CHIEF COMPLAINT: s/p Motor Vehicle Collision

PRESENT ILLNESS: 18 yo female s/p high speed motor vehicle crash; agonal and
hypotensive in field. Intubated in filed, transferred to [**Location (un) 8641**]
Hopsital, found with diaphragm rupture, liver laceration and
left renal laceration. Patient was later transferred to [**Hospital1 18**]
for continued trauma care.

MEDICAL HISTORY: Depression

MEDICATION ON ADMISSION: Effexor
Lithium
Seroquel
Melatonin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Injury to diaphragm, without mention of open wound into cavity,Multiple closed pelvic fractures with disruption of pelvic circle,Closed fracture of shaft of femur,Injury to iliac artery,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acute posthemorrhagic anemia,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle,Thrombocytopenia, unspecified,Injury to spleen without mention of open wound into cavity, hematoma without rupture of capsule,Traumatic pneumohemothorax without mention of open wound into thorax,Injury to kidney without mention of open wound into cavity, laceration,Injury to liver without mention of open wound into cavity, laceration, minor,Hyperosmolality and/or hypernatremia,Bacteremia,Closed Monteggia's fracture,Injury to descending [left] colon, without mention of open wound into cavity,Contusion of lung without mention of open wound into thorax,Open wound of scalp, without mention of complication,Acute sinusitis, unspecified,Closed fracture of navicular [scaphoid], foot
Diaphragm injury-closed,Pelv fx-clos/pelv disrup,Fx femur shaft-closed,Injury iliac artery,Fx lumbar vertebra-close,Ac posthemorrhag anemia,Mv collision NOS-pasngr,Thrombocytopenia NOS,Spleen hematoma-closed,Traum pneumohemothor-cl,Kidney laceration-closed,Liver laceration, minor,Hyperosmolality,Bacteremia,Monteggia's fx-closed,Descending colon inj-cl,Lung contusion-closed,Open wound of scalp,Acute sinusitis NOS,Fx navicular, foot-clos
Admission Date:  [**2163-10-14**]              Discharge Date:   [**2163-11-1**]

Date of Birth:  [**2145-8-24**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5880**]
Chief Complaint:
s/p Motor Vehicle Collision

Major Surgical or Invasive Procedure:
Exploratory Laparotomy & Left Diaphragm Repair [**10-14**]
ORIF Pelvis & Right Femur; IM Rod RIght Femur [**10-17**]
Closure of Abdomen [**10-17**]
IVC filter placement

History of Present Illness:
18 yo female s/p high speed motor vehicle crash; agonal and
hypotensive in field. Intubated in filed, transferred to [**Location (un) 8641**]
Hopsital, found with diaphragm rupture, liver laceration and
left renal laceration. Patient was later transferred to [**Hospital1 18**]
for continued trauma care.

Past Medical History:
Depression

Family History:
Noncontributory

Pertinent Results:
[**2163-10-14**] 10:57PM   TYPE-ART TEMP-36.4 RATES-33/0 TIDAL VOL-300
PEEP-14 O2-70 PO2-114* PCO2-41 PH-7.39 TOTAL CO2-26 BASE XS-0
INTUBATED-INTUBATED VENT-CONTROLLED
[**2163-10-14**] 10:57PM   GLUCOSE-126* LACTATE-2.5*
[**2163-10-14**] 10:47PM   GLUCOSE-119* UREA N-13 CREAT-0.9 SODIUM-153*
POTASSIUM-3.2* CHLORIDE-121* TOTAL CO2-23 ANION GAP-12
[**2163-10-14**] 10:47PM   CALCIUM-7.8* PHOSPHATE-3.1 MAGNESIUM-2.0
[**2163-10-14**] 10:47PM   WBC-22.6* RBC-3.93* HGB-11.6* HCT-30.9*
MCV-79* MCH-29.5 MCHC-37.5* RDW-14.8
[**2163-10-14**] 10:47PM   PLT COUNT-64*
[**2163-10-14**] 10:47PM   PT-13.2 PTT-30.8 INR(PT)-1.2

CT RECONSTRUCTION  [**2163-10-14**] 12:56 PM

CT L-SPINE W/O CONTRAST; CT RECONSTRUCTION

Reason: trauma r/o fx

[**Hospital 93**] MEDICAL CONDITION:
18 year old woman with
REASON FOR THIS EXAMINATION:
trauma r/o fx
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 18-year-old female status post trauma. Rule out
fracture.

COMPARISON: None.

TECHNIQUE: MDCT imaging of the lumbar spine was performed
without intravenous contrast. Coronal and sagittal reformatted
images were obtained.

FINDINGS: There is no malalignment within the lumbar spine.
There is no loss of vertebral body, or intervertebral disc space
height. Fractures are seen from the L1 through L5 right
transverse processes, increasing in extent of displacement in
the caudal direction. At L5, there is a comminuted fracture
through the left transverse process, extending into the left
inferior articular process . Comminuted fractures are seen
involving bilateral sacral alae, with angulation of the iliac
bones laterally. Bony fragments surround the exiting left S1
nerve root. CT is not as sensitive as MR in defining intrathecal
detail. The visualized outline of the remaining thecal sac is
unremarkable.

The surrounding soft tissues reveal a large amount of
intrapelvic ascites, and subcutaneous edema. This heterogeneous
enhancement of the spleen consistent with patient's known
splenic laceration.

IMPRESSION: Multiple fractures of the lumbar spine including L1
through L5 right transverse processes, L5 left transverse
process and inferior articular facet. Additionally, comminuted
fractures are seen through both sacral alae, adjacent to left S1
nerve root foramen.

CT HEAD W/O CONTRAST  [**2163-10-14**] 12:54 PM

CT HEAD W/O CONTRAST

Reason: head CT S/P MVC

[**Hospital 93**] MEDICAL CONDITION:
18 year old woman with
REASON FOR THIS EXAMINATION:
head CT S/P MVC
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 18-year-old female status post motor vehicle
accident. Evaluate.

COMPARISON: None.

TECHNIQUE: Routine non-contrast head CT.

FINDINGS: Hyperdense material was seen within the superior
sagittal sinus, transverse sinuses, straight and sigmoid
sinuses. While this is most likely related to prior contrast
administration, an underlying subarachnoid hemorrhage cannot
definitively be ruled out. There is no presence of subdural or
epidural hematoma. There is no major vascular territorial
infarction. The density values of the brain parenchyma are
within normal limits. The [**Doctor Last Name 352**]- white matter differentiation is
preserved. The surrounding soft tissue and osseous structures
reveal clips along the right parietal scalp. No fractures are
seen. There is dense opacification of bilateral maxillary
sinuses, and mild opacification of the sphenoid sinuses and
ethmoid air cells. The frontal sinuses and mastoid air cells are
appropriately aerated.

IMPRESSION:
1. Hyperdense material within the sinuses most likely represents
prior contrast administration. An underlying subarachnoid
hemorrhage cannot be entirely ruled out. A follow up CT is
recommended in [**5-1**] hours as clinically warranted.
2. Sinusitis.

CT ABDOMEN W/CONTRAST  [**2163-10-14**] 1:00 PM

CT CHEST W/CONTRAST; CT ABDOMEN W/CONTRAST

Reason: Trauma MVC S/P Ex-lap
Field of view: 36 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
18 year old woman with
REASON FOR THIS EXAMINATION:
Trauma MVC S/P Ex-lap
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 18-year-old female status post motor vehicle
accident and exploratory laparotomy.

COMPARISON: None.

TECHNIQUE: MDCT imaging of the chest, abdomen and pelvis was
performed following the administration of 150 cc of intravenous
Optiray. Nonionic contrast was administered per protocol.
Coronal and sagittal reformatted images were obtained.

CT CHEST WITH INTRAVENOUS CONTRAST: An endotracheal tube,
nasogastric tube, and left chest tube are in place. The left
chest tube terminates within the left lung apex. A left
subclavian central venous catheter terminates within the distal
SVC. The aorta is normal in caliber and contour. The heart,
pericardium, and great vessels are unremarkable. There is no
pericardial effusion. High-density material directly posterior
to the sternum is most consistent with a hematoma. On lung
windows, there is a right- sided moderately large hemothorax.
Patchy consolidations within bilateral lungs, but mainly within
the right posterior lung are consistent with contusions. There
is a residual small left anterior pneumothorax.

CT ABDOMEN WITHOUT ORAL, WITH INTRAVENOUS CONTRAST: The patient
is status post exploratory laparotomy with an open abdominal
wound, diastasis of the anterior abdominal wall with multiple
exposed loops of large and small bowel covered by a mesh. The
nasogastric tube is coiled within the stomach lumen. The liver
enhances normally, and there is no evidence of active contrast
extravasation surrounding the liver. Lacerations are seen within
segment 4, 6 and 7 of the liver, consistent with grade III to IV
laceration. The gallbladder, pancreas, and right kidney are
normal. Both adrenal glands are enlrrged, likely due to
hematoma. Heterogeneous enhancement of the spleen is consistent
with partial devascularization. There is no evidence of active
contrast extravasation surrounding the spleen. Additionally,
there is a laceration involving the upper pole of the left
kidney, which appears to extend through the cortex and medulla.
No contrast extravasation is seen within the fluid surrounding
the kidney.

There is dense fluid throughout the abdomen consistent with
blood. The abdominal loops of large and small bowel are normal
in caliber and contour.

CT PELVIS WITH ORAL, WITH INTRAVENOUS CONTRAST: A Foley catheter
is seen within a partially collapsed bladder. The distal
ureters, bladder, sigmoid, rectum, uterus and adnexa are
unremarkable. A large amount of blood is seen throughout the
pelvis. A left inguinal catheter terminates within the left mid
iliac vein.

BONE WINDOWS: There is an open-book fracture of the pelvis
involving the left ischium, bilateral superior pubic rami, and
bilateral sacral alae. There are multiple fractures along the L1
through L5 right transverse processes. Additionally, there is a
fracture through the T12 right superior facet joint. There are
multiple right posterior rib fractures, including T6 through T9.

Coronal and sagittal reformatted images confirm the axial
findings. MPR value grade III.

IMPRESSION:

1. Status post exploratory laparotomy, with diastasis of the
anterior abdominal wall containing multiple normal-appearing
loops of large and small bowel.

2. No evidence of active contrast extravasation surrounding the
liver, spleen, or left kidney. Large amount of intra and
retroperitoneal blood.

3. Known open book pelvic fracutre without signs to suggest
bladder or major vessel injury.

4. Grade III to IV liver laceration, involving the right lobe,
segment 4, 6 and 7.

5. Grade III to IV splenic laceration with probable
devascularization of the inferior pole.

6. Cortical and medullary laceration involving the upper pole of
left kidney, without active contrast extravasation on this
expiratory phase CT.

7. Right hemothorax with diffuse lung contusion. No tracheal
deviation to suggest tension.

8. Status post left chest tube placement, with tip at left lung
apex with small residual left anterior pneumothorax.

9. Bilateral adrenal hematomas versus adenomas. Follow-up
dedicated CT could be performed when patient's condition
stabilizes.

10. Fractures through the right T12 facet joint, and multiple
right lateral masses (L1 through L5).

11. Multiple right-sided rib fractures, including the posterior
6-9th ribs.

CHEST (PORTABLE AP)  [**2163-10-25**] 9:50 PM

CHEST (PORTABLE AP)

Reason: eval for placement of duotube

[**Hospital 93**] MEDICAL CONDITION:
18 year old woman s/p trauma with L diaphragm rupture s/p
repair. duotube placed
REASON FOR THIS EXAMINATION:
eval for placement of duotube
INDICATION: 18-year-old female with Dobhoff tube placement.

AP supine chest radiograph [**2163-10-25**] is compared to the
prior chest radiograph of [**2163-10-24**].

FINDINGS: A Dobbhoff tube is seen with its tip coiled in the
stomach. Right subclavian line is unchanged. There has been
interval removal of a left subclavian line with no evidence of
pneumothorax. Heart and mediastinal contours are stable.
Interval development of mild increase in pulmonary vasculature
and pulmonary edema. Mild left lower lobe atelectasis.

IMPRESSION:
1. Dobbhoff tube with tip in the stomach.
2. Interval development of mild pulmonary edema.

GALLBLADDER SCAN  [**2163-10-25**]

GALLBLADDER SCAN

Reason: PT WITH FEVER,ELEVATED LFT'S ,ON TPN PLEASE EVAL FOR
CHOLECYSTITIS

HISTORY: 18 yo F with fever, elevated LFTs, on TPN. Please
evaluate for
cholecystitis.

DECISION: Additional lateral view was obtained.

INTERPRETATION: Serial images over the abdomen show prompt
uptake of tracer
into the hepatic parenchyma. At 13 minutes, the gallbladder is
visualized with
initial tracer activity noted in the small bowel at 10 minutes
and more
prominent tracer activity noted in the small bowel at
approximately 35 minutes.

The above findings are consistent with no evidence of
cholecystitis.

IMPRESSION: Normal study. No evidence of cholecystitis.


Brief Hospital Course:
Patient admitted to the trauma service. She was taken
immediately to the operating room for exploratory laparotomy and
repair of diaphragm; hr abdomen was left open and was later
closed on [**10-17**]. Orthopedics was consulted because of her
multiple orthopedic injuries; she was later taken to the
operating room on [**10-17**] for repair of her pelvis, right femur
and right ulna. She is to remain non weight bearing of both
lower extremities and her right upper extremity until she
follows up with Orthopedics in 2 weeks. Her cervical spine was
cleared on [**10-24**].

An IVC filter was placed by Vascular Surgery prophylactically;
she will need to follow up with Vascular for removal of this in
the next month.

Psychiatry was consulted because of her past psychological
issues; her Effexor XR was restarted on [**10-28**] with
recommendations to increase dose to 150 mg qd if tolerating
starting 75 mg dose;  and her Aripiprazole was restarted and
subsequently increased to 5 mg on [**10-28**].

Speech and Swallow was consulted because of dysphagia and have
recommended a clear diet with advancement to regular diet with
strict aspiration precautions. She is tolerating the regular
diet at this point.

Physical therapy has been consulted and has worked with patient;
her mobility will be limited because of her non weight bearing
status until follow up with Orthopedics.

Medications on Admission:
Effexor
Lithium
Seroquel
Melatonin

Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
2. Artificial Tear Ointment 0.1-0.1 % Ointment Sig: One (1) Appl
Ophthalmic  PRN (as needed).
3. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed.
4. Quetiapine 300 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4
to 6 hours) as needed for breakthrough pain.
7. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours
as needed for anxiety.
8. Fentanyl 50 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
9. Aripiprazole 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
10. Venlafaxine 37.5 mg Capsule, Sust. Release 24HR Sig: Two (2)
Capsule, Sust. Release 24HR PO DAILY (Daily): Increase to 150 mg
in 4 days if tolerating 75 mg dose.
11. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
12. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
13. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
s/p Motor Vehicle Collision
Bilateral Lung Contusions
Diaphragm Rupture
Retroperitoneal Hematoma
Liver Laceration
Left Renal Laceration
Right Femur Fracture
Bilateral Sacral Ala Fracture
Inferior & Superior Pubic Rami Fracture
Proximal Right Ulna Fracture & Radial Dislocation


Discharge Condition:
Stable


Discharge Instructions:
Do not participate in any physical contact sports/activities for
the next 8 weeks.

Follow up with Orthopedics & Trauma Clinic after discharge from
hospital.

Follow up with Vascular Surgery for removal of your IVC filter.

Do not bear any weight on both lower extremities and your right
upper extremity

Followup Instructions:
Call [**Telephone/Fax (1) 1228**] for an appointment in [**Hospital **] Clinic in 2
weeks.

Call [**Telephone/Fax (1) 6439**] for an appointment in Trauma Clinic in [**12-23**]
weeks.

Call [**Telephone/Fax (1) 1237**] for an appointment with Vascular Surgery to
remove your IVC filter.



Completed by:[**2163-11-1**]
{"Injury to diaphragm, without mention of open wound into cavity,Multiple closed pelvic fractures with disruption of pelvic circle,Closed fracture of shaft of femur,Injury to iliac artery,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acute posthemorrhagic anemia,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle,Thrombocytopenia, unspecified,Injury to spleen without mention of open wound into cavity, hematoma without rupture of capsule,Traumatic pneumohemothorax without mention of open wound into thorax,Injury to kidney without mention of open wound into cavity, laceration,Injury to liver without mention of open wound into cavity, laceration, minor,Hyperosmolality and/or hypernatremia,Bacteremia,Closed Monteggia's fracture,Injury to descending [left] colon, without mention of open wound into cavity,Contusion of lung without mention of open wound into thorax,Open wound of scalp, without mention of complication,Acute sinusitis, unspecified,Closed fracture of navicular [scaphoid], foot"}


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: s/p Motor Vehicle Collision

PRESENT ILLNESS: 18 yo female s/p high speed motor vehicle crash; agonal and
hypotensive in field. Intubated in filed, transferred to [**Location (un) 8641**]
Hopsital, found with diaphragm rupture, liver laceration and
left renal laceration. Patient was later transferred to [**Hospital1 18**]
for continued trauma care.

MEDICAL HISTORY: Depression

MEDICATION ON ADMISSION: Effexor
Lithium
Seroquel
Melatonin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{"Injury to diaphragm, without mention of open wound into cavity,Multiple closed pelvic fractures with disruption of pelvic circle,Closed fracture of shaft of femur,Injury to iliac artery,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acute posthemorrhagic anemia,Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle,Thrombocytopenia, unspecified,Injury to spleen without mention of open wound into cavity, hematoma without rupture of capsule,Traumatic pneumohemothorax without mention of open wound into thorax,Injury to kidney without mention of open wound into cavity, laceration,Injury to liver without mention of open wound into cavity, laceration, minor,Hyperosmolality and/or hypernatremia,Bacteremia,Closed Monteggia's fracture,Injury to descending [left] colon, without mention of open wound into cavity,Contusion of lung without mention of open wound into thorax,Open wound of scalp, without mention of complication,Acute sinusitis, unspecified,Closed fracture of navicular [scaphoid], foot"}
