CHIEF COMPLAINT: L arm pain

PRESENT ILLNESS: 64F pedestrian struck.  Was crossing the street and was hit by a
car traveling an unknown MPH.  Pt experienced loss of
consciousness, doesn't remember being hit or falling to the
ground.  Evaluated by trauma team, c/o isolated left shoulder
pain.

MEDICAL HISTORY: coronary artery disease, s/p coronary artery bypass [**2173-9-8**]
PMH:
Hypertension
hyperlipidemia
Peripheral Arterial Disease
Carotid Artery Disease
Bilateral subclavian stenosis s/p L stent [**5-23**]
Chronic back pain/Head ache on narcotics
Herpes Simplex

MEDICATION ON ADMISSION: 2. Acyclovir 400 mg PO Q12H
PRN cold sores. Pt may refuse if not needed
3. Amlodipine 10 mg PO DAILY
BP<100
4. Aspirin 325 mg PO DAILY
5. Atorvastatin 10 mg PO DAILY
6. BuPROPion (Sustained Release) 150 mg PO BID
7. Clopidogrel 75 mg PO DAILY
9. Furosemide 20 mg PO DAILY
BP<100
10. Isosorbide Mononitrate 30 mg PO DAILY
BP<100, HR<60
11. Lisinopril 40 mg PO DAILY
BP<100
12. Metoprolol Tartrate 12.5 mg PO BID
Hold BP<100, HR<60
15. Sertraline 100 mg PO DAILY
16. Tizanidine 2 mg PO TID
hold BP<100

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: AOx3
NAD
Breathing comfortably, speaking in full sentences
RUE skin clean and intact
No tenderness, deformity, erythema, edema, induration or
ecchymosis
Arms and forearms are soft
LUE: incision on shoulder c/d/i; dressed
No other skin changes.
Axillary, R/M/U SITLT
EPL FPL EIP EDC FDP FDI fire
2+ radial pulses
LLE: ttp at lateral malleolus with mild swelling. Wrapped in
ACE-bandage.

FAMILY HISTORY: Father died of MI age 50, mother with MI age 65

SOCIAL HISTORY: Lives with:alone
Occupation:financial planner
Tobacco:quit age 32
ETOH:6 glasses/week
Closed fracture of surgical neck of humerus,Acute posthemorrhagic anemia,Hypotension, unspecified,Contusion of face, scalp, and neck except eye(s),Pain in joint, ankle and foot,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Depressive disorder, not elsewhere classified,Peripheral vascular disease, unspecified,Aortocoronary bypass status,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Personal history of malignant melanoma of skin,Personal history of tobacco use,Other acquired absence of organ
Fx surg nck humerus-clos,Ac posthemorrhag anemia,Hypotension NOS,Contusion face/scalp/nck,Joint pain-ankle,Hypertension NOS,Hyperlipidemia NEC/NOS,Ocl mlt bi art wo infrct,Depressive disorder NEC,Periph vascular dis NOS,Aortocoronary bypass,Mv coll w pedest-pedest,Hx-malig skin melanoma,History of tobacco use,Acq absence of organ NEC
Admission Date:  [**2175-8-9**]              Discharge Date:   [**2175-8-14**]

Date of Birth:  [**2110-12-10**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 8587**]
Chief Complaint:
L arm pain

Major Surgical or Invasive Procedure:
L humerus ORIF


History of Present Illness:
64F pedestrian struck.  Was crossing the street and was hit by a
car traveling an unknown MPH.  Pt experienced loss of
consciousness, doesn't remember being hit or falling to the
ground.  Evaluated by trauma team, c/o isolated left shoulder
pain.


Past Medical History:
coronary artery disease, s/p coronary artery bypass [**2173-9-8**]
PMH:
Hypertension
hyperlipidemia
Peripheral Arterial Disease
Carotid Artery Disease
Bilateral subclavian stenosis s/p L stent [**5-23**]
Chronic back pain/Head ache on narcotics
Herpes Simplex

coronary artery disease, s/p coronary artery bypass [**2173-9-8**]
PMH:
Hypertension
hyperlipidemia
Peripheral Arterial Disease
Carotid Artery Disease
Bilateral subclavian stenosis s/p L stent [**5-23**]
Chronic back pain/Head ache on narcotics
Herpes Simplex


Social History:
Lives with:alone
Occupation:financial planner
Tobacco:quit age 32
ETOH:6 glasses/week


Family History:
Father died of MI age 50, mother with MI age 65


Physical Exam:
AOx3
NAD
Breathing comfortably, speaking in full sentences
RUE skin clean and intact
No tenderness, deformity, erythema, edema, induration or
ecchymosis
Arms and forearms are soft
LUE: incision on shoulder c/d/i; dressed
No other skin changes.
Axillary, R/M/U SITLT
EPL FPL EIP EDC FDP FDI fire
2+ radial pulses
LLE: ttp at lateral malleolus with mild swelling. Wrapped in
ACE-bandage.

Pertinent Results:
[**2175-8-9**] 10:00PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.019
[**2175-8-9**] 10:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-TR
[**2175-8-9**] 10:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-TR
[**2175-8-9**] 10:00PM URINE  RBC-1 WBC-2 BACTERIA-FEW YEAST-NONE
EPI-1 TRANS EPI-<1
[**2175-8-9**] 10:00PM URINE  HYALINE-15*
[**2175-8-9**] 10:00PM URINE  MUCOUS-OCC
[**2175-8-9**] 01:45PM   PT-11.1 PTT-27.3 INR(PT)-1.0

Brief Hospital Course:
The patient was admitted to the Orthopaedic Trauma Service for
repair of a L Humerus fracture. The patient was taken to the OR
and underwent an uncomplicated ORIF L Humerus. The patient
tolerated the procedure without complications and was
transferred to the PACU in stable condition.  Please see
operative report for details. Post operatively pain was
controlled with a PCA with a transition to PO pain meds once
tolerating POs.  The patient became hypotensive on POD1 and was
transferred to the TSICU for further care. Due to acute blood
loss anemia, she was transfused 2UPRBC. The patient tolerated
diet advancement without difficulty and made steady progress
with PT.

Weight bearing status: NWB LUE. Sling for comfort.

The patient received peri-operative antibiotics as well as
lovenox for DVT prophylaxis.  The incision was clean, dry, and
intact without evidence of erythema or drainage; and the
extremity was NVI distally throughout.  The patient was
discharged in stable condition with written instructions
concerning precautionary instructions and the appropriate
follow-up care. All questions were answered prior to discharge
and the patient expressed readiness for discharge.


Medications on Admission:
2. Acyclovir 400 mg PO Q12H
PRN cold sores. Pt may refuse if not needed
3. Amlodipine 10 mg PO DAILY
BP<100
4. Aspirin 325 mg PO DAILY
5. Atorvastatin 10 mg PO DAILY
6. BuPROPion (Sustained Release) 150 mg PO BID
7. Clopidogrel 75 mg PO DAILY
9. Furosemide 20 mg PO DAILY
BP<100
10. Isosorbide Mononitrate 30 mg PO DAILY
BP<100, HR<60
11. Lisinopril 40 mg PO DAILY
BP<100
12. Metoprolol Tartrate 12.5 mg PO BID
Hold BP<100, HR<60
15. Sertraline 100 mg PO DAILY
16. Tizanidine 2 mg PO TID
hold BP<100


Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
2. Acyclovir 400 mg PO Q12H
PRN cold sores. Pt may refuse if not needed
3. Amlodipine 10 mg PO DAILY
BP<100
4. Aspirin 325 mg PO DAILY
5. Atorvastatin 10 mg PO DAILY
6. BuPROPion (Sustained Release) 150 mg PO BID
7. Clopidogrel 75 mg PO DAILY
8. Docusate Sodium 100 mg PO BID
9. Furosemide 20 mg PO DAILY
BP<100
10. Isosorbide Mononitrate 30 mg PO DAILY
BP<100, HR<60
11. Lisinopril 40 mg PO DAILY
BP<100
12. Metoprolol Tartrate 12.5 mg PO BID
Hold BP<100, HR<60
13. OxycoDONE (Immediate Release)  5-10 mg PO Q4H:PRN pain
After PCA has been d/c
RX *oxycodone 5 mg [**2-13**] Tablet(s) by mouth q4hrs Disp #*90 Tablet
Refills:*0
14. Senna 1 TAB PO BID:PRN constipation
15. Sertraline 100 mg PO DAILY
16. Tizanidine 2 mg PO TID
hold BP<100
17. Zolpidem Tartrate 5 mg PO HS:PRN insomnia


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
status post L humerus fracture ORIF


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
******SIGNS OF INFECTION**********
should experience severe pain, increased swelling, decreased
sensation, difficulty with movement; fevers >101.5, chills,
redness or drainage at the incision site; chest pain, shortness
of breath or any other concerns.
-Wound Care: You can get the wound wet/take a shower starting
from 3 days post-op. No baths or swimming for at least 4 weeks.
Any stitches or staples that need to be removed will be taken
out at your 2-week follow up appointment. No dressing is needed
if wound continued to be non-draining.

******WEIGHT-BEARING*******
Non weight bearing L arm

******MEDICATIONS***********
- Resume your pre-hospital medications.
- You have been given medication for your pain control. Please
do not operate heavy machinery or drink alcohol when taking this
medication. As your pain improves please decrease the amount of
pain medication. This medication can cause constipation, so you
should drink 8-8oz glasses of water daily and take a stool
softener (colace) to prevent this side effect.
-Medication refills cannot be written after 12 noon on Fridays.

******FOLLOW-UP**********
Please have your staples removed at your rehabilitation facility
at post-operative day 14.

Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**11-26**] days
post-operation for evaluation. Call [**Telephone/Fax (1) 1228**] to schedule
appointment upon discharge.

Please follow up with your PCP regarding this admission and any
new medications/refills.

Physical Therapy:
NWB LUE
Treatments Frequency:
dry to dry; staples to be removed at 10-14 days

Followup Instructions:
******FOLLOW-UP**********
Please have your staples removed at your rehabilitation facility
at post-operative day 14.

Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**11-26**] days
post-operation for evaluation. Call [**Telephone/Fax (1) 1228**] to schedule
appointment upon discharge.

Please follow up with your PCP regarding this admission and any
new medications/refills.

Please call Cognitive Neurology for further testing given your
recent loss of consciousness: [**Telephone/Fax (1) 6335**].



Completed by:[**2175-8-14**]
{'Closed fracture of surgical neck of humerus,Acute posthemorrhagic anemia,Hypotension, unspecified,Contusion of face, scalp, and neck except eye(s),Pain in joint, ankle and foot,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Depressive disorder, not elsewhere classified,Peripheral vascular disease, unspecified,Aortocoronary bypass status,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Personal history of malignant melanoma of skin,Personal history of tobacco use,Other acquired absence of organ'}


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: L arm pain

PRESENT ILLNESS: 64F pedestrian struck.  Was crossing the street and was hit by a
car traveling an unknown MPH.  Pt experienced loss of
consciousness, doesn't remember being hit or falling to the
ground.  Evaluated by trauma team, c/o isolated left shoulder
pain.

MEDICAL HISTORY: coronary artery disease, s/p coronary artery bypass [**2173-9-8**]
PMH:
Hypertension
hyperlipidemia
Peripheral Arterial Disease
Carotid Artery Disease
Bilateral subclavian stenosis s/p L stent [**5-23**]
Chronic back pain/Head ache on narcotics
Herpes Simplex

MEDICATION ON ADMISSION: 2. Acyclovir 400 mg PO Q12H
PRN cold sores. Pt may refuse if not needed
3. Amlodipine 10 mg PO DAILY
BP<100
4. Aspirin 325 mg PO DAILY
5. Atorvastatin 10 mg PO DAILY
6. BuPROPion (Sustained Release) 150 mg PO BID
7. Clopidogrel 75 mg PO DAILY
9. Furosemide 20 mg PO DAILY
BP<100
10. Isosorbide Mononitrate 30 mg PO DAILY
BP<100, HR<60
11. Lisinopril 40 mg PO DAILY
BP<100
12. Metoprolol Tartrate 12.5 mg PO BID
Hold BP<100, HR<60
15. Sertraline 100 mg PO DAILY
16. Tizanidine 2 mg PO TID
hold BP<100

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: AOx3
NAD
Breathing comfortably, speaking in full sentences
RUE skin clean and intact
No tenderness, deformity, erythema, edema, induration or
ecchymosis
Arms and forearms are soft
LUE: incision on shoulder c/d/i; dressed
No other skin changes.
Axillary, R/M/U SITLT
EPL FPL EIP EDC FDP FDI fire
2+ radial pulses
LLE: ttp at lateral malleolus with mild swelling. Wrapped in
ACE-bandage.

FAMILY HISTORY: Father died of MI age 50, mother with MI age 65

SOCIAL HISTORY: Lives with:alone
Occupation:financial planner
Tobacco:quit age 32
ETOH:6 glasses/week 

### Response:
{'Closed fracture of surgical neck of humerus,Acute posthemorrhagic anemia,Hypotension, unspecified,Contusion of face, scalp, and neck except eye(s),Pain in joint, ankle and foot,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Depressive disorder, not elsewhere classified,Peripheral vascular disease, unspecified,Aortocoronary bypass status,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Personal history of malignant melanoma of skin,Personal history of tobacco use,Other acquired absence of organ'}
