CHIEF COMPLAINT: Left wrist crush injury

PRESENT ILLNESS: 64 year-old Right hand dominant house keeper s/p rollover
MVC. Patient was restrained driver during accident. She states
that her left hand was on the steering wheel when her car ran
off
the road and struck a [**Doctor Last Name **]. She suffered a physiologic
amputation of her left wrist with complete dislocation of her
left wrist.

MEDICAL HISTORY: DM II,  HTN, Hypercholesterolemia

MEDICATION ON ADMISSION: Glyburide, norvasc, lipitor, advair

ALLERGIES: Tape

PHYSICAL EXAM: On admission:
Vs: 96.4  92 1 46/54 17 100% (on suppl. 02)
Gen: awake, alert oriented x 3, C-Collar in place

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives alone near [**Last Name (un) 17679**].  Works two jobs - factory in
evening, housecleaning in daytime.  Never smoked.  Does not
drink, no drug use.
Traumatic amputation of arm and hand (complete) (partial), unilateral, below elbow, without mention of complication,Crushing injury of forearm,Other open fractures of distal end of radius (alone),Open fracture of other bone of wrist,Open fracture of multiple sites of metacarpus,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Open wound of wrist, with tendon involvement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Injury to digital blood vessels,Traumatic amputation of other finger(s) (complete) (partial), without mention of complication
Amput below elb, unilat,Crushing injury forearm,Fx distal radius NEC-opn,Fx carpal bone NEC-open,Mult fx metacarpus-open,Loss control mv acc-driv,Opn wound wrist w tendon,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Injury finger vessels,Amputation finger
Admission Date:  [**2122-5-6**]              Discharge Date:   [**2122-6-30**]

Date of Birth:  [**2057-12-2**]             Sex:   F

Service: PLASTIC

Allergies:
Tape

Attending:[**First Name3 (LF) 7733**]
Chief Complaint:
Left wrist crush injury

Major Surgical or Invasive Procedure:
1.  Open reduction internal fixation of left distal radius
fracture.
2.  ORIF left long finger CMC joint.
3.  ORIF left index to long finger metacarpal dislocation.
4.  ORIF left ring finger and long finger CMC dislocation.
5.  ORIF left small finger to ring finger CMC dislocation.
6.  Left proximal carpectomy.
7.  Excision of left wrist hamate bone.
8.  Excision of left wrist pisiform bone.
9.  Irrigation and debridement down to bone of the entire wrist,
as well as the hand.
10. Revascularization right hand ulnar and radial arterial
systems with autogenous vein grafts (microvascular).
11. Application of reconstruction plate left wrist.
12.  Tendon transfer for extensor indicis proprius to extensor
pollicis longus
13. Radical debridement all extensor tendons and nonviable
tissue, left hand, forearm and wrist.
14.  Split-thickness skin graft, left forearm, hand and wrist
15. Debridement left wrist, forearm and dorsum of hand.
16.  Distally based dorsal interosseous island flap coverage of
dorsum of hand.
17.  Local forearm advancement flap to cover volar wrist region.
18.  Removal of three deep buried pins.
19.  Split-thickness skin graft to dorsal aspect of vascularized
flap.


History of Present Illness:
64 year-old Right hand dominant house keeper s/p rollover
MVC. Patient was restrained driver during accident. She states
that her left hand was on the steering wheel when her car ran
off
the road and struck a [**Doctor Last Name **]. She suffered a physiologic
amputation of her left wrist with complete dislocation of her
left wrist.


Past Medical History:
DM II,  HTN, Hypercholesterolemia

Social History:
Lives alone near [**Last Name (un) 17679**].  Works two jobs - factory in
evening, housecleaning in daytime.  Never smoked.  Does not
drink, no drug use.

Family History:
Non-contributory

Physical Exam:
On admission:
Vs: 96.4  92 1 46/54 17 100% (on suppl. 02)
Gen: awake, alert oriented x 3, C-Collar in place

Left Hand has significant laxity at the wrist. There is
degloving
of  the dorsal aspect of hand from wrist joint to MCP joint with
significant tendon, muscle exposure. Patient has intact
sensation
to level of wrist but no sensation in hand or fingers. Capillary
refil is noted in fingers at approx. 3-4 seconds. Left 4th
finger
is partially avulsed at the DIP joint.
.
On discharge:
Gen: Well-appearing, no acute distress
HEENT: NC/AT, PERRL, erythema and mild swelling below each eye
Chest: Clear to auscultation bilaterally
CV: Regular rate and rhythm, no murmurs
Abd: obese, soft, non-distended, non-tender, +bowel sounds
Ext: warm well-perfused, 2+ distal pulses
Left wrist: general edema.  Numerous surgical incisions all
clean, dry and intact without evidence of infection.  Hand warm
and well-perfused.  Capillary refill about 3secs.  Minimal
ability to flex and extend at all joints.  Severely decreased
sensation to light touch - some mild sensation most prominently
along volar side of middle finger and along ulnar side of small
finger.

Pertinent Results:
[**2122-5-6**] 09:37PM   GLUCOSE-233* UREA N-22* CREAT-0.7 SODIUM-137
POTASSIUM-3.8 CHLORIDE-106 TOTAL CO2-25 ANION GAP-10
[**2122-5-6**] 09:37PM   WBC-9.1 RBC-2.42* HGB-7.7* HCT-22.6* MCV-93
MCH-31.9 MCHC-34.2 RDW-13.7
[**2122-5-6**] 09:37PM   PLT COUNT-222

Brief Hospital Course:
Pt is a 64 year-old Right hand dominant house keeper s/p
rollover motor vehicle collision. She was the restrained driver
during the accident. She states that her left hand was on the
steering wheel when her car ran off the road and struck a [**Doctor Last Name **].
She suffered a physiologic amputation of her left wrist with
complete dislocation of her left wrist.
.
The pt underwent numerous operations over the coures of her
extended stay.  These included the following (as well as
numerous irrigation and debridement procedures and
vacuum-assisted closure device placements):
1.  Open reduction internal fixation of left distal radius
fracture.
2.  ORIF left long finger CMC joint.
3.  ORIF left index to long finger metacarpal dislocation.
4.  ORIF left ring finger and long finger CMC dislocation.
5.  ORIF left small finger to ring finger CMC dislocation.
6.  Left proximal carpectomy.
7.  Excision of left wrist hamate bone.
8.  Excision of left wrist pisiform bone.
9.  Irrigation and debridement down to bone of the entire wrist,
as well as the hand.
10. Revascularization right hand ulnar and radial arterial
systems with autogenous vein grafts (microvascular).
11. Application of reconstruction plate left wrist.
12.  Tendon transfer for extensor indicis proprius to extensor
pollicis longus
13. Radical debridement all extensor tendons and nonviable
tissue, left hand, forearm and wrist.
14.  Split-thickness skin graft, left forearm, hand and wrist
15. Debridement left wrist, forearm and dorsum of hand.
16.  Distally based dorsal interosseous island flap coverage of
dorsum of hand.
17.  Local forearm advancement flap performed to cover volar
wrist region.
18.  Removal of three deep buried pins.
19.  Split-thickness skin graft to dorsal aspect of vascularized
flap.
.
The goal of these operations was to restore sensation and
perfusion to the hand as much as possible to allow for the
maximal amount of post-injury function.  On hospital day 55
([**2122-6-30**]), the patient was discharged to her home in stable
condition with plans for follow-up in hand clinic and with
visiting nursing services.

Medications on Admission:
Glyburide, norvasc, lipitor, advair

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
6. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO four times
a day for 7 days.
Disp:*28 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
TLC

Discharge Diagnosis:
1) Physiologic amputation of right hand at the wrist level.
2) Completion dislocation of hand at wrist level
3) Fracture dislocations involving radiocarpal, carpal, and
proximal metacarpal bones/joints


Discharge Condition:
Stable


Discharge Instructions:
Please [**Name8 (MD) 138**] MD or return to Emergency Department if you
experience
any of the following:
Fever >101.5
Increased pain, redness, swelling from incision sites
Worsening of rash
Any other disturbing symptoms
-Please finish all of your antibiotics
-Please follow-up in our plastic surgery hand clinic next week;
call to make an appointment ([**Telephone/Fax (1) 4652**])
-Do not perform any strenuous activity with your left arm or
hand.
-Keep your hand protected from injury

Followup Instructions:
-Please follow-up in our plastic surgery hand clinic next week;
call to make an appointment ([**Telephone/Fax (1) 4652**])


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 7738**]
{'Traumatic amputation of arm and hand (complete) (partial), unilateral, below elbow, without mention of complication,Crushing injury of forearm,Other open fractures of distal end of radius (alone),Open fracture of other bone of wrist,Open fracture of multiple sites of metacarpus,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Open wound of wrist, with tendon involvement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Injury to digital blood vessels,Traumatic amputation of other finger(s) (complete) (partial), without mention of complication'}


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: Left wrist crush injury

PRESENT ILLNESS: 64 year-old Right hand dominant house keeper s/p rollover
MVC. Patient was restrained driver during accident. She states
that her left hand was on the steering wheel when her car ran
off
the road and struck a [**Doctor Last Name **]. She suffered a physiologic
amputation of her left wrist with complete dislocation of her
left wrist.

MEDICAL HISTORY: DM II,  HTN, Hypercholesterolemia

MEDICATION ON ADMISSION: Glyburide, norvasc, lipitor, advair

ALLERGIES: Tape

PHYSICAL EXAM: On admission:
Vs: 96.4  92 1 46/54 17 100% (on suppl. 02)
Gen: awake, alert oriented x 3, C-Collar in place

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives alone near [**Last Name (un) 17679**].  Works two jobs - factory in
evening, housecleaning in daytime.  Never smoked.  Does not
drink, no drug use. 

### Response:
{'Traumatic amputation of arm and hand (complete) (partial), unilateral, below elbow, without mention of complication,Crushing injury of forearm,Other open fractures of distal end of radius (alone),Open fracture of other bone of wrist,Open fracture of multiple sites of metacarpus,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Open wound of wrist, with tendon involvement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Injury to digital blood vessels,Traumatic amputation of other finger(s) (complete) (partial), without mention of complication'}
