CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 82 y.o. female unrestrained driver of motor vehicle, struck
another car at low speed, veered off and struck a stone wall
head on. Denies LOC, but does not recall events. Transported to
[**Hospital1 18**] for further care.

MEDICAL HISTORY: PMH: emphysema, TIA 3y ago, CHF, crtical aortic stenosis
PSH: tonsillectomy, appy,carpal tunnel release X2, cataract
surgery X2

MEDICATION ON ADMISSION: detrol LA 4', spirinolactone 12.5', ranexa 500:, toprol 100', Fe
325", Dilt 240', coumadin 5'
ALL: PCN

ALLERGIES: Penicillins

PHYSICAL EXAM: Upon admission:
O: T:98.7  BP: 130/80    HR: 62   R:16  O2Sats: 96%RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3 to 2 mm, bilaterally. EOMIs intact.
Face: 4cm laceration upper lip, sutured
Neck: Posterior neck pain on palpation. C-collar in place
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, obese
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor:
      D    B     T    WE   WF    IP    Q  H     AT    [**Last Name (un) 938**]    G
R     5    5     5     5    5     5    5  5      5     5     5
L     5    5     5     5    5     5    5  5      5     5     5

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Closed dislocation, third cervical vertebra,Contusion of lung without mention of open wound into thorax,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Syncope and collapse,Open wound of lip, without mention of complication,Aortic valve disorders,Other emphysema,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Atrial fibrillation,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of large intestine,Unspecified glaucoma,Other abnormal glucose,Poisoning by sympatholytics [antiadrenergics],Other iatrogenic hypotension,Accidental poisoning by sympatholytics [antiadrenergics],Old myocardial infarction
Disloc 3rd cerv vert-cl,Lung contusion-closed,Mv collision NOS-driver,Syncope and collapse,Open wound of lip,Aortic valve disorder,Emphysema NEC,Long-term use anticoagul,Hx TIA/stroke w/o resid,Atrial fibrillation,CHF NOS,Chronic kidney dis NOS,Hx of colonic malignancy,Glaucoma NOS,Abnormal glucose NEC,Poisoning-sympatholytics,Iatrogenc hypotnsion NEC,Acc poisn-sympatholytics,Old myocardial infarct
Admission Date:  [**2152-11-9**]              [**Month/Day/Year **] Date:   [**2152-11-15**]

Date of Birth:  [**2070-9-23**]             Sex:   F

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
[**2152-11-9**] Suture lip laceration

History of Present Illness:
82 y.o. female unrestrained driver of motor vehicle, struck
another car at low speed, veered off and struck a stone wall
head on. Denies LOC, but does not recall events. Transported to
[**Hospital1 18**] for further care.

Past Medical History:
PMH: emphysema, TIA 3y ago, CHF, crtical aortic stenosis
PSH: tonsillectomy, appy,carpal tunnel release X2, cataract
surgery X2


Family History:
Noncontributory

Physical Exam:
Upon admission:
O: T:98.7  BP: 130/80    HR: 62   R:16  O2Sats: 96%RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3 to 2 mm, bilaterally. EOMIs intact.
Face: 4cm laceration upper lip, sutured
Neck: Posterior neck pain on palpation. C-collar in place
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, obese
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor:
      D    B     T    WE   WF    IP    Q  H     AT    [**Last Name (un) 938**]    G
R     5    5     5     5    5     5    5  5      5     5     5
L     5    5     5     5    5     5    5  5      5     5     5

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Reflexes: B Pa Ac
Right     2 2  2
Left      2 2  2

Propioception intact


Pertinent Results:
[**2152-11-10**] 12:00AM   CK(CPK)-140
[**2152-11-10**] 12:00AM   CK-MB-6 cTropnT-0.03*
[**2152-11-9**] 02:00PM   CALCIUM-9.9 PHOSPHATE-3.2 MAGNESIUM-2.3
[**2152-11-9**] 02:00PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2152-11-9**] 02:00PM   WBC-7.5 RBC-3.91* HGB-12.1 HCT-36.7 MCV-94
MCH-31.1 MCHC-33.1 RDW-14.2
[**2152-11-9**] 02:00PM   PLT COUNT-236
[**2152-11-9**] 02:00PM   PT-31.4* PTT-22.5 INR(PT)-3.1*

Micro/Imaging:
[**2152-11-14**] Impression: Right ICA stenosis <40% .
Left ICA with stenosis <40% .
[**2152-11-12**] ucx 10,000-100,000 ORGANISMS alpha strep or
lactobacillus
[**2152-11-11**] MR [**Last Name (Titles) 12784**] C4-5 herniation, mod-severe spinal stenosis,
spinal cord compress
[**2152-11-10**] CT sinus no facial bone fracture, upper lip laceration

[**2152-11-10**] Left knee no fracture
[**2152-11-10**] TTE [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1915**], LVEF 70%, AV stenosis <.8cm2, AV mod
thickened
[**2152-11-9**] CT-Head No acute intracranial injury.
[**2152-11-9**] CT-Neck Disc bugling at C3/4, with central canal narrow

[**2152-11-9**] CT-Torso ?Pulm contusion, thrombus in coronary sinus,
old left rib fx


Brief Hospital Course:
She was admitted to the Trauma service. Her lip laceration was
sutured by Plastic surgery in the ED. Neurosurgery was consulted
for disc bulging at level of C3,4 and an MRI was recommended,
she was kept in a hard collar until final [**Location (un) 1131**] of the MRI.
Final [**Location (un) 1131**] revealed large central disc herniation at C4-5
level resulting in moderate-to- severe spinal stenosis and
extrinsic indentation on the spinal cord; mild-to-moderate
spinal stenosis due to small disc herniation at C3-4
level; no abnormal signal within the spinal cord and multilevel
degenerative changes at other levels. The collar was then
removed and no further neurosurgery follow up is being
recommended at this time. The patient will however be given the
name and number of Dr. [**Last Name (STitle) 548**], Neurosurgery if she has any
concerns regarding her cervical spine after [**Last Name (STitle) **].

She was noted with a hypotensive and bradycardic episode while
on the regular nursing unit triggering a transfer to the trauma
ICU. She was given IVF bolus and started on a Levophed drip. She
was eventually weaned off, adjustments in her cardiac meds were
made and she was transferred back to the regular nursing unit.

She was evaluated by Cardiology because of concerns that motor
vehicle crash was related to syncopal episode. She was ruled out
for MI with serial CK's and troponin and underwent ECHO and TTE.
 Her ECHO revealed the left atrium mildly dilated; moderate
symmetric left ventricular hypertrophy with left ventricular
cavity size normal. Overall left ventricular systolic function
is normal (LVEF 70%). Right ventricular chamber size and free
wall motion are normal. Aortic valve leaflets are moderately
thickened. There is critical aortic valve stenosis (valve area
<0.8cm2). The mitral valve leaflets are mildly thickened. There
is no mitral valve prolapse. Trivial mitral regurgitation is
seen. The estimated pulmonary artery systolic pressure is
normal. There is no pericardial effusion. The carotid series
revealed <40% right ICA and left ICA stenosis. Several
recommendations were made for continuing the beta blockade for
her atrial fibrillation and anticoagulation with Coumadin for
thromboembolic prophylaxis. She received Coumadin 2.5 mg on
[**11-14**], her INR on [**11-15**] was 2.6. She will need to follow up with
her primary cardiologist Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Hospital 1411**] Medical after
[**Hospital **] from hospital.

Cardiac surgery was consulted for AVR given the critical AS, it
was discussed with patient and her son to that surgery was
indicated. The patient at this time has declined any surgical
intervention.

Physical and Occupational therapy were consulted and have
recommended rehab after her acute hospital stay.




Medications on Admission:
detrol LA 4', spirinolactone 12.5', ranexa 500:, toprol 100', Fe
325", Dilt 240', coumadin 5'
ALL: PCN


[**Hospital **] Medications:
1. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed for sleep.
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for Constipation.
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO HS (at bedtime) as needed for
Constipation.
6. Ranolazine 500 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO bid ().
7. Spironolactone 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).

8. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
9. Tolterodine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
12. Bimatoprost 0.03 % Drops Sig: One (1) drop Ophthalmic once a
day: OU.
13. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO ONCE (Once)
for 1 doses: Goal INR [**3-14**].
14. Insulin Regular Human 100 unit/mL Solution Sig: One (1) dose
Injection four times a day as needed for per sliding scale: see
attached sliding scale for dosing.


[**Month/Day (3) **] Disposition:
Extended Care

Facility:
[**Location (un) 86**] Center - [**Location (un) 2312**]

[**Location (un) **] Diagnosis:
s/p Motor vehicle crash
C3,4 disc bulging w/ central canal narrowing
Lip laceration

Secondary disgnosis:
Syncopal episode
Critical Aortic Stenosis

[**Location (un) **] Condition:
Hemodynamically stable, tolerating a regular diet, pain
adequately controlled.

[**Location (un) **] Instructions:
DO NOT drive until you are given medical clearance to do so from
your cardiologist.

Followup Instructions:
Follow up with your primary cardiolost Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] within a
week after dicharge from rehab. You will need to call for an
appointment.

Follow up with your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **] from
rehab, you will need to call for an appointment.

For any concerns related to your cervical spine disc bulge you
may follow up with Dr. [**Last Name (STitle) 548**], Neurosurgery by calling
[**Telephone/Fax (1) 2992**] if an appointment is needed.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2152-11-21**]
{'Closed dislocation, third cervical vertebra,Contusion of lung without mention of open wound into thorax,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Syncope and collapse,Open wound of lip, without mention of complication,Aortic valve disorders,Other emphysema,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Atrial fibrillation,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of large intestine,Unspecified glaucoma,Other abnormal glucose,Poisoning by sympatholytics [antiadrenergics],Other iatrogenic hypotension,Accidental poisoning by sympatholytics [antiadrenergics],Old myocardial infarction'}


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 Motor vehicle crash

PRESENT ILLNESS: 82 y.o. female unrestrained driver of motor vehicle, struck
another car at low speed, veered off and struck a stone wall
head on. Denies LOC, but does not recall events. Transported to
[**Hospital1 18**] for further care.

MEDICAL HISTORY: PMH: emphysema, TIA 3y ago, CHF, crtical aortic stenosis
PSH: tonsillectomy, appy,carpal tunnel release X2, cataract
surgery X2

MEDICATION ON ADMISSION: detrol LA 4', spirinolactone 12.5', ranexa 500:, toprol 100', Fe
325", Dilt 240', coumadin 5'
ALL: PCN

ALLERGIES: Penicillins

PHYSICAL EXAM: Upon admission:
O: T:98.7  BP: 130/80    HR: 62   R:16  O2Sats: 96%RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3 to 2 mm, bilaterally. EOMIs intact.
Face: 4cm laceration upper lip, sutured
Neck: Posterior neck pain on palpation. C-collar in place
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, obese
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor:
      D    B     T    WE   WF    IP    Q  H     AT    [**Last Name (un) 938**]    G
R     5    5     5     5    5     5    5  5      5     5     5
L     5    5     5     5    5     5    5  5      5     5     5

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Closed dislocation, third cervical vertebra,Contusion of lung without mention of open wound into thorax,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Syncope and collapse,Open wound of lip, without mention of complication,Aortic valve disorders,Other emphysema,Long-term (current) use of anticoagulants,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Atrial fibrillation,Congestive heart failure, unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of large intestine,Unspecified glaucoma,Other abnormal glucose,Poisoning by sympatholytics [antiadrenergics],Other iatrogenic hypotension,Accidental poisoning by sympatholytics [antiadrenergics],Old myocardial infarction'}
