CHIEF COMPLAINT: self inflicted stab wound to abdomen

PRESENT ILLNESS: Patient is 40 yo woman with extensive psychiatric history who is
Medflighted from outside hospital after stabbing herself in the
abdomen with a pearing knife. The patient called EMS herself.
EMS arrived and found patient with a knife in the epigastrium.
EMS was unable to intubate the patient, and she was transported
with an LMA. She was hemodynamically stable throughout
transport.

MEDICAL HISTORY: Insulin dependent DM
HTN
s/p cholecystectomy
s/p suicide attempts (overdose)
s/p cutting behavior

MEDICATION ON ADMISSION: Effexor XR 150mg qd
Trazodone 300qhs
Seroquel 200 qHs
Xanax 1 TID
ReVia 50 qd
Insulin

ALLERGIES: Codeine / Sulfa (Sulfonamides)

PHYSICAL EXAM: 110/palp   HR 130   O2SAT 100%
NAD
pupils equal 3mm nonreactive, NGT/LMA in place
C-collar in place
CTA bilateral
RRR
knife handle protruding from midline epigastrium, angled toward
patient's left
stabilizing bulky dressing in place
FAST exam negative
No edema of extremity
Paralyzed secondary to sedation.

FAMILY HISTORY: Brother - EtOH
Maternal Aunt - schizophrenia

SOCIAL HISTORY: Denies Hx drugs/occ EtOH/denies tobacco
Divorced x 5 yrs
lives with 1 son, divorced x 5 yrs
unemployed, on Welfare
Injury to other intra-abdominal organs with open wound into cavity, peritoneum,Acidosis,Suicide and self-inflicted injury by cutting and piercing instrument,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension,Posttraumatic stress disorder,Major depressive affective disorder, single episode, unspecified,Unemployment
Peritoneum injury-open,Acidosis,Injury-cut instrument,DMII wo cmp nt st uncntr,Long-term use of insulin,Hypertension NOS,Posttraumatic stress dis,Depress psychosis-unspec,Unemployment
Admission Date:  [**2139-7-24**]              Discharge Date:   [**2139-7-30**]

Date of Birth:  [**2098-11-21**]             Sex:   F

Service: SURGERY

Allergies:
Codeine / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
self inflicted stab wound to abdomen

Major Surgical or Invasive Procedure:
exploratory laparotomy


History of Present Illness:
Patient is 40 yo woman with extensive psychiatric history who is
Medflighted from outside hospital after stabbing herself in the
abdomen with a pearing knife. The patient called EMS herself.
EMS arrived and found patient with a knife in the epigastrium.
EMS was unable to intubate the patient, and she was transported
with an LMA. She was hemodynamically stable throughout
transport.

Past Medical History:
Insulin dependent DM
HTN
s/p cholecystectomy
s/p suicide attempts (overdose)
s/p cutting behavior

Social History:
Denies Hx drugs/occ EtOH/denies tobacco
Divorced x 5 yrs
lives with 1 son, divorced x 5 yrs
unemployed, on Welfare

Family History:
Brother - EtOH
Maternal Aunt - schizophrenia

Physical Exam:
110/palp   HR 130   O2SAT 100%
NAD
pupils equal 3mm nonreactive, NGT/LMA in place
C-collar in place
CTA bilateral
RRR
knife handle protruding from midline epigastrium, angled toward
patient's left
stabilizing bulky dressing in place
FAST exam negative
No edema of extremity
Paralyzed secondary to sedation.

Pertinent Results:
[**2139-7-24**] 06:27PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-30
GLUCOSE-250 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2139-7-24**] 06:27PM   FIBRINOGE-324
[**2139-7-24**] 06:27PM   PT-12.5 PTT-24.4 INR(PT)-1.0
[**2139-7-24**] 06:27PM   PLT COUNT-243
[**2139-7-24**] 06:27PM   WBC-9.6 RBC-4.77 HGB-12.9 HCT-36.9 MCV-77*
MCH-27.0 MCHC-34.9 RDW-14.4
[**2139-7-24**] 06:27PM URINE  bnzodzpn-POS barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2139-7-24**] 06:27PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2139-7-24**] 06:27PM   AMYLASE-64
[**2139-7-24**] 06:27PM   UREA N-7 CREAT-0.6
[**2139-7-24**] 06:28PM   GLUCOSE-200* LACTATE-3.5* NA+-140 K+-4.1
CL--104
[**2139-7-24**] 06:28PM   PO2-143* PCO2-42 PH-7.41 TOTAL CO2-28 BASE
XS-2
[**2139-7-24**] 07:11PM   freeCa-1.09*

CXR
1. Extremely low lung volumes on this limited study, but no
definite evidence
of pneumothorax or hydrothorax. PA and lateral films should be
obtained when
the patient is able.

2. Extremely distended gaseous stomach.


Brief Hospital Course:
Patient was immediately transferred to the operating room for
exploratory laparotomy, which showed violation of the peritoneum
but no intraabdominal solid/hollow organ injury.
Postoperatively, she was placed on an epidural
dilaudid/lidocaine infusion for pain control, and transferred to
the floor. On POD#0, whe began to become tachycardic to the
130s-150s, febrile, and had difficulty maintaining adequate
saturation. EKG showed sinus tachycardia. Pan culture was
negative for acute infection. A work up for pulmonary embolus
was negative, and no acute infiltrates were identified. She was
transferred to the trauma/surgical ICU for closer monitoring.
Over the next 2 days, she defervesced, and her saturations
improved with discontinuation of the epidural anesthesia and
minimization of sedating medications. Her blood pressures were
occasionally low, but responsive to conservative management with
hydration. She did not require pressure support. On HD #4, she
was medically stable and transferred to the floor. Psychiatry
was consulted and reccomended inpatient psychiatric admission.
She remained medically stable throughout the rest of her course,
and was deemed safe for discharge to inpatient psychiatry on
hospital day number 6.

Medications on Admission:
Effexor XR 150mg qd
Trazodone 300qhs
Seroquel 200 qHs
Xanax 1 TID
ReVia 50 qd
Insulin

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*15 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
Disp:*30 Capsule(s)* Refills:*2*

Additionally, patient will be on psychiatric medications at the
discretion of the treating psychiatrist.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] 4

Discharge Diagnosis:
1. stab wound to abdomen (self-inflicted)
2. suicidal ideations


Discharge Condition:
Stable.

Discharge Instructions:
Call or return to the emergency department if you have severely
increased abdominal pain, fevers, or you notice an increased
redness/swelling/pain/discharge around your surgical wound.

Take the pain medication as prescribed.

Followup Instructions:
Follow up in trauma clinic in [**1-29**] weeks. Call 1-[**Telephone/Fax (1) 56358**] for
an appointment.
{'Injury to other intra-abdominal organs with open wound into cavity, peritoneum,Acidosis,Suicide and self-inflicted injury by cutting and piercing instrument,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension,Posttraumatic stress disorder,Major depressive affective disorder, single episode, unspecified,Unemployment'}


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: self inflicted stab wound to abdomen

PRESENT ILLNESS: Patient is 40 yo woman with extensive psychiatric history who is
Medflighted from outside hospital after stabbing herself in the
abdomen with a pearing knife. The patient called EMS herself.
EMS arrived and found patient with a knife in the epigastrium.
EMS was unable to intubate the patient, and she was transported
with an LMA. She was hemodynamically stable throughout
transport.

MEDICAL HISTORY: Insulin dependent DM
HTN
s/p cholecystectomy
s/p suicide attempts (overdose)
s/p cutting behavior

MEDICATION ON ADMISSION: Effexor XR 150mg qd
Trazodone 300qhs
Seroquel 200 qHs
Xanax 1 TID
ReVia 50 qd
Insulin

ALLERGIES: Codeine / Sulfa (Sulfonamides)

PHYSICAL EXAM: 110/palp   HR 130   O2SAT 100%
NAD
pupils equal 3mm nonreactive, NGT/LMA in place
C-collar in place
CTA bilateral
RRR
knife handle protruding from midline epigastrium, angled toward
patient's left
stabilizing bulky dressing in place
FAST exam negative
No edema of extremity
Paralyzed secondary to sedation.

FAMILY HISTORY: Brother - EtOH
Maternal Aunt - schizophrenia

SOCIAL HISTORY: Denies Hx drugs/occ EtOH/denies tobacco
Divorced x 5 yrs
lives with 1 son, divorced x 5 yrs
unemployed, on Welfare 

### Response:
{'Injury to other intra-abdominal organs with open wound into cavity, peritoneum,Acidosis,Suicide and self-inflicted injury by cutting and piercing instrument,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension,Posttraumatic stress disorder,Major depressive affective disorder, single episode, unspecified,Unemployment'}
