CHIEF COMPLAINT: trauma - MVC

PRESENT ILLNESS: 48M s/p MVC, restrained driver, +air bag deployment, car
rollover onto roof. +EtOH - fell asleep while driving. Found w/
R leg trapped under steering wheel.

MEDICAL HISTORY: PMH:
- Renal insufficiency
- HTN
- EtOH cirrhosis - on liver transplant list
- [**Last Name (un) **] Gastric bypass
- Hypothyroidism
PSH:
- humerus repair
- [**Last Name (un) **] gastric bypass
- cholecystectomy

MEDICATION ON ADMISSION: levothyroxine 50mcg daily, lasix 10 qAM & 5qPM, cialis prn,
oxycontin 80mg tid, oxycodone 5mg TIDprn, gabapentin 200mg TID,
lorazepam 1mg TID, Bactrim DS tab daily, cymbalta 60mg [**Hospital1 **],
combivent 2puffs daily, spironolactone 150mg daily, B12, mag,
amitriptyline 50mg qHS

ALLERGIES: Morphine

PHYSICAL EXAM: Per Admission ED Note:
PE:
 HR:101 BP:107/73 Resp:18 O(2)Sat:96 Normal

FAMILY HISTORY: No family history of liver disease.
Mother died from stroke at young age and history of alcohol
abuse
Father had urethral cancer and history of alcohol abuse.

SOCIAL HISTORY: Reportedly stopped drinking EtOH in [**Month (only) **], but states he drank
prior to this admission. Still smokes 10 cig/day but openly
admits it is more than that. No drug use. Married with two kids.
Closed fracture of two ribs,Hepatic encephalopathy,Other closed fracture of upper end of humerus,Other closed fractures of distal end of radius (alone),Closed fracture of sternal end of clavicle,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Awaiting organ transplant status,Bariatric surgery status,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle
Fracture two ribs-closed,Hepatic encephalopathy,Fx upper humerus NEC-cl,Fx distal radius NEC-cl,Fx clavicl, stern end-cl,Alcohol cirrhosis liver,Alcohol abuse-unspec,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hypothyroidism NOS,Await organ transplnt st,Bariatric surgery status,Loss control mv acc-driv
Admission Date:  [**2146-1-28**]              Discharge Date:   [**2146-2-4**]

Date of Birth:  [**2097-5-1**]             Sex:   M

Service: SURGERY

Allergies:
Morphine

Attending:[**First Name3 (LF) 1390**]
Chief Complaint:
trauma - MVC

Major Surgical or Invasive Procedure:
Epidural placement [**2146-1-28**]

History of Present Illness:
48M s/p MVC, restrained driver, +air bag deployment, car
rollover onto roof. +EtOH - fell asleep while driving. Found w/
R leg trapped under steering wheel.

Past Medical History:
PMH:
- Renal insufficiency
- HTN
- EtOH cirrhosis - on liver transplant list
- [**Last Name (un) **] Gastric bypass
- Hypothyroidism
PSH:
- humerus repair
- [**Last Name (un) **] gastric bypass
- cholecystectomy


Social History:
Reportedly stopped drinking EtOH in [**Month (only) **], but states he drank
prior to this admission. Still smokes 10 cig/day but openly
admits it is more than that. No drug use. Married with two kids.



Family History:
No family history of liver disease.
Mother died from stroke at young age and history of alcohol
abuse
Father had urethral cancer and history of alcohol abuse.

Physical Exam:
Per Admission ED Note:
PE:
 HR:101 BP:107/73 Resp:18 O(2)Sat:96 Normal

Constitutional: Right eye periorbital edema. Ecchymosis of
the right eye. No hyphema. No proptosis. Extraocular eye
movements intact
HEENT: C. collar in place.
Chest: Clear to auscultation. Large area of ecchymosis over
the right anterior chest wall. No crepitus.
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Soft, Nontender, Nondistended
Extr/Back: Lacerations to the right hand and left ankle
stable pelvis.
Neuro: Speech fluent. GCS 15.


Pertinent Results:
IMAGING:
- [**1-28**]: CT Head (wet read): No acute intracranial process
- [**1-28**]: CT C-spine (wet read): 1. left clavicle fx 2. T1 body
fx, likely chronic. 3. Old C7 spinous process fx.
- [**1-28**]: CT Chest/Abd/Pelvis (wet read): 1. left clavicle fx. 2.
sternal fx 3. acute left 7-10th rib fx, displaced from [**9-21**].
4. Healed right and left rib fxs. 5. moderate-severe LLL
atelectasis with a high riding left hemidiagphram. no
diaphraghmatic defect seen.
6. s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] gastric bypass and cholecystectomy.
- [**1-28**]: LEFT UE XRay: 1. Strong suggestion of a re-fracturing
through what is thought to be a likely prior healed fracture of
the proximal humeral diaphysis. 3. There is suggestion of an
impacted non-intraarticular fracture of the distal radius. A
more definite nearly nondisplaced transverse fracture of the
ulnar styloid process is noted with associated soft tissue
swelling.
- [**1-28**]: L ankle XRay: There is no acute fracture or
dislocation.
- [**1-28**]: R Hand Xray: No acute fracture or dislocation is seen.

- [**1-29**] CXR: Elevation of the left hemidiaphragm and left
basilar atelectasis. Multiple rib fractures.
- [**1-29**] CXR: Worsened LLL consolidation


Brief Hospital Course:
Patient admitted to trauma ICU after trauma evaluation/imaging
revealed the following injuries:
L 8-10th rib fx (displaced)
L clavical fx; Sternal fx
L prox humerus fx
L distal radius fx

He was admitted to trauma ICU for pain control and had an
epiduralM (T6) placed on [**1-28**].  Orthopedic surgery was
consulted and recommended a sling to his LUE and plan for
casting on [**2-1**].  His epidural was removed on [**1-30**] without
incident.  On [**1-31**] he was transferred to the surgical floor for
further care.

While on the floor he contined to be confused due to hepatic
encephalopathy due to known liver cirrhosis.  He was seen by
hepatology who made some pharmacologic recommendations and his
confusion resolved over the following 2 days.  At time of
discharge he was alert and oriented to person, place and time
and he was appropriately answering questions.

He was seen by physical therapy while on the floor and they
recommended discharge home with outpatient physical therapy.

At time of discharge, the patient's pain was well controlled, he
was voiding spontaneously and ambulating.  He was not confused,
affect was appropriate and he was alert and oriented.  He was
tolerating a regular diet.

Medications on Admission:
levothyroxine 50mcg daily, lasix 10 qAM & 5qPM, cialis prn,
oxycontin 80mg tid, oxycodone 5mg TIDprn, gabapentin 200mg TID,
lorazepam 1mg TID, Bactrim DS tab daily, cymbalta 60mg [**Hospital1 **],
combivent 2puffs daily, spironolactone 150mg daily, B12, mag,
amitriptyline 50mg qHS

Discharge Medications:
1. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
4. furosemide 20 mg Tablet Sig: 0.25 Tablet PO QPM (once a day
(in the evening)).
5. spironolactone 100 mg Tablet Sig: 1.5 Tablets PO DAILY
(Daily).
6. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
7. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
Disp:*7 Adhesive Patch, Medicated(s)* Refills:*2*
9. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: [**2-13**]
Puffs Inhalation Q4H (every 4 hours) as needed for SOB, wheezes.

10. gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours).
11. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day) as needed for encephalopthy.
Disp:*1000 ML(s)* Refills:*3*
12. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
13. rifaximin 550 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
14. OxyContin 10 mg Tablet Sustained Release 12 hr Sig: Five (5)
Tablet Sustained Release 12 hr PO every twelve (12) hours.
Disp:*300 Tablet Sustained Release 12 hr(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
1. L 8-10th rib fx (displaced)
2. L clavical fx
3. Sternal fx
4. L prox humerus fx
5. L distal radius fx


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


Discharge Instructions:
* You were admitted to the hospital after your car accident with
multiple injuries including left rib fractures, left clavicle
fracture, left proximal humerus fracture and left distal radius
fracture

*You were seen by hepatology while you were admitted to the
hospital and you have to follow-up with your hepatologist as an
outpatient.

*  You should take your pain medication 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.

*  Pneumonia 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.

*  Narcotic pain medication can cause constipation therefore you
should take a stool softener twice daily and increase your fluid
and fiber intake if possible.

*  Do NOT smoke

*  Return to the Emergency Room right away for any acute
shortness of breath, increased pain or crackling sensation
around your ribs (crepitus ).


Followup Instructions:
1. Please call the Acute care Clinic at [**Telephone/Fax (1) 600**] for a
follow up appointment in [**3-17**] weeks

2. Call the [**Hospital **] Clinic at [**Telephone/Fax (1) 1228**] for a follow up
appointment in 2 weeks with Dr. [**Last Name (STitle) **]

3. Please call a physical therapist that is convenient for you
to make an appoitment for outpatient physical therapy, which was
recommended by the physical therapists in the hospital.  You
have been provided with a script for physical therapy.
{'Closed fracture of two ribs,Hepatic encephalopathy,Other closed fracture of upper end of humerus,Other closed fractures of distal end of radius (alone),Closed fracture of sternal end of clavicle,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Awaiting organ transplant status,Bariatric surgery status,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle'}


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: trauma - MVC

PRESENT ILLNESS: 48M s/p MVC, restrained driver, +air bag deployment, car
rollover onto roof. +EtOH - fell asleep while driving. Found w/
R leg trapped under steering wheel.

MEDICAL HISTORY: PMH:
- Renal insufficiency
- HTN
- EtOH cirrhosis - on liver transplant list
- [**Last Name (un) **] Gastric bypass
- Hypothyroidism
PSH:
- humerus repair
- [**Last Name (un) **] gastric bypass
- cholecystectomy

MEDICATION ON ADMISSION: levothyroxine 50mcg daily, lasix 10 qAM & 5qPM, cialis prn,
oxycontin 80mg tid, oxycodone 5mg TIDprn, gabapentin 200mg TID,
lorazepam 1mg TID, Bactrim DS tab daily, cymbalta 60mg [**Hospital1 **],
combivent 2puffs daily, spironolactone 150mg daily, B12, mag,
amitriptyline 50mg qHS

ALLERGIES: Morphine

PHYSICAL EXAM: Per Admission ED Note:
PE:
 HR:101 BP:107/73 Resp:18 O(2)Sat:96 Normal

FAMILY HISTORY: No family history of liver disease.
Mother died from stroke at young age and history of alcohol
abuse
Father had urethral cancer and history of alcohol abuse.

SOCIAL HISTORY: Reportedly stopped drinking EtOH in [**Month (only) **], but states he drank
prior to this admission. Still smokes 10 cig/day but openly
admits it is more than that. No drug use. Married with two kids. 

### Response:
{'Closed fracture of two ribs,Hepatic encephalopathy,Other closed fracture of upper end of humerus,Other closed fractures of distal end of radius (alone),Closed fracture of sternal end of clavicle,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Awaiting organ transplant status,Bariatric surgery status,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle'}
