CHIEF COMPLAINT: S/P MVA

PRESENT ILLNESS: Pt is a 70 year old male unrestrained driver, lost control of
vehicle and hit pole travelling at approx 45 mph.  Possible LOC,
chest struck steering wheel.  C/o facial laceration, right elbow
pain, L hand laceration, diffuse chest pain, R knee swelling.

MEDICAL HISTORY: Unknown congenitcal spine abnormality

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pt [**Name (NI) 9830**]3
PERRLA
HEENT: midface stable, large through& through lip laceration
CHEST: crepitus on palpation of L chest with palpable bony
instability. CTA
CARD: RRR
ABD: soft, diffusely tender, stable pelvis, rectal neg
EXT: LUE diffusely tender, decreased ROM
L hand lacerated, no visible tendons or deep structures
bilateral knee abrasions

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Noncontributory
Injury to celiac and mesenteric arteries, other,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of six ribs,Other specified complications of procedures not elsewhere classified,Closed fracture of olecranon process of ulna,Closed fracture of upper end of tibia alone,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Closed fracture of nasal bones,Open wound of lip, without mention of complication,Contusion of lung without mention of open wound into thorax,Closed fracture of metacarpal bone(s), site unspecified
Inj mesenteric vess NEC,Traum pneumohemothor-cl,Fracture six ribs-closed,Oth spcf cmplc procd NEC,Fx olecran proc ulna-cl,Fx upper end tibia-close,Mv coll w oth obj-driver,Nasal bone fx-closed,Open wound of lip,Lung contusion-closed,Fx metacarpal NOS-closed
Admission Date:  [**2126-12-29**]              Discharge Date:   [**2127-1-9**]

Date of Birth:  [**2056-7-5**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
S/P MVA

Major Surgical or Invasive Procedure:
Exploratory laparotomy with 1 foot small bowel resection
ORIF of R tibia, R olecranon


History of Present Illness:
Pt is a 70 year old male unrestrained driver, lost control of
vehicle and hit pole travelling at approx 45 mph.  Possible LOC,
chest struck steering wheel.  C/o facial laceration, right elbow
pain, L hand laceration, diffuse chest pain, R knee swelling.

Past Medical History:
Unknown congenitcal spine abnormality


Social History:
Noncontributory

Family History:
Noncontributory

Physical Exam:
Pt [**Name (NI) 9830**]3
PERRLA
HEENT: midface stable, large through& through lip laceration
CHEST: crepitus on palpation of L chest with palpable bony
instability. CTA
CARD: RRR
ABD: soft, diffusely tender, stable pelvis, rectal neg
EXT: LUE diffusely tender, decreased ROM
L hand lacerated, no visible tendons or deep structures
bilateral knee abrasions


Pertinent Results:
[**2126-12-29**] 03:00PM   WBC-12.8* RBC-5.13 HGB-15.5 HCT-45.1 MCV-88
MCH-30.2 MCHC-34.4 RDW-13.9
[**2126-12-29**] 03:00PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2126-12-29**] 03:00PM   AMYLASE-65
[**2126-12-29**] 03:15PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2126-12-29**] 05:52PM   HGB-11.1* calcHCT-33
[**2126-12-29**] 05:52PM   TYPE-ART PO2-125* PCO2-32* PH-7.43 TOTAL
CO2-22 BASE XS--1

Studies on Presentation:

Head CT: IMPRESSION: No mass effect, hemorrhage, or skull
fractures.

C-Spine CT: IMPRESSION: No fractures or dislocations.

CT TLS Spine:
IMPRESSION: Bilateral spondylolysis L5/S1 without
spondylolisthesis. No evidence of fracture.

CT Chest/Abd/Pelvis:
IMPRESSION
1. Left pneumo- and hemothorax.
2. Left-sided pulmonary contusions.
3. Multiple left-sided rib fractures and sternal fracture.
4. Left-sided subcutaneous emphysema and air around the
pectoralis muscles.
5. Small amount of mesenteric stranding likely representing
mesenteric injury and hemorrhage.

CT Facial Cuts:
IMPRESSION: Nasal fracture. No definite acute fracture. Sinus
disease.

XR Bilateral UE: FINDINGS: Two views of the right forearm and a
single view of the left hand show an avulsion fracture of the
olecranon process. There is distraction of approximately 2 cm
between fracture fragments. There is no evidence of dislocation.
No radio- opague foreign bodies are seen. Extensive soft tissue
swelling is seen in the right elbow. A minimally displaced
fracture of the sahft of the proximal phalanx of the left thumb
is also seen.

R Tib/FIb XR:
FINDINGS: An oblique minimally displaced right tibial plateau
fracture traverses the knee joint from the lateral tibial
plateau to the metaphysis medially. There is minimal step-off at
the articular surface. No other fractures are seen. Associated
lipohemarthrosis is seen.


Brief Hospital Course:
The pt presented to the trauma bay on [**2126-12-29**] by EMS. Vitals on
presentation were normal and stable.  Physical exam and results
of studies obtained on admission are as above.  When the L
hemopneumothorax was noted on CXR, a L chest tube was placed.
Orhtopedics was consulted for the tibial plateau and elbow fx.
Plastics was consulted for the hand fx.  OMFS was consulted for
the nasal fx.  The pt was admitted to the trauma SICU.  Plastics
placed the L hand in thumb SPICA splint and planned on following
up with the pt in clinic.  Orthopedics placed the R arm in a
posterior splint and the R knee in an immobilizer with a plan
for operative fixation of injuries the following day.  OMFS
repaired the pt's lip laceration and upon review of the facial
CT stated there was no nasal fracture.

While waiting in the Emergency department for a trauma SICU bed
to become available, the pt was noted to become tachycardic and
hypotensive to the 80s with a Hct drop of 14 points 4 hours
after arrival.  A repeat abdominal CT was obtained showing
evolution of the mesenteric hematoma noted on the initial scan.
The pt was then brought to the OR for an emergent exploratory
laparotomy during which a branch of the SMA was noted to be
lacerated and was clamped.  A one-foot section of non-viable
small bowel was resected.  Post operatively, the pt was
transferred to the Trauma SICU still intubated.

The pt did well on the night of [**12-29**] and on [**12-30**] was taken to the
OR by othopedics for ORIF of the Right elbow and Right tibial
plateau fx.  The pt remained stable until [**1-3**] when he was
extubated.  From [**1-3**] to [**1-5**] the pt was noted to have severl
bloody stools, likely from oozing from his small bowel
anastomosis.  His hct trended downward over this period to 25.
He was given 2 units PRBCs on [**1-4**] which increased his HCT to
31.5 on [**1-5**].  He was transferred to the floor in the evening of
[**1-5**].  Hct remained stable throughout his stay on the floor and
the pt had no adverse events until discharge.

Medications on Admission:
None

Discharge Medications:
1. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): See sliding scale.
2. Acetaminophen 650 mg Suppository Sig: One (1) Suppository
Rectal Q6H (every 6 hours) as needed.
3. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
4. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
5. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4-6H (every 4 to 6 hours) as needed.
6. Hydralazine HCl 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours).
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
8. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
9. Enoxaparin Sodium 40 mg/0.4mL Syringe Sig: One (1) syringe
Subcutaneous Q12H (every 12 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - Acute Rehab

Discharge Diagnosis:
R olecranon fx
L hemopneumothorax
L [**1-27**] rib fx with flail chest
Mesenteric vessel injury
L 1st metacarpal fx


Discharge Condition:
Improved

Discharge Instructions:
Please take all medications as directed.

Return to the ER if you develop:
chest pain, shortness of breath, severe nausea or vomiting, high
fever, weakness

Followup Instructions:
Please arrange to follow up with Dr. [**Last Name (STitle) 1005**] from orthopedics
in 2 weeks.  His number is ([**Telephone/Fax (1) 8746**].  You will need to
arrange to have a pin placed in your elbow.

Please follow up with Dr. [**Last Name (STitle) **] from gerontology, your new PCP.
 [**Name10 (NameIs) **] expects to see you on Thursday, [**2-13**] at 3:30 PM.
Her address is [**Last Name (NamePattern1) **], [**Location (un) 86**], [**Location (un) 453**]. Please call
ahead to confirm your appointment.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]
{'Injury to celiac and mesenteric arteries, other,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of six ribs,Other specified complications of procedures not elsewhere classified,Closed fracture of olecranon process of ulna,Closed fracture of upper end of tibia alone,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Closed fracture of nasal bones,Open wound of lip, without mention of complication,Contusion of lung without mention of open wound into thorax,Closed fracture of metacarpal bone(s), site unspecified'}


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 MVA

PRESENT ILLNESS: Pt is a 70 year old male unrestrained driver, lost control of
vehicle and hit pole travelling at approx 45 mph.  Possible LOC,
chest struck steering wheel.  C/o facial laceration, right elbow
pain, L hand laceration, diffuse chest pain, R knee swelling.

MEDICAL HISTORY: Unknown congenitcal spine abnormality

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pt [**Name (NI) 9830**]3
PERRLA
HEENT: midface stable, large through& through lip laceration
CHEST: crepitus on palpation of L chest with palpable bony
instability. CTA
CARD: RRR
ABD: soft, diffusely tender, stable pelvis, rectal neg
EXT: LUE diffusely tender, decreased ROM
L hand lacerated, no visible tendons or deep structures
bilateral knee abrasions

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Noncontributory 

### Response:
{'Injury to celiac and mesenteric arteries, other,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of six ribs,Other specified complications of procedures not elsewhere classified,Closed fracture of olecranon process of ulna,Closed fracture of upper end of tibia alone,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Closed fracture of nasal bones,Open wound of lip, without mention of complication,Contusion of lung without mention of open wound into thorax,Closed fracture of metacarpal bone(s), site unspecified'}
