CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 63 year old
pedestrian who was struck by a car at 40 MPH.  He was
initially seen at [**Doctor Last Name **] [**Hospital 107**] Hospital in [**Location (un) 3844**]
and he was transferred to the [**Hospital6 2018**].  The patient was initiated intubated at [**Doctor Last Name **]
[**Hospital 107**] Hospital and he had left pneumothorax.  A chest tube
was placed on the left side.  He also had left rib fracture,
left humeral shaft fracture and a left subarachnoid
hemorrhage and left open radioulnar fracture, and left
subclavian line was placed at the outside hospital.

MEDICAL HISTORY: Significant for left knee scope and
left thumb amputation in the past.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married with no ethyl
alcohol, tobacco or intravenous drug abuse in the past.
Open fracture of shaft of ulna (alone),Closed dislocation of radiocarpal (joint),Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Cortex (cerebral) contusion without mention of open intracranial wound, with concussion, unspecified,Open wound of other and multiple sites of face, complicated,Traumatic pneumohemothorax without mention of open wound into thorax,Pulmonary collapse,Contusion of lung without mention of open wound into thorax
Fx ulna shaft-open,Disloc radiocarpal-clos,Opn skl/oth fx/menin hem,Cortex contus-concus NOS,Open wnd face NEC-compl,Traum pneumohemothor-cl,Pulmonary collapse,Lung contusion-closed
Name: [**Known lastname 3567**],PACKIE                        Unit No:  [**Numeric Identifier 9346**]

Admission Date:  [**2173-4-12**]     Discharge Date:  [**2173-4-12**]

Date of Birth:   [**2137-1-11**]     Sex:

Service:  TRAUMA

FOLLOW UP:
1.  Orthopedics with Dr. [**Last Name (STitle) 9347**] in one week.
2.  Trauma clinic with Dr. [**Last Name (STitle) 998**] in one month.
3.  [**Hospital 8653**] Clinic with Dr. [**Last Name (STitle) 690**] in one month.
4.  [**Hospital 9348**] Clinic in two weeks with an added comment
that the care facility should ask when they call for this
appointment to see if a repeat head CT prior to the clinic
visit is required.






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

Dictated By:[**Last Name (NamePattern1) 9349**]

MEDQUIST36

D:  [**2200-12-4**]  10:47
T:  [**2200-12-4**]  11:08
JOB#:  [**Job Number 9350**]


Admission Date:  [**2200-11-8**]       Discharge Date:  [**2200-12-4**]

Date of Birth:   [**2137-1-11**]       Sex:  M

Service:  Trauma Surgery Service

HISTORY OF PRESENT ILLNESS:  The patient is a 63 year old
pedestrian who was struck by a car at 40 MPH.  He was
initially seen at [**Doctor Last Name **] [**Hospital 107**] Hospital in [**Location (un) 3844**]
and he was transferred to the [**Hospital6 2018**].  The patient was initiated intubated at [**Doctor Last Name **]
[**Hospital 107**] Hospital and he had left pneumothorax.  A chest tube
was placed on the left side.  He also had left rib fracture,
left humeral shaft fracture and a left subarachnoid
hemorrhage and left open radioulnar fracture, and left
subclavian line was placed at the outside hospital.

PAST MEDICAL HISTORY:  Significant for left knee scope and
left thumb amputation in the past.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient is married with no ethyl
alcohol, tobacco or intravenous drug abuse in the past.

PHYSICAL EXAMINATION:  On admission the patient's vital signs
were temperature 96.5, heartrate 125, blood pressure 124/60,
and the patient was on a ventilator.  Initially in the
Emergency Room, the patient was very critical-appearing and
appeared very sick.  The patient has profound bleeding from
all surfaces, however, trachea appeared to be midline.  The
pupils were 3 mm and sluggishly reactive.  The patient had
bilateral breathsounds although they appear coarse.  The
patient's heart was regular rate and rhythm.  The abdomen was
soft and nondistended at first.  Right upper extremity, he
had elbow radial pulse and right lower extremity with no
obvious injury and palpable dorsalis pedis and posterior
tibial on the right lower extremity.  Initially his APL on
the right side was .88.  His left upper extremity has
shoulder bruises and open forearm fractures, but he has
palpable radial pulse.  His left lower extremity has a bruise
over his left knee and broken deformity and dopplerable
pulses on the left side.  Initially the patient had a
hematocrit of 35.3 and BUN of 20.  Creatinine was 1.1 and his
INR was 1.3.  Lactase was 3.9.  The patient was taken to the
computerized tomography unit to obtain computerized
tomography scan of the head which showed right frontal
contusion, left subdural hemorrhage and left orbital fracture
and fourth rib fracture, right axillary sinus fracture,
basilar skull fracture and petrous bone fracture.
Computerized tomography scan of the spine was done at the
outside hospital which was negative by report.  Computerized
tomographic angiography of the head and neck was negative for
any vessel injury.  Computerized tomography scan of the chest
showed a left clavicular hair fracture and lateral lung
contusion, rib fractures and the patient also had a humeral
head fracture.  Left lower extremity, the patient had a
tibia-fibula fracture and tibial plateau fracture and knee
effusion.  Left upper extremity, the patient had a humerus
fracture and open radial and ulnar fracture.

HOSPITAL COURSE:  In the Emergency Room, an emergent right
chest tube was placed and central line was then placed.
Neurosurgery was consulted, and ICP monitor was placed by
Neurosurgery for monitoring his intracranial pressure and the
patient was given intravenous antibiotics for his open
fracture and Vascular Surgery and Orthopedic Surgery were
also consulted.  Vascular Surgery was consulted for his
deformity in his left knee and decrease of pulse on his left
foot, however, after the patient was being resuscitated his
pulse appeared to be improving in his left foot.  Vascular
Surgery opted to observe the left foot and do frequent pulse
examinations.  The patient's pulse appeared to improve over
the next few days.  No intervention was done by Vascular
Surgery.  Orthopedic after seeing the patient decided to take
the patient to the Operating Room for incision and drainage
and open reduction and internal fixation of his left ulnar
fracture.  The patient was taken by Dr. [**Last Name (STitle) 284**] to the
Operating Room on [**2200-11-8**] and underwent the
incision and drainage and open reduction and internal
fixation of his left forearm fractures.  Postoperatively the
patient was transferred to the Intensive Care Unit to manage
his multiple traumas.  The patient remained intubated and was
placed on SMV and the patient was initially placed on
Dopamine drip and Levophed drip to maintain his blood
pressure.  He was subsequently weaned off.

On postoperative day #1 the patient was put on Vancomycin,
Ceptaz and Clindamycin.  Vancomycin was for his open skull
fracture and Ceptaz was perioperatively for his facial
fractures.  Oromaxillofacial Surgery was consulted for his
facial fractures, which they saw the patient for and
recommended no operative repair and recommended Clindamycin
for ten days for his maxillary facial fracture.  Neurosurgery
was following the patient subsequently for his intracranial
ICP pressures.

On postoperative day #3 Propofol was weaned off and the
patient was placed on SMV ventilation, plus pressure support
and appeared to be oxygenating okay.  The patient had ICP
pressure of 4 and the patient appeared to be somewhat stable.
The patient had a repeat head computerized tomography scan
for Neurosurgery to assess this intracranial hemorrhage which
appeared with no change.  The patient was continued on
Dilantin from Neurosurgery.  The patient also underwent
subsequent head computerized tomography scan again on
[**11-11**] which showed no change in his intracranial
hemorrhage.  The patient's hematocrit was stabilized around
28 and INR was stable around 1.2.  The patient appeared to be
making good urine and appeared to be adequately
fluid-resuscitated.  Attempts were made to try to wean the
patient off of the ventilator.  On [**11-11**], the patient
was taken by the orthopedic surgeon to the Operating Room and
underwent a left tibial plateau fracture repair and open
reduction and internal fixation of the left tibial plateau
fracture.  The patient appeared to tolerate the procedure
well.  Due to the patient's multiple lower extremity traumas
and injuries and due to the patient's heparin bleed the
patient is not able to receive Lovenox for deep vein
thrombosis prophylaxis and an inferior vena cava filter was
then placed.  It was retrievable inferior vena cava filter
which was placed by Dr. [**Last Name (STitle) 22063**] from Vascular Surgery on
[**2200-11-11**].  On [**11-13**], the patient underwent
another head computerized tomography scan which showed no
change in terms of his intracranial bleed or hemorrhage and
ICP drain was then subsequently discontinued by Neurosurgery.
The patient was evaluated by an orthopedic surgeon and his
left shoulder, due to his multiple fractures, and he
underwent a left shoulder hemiarthroplasty on [**2200-11-14**], by the orthopedic surgeon.  The patient tolerated the
procedure well postoperatively and the patient was
transferred to the Intensive Care Unit for further care.
Neurologically the patient was moving all fours and following
commands.  The patient was put on pressure support
ventilation and seemed to be tolerating the pressure support
ventilation.  The patient was placed on spontaneous breathing
trial on [**2200-11-16**] and the patient passed one day of
breathing trial and he was extubated.  Following the
extubation, his chest tube was discontinued.  However, it was
reported over the next several days the patient remained
tenuous in terms of respiratory condition and he has a lot of
secretions that require frequent suctioning and the patient's
mental status deteriorated.  The repeat head computerized
tomography scan shows no change from previous intracranial
bleed.  Neurosurgery opted to observe the patient.

On [**2200-11-18**], the patient had finished a ten day course
of Vancomycin and a ten day course of Clindamycin for
neurosurgery and oromaxillofacial fractures and the patient's
antibiotics were discontinued, and on [**2200-11-18**], the
patient apparently spiked a fever to 101.4.  The patient had
a panculture and sputum grew out Acinetobacter and
pseudomonas and blood culture at the same time grew out
Acinetobacter.  The patient was placed on [**Year (4 digits) **] for
coverage.  Chest x-ray showed small bilateral pleural
effusion, although no frank pneumonia was seen.  The patient
was placed on a course of [**Year (4 digits) **].  At the same time, the
patient's mental status appeared to be the same, still
appeared somewhat sleepy and not really following commands.
The patient has a lot of secretions, requiring frequent
suctioning.  The patient's Dilantin was discontinued, as he
finished a course of 13 days of Dilantin per Neurosurgery.
The patient was started on Lasix for diuresis, as he appeared
to be edematous and his PT was high.

On [**2200-11-21**], the patient had a repeat head
computerized tomography scan which was negative and still
showed the right frontal contusion and subarachnoid
hemorrhage was unchanged.  At the same time the patient was
making good urine and continued the coverage.  The
Acinetobacter was apparently sensitive to [**Last Name (LF) **], [**First Name3 (LF) **] we
will continue the [**First Name3 (LF) **] coverage, although the patient's
later spiked again to 101.9.  The patient was again
pancultured.  On [**11-22**], due to his recent spike, his
antibiotic coverage was broadened to Zosyn, Vancomycin and
Gentamicin and the patient appeared to defervesce with the
new antibiotic coverage, and the patient's incision was
clean, dry and intact.  He has warm palpable pulses distally,
and he moves all four extremities spontaneously, although not
following command.  The patient had a feeding tube placed by
Interventional Radiology and the patient was started on
broadly advanced to O2V of breast pallor at 60 cc/hr.  At the
same time Neurosurgery agreed with heparin subcutaneously for
the patient and the patient was placed on the heparin
subcutaneously and inferior vena cava filter was removed on
[**2200-11-23**] and the patient had bilateral lower
extremity ultrasound which showed no deep vein thromboses,
prior to the inferior vena cava filter extraction.  The
patient was placed on Lovenox 30 subcutaneously b.i.d. for
deep vein thrombosis prophylaxis.  At the same time the
patient's pressure was controlled on Lopressor p.o. and
Captopril was added for better blood pressure control.  On
[**11-25**], a neuropsyche behavior consult was obtained, due
to the patient's stagnant mental status.  The neurologist saw
the patient and recommended a spinal tap and computerized
tomography scan with intravenous contrast to further evaluate
to rule out cerebrovascular accident and rule out the
meningitis, given the patient's history of open skull
fracture.  Computerized tomography scan with intravenous
contrast on [**11-26**], shows no embolic or hemorrhagic
infarct and his right frontal contusion is about the same as
previous.  His left subarachnoid hemorrhage has improved
prior to previous, and a lumbar puncture was performed on the
patient with approximately 10 white blood cells, however, the
lumbar puncture grew out coagulase negative Staphylococcus
for which we consulted Infectious Disease.  They agreed that
coagulase negative Staphylococcus most likely could be a
contaminate of the lumbar puncture and they do not believe
the patient's lumbar tap was indicative of a meningitis.
They recommended to continue 14 days of Zosyn and Vancomycin
for the complete treatment of his respiratory-associated
pneumonia.  The patient's mental status began to gradually
improve over the next few days.

On [**11-30**], the patient began to follow commands and open
eyes and become more responsive.  His secretion at the same
time was beginning to decrease.  The patient was tolerating
tube feeds at 60 cc/hr.  Neurobehavior saw the patient once
again and believed that the patient most likely had altered
behavior pattern and altered mental status due to his frontal
contusion and recommended follow up in the clinic.  The
patient was transferred out to the floor on [**2200-12-3**]
and began to screen for rehabilitation.

Prior to discharge, the patient was afebrile, vital signs
stable, chest clear, abdomen soft, nontender, nondistended,
and the patient has a feeding tube placed and was tolerating
tube feed as goal, tolerating at 60 cc/hr.  The patient still
required chest physical therapy and frequent pulmonary
toileting and frequent suctioning, although was much improved
compared to before.  The patient follows commands and is
responsive to voice, although the patient does not really
verbalize his thoughts much.  The patient moves all four
extremities.  Dressing was clean, dry and intact.  Splint was
noted over his left forearm and he had a knee brace over his
left knee.

The patient is to be discharged to rehabilitation whenever
there is a bed available.

DISCHARGE MEDICATIONS:  .................. 60 cc/hr and
Captopril 6.25 p.o. t.i.d., Lovenox 30 subcutaneously b.i.d.,
Paxil, Lopressor 50 p.o. t.i.d., Albuterol nebulizers prn,
Sodium chloride tablets two tablets b.i.d.  The patient is to
have q. 4 hour chest physical therapy and incentive
spirometer.  The patient is to have passive range of motion
to his left knee t.i.d. and the patient is to work with
physical therapy for range of motion for his right shoulder
and his elbow.

FOLLOW UP:  The patient is to be followed up with Orthopedic
Surgery in one week and follow up with Trauma Service in
approximately two weeks.  The patient is to be discharged
with a feeding tube.  In two weeks we will assess the patient
again to evaluate him and see if he can take enough p.o. and
see if he can use a more permanent feeding access such as a
percutaneous endoscopic gastrostomy.  The patient underwent a
swallow evaluation prior to discharge, however, due to the
patient's inability to cooperate fully it was felt that it is
far better to continue on with feeding tube for two weeks
prior to arranging for a more permanent access.  It was felt
that the patient is not going to be stable to take in enough
p.o. to sustain himself.





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

Dictated By:[**Dictator Info **]
MEDQUIST36

D:  [**2200-12-3**]  18:01
T:  [**2200-12-3**]  18:13
JOB#:  [**Job Number 50496**]
{'Open fracture of shaft of ulna (alone),Closed dislocation of radiocarpal (joint),Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Cortex (cerebral) contusion without mention of open intracranial wound, with concussion, unspecified,Open wound of other and multiple sites of face, complicated,Traumatic pneumohemothorax without mention of open wound into thorax,Pulmonary collapse,Contusion of lung without mention of open wound into thorax'}


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 63 year old
pedestrian who was struck by a car at 40 MPH.  He was
initially seen at [**Doctor Last Name **] [**Hospital 107**] Hospital in [**Location (un) 3844**]
and he was transferred to the [**Hospital6 2018**].  The patient was initiated intubated at [**Doctor Last Name **]
[**Hospital 107**] Hospital and he had left pneumothorax.  A chest tube
was placed on the left side.  He also had left rib fracture,
left humeral shaft fracture and a left subarachnoid
hemorrhage and left open radioulnar fracture, and left
subclavian line was placed at the outside hospital.

MEDICAL HISTORY: Significant for left knee scope and
left thumb amputation in the past.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married with no ethyl
alcohol, tobacco or intravenous drug abuse in the past. 

### Response:
{'Open fracture of shaft of ulna (alone),Closed dislocation of radiocarpal (joint),Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Cortex (cerebral) contusion without mention of open intracranial wound, with concussion, unspecified,Open wound of other and multiple sites of face, complicated,Traumatic pneumohemothorax without mention of open wound into thorax,Pulmonary collapse,Contusion of lung without mention of open wound into thorax'}
