory in etiology.

3. Enlarged mediastinal and right hilar lymph nodes. A followup
dictated chest CT is recommended when the patient's condition
improved, to evaluate for interval change of pulmonary opacities
and lymphadneopathy.

4. Several gas pockets in the soft tissues of the left axilla
which may iatrogenic or may also be related to a recent stab
wound.

CT CHEST W/CONTRAST  [**2139-7-12**] 11:50 AM

CT OF THE CHEST: The paratracheal lymph nodes seen on the prior
study are unchanged in size. There are some small prevascular
and AP window lymph nodes. The heart, pericardium, and great
vessels appear unremarkable. The central airways are patent
without endoluminal lesion.

In the lungs, again seen are bullous changes along the medial
aspect of the right upper lobe. There has been worsening of
ground-glass opacities, now involving a large portion of the
left upper lobe, which were previously much more focal, and
there has been coalescence into a more consolidative focal
opacity in the posterior left upper lobe with air bronchograms
(series 2, image 27). However, in the right upper lobe, there
has been improvement in the multiple opacities seen previously,
which are now more ground-glass in appearance rather than dense
as they were on the prior study. See for example series 2, image
17. More inferiorly, in the right middle lobe, there has also
been slight improvement with a more ground-glass rather than
dense consolidative appearance compared to the previous study.
In the left lower lobe; however, the ground-glass opacities
appear to have slightly worsened and are more extensive
involving the superior segment now to a greater degree than
previously, and the consolidative focal area of opacity in the
left base appears roughly stable though slightly changed in
configuration. There are small bilateral pleural effusions. In
the right lower lobe, areas of more linear opacity have
improved, which were probably atelectatic in nature.

CT OF THE ABDOMEN: There has been a midline incision with skin
staples still noted. There is a small amount of postoperative
fluid just inferior to the incision line with a focal area along
the inferior incision, where the staples have been removed.
Within the left lobe of the liver, there is a fluid collection
measuring 3.8 x 2.9 cm with small foci of air within it
non-dependently. Just posterior and possibly continuous with
this, there is a second fluid collection measuring 3.6 x 2.6 cm,
also with a small focus of air within it and probably within the
liver capsule as well (series 2, image 65). Apart from these
areas, there is no free intra-abdominal air remaining. There
remains mesenteric stranding, particularly in the anterior
abdomen along the area of incision. The gallbladder, adrenal
glands, spleen, pancreas, and kidneys appear unremarkable. Small
retroperitoneal and mesenteric nodes are identified, measuring
up to 9 mm. A small amount of ascites tracks into the pelvis.
The abdominal aorta is of normal caliber. The portal vein is
patent. Loops of small and large bowel appear normal in caliber
and contour. The appendix appears normal. Contrast flows freely
past the stomach, and has reached the rectum.

CT OF THE PELVIS: The bladder, prostate, seminal vesicles, and
rectum are unremarkable. As above, there is a small amount of
free fluid in the pelvis. There is no lymphadenopathy. As
described above, there is a small amount of fluid just under the
area of incision along the abdominal and pelvic midline, which
is probably related to postoperative seroma, although infection
cannot be excluded.

OSSEOUS STRUCTURES: There are no concerning lytic or sclerotic
lesions. There are no fractures apparent.

Within the dermis of the posterior left chest, just behind the
scapula, there are two radiodensities, which are somewhat linear
and may represent a skin staples. Please correlate with exam.

IMPRESSION:

1. Multifocal ground-glass and patchy opacities involving both
lungs, some areas which have demonstrated improvement in the
right lung, however, some areas in the left lung which have
worsened since the previous study.

2. Fluid collections with small foci of air as above within the
left lobe of the liver. A small pocket of fluid just under the
incision line in the lower abdominal/pelvic midline. Infection
in these areas cannot be excluded.

3. No residual free intraperitoneal air. Small amount of free
fluid in the pelvis.

GUIDANCE/LOCALIZATION FOR NEEDLE BIOPSY US (S&I)  [**2139-7-13**] 11:09
AM

ULTRASOUND-GUIDED LIVER ASPIRATION: The risks and benefits of
the procedure were explained to the patient, and written
informed consent was obtained. A preprocedure timeout was
performed using two patient identifiers. Preprocedure scanning
demonstrates a 3-cm heterogeneous predominantly cystic
collection in the left lobe of the liver. Posterior to this
collection is an ill-defined echogenic area, likely
corresponding to the additional collection seen on CT. A
suitable spot was chosen in the mid abdomen for drainage. The
area was prepped and draped in standard sterile fashion. 1%
lidocaine was instilled for local anesthesia. Using ultrasound
guidance, a 20-gauge spinal needle was advanced into the
collection and approximately 5 cc of bloody fluid was aspirated
with near complete collapse of the fluid collection. The sample
was sent for microbiologic analysis. The patient tolerated the
procedure well with no immediate complications. Moderate
sedation was provided using 2 mg of Versed and 100 mcg of
fentanyl in divided doses, and the patient's hemodynamic
parameters were monitored continuously throughout the 20 minute
intraservice time. The attending radiologist, Dr. [**Last Name (STitle) **], was
present and supervising throughout.

IMPRESSION: Successful ultrasound-guided aspiration of left
hepatic fluid collection, with drainage of 5 cc of bloody fluid,
sent for microbiologic analysis.


Brief Hospital Course:
He was admitted to the Trauma service and taken to the operating
room urgently for
exploratory laparotomy, oversewing of stomach laceration,
control of liver laceration bleeding and irrigation and closure
of left chest laceration. There were no reported complications.
Postoperatively he was taken to the Trauma ICU where he remained
for several days.

He was later transferred to the regular nursing unit. He did
have significant pain management issues; initially he was on PCA
narcotics with IV for breakthrough and once he was able to
tolerate po's he was changed to short acting narcotics. He
required higher doses of the oral narcotics and was changed to
long acting narcotics. He was noted to become very sleepy with
higher doses of short acting narcotics. The Acute Pain Service
was consulted to optimize his pain regimen; Neurontin and
NSAID's were added.

He was noted with a fever spike to >103 F; he was cultured,
chest xray done which revealed a significant pneumonia. He was
treated with IV antibiotics but continued to have fevers.
Infectious Disease was the consulted and made several
recommendations regarding his antibiotics, including oral
antibiotics that he was discharged on (Levo & Flagyl for 14
days).

Despite his fevers and consistent reinforcement from medical and
nursing staff he contiued to leave the hopsital to smoke
cigarettes; he did this multiple times during the day. At one
point security officers had to be called and assisted with
returning patient back to his room.

Social work was closely involved during his hospital stay
because of issues surrounding his substance use, nature of the
trauma and his homeless situation. A safe discharge plan was
formulated.


Discharge Medications:
1. Buspirone 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
2. Risperidone 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
3. Divalproex 500 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO BID (2 times a day).
Disp:*120 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
6. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*90 Capsule(s)* Refills:*2*
7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 2 weeks.
Disp:*42 Tablet(s)* Refills:*0*
8. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
9. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q3H (every 3
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
10. Motrin 600 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain: take with food.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
s/p Stab wound to abdomen
Liver laceration
Pneumonia

Discharge Condition:
Good

Discharge Instructions:
Continue with the antibiotics as prescribed for the next 2
weeks, complete the entire course.

Return to the Emergency room if you develop any fevrs, chills,
headache, dizziness, increased shortness of breath, productive
cough, chest pain, abdominal pain different from the pain you
have been experiencing [**Last Name (un) 5720**] your recent surgery, nausea,
vomiting, diarrhea, increased redness or drainage from your
incision and/or any otehr symptoms that are concerning to you.

Followup Instructions:
Follow up next wek with Dr. [**Last Name (STitle) **] in Surgery clinic, call
[**Telephone/Fax (1) 2359**] for an appointment.

Follow up in the Pain Clinic in the next 1-2 weeks, call
[**Telephone/Fax (1) 1652**] for an appointment.


Completed by:[**2139-7-16**]
{'Injury to stomach, with open wound into cavity,Pneumonitis due to inhalation of food or vomitus,Injury to liver with open wound into cavity, laceration, unspecified,Open wound of chest (wall), without mention of complication,Seroma complicating a procedure,Assault by cutting and piercing instrument,Tobacco use disorder,Atypical manic disorder,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: s/p Stab wound to abdomen

PRESENT ILLNESS: 36 yo male with PMHx of depression, EtOH abuse, manic
disorder admittted s/p assault with multiple stab wounds to
abdomen and left shoulder. Pt relates that that he had been
attacked by an associate  of his friend on [**7-4**] in
[**Hospital1 **]. Pt had been drinking and was involved in an argument
with his friend. [**Name (NI) **] was stabbed multiple times following a
scuffle. Pt was taken to the OR upon admission for exploratory
laparotomy and incision and drainage of back stab wounds.

MEDICAL HISTORY: Bipolar disorder

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillins

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: h/o substance abuse
Reportedly homeless 

### Response:
{'Injury to stomach, with open wound into cavity,Pneumonitis due to inhalation of food or vomitus,Injury to liver with open wound into cavity, laceration, unspecified,Open wound of chest (wall), without mention of complication,Seroma complicating a procedure,Assault by cutting and piercing instrument,Tobacco use disorder,Atypical manic disorder,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
