CHIEF COMPLAINT: Motorcycle crash

PRESENT ILLNESS: This patient is a 54 year old male who complains of MCC.
Transferred from outside hospital after motor cycle accident. He
was reportedly riding with a helmet in the [**Doctor Last Name 6641**], and had some
accident leading him to fall off his bike. He was extricated
from the [**Doctor Last Name 6641**] by his friend on the back of the motorcycle and
EMS was called. He was in significant respiratory distress upon
paramedic arrival, and with no right-sided breath sounds, needle
decompression was
performed with a rush of air and moderate symptomatic
improvement. He was taken to the outside hospital where he had
recurrent respiratory distress with oxygen saturations in the
low 80s. He was intubated which was reportedly a very
difficult intubation with a oxygenation nadir of 50% but
ultimate tube placement was successful. A chest tube on the
right was placed with return of air only. No other imaging was
undertaken at outside hospital. He is brought in by med flight
was hemodynamically stable en route

MEDICAL HISTORY: Epilepsy, DM1

MEDICATION ON ADMISSION: Diclofen 75', keppra 750''', lyrica 150'', phenobarb 150 qpm,
Potiga 50', insulin 15 units in pm, 10 in pm, unknown what type

ALLERGIES: phenytoin

PHYSICAL EXAM: On arrival to the ED:
Constitutional: Intubated sedated
HEENT: Pupils equal, round and reactive to light,
Extraocular muscles intact, Normocephalic, atraumatic
C. collar in place ET tube in place
Chest: Right-sided chest tube, no crepitus
Cardiovascular: Regular Rate and Rhythm
Abdominal: Soft, Nontender, Nondistended
GU/Flank: No costovertebral angle tenderness
Extr/Back: No clear long bone fractures
Skin: No rash
Neuro: Intubated sedated

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Patient is a school teacher
Closed fracture of scapula, other,Closed fracture of two ribs,Traumatic pneumothorax without mention of open wound into thorax,Injury to other intra-abdominal organs without mention of open wound into cavity, adrenal gland,Closed fracture of acromial end of clavicle,Closed fracture of nasal bones,Other motor vehicle nontraffic accident involving collision with stationary object injuring motorcyclist,Contusion of lung without mention of open wound into thorax,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled,Long-term (current) use of insulin
Fx scapula NEC-closed,Fracture two ribs-closed,Traum pneumothorax-close,Adrenal gland injury-cl,Fx clavicl, acrom end-cl,Nasal bone fx-closed,Oth coll stnd obj-mocycl,Lung contusion-closed,Epilep NOS w/o intr epil,DMI wo cmp uncntrld,Long-term use of insulin
Admission Date:  [**2114-7-23**]              Discharge Date:   [**2114-7-29**]

Date of Birth:  [**2060-5-17**]             Sex:   M

Service: SURGERY

Allergies:
phenytoin

Attending:[**First Name3 (LF) 3200**]
Chief Complaint:
Motorcycle crash

Major Surgical or Invasive Procedure:
None


History of Present Illness:
This patient is a 54 year old male who complains of MCC.
Transferred from outside hospital after motor cycle accident. He
was reportedly riding with a helmet in the [**Doctor Last Name 6641**], and had some
accident leading him to fall off his bike. He was extricated
from the [**Doctor Last Name 6641**] by his friend on the back of the motorcycle and
EMS was called. He was in significant respiratory distress upon
paramedic arrival, and with no right-sided breath sounds, needle
decompression was
performed with a rush of air and moderate symptomatic
improvement. He was taken to the outside hospital where he had
recurrent respiratory distress with oxygen saturations in the
low 80s. He was intubated which was reportedly a very
difficult intubation with a oxygenation nadir of 50% but
ultimate tube placement was successful. A chest tube on the
right was placed with return of air only. No other imaging was
undertaken at outside hospital. He is brought in by med flight
was hemodynamically stable en route



Past Medical History:
Epilepsy, DM1


Social History:
Patient is a school teacher


Family History:
non-contributory

Physical Exam:
On arrival to the ED:
Constitutional: Intubated sedated
HEENT: Pupils equal, round and reactive to light,
Extraocular muscles intact, Normocephalic, atraumatic
C. collar in place ET tube in place
Chest: Right-sided chest tube, no crepitus
Cardiovascular: Regular Rate and Rhythm
Abdominal: Soft, Nontender, Nondistended
GU/Flank: No costovertebral angle tenderness
Extr/Back: No clear long bone fractures
Skin: No rash
Neuro: Intubated sedated


Pertinent Results:
CT Chest/Abdomen/Pelvis [**2114-7-23**]:
IMPRESSION:

1.  Comminuted right scapular fracture with subscapular
hematoma.  Minimally displaced right distal clavicular fracture.
 Non-displaced fractures of right first rib at costovertebral
junction and posterior right fourth rib.
2.  Trace right apical pneumothorax.  Widespread consolidation
in the
posterior right upper and lower lobes, compatible with traumatic
injury such as pulmonary hemorrhage.  Probable
hematopneumatocele in medial aspect of right lower lobe.  Small
posterior left lower lobe consolidation.
3.  Right chest tube may be within the right major fissure, but
intrusion into the pulmonary parenchyma is hard to definitively
excluded, though doubted.  Moderate right chest wall
subcutaneous emphysema.
4.  Right adrenal gland hemorrhage, which appears to be in
continuity with fluid adjacent to the IVC as well as the right
anterior pararenal space.  The IVC appears patent but is
narrowed and IVC injury cannot be excluded.
5.  NG tube terminates in the distal esophagus and should be
advanced for
optimal positioning.  Moderate gastric distention.
6.  Clips and postoperative changes in lower anterior pelvis,
compatible with prior inguinal hernia repair.  Small bowel
approaches and may be adherent to the region of repair.

[**2114-7-23**] CT Head:
IMPRESSION:  No evidence of intracranial hemorrhage or acute
calvarial
fracture.  Mildly impacted isolated fracture of the nasal bones.


[**2114-7-23**] CT c-spine:
No cervical spine fracture, acute alignment abnormality, or
prevertebral
soft tissue abnormality.

[**2114-7-23**] SHOULDER (AP, NEUTRAL & AXILLARY) TRAUMA RIGHT
1.  No dislocation of the acromioclavicular or glenohumeral
joints.
2.  Minimally displaced distal right clavicular fracture.
3.  Comminuted right scapular fracture and right-sided rib
fractures are
better depicted on concurrent CT study.
4.  Tiny apical right pneumothorax also better seen on
accompanying CT.
5.  Moderate subcutaneous emphysema and dense right upper lung
opacities may represent contusion.



[**2114-7-23**] 09:10PM   WBC-14.6* RBC-4.34* HGB-14.8 HCT-43.1 MCV-99*
MCH-34.1* MCHC-34.3 RDW-12.1
[**2114-7-23**] 09:10PM   PT-12.4 PTT-19.2* INR(PT)-1.1
[**2114-7-23**] 09:10PM   PLT COUNT-267
[**2114-7-23**] 09:10PM   FIBRINOGE-92*
[**2114-7-23**] 09:10PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-POS tricyclic-NEG
[**2114-7-23**] 09:10PM   LIPASE-42
[**2114-7-23**] 09:10PM   UREA N-22* CREAT-1.2
[**2114-7-23**] 09:36PM   TYPE-ART TEMP-37 RATES-18/ TIDAL VOL-500
PEEP-5 O2-100 PO2-298* PCO2-60* PH-7.22* TOTAL CO2-26 BASE XS--4
AADO2-361 REQ O2-64 INTUBATED-INTUBATED VENT-CONTROLLED


Brief Hospital Course:
Mr. [**Known lastname 26991**] was admitted on [**2114-7-23**] to the trauma ICU under the
Acute Care Surgery service. The [**Date Range **] trauma service was
consulted upon admission and followed the patient throughout his
hospital course. Initially he was kept intubated; on hospital
day 2 his c-collar was removed once his c-spine was cleared. He
was extubated on hospital day 1, and his respiratory status
remained stable on face mask and then nasal cannula. His NGT was
removed and he was advanced to clears, which he tolerated. Pain
was well controlled on dilaudid PCA and he was neurologically
intact. On hospital day 3, he remained stable on nasal cannula,
tolerating diet, with pain controlled with PCA. He was
transferred to the floor on hospital day 3, [**2114-7-25**].

On the evening of [**7-25**] he was transferred to the floor
hemodynamically stable without respiratory compromise. On the
morning of [**7-26**] his chest tube was placed to waterseal. After
near complete resolution of his apical pneumothorax, his chest
tube was pulled on [**7-28**], and post-pull chest x-ray showed no new
changes. While on the floor he worked with occupational therapy
to improve his cognitive and functioning in activities of daily
living, and he was advanced to a regular diet which he tolerated
well. He was maintained on subcutaneous heparin for DVT
prophylaxis. He complained of some right lower extremity
swelling on [**7-28**], and ultrasound revealed a saphenous vein
thrombosis but no DVT. He was recommended leg elevation and
assured that further management for this is not necessary. One
additional chest x-ray was taken prior to his discharge, which
showed a stable tiny right apical pneumothorax, and he was
discharged home with visiting nurse services and a prescription
for occupational therapy home visits, and will have follow-up
with trauma surgery clinic (with repeat chest x-ray) and
orthopedic surgery.

Medications on Admission:
Diclofen 75', keppra 750''', lyrica 150'', phenobarb 150 qpm,
Potiga 50', insulin 15 units in pm, 10 in pm, unknown what type

Discharge Medications:
1. Pregabalin 150 mg PO BID
2. PHENObarbital 150 mg PO QPM
3. LeVETiracetam 750 mg PO TID
4. Acetaminophen 650 mg PO Q6H:PRN pain
5. Diclofenac Sodium DR 75 mg PO DAILY:PRN arthritis
6. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily
Disp #*30 Capsule Refills:*0
7. ezogabine *NF* 100 mg Oral TID Reason for Ordering: Wish to
maintain preadmission medication while hospitalized, as there is
no acceptable substitute drug product available on formulary.
8. HYDROmorphone (Dilaudid) 2-4 mg PO Q3H:PRN pain
RX *hydromorphone 2 mg 1 tablet(s) by mouth every 3 hours Disp
#*40 Tablet Refills:*0
9. Outpatient Occupational Therapy
Patient requires outpatient occupational rehab services -
cognitive training, IADL assessment, upper extremity range of
motion exercises
10. Senna 1 TAB PO BID:PRN constipation


Discharge Disposition:
Home

Discharge Diagnosis:
s/p motorcycle crash:
Injuries:
Right comminuted scapula fracture
Minimally displaced right distal clavicular fracture
Small right apical pneumothorax
Non-displaced fractures of right first rib at costovertebral
junction and posterior right fourth rib

Right adrenal hematoma


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Lethargic but arousable.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital after a motorcycle crash. You
were noted to have difficulty breathing by EMS at the scene of
the accident and required a breathing tube and chest tube
placement for air around your lung at the outside hospital. You
were then transferred to [**Hospital1 18**] for ICU care. The breathing tube
was removed and you were able to breath on your own. The air
around your improved and your chest tube was removed.

You also have a broken shoulder blade (scapular) and collar bone
(clavicle), broken ribs, and a hematoma around your adrenal
gland. These injuries did not require intervention. You should
follow up in the [**Hospital **] clinic and in the Acute Care Surgery
clinic at the appointments scheduled for you below.

Do not bear weight on your right arm. You may wear the sling for
comfort to support your arm.

You sustained rib fractures which can cause severe pain and
subsequently cause you to take shallow breaths because of the
pain.
You should take your pain medicine as as directed to stay ahead
of the pain otherwise you won't be able to take deep breaths.
If the pain medication is too sedating, take half the dose and
notify your physician.
[**Name10 (NameIs) **] is a complication of rib fractures. In order to
decrease your risk you must use your incentive spirometer 4
times every hour while awake. This will help expand the small
airways in your lungs and assist in coughing up secretions that
pool in the lungs.
You will be more comfortable if you use a cough pillow to hold
against your chest and guard your rib cage while coughing and
deep breathing.
Symptomatic relief with ice packs or heating pads for short
periods may ease the pain.
Do NOT smoke.
Return to the ED right away for any acute shortness of breath,
increased pain or crackling sensation around your rips
(crepitus).
Narcotic pain medication can cause constipation. Thefore you
should take a stool softener twice daily and increase your fluid
and fiber intake if possible.
If your doctor allows, non steriodal anti-inflammatory drugs are
very effective in controlling pain (i.e. Ibuprofen, Motrin,
Advil, Aleve, Naprosyn) but they have their own set of side
effects so make sure your doctor approves.

Followup Instructions:
Orthopedic Surgery
Provider: [**Name10 (NameIs) **] XRAY (SCC 2) Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2114-8-9**] 12:00
Provider: [**First Name11 (Name Pattern1) 2191**] [**Last Name (NamePattern4) 2192**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 1228**]
Date/Time:[**2114-8-9**] 12:20
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6403**], MD Phone:[**Telephone/Fax (1) 1690**]
Date/Time:[**2114-8-16**] 1:00

**Please call Acute Care Surgery/Trauma clinic ([**Telephone/Fax (1) 600**])
to follow up in 2 weeks. Have them schedule you for a chest
X-ray with radiology on the same day before your appointment
{'Closed fracture of scapula, other,Closed fracture of two ribs,Traumatic pneumothorax without mention of open wound into thorax,Injury to other intra-abdominal organs without mention of open wound into cavity, adrenal gland,Closed fracture of acromial end of clavicle,Closed fracture of nasal bones,Other motor vehicle nontraffic accident involving collision with stationary object injuring motorcyclist,Contusion of lung without mention of open wound into thorax,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled,Long-term (current) use of insulin'}


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: Motorcycle crash

PRESENT ILLNESS: This patient is a 54 year old male who complains of MCC.
Transferred from outside hospital after motor cycle accident. He
was reportedly riding with a helmet in the [**Doctor Last Name 6641**], and had some
accident leading him to fall off his bike. He was extricated
from the [**Doctor Last Name 6641**] by his friend on the back of the motorcycle and
EMS was called. He was in significant respiratory distress upon
paramedic arrival, and with no right-sided breath sounds, needle
decompression was
performed with a rush of air and moderate symptomatic
improvement. He was taken to the outside hospital where he had
recurrent respiratory distress with oxygen saturations in the
low 80s. He was intubated which was reportedly a very
difficult intubation with a oxygenation nadir of 50% but
ultimate tube placement was successful. A chest tube on the
right was placed with return of air only. No other imaging was
undertaken at outside hospital. He is brought in by med flight
was hemodynamically stable en route

MEDICAL HISTORY: Epilepsy, DM1

MEDICATION ON ADMISSION: Diclofen 75', keppra 750''', lyrica 150'', phenobarb 150 qpm,
Potiga 50', insulin 15 units in pm, 10 in pm, unknown what type

ALLERGIES: phenytoin

PHYSICAL EXAM: On arrival to the ED:
Constitutional: Intubated sedated
HEENT: Pupils equal, round and reactive to light,
Extraocular muscles intact, Normocephalic, atraumatic
C. collar in place ET tube in place
Chest: Right-sided chest tube, no crepitus
Cardiovascular: Regular Rate and Rhythm
Abdominal: Soft, Nontender, Nondistended
GU/Flank: No costovertebral angle tenderness
Extr/Back: No clear long bone fractures
Skin: No rash
Neuro: Intubated sedated

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Patient is a school teacher 

### Response:
{'Closed fracture of scapula, other,Closed fracture of two ribs,Traumatic pneumothorax without mention of open wound into thorax,Injury to other intra-abdominal organs without mention of open wound into cavity, adrenal gland,Closed fracture of acromial end of clavicle,Closed fracture of nasal bones,Other motor vehicle nontraffic accident involving collision with stationary object injuring motorcyclist,Contusion of lung without mention of open wound into thorax,Epilepsy, unspecified, without mention of intractable epilepsy,Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled,Long-term (current) use of insulin'}
