CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 21-year-old
male who was the driver involved in a high speed motor
vehicle collision car versus tree, and was unrestrained,
positive loss of consciousness at the scene.  He was
transferred by ambulance to [**Hospital 189**] [**Hospital 107**] Hospital.  X-rays
there had demonstrated a closed fracture of the right femur.
Traction not applied.  Right leg traction was applied, and
the patient was transferred to the [**Hospital1 190**] for further management.  Patient also had
Venodyne boots placed and was stable through the transfer.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: Denies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of shaft of femur,Injury to liver without mention of open wound into cavity, unspecified injury,Alcohol abuse, unspecified,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle
Fx femur shaft-closed,Liver injury NOS-closed,Alcohol abuse-unspec,Loss control mv acc-driv
Admission Date:  [**2119-3-18**]       Discharge Date:  [**2119-3-22**]

Date of Birth:   [**2098-1-6**]       Sex:  M

Service:  Trauma Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 21-year-old
male who was the driver involved in a high speed motor
vehicle collision car versus tree, and was unrestrained,
positive loss of consciousness at the scene.  He was
transferred by ambulance to [**Hospital 189**] [**Hospital 107**] Hospital.  X-rays
there had demonstrated a closed fracture of the right femur.
Traction not applied.  Right leg traction was applied, and
the patient was transferred to the [**Hospital1 190**] for further management.  Patient also had
Venodyne boots placed and was stable through the transfer.

PAST MEDICAL HISTORY:  None.

MEDICATIONS:  None.

ALLERGIES:  Denies.

PHYSICAL EXAMINATION:  On examination, heart rate was 108,
blood pressure 128/60, respiratory rate 18, and O2 saturation
100%.  In general, the patient appeared to be a young male in
moderate distress with right leg traction applied.  The
patient was awake, alert, but was disoriented.  Pupils are
equal, round, and reactive to light.  Midface was stable.
Tympanic membranes were clear.  Trachea was midline.  There
was a right laceration over the chin as well as an abrasion
on the right face.  The neck was nontender and the collar was
in place.  Examination of the chest revealed bilateral breath
sounds that were clear to auscultation.  Cardiac examination
was tachycardic with a regular rhythm.  Abdomen was soft,
nondistended.  FAST scan was negative.  Rectal examination
revealed normal tone, heme negative.  Genitourinary
examination:  The patient had a Foley placed.  On examination
of the back, there was no tenderness, no step-offs.  The
extremities revealed the right lower leg with traction
applied.  DP and PT pulses were 2+ bilaterally.

LABORATORY:  Sodium 148, potassium 3.7, chloride 109,
bicarbonate 25, BUN 11, creatinine was 1.0, glucose 131,
white blood cell count 17.2, hematocrit 40.9, platelets 118.
PT 12.5, PTT 19.2, INR 1.0.  Serum tox screen revealed EtOH
count of 111.  Fibrinogen was 180.  Amylase 190.  Urinalysis
showed large blood, [**11-9**] red cells.

On imaging, chest x-ray was significant for a widen
mediastinum at 9.6 mm.  Pelvic films were negative for
dislocation.  Abdominal CT scan revealed liver hematoma.
There is a question of free air present in the bladder on CT
scan.  CT scan of the mandible was negative for fracture.
CTA was negative.  Plain film of the right femur revealed a
transverse fracture of the proximal femur with full shaft
with posteromedial displacement with slight varus angulation.
No fracture or dislocation over the knee or lower leg was
detected.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D.  [**MD Number(1) 521**]

Dictated By:[**Last Name (NamePattern1) 28534**]
MEDQUIST36

D:  [**2119-3-22**]  19:10
T:  [**2119-3-23**]  05:47
JOB#:  [**Job Number 46224**]


Name:  [**Known lastname 8486**], [**Known firstname 8487**]                           Unit No:  [**Numeric Identifier 8488**]

Admission Date:  [**2119-3-18**]     Discharge Date:  [**2119-3-22**]

Date of Birth:   [**2098-1-6**]     Sex:  M

Service:

To continue, the patient was admitted to the Trauma Service.
The plan was to admit the patient to the Intensive Care Unit
for serial hematocrit and abdominal examinations.  The
Orthopedic Service was consulted for the right lower
extremity fracture.  The patient's hematocrit was found to be
serially 39.9, and subsequently 37.3.  The patient was then
taken to the operating room by the Orthopedic Service for
open reduction internal fixation of the right femur fracture,
which was repaired with a right IM nail.

The patient was transferred back to the SICU postoperatively.
Postoperative hematocrit was 38.0.  On hospital day two, the
patient was found to be doing well.  Amylase initially was
elevated and it was now 98 on repeat.  The patient was found
to have an adequate urine output.  He was febrile
postoperatively with a temperature max of 101.4.

The patient was subsequently transferred out to the floor.
On postoperative day two, the patient was found to be doing
well, but was still febrile.  A repeat abdominal CT scan was
obtained because of a persistently elevated liver function
tests.  Initially ALT on presentation was 479 and was 304,
and by discharge it was 186.  AST on presentation was 318 and
then trended down to 162 and was 182 on discharge.  This
repeat CT scan of the abdomen was read as significant for
improved size of the intraparenchymal hematoma.  This was
previously measured at 7.9 x 6.8 cm and a repeat was 5.6 x
3.2 cm with no ductile dictation, no extravasation of blood,
and no free fluid in the abdomen.  There is a small hematoma
in the gluteus maximus on the right side measuring 3.4 x 2.2.

Per the Orthopedic Service, the patient's weightbearing was
to be partial weightbearing (50%) on the right lower
extremity.  Patient was maintained on subQ Heparin
perioperatively.  The patient's hematocrit was stable and the
patient continued to improve.  On postoperative day four, the
patient had been afebrile for 24 hours, and pain was well
controlled on po pain medication, and the patient was
ambulating per Physical Therapy with crutches.  The patient
was voiding, tolerating po, and was afebrile over the last 24
hours.  The patient was subsequently discharged home to
followup in Trauma Clinic as well as with the Orthopedic
Service, Dr. [**First Name (STitle) **].  Arrangements were made and prescriptions
were provided for the patient to arrange for home Physical
Therapy.

The patient provided disability paperwork which is also
filled out and sent over to his insurance company.

DISCHARGE STATUS:  Discharged to home with services.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSES:
1. Status post motor vehicle crash.
2. Status post closed right femur fracture.
3. Status post intraparenchymal liver hematoma.
4. Status post open reduction internal fixation right femur
fracture.

DISCHARGE MEDICATIONS:
1. Percocet 1-2 tablets po q4-6h prn pain, #40 tablets.
2. Colace 100 mg po bid.

FOLLOW-UP INSTRUCTIONS:  The patient was instructed to
followup in Trauma Clinic in two weeks and call for an
appointment at [**Telephone/Fax (1) 8489**].  The patient was also instructed
to followup in 10 days of Dr. [**First Name (STitle) **] of the Orthopedic Service,
[**Telephone/Fax (1) 5972**].




                          [**First Name11 (Name Pattern1) 1080**] [**Last Name (NamePattern4) 3711**], M.D.  [**MD Number(1) 3712**]

Dictated By:[**Last Name (NamePattern1) 8475**]

MEDQUIST36

D:  [**2119-3-22**]  19:23
T:  [**2119-3-23**]  06:10
JOB#:  [**Job Number 8490**]
{'Closed fracture of shaft of femur,Injury to liver without mention of open wound into cavity, unspecified injury,Alcohol abuse, unspecified,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of 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: The patient is a 21-year-old
male who was the driver involved in a high speed motor
vehicle collision car versus tree, and was unrestrained,
positive loss of consciousness at the scene.  He was
transferred by ambulance to [**Hospital 189**] [**Hospital 107**] Hospital.  X-rays
there had demonstrated a closed fracture of the right femur.
Traction not applied.  Right leg traction was applied, and
the patient was transferred to the [**Hospital1 190**] for further management.  Patient also had
Venodyne boots placed and was stable through the transfer.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: Denies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of shaft of femur,Injury to liver without mention of open wound into cavity, unspecified injury,Alcohol abuse, unspecified,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle'}
