CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 42 F restrained driver s/p motor vehicle crash head on collision
with another car, ~30-50 mph, no LOC, +airbags, prolonged
extrication. transportedto [**Hospital1 18**] for further care.

MEDICAL HISTORY: Colon CA
PSH: s/p resection for colon CA

MEDICATION ON ADMISSION: Meds: iron
All: augmentin

ALLERGIES: Augmentin

PHYSICAL EXAM: Upon admission:

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Has 3 children
Closed fracture of intertrochanteric section of neck of femur,Injury to liver without mention of open wound into cavity laceration, unspecified,Closed fracture of sternum,Acidosis,Closed fracture of upper end of fibula with tibia,Jaundice, unspecified, not of newborn,Closed fracture of shaft of femur,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Sprains and strains of other specified sites of knee and leg,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Unspecified fracture of ankle, closed,Personal history of malignant neoplasm of large intestine,Closed fracture of carpal bone, unspecified
Intertrochanteric fx-cl,Liver lacerat unspcf cls,Fracture of sternum-clos,Acidosis,Fx up tibia w fibula-cl,Jaundice NOS,Fx femur shaft-closed,Mv collision NOS-driver,Sprain of knee & leg NEC,Open wnd knee/leg/ankle,Fx ankle NOS-closed,Hx of colonic malignancy,Fx carpal bone NOS-close
Admission Date:  [**2162-2-28**]              Discharge Date:   [**2162-3-9**]

Date of Birth:  [**2120-1-15**]             Sex:   F

Service: SURGERY

Allergies:
Augmentin

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
1. Open reduction, internal fixation right intertrochanteric hip
fracture with dynamic hip screw.
2. Closed treatment right femoral shaft fracture with
manipulation.
3. Closed treatment right intercondylar, supracondylar femur
fracture with manipulation.
4. Application of uniplanar external fixator.
5. Washout and closure wound over anterior knee, 3 cm in length.
6. Open reduction internal fixation femoral shaft segmental
fracture.
7. Open reduction internal fixation distal femur intra-articular
fracture.
8. Open reduction internal fixation tibial plateau fracture.
9. Open reduction internal fixation ankle fracture.
10. Examination under anesthesia of wrist, all right lower
extremity and right upper extremity.
11. Removal of external fixator.
12. Lateral meniscal attachment and examination under anesthesia
ankle mortise.

History of Present Illness:
42 F restrained driver s/p motor vehicle crash head on collision
with another car, ~30-50 mph, no LOC, +airbags, prolonged
extrication. transportedto [**Hospital1 18**] for further care.

Past Medical History:
Colon CA
PSH: s/p resection for colon CA


Social History:
Has 3 children

Family History:
Noncontributory

Physical Exam:
Upon admission:

HR:110 BP:130/80 Resp:30 O(2)Sat:98% normal

               Constitutional: Patient is in severe pain
                  Head / Eyes: Extraocular muscles intact
                   ENT / Neck: In c-collar
                   Chest/Resp: Equal breath sounds without
                               chest wall tenderness
               Cardiovascular: Heart sounds
               GI / Abdominal: Soft, Nontender
               Musc/Extr/Back: Back is negative\npatient
                               has a obviously deformed
                               right proximal femur.\nThere
                               is a laceration over her
                               right knee.\nThe ankle is
                               obviously dislocated on the
                               right.\nHer dorsalis pedis
                               pulse is present by Doppler
                               on the right.\nShe seems to
                               have decreased sensation on
                               the right foot dorsum.
                        Neuro: Speech fluent and can move
                               all 4 extremities


Pertinent Results:
[**2162-2-28**] 11:37PM   GLUCOSE-152* UREA N-6 CREAT-0.4 SODIUM-141
POTASSIUM-4.0 CHLORIDE-115* TOTAL CO2-21* ANION GAP-9
[**2162-2-28**] 11:37PM   CALCIUM-7.0* PHOSPHATE-3.1 MAGNESIUM-1.4*
[**2162-2-28**] 11:37PM   CALCIUM-7.0* PHOSPHATE-3.1 MAGNESIUM-1.4*
[**2162-2-28**] 11:37PM   WBC-6.3# RBC-3.91* HGB-11.4* HCT-32.8* MCV-84
MCH-29.2 MCHC-34.9 RDW-13.9
[**2162-2-28**] 11:37PM   PLT COUNT-215#

[**2-28**] Abdominal CT:
1. Acute minimally displaced fracture of the sternal manubrium
with possible minimal associated underlying anterior mediastinal
hematoma. No evidence of acute visceral injury in the abdomen or
pelvis.

2. Mildly displaced right-sided intratrochanteric femur
fracture.

3. Rounded 2.0 x 1.2cm asymmetric hypodense area involving the
left breast, may represent a cyst. However, recommend
correlation with
mammography/ultrasound to exclude a more aggressive lesion.

4. Multiple splenic hypodensities involving the spleen,
non-specific. Differential diagnosis is broad and includes
neoplastic/lymphomatous/metastatic involvement or microabcesses.
Other considerations include sarcoidosis although there are no
findings of sarcoidosis in the chest. Recommend clinical
correlation with history of malignancy (chain sutures in rectal
region, question history of colorectal carcinoma) or
immunocompromise.

5. 9mm incompletely characterized hypoattenuating liver lesion.
Area of nodularity involving the mid aspect of the gallbladder,
non-specific may represent atypical adenomyosis or polyp.
Recommend further evaluation of these findings, in addition to
the splenic lesions, with MRI (preferred) or ultrasound.

6. Subcentimeter hypodensity seen within the interpolar region
of the left kidney, incompletely characterized. Attention at the
aforerecommended MRI/ultrasound.

[**2162-3-5**] MRCP
IMPRESSION:
1. No evidence of bile duct injury.
2. Hepatic steatosis.
3. Multiple, nonspecific T2 hyperintense splenic lesions. Unless
the patient has a known primary malignancy or systemic disease,
this finding is most likely in keeping with benign cysts versus
hamartomas.

[**2162-3-8**] LENIS
IMPRESSION: No evidence of DVT in the left lower extremity.


Brief Hospital Course:
She was admitted to the Trauma service. Orthopedics was
consulted for her lower extremity injuries. She was taken to the
operating room on [**2-28**] & [**3-1**] for washout and repair of her
injuries. Postoepratively she remained in the Trauama ICU and
was dificult to wean for extubation. It was felt that this was
primarily due to large amounts of intravenous narcotics required
to control her pain; 0.1% bupivacaine at 10 mL/hr was infused
with adequate pain control. Neurology was very briefly involved
in her care after consult request per ICU team for her decreased
mental status. This was also felt per Neurology to be a result
of her narcotics and not related to seizures or other
intracranial processes. She eventually was more awake and able
to be weaned and extubated. She was then transferred to the
regular nursing unit.

Her LFT's were noted to be elevated during her stay and a GI
consult was requested. An MRCP was done which was normal. Her
LFT's were trending down during her stay and will need to be
checked weekly while at rehab. Given her history of colon CA a
CEA was checked and was less than 1.0. She has given us
permission to forward these results to her primary
hematologist/oncologist. The GI team recommends that she have an
ECHO at some point as an outpatient.

She did have pain control issues once on the nursing unit and it
was recommended per pain service to add Nortriptyline at HS; she
is also receiving po Dilaudid.

Physical therapy has been working with her regularly and she is
being recommended for acute rehab.


Medications on Admission:
Meds: iron
All: augmentin


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Enoxaparin 30 mg/0.3 mL Syringe Sig: Thirty (30) MG
Subcutaneous Q12H (every 12 hours).
3. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime as
needed for constipation.
4. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

5. Nortriptyline 10 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
6. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] [**Hospital 1108**] Rehab Unit at
[**Hospital6 1109**] - [**Location (un) 1110**]

Discharge Diagnosis:
s/p Motor vehicle crash
Injuires:
 - Manubrial fracture with retrosternal fluid collection
 - Right mid-shaft femur fracture
 - Right tibial plateau with lateral split-depression
 - Right [**Doctor Last Name 11586**] B bimalleolus equivalent
 - Right comminuted talar neck fracture
 - Right knee laceration

Discharge Condition:
Mental Status: Clear and coherent
Level of Consciousness: Alert and interactive

Activity Status: Ambulatory - requires assistance or aid
(platform walker or cane)

Discharge Instructions:
Wound Care:
-Keep Incision dry.
-Do not soak the incision in a bath or pool.
-Staples will be removed at your first post-operative visit.

Activity:
-Continue to be touch down weight bearing on your right leg.
-Continue to be non weight bearing on your right wrist and
weight bearing as tolerated on your elbow.

Other Instructions
- Resume your regular diet.
- Avoid nicotine products to optimize bone healing.
- Resume your home medications. Take all medications as
instructed.
- Continue taking the Lovenox to prevent blood clots.

-If you have questions, concerns or experience any of the below
danger signs then please call your doctor at [**Telephone/Fax (1) 1228**] or go
to your local emergency room.


Followup Instructions:
It is important that you follow up with your
Hematologist/Oncologist at [**Hospital3 2576**] [**Hospital3 **] upon discharge
from rehab. You will need to call for an appointment. It is
being recommended that you follow up with a liver specialist
within 3 months and this can be arranged through Dr. [**First Name (STitle) 916**].

2 weeks in the [**Hospital **] clinic with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP.
Please call [**Telephone/Fax (1) 1228**] to make this appointment. Clinic held
on Tuesday's.

Follow up in Hand Surgery clinic next Tuesday.  Call
[**Telephone/Fax (1) 3009**] to schedule this appointment.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2162-3-9**]
{'Closed fracture of intertrochanteric section of neck of femur,Injury to liver without mention of open wound into cavity laceration, unspecified,Closed fracture of sternum,Acidosis,Closed fracture of upper end of fibula with tibia,Jaundice, unspecified, not of newborn,Closed fracture of shaft of femur,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Sprains and strains of other specified sites of knee and leg,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Unspecified fracture of ankle, closed,Personal history of malignant neoplasm of large intestine,Closed fracture of carpal bone, 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 Motor vehicle crash

PRESENT ILLNESS: 42 F restrained driver s/p motor vehicle crash head on collision
with another car, ~30-50 mph, no LOC, +airbags, prolonged
extrication. transportedto [**Hospital1 18**] for further care.

MEDICAL HISTORY: Colon CA
PSH: s/p resection for colon CA

MEDICATION ON ADMISSION: Meds: iron
All: augmentin

ALLERGIES: Augmentin

PHYSICAL EXAM: Upon admission:

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Has 3 children 

### Response:
{'Closed fracture of intertrochanteric section of neck of femur,Injury to liver without mention of open wound into cavity laceration, unspecified,Closed fracture of sternum,Acidosis,Closed fracture of upper end of fibula with tibia,Jaundice, unspecified, not of newborn,Closed fracture of shaft of femur,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Sprains and strains of other specified sites of knee and leg,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Unspecified fracture of ankle, closed,Personal history of malignant neoplasm of large intestine,Closed fracture of carpal bone, unspecified'}
