CHIEF COMPLAINT: s/p Fall

PRESENT ILLNESS: 58M s/p fall down stairs who presents to the ED with left
scapular and left rib tenderness.  +EtOH.

MEDICAL HISTORY: Arthritis, scoliosis

MEDICATION ON ADMISSION: Cymbalta 60

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Closed fracture of multiple ribs, unspecified,Traumatic subcutaneous emphysema,Closed fracture of pubis,Traumatic pneumothorax without mention of open wound into thorax,Pulmonary collapse,Closed fracture of scapula, unspecified part,Accidental fall on or from other stairs or steps,Open wound of face, unspecified site, without mention of complication
Fx mult ribs NOS-closed,Traum subcutan emphysema,Fracture of pubis-closed,Traum pneumothorax-close,Pulmonary collapse,Fx scapula NOS-closed,Fall on stair/step NEC,Open wound of face NOS
Admission Date:  [**2131-5-13**]              [**Month/Day/Year **] Date:   [**2131-5-17**]

Date of Birth:  [**2072-5-31**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
s/p Fall

Major Surgical or Invasive Procedure:
[**2131-5-13**] Facial laceration sutured

History of Present Illness:
58M s/p fall down stairs who presents to the ED with left
scapular and left rib tenderness.  +EtOH.

Past Medical History:
Arthritis, scoliosis

Family History:
Noncontributory

Pertinent Results:
[**2131-5-13**] 09:20AM URINE  RBC-0-2 WBC-0-2 BACTERIA-OCC YEAST-NONE
EPI-0-2
[**2131-5-13**] 07:15AM   UREA N-13 CREAT-0.7
[**2131-5-13**] 07:15AM   WBC-10.0 RBC-3.56* HGB-12.3* HCT-35.4*
MCV-99* MCH-34.5* MCHC-34.7 RDW-13.9
[**2131-5-13**] 07:15AM   PLT COUNT-244
[**2131-5-13**] 07:15AM   PT-11.8 PTT-23.0 INR(PT)-1.0

Imaging upon admission: CT head - no acute intracranial process.

subcutaneous air in the posterior deep fat starting at the skull
base,
extending inferiorly, incompletely assessed on this study. also

retropharyngeal air, incompletely assessed.
metallic density foreign body in the left orbit, please
correlate with history of eye surgery, possible new foreign
body?

CT C-spine: no fracture. alignment maintained. extensive
subcutaneous air in the left neck, prevertebral soft tissues
extending from mediastinum.

CT torso - 1. small left basilar and apical pneumothorax.
extensive subcutaneous air in the left chest wall extending to
neck; pneumomediastinum extending to prevertebral soft tissues.

2. small left hemothorax.
3. Left rib fractures: acute 1st through 6th ribs.
4. Right rib fractures: 5, 7, 8, 9 subacute.
5. Bibasilar atelectasis/possible aspiration.
6. acute left inferior pubic ramus fracture with adjacent small
hematoma.
7. left scapular fracture.


Brief Hospital Course:
He was admitted to the Trauma service and transferred to the
Trauma ICU for close monitoring given his small hemothorax and
multiple rib fractures. Orthopedics consulted for his injuries
which were managed non operatively. He may weight bear as
tolerated on his lower extremities. A sling for comfort is being
used for his scapula fracture. He will follow up as an
outpatient in [**Hospital 5498**] clinic in 2 weeks.

Acute Pain Service was consulted for his multiple rib fractures.
An epidural was placed for managing his pain. The epidural
remained in place for several days and was removed. His pain was
not adequately controlled with short acting narcotics alone so
long acting meds were added. His pain is fairly well controlled,
he will require ongoing adjustment of his pain meds.

He has a reported history of regular alcohol use and was placed
on CIWA protocol. He did not experience any delirium tremors
during his hospital stay.

He was evaluated by Physical and Occupational therapy and is
being recommended for rehab after his acute hospital stay.


Medications on Admission:
Cymbalta 60

[**Hospital **] Medications:
1. Duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).
4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) 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. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
7. Morphine 15 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours)
as needed for breathrough pain.
8. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) Neb Inhalation Q6H (every 6 hours).
9. Ipratropium Bromide 0.02 % Solution Sig: One (1) Neb
Inhalation Q6H (every 6 hours).
10. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ML
Injection TID (3 times a day).


[**Hospital **] Disposition:
Extended Care

Facility:
[**Hospital 38**] Rehab Hospital Unit at [**Hospital1 **]

[**Hospital1 **] Diagnosis:
s/p Fall
Facial laceration
Left scapula fracture
Left inferior pubic ramus fracture
Left rib fractures [**1-24**]

[**Month/Day (3) **] Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).

[**Month/Day (3) **] Instructions:
You were hospitalized after a fall where you sustained fractures
to your left shoulder blade and ribs [**1-24**] on the left side. Your
injuries did not require any operations. Rib fractures can take
several weeks, sometimes months to heal and can be very painful.
Pain control and breathing exercises are key to minimizing
complications such as pneumonia.

You also sustained a laceration on the left side of your face
which was cleaned and sutured; these sutures will be taken out
in [**4-23**] days.

Followup Instructions:
Follow up in 2 weeks with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP for Orthopedic
Trauma; call [**Telephone/Fax (1) 1228**] for an appointment.

Follow up in 2 weeks with Dr. [**Last Name (STitle) **], Trauma for evaluation of
your rib fractures; call [**Telephone/Fax (1) 1864**] for an appointment.

Follow up with your primary doctor [**First Name (Titles) **] [**Last Name (Titles) **] from rehab.

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2131-6-13**]
{'Closed fracture of multiple ribs, unspecified,Traumatic subcutaneous emphysema,Closed fracture of pubis,Traumatic pneumothorax without mention of open wound into thorax,Pulmonary collapse,Closed fracture of scapula, unspecified part,Accidental fall on or from other stairs or steps,Open wound of face, unspecified site, 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: s/p Fall

PRESENT ILLNESS: 58M s/p fall down stairs who presents to the ED with left
scapular and left rib tenderness.  +EtOH.

MEDICAL HISTORY: Arthritis, scoliosis

MEDICATION ON ADMISSION: Cymbalta 60

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Closed fracture of multiple ribs, unspecified,Traumatic subcutaneous emphysema,Closed fracture of pubis,Traumatic pneumothorax without mention of open wound into thorax,Pulmonary collapse,Closed fracture of scapula, unspecified part,Accidental fall on or from other stairs or steps,Open wound of face, unspecified site, without mention of complication'}
