CHIEF COMPLAINT: 

PRESENT ILLNESS: He is a 46-year-old gentleman
who fell 10 feet into an elevator shaft.  He had a loss of
consciousness for approximately 1 hour.  He had confirmed
injuries and fractures of L1 and L5, a right clavicle
fracture, and multiple rib fractures, a right maxillary sinus
fracture, and a subdural hematoma.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He works as a funeral director.
Subarachnoid hemorrhage following injury without mention of open intracranial wound, with moderate [1-24 hours] loss of consciousness,Contusion of lung without mention of open wound into thorax,Closed fracture of lumbar vertebra without mention of spinal cord injury,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Other accidental fall from one level to another
Subarach hem-mod coma,Lung contusion-closed,Fx lumbar vertebra-close,Fx clavicle NOS-closed,Fracture one rib-closed,Fall-1 level to oth NEC
Admission Date:                   Discharge Date:

Date of Birth:                    Sex:  M

Service: ORTHO


DIAGNOSES:
1. Right scapular fracture.
2. Closed head injury.
3. Multiple lumbar fractures.


HOSPITAL COURSE:  On the day of admission, Mr. [**Known lastname **] was
evaluated for his closed injury which was associated with
loss of consciousness.  He was cleared for subarachnoid
hemorrhage by the Neurosurgery Service after a repeat scan
revealed no significant mass expansion.  A head laceration
was repaired.

Orthopaedics evaluated him for a right shoulder injury -
which included a scapular fracture and possible rotator cuff
dysfunction.  He will follow up with General Orthopaedics for
this.

Upon examination - and throughout his hospitalization - his
neurologic status in the upper and lower extremities remained
intact.  His spinal injuries include compression fractures of
L1 and L2 and a compression fracture/stable burst fracture
pattern superior inner plate fracture of L5.  He experienced
a moderate ileus which resolved with time and diet
restriction.  He was fitted a thoracolumbosacral device and
mobilized to ambulatory status with assistance.  A sling was
used for his right upper extremity.

He has resumed normal bowel and bladder function.

Plan for thoracolumbosacral wear is eight weeks full time and
one month of weaning.  He will follow up in two weeks with
Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 363**] for a radiograph of the spine - AP and
lateral of the lumbar spine - to assess the fracture
alignment and position.  Then, 4-week intervals will be
established for further followup radiographically and
clinically.

He remains temporarily totally disabled from his work
activities for three months from his date of injury.

He and his wife have been counseled regarding the possible
long-term dysfunction related to his injuries - which include
disc disruption and back pain, axial, related to his injury,
but his fractures are in acceptable alignment and position
and he should not have significant risks for malunion and
pain related to that.

DISCHARGE DISPOSITION:  He is discharged to acute
rehabilitation due to the need for upper extremity and
thoracolumbosacral orthosis bracing. He
requires assistance for transitions from bed to
walking and for activities of daily living.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3191**], [**MD Number(1) 3192**]

Dictated By:[**Last Name (NamePattern1) 3193**]
MEDQUIST36
D:  [**2153-9-22**] 09:35:44
T:  [**2153-9-22**] 09:59:22
Job#:  [**Job Number 57156**]

cc:[**Name8 (MD) 57157**]

Admission Date: [**2153-9-18**]        Discharge Date: [**2153-9-26**]

Date of Birth:  [**2107-5-25**]        Sex:  M

Service:  ORTHO


ADDENDUM:  Mr. [**Known lastname **] has slowly improved from the
previous dictation. He has now had a bowel movement and is
cleared for discharge from hospital setting care medically.

His injury list includes:
1. Closed head injury status post subarachnoid hemorrhage.
2. L1 and L2 fractures, compression.
3. L5 fracture, burst pattern.
4. Right scapular fracture
5. Pulmonary contusion and rib fracture.

Overall, Mr. [**Known lastname 57158**] progress has been slow and steady.
He is able to ambulate but has difficulties with transitions.
He is becoming independent in his activities of daily
living. He does not meet the criteria for acute
rehabilitative care. He may benefit from a skilled nursing
situation or home nursing assistance, mainly for activities
of daily living and/or therapeutic aids or devices in the
home.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3191**], [**MD Number(1) 3192**]

Dictated By:[**Last Name (NamePattern1) 3193**]
MEDQUIST36
D:  [**2153-9-26**] 09:01:57
T:  [**2153-9-26**] 09:17:45
Job#:  [**Job Number 57159**]


Admission Date: [**2153-9-18**]        Discharge Date: [**2153-9-28**]

Date of Birth:  [**2107-5-25**]        Sex:  M

Service:  ORT


HISTORY OF PRESENT ILLNESS:  He is a 46-year-old gentleman
who fell 10 feet into an elevator shaft.  He had a loss of
consciousness for approximately 1 hour.  He had confirmed
injuries and fractures of L1 and L5, a right clavicle
fracture, and multiple rib fractures, a right maxillary sinus
fracture, and a subdural hematoma.

HISTORY OF PRESENT ILLNESS:  Noncontributory.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  None.

SOCIAL HISTORY:  He works as a funeral director.

He had a left central sulcus with a small subdural hematoma.
There was no mass effect.  Chest showed a right fifth rib
fracture.  No pneumothorax.

PHYSICAL EXAMINATION AT TIME OF ADMISSION:  He is awake and
alert.  He is in a cervical spine collar.  He has a clavicle
fractur which is mildly tenting the skin and is not an open
fracture. He has good strength throughout the upper extremities
and bilateral lower extremities.
His CT scan showed a C5 spinous process fracture.  The L-
spine showed an L1 fracture and an L5 end plate fracture.
Again, he was kept on bed rest precautions initially.
Neurologically, he remained intact throughout both upper and
lower extremities.  His sensation was intact throughout.

HOSPITAL COURSE:  He was admitted initially to the Trauma
SICU and was followed carefully by the Neurosurgery staff for
2 days.  He was then transferred to the floor.  His lumbar
films appeared to be stable injuries, and he was fitted for a
TLSO brace.  Because of the multiple injuries, he was slow in
terms of his transitioning from bed to chair.  On [**2153-9-23**]
he was noted to have a small effusion on chest x-ray with no
infiltrate.  He had minimal ileus with no nausea or vomiting.
There was no evidence of an acute pneumonic process.  He was
begun on OxyContin for pain relief and Percocet q. 4h.  He
was seen by Physical Therapy, and there was a question
whether he was stable enough to go home given his head injury
and his multiple extremity injuries.  Then, after multiple
discussions with his wife and the Physical Therapy staff and
discharge team, he was felt to be stable to go home on
[**2153-9-28**] with visiting nurse follow-up.

DISCHARGE INSTRUCTIONS:  He is to be followed up in Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] office for repeat x-ray evaluation of the lumbar
spine.  He is to wear the TLSO brace when out of bed.

DISCHARGE CONDITION:  Ambulating independently in the TLSO
brace.

DISCHARGE DIAGNOSES:
1. Small subdural hematoma
2. Multiple rib fractures
3. Clavicle fracture
4. Lumbar spine fracture
5. Cervical spine fracture

He is to follow up in 2 weeks' time.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3191**], [**MD Number(1) 3192**]

Dictated By:[**Last Name (NamePattern4) 57338**]
MEDQUIST36
D:  [**2153-10-16**] 11:01:29
T:  [**2153-10-16**] 11:57:25
Job#:  [**Job Number 57339**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with moderate [1-24 hours] loss of consciousness,Contusion of lung without mention of open wound into thorax,Closed fracture of lumbar vertebra without mention of spinal cord injury,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Other accidental fall from one level to another'}


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: He is a 46-year-old gentleman
who fell 10 feet into an elevator shaft.  He had a loss of
consciousness for approximately 1 hour.  He had confirmed
injuries and fractures of L1 and L5, a right clavicle
fracture, and multiple rib fractures, a right maxillary sinus
fracture, and a subdural hematoma.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He works as a funeral director. 

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with moderate [1-24 hours] loss of consciousness,Contusion of lung without mention of open wound into thorax,Closed fracture of lumbar vertebra without mention of spinal cord injury,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Other accidental fall from one level to another'}
