CHIEF COMPLAINT: Motorcycle crash

PRESENT ILLNESS: Mr. [**Known lastname 20118**] is a 43 year old man who was a motorcycle drive who
was involved in a crash with a car.  He was taken by [**Location (un) **]
from the scene to the [**Hospital1 18**] with a suspected right open tibia
fracture.

MEDICAL HISTORY: History of Heroin abuse (snorting)

MEDICATION ON ADMISSION: methadone

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION

FAMILY HISTORY: n/a

SOCIAL HISTORY: Lives with wife and children
Unemployed
Lives in [**Location **] with 3 flights of stairs to enter
Open fracture of shaft of fibula with tibia,Acute posthemorrhagic anemia,Traumatic compartment syndrome of lower extremity,Injury to posterior tibial artery,Fracture of lateral malleolus, closed,Motor vehicle traffic accident involving collision with other vehicle injuring motorcyclist,Contusion of lower leg,Opioid abuse, unspecified
Fx shaft tibia w fib-opn,Ac posthemorrhag anemia,Trauma comp synd low ext,Inj post tibial artery,Fx lateral malleolus-cl,Mv-oth veh coll-motcycl,Contusion of lower leg,Opioid abuse-unspec
Admission Date:  [**2103-8-16**]              Discharge Date:   [**2103-9-6**]

Date of Birth:  [**2059-11-30**]             Sex:   M

Service: ORTHOPAEDICS

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8587**]
Chief Complaint:
Motorcycle crash

Major Surgical or Invasive Procedure:
[**2103-8-17**]:  I&D with closed reduction, external fixator placement
left tibia and 4 compartment fasciotmies for compartment
syndrome
[**2103-8-19**]:  I&D with VAC change open fracture and faciotomies
[**2103-8-22**]:  I&D with VAC change
[**2103-8-25**]:  I&D with IM nail to left tibia with removal of
external fixator and split thickness skin graft to wound with
VAC placment.


History of Present Illness:
Mr. [**Known lastname 20118**] is a 43 year old man who was a motorcycle drive who
was involved in a crash with a car.  He was taken by [**Location (un) **]
from the scene to the [**Hospital1 18**] with a suspected right open tibia
fracture.

Past Medical History:
History of Heroin abuse (snorting)

Social History:
Lives with wife and children
Unemployed
Lives in [**Location **] with 3 flights of stairs to enter

Family History:
n/a

Physical Exam:
PHYSICAL EXAMINATION

Constitutional: Awake alert and oriented, uncomfortable
HEENT: Normocephalic, atraumatic, Pupils equal, round and
reactive to light
C. collar in place
Chest: Clear to auscultation
Cardiovascular: Regular Rate and Rhythm
Abdominal: Obese, soft, nontender
Pelvic: Pelvis stable to anterior compression
Extr/Back: The right lower extremity shows an open fracture
of the mid lower leg, the distal foot is mottled and dusky
in appearance, with intact capillary refill and very faintly
palpable pulses patient does have some sensation of the
dorsum of the foot and is able to move the toes
Neuro: Speech fluent
Psych: Normal mood


Pertinent Results:
[**2103-8-17**]
INDICATION: External fixation of tibial fracture.
COMPARISON: None.
Four fluoroscopic images were submitted for review without the
radiologist
present. The patient is status post external fixation of the
segmental
comminuted fracture through the mid and distal tibial diaphysis.
There is
lateral displacement of some of the distal comminuted fracture
fragments.
Also noted is the segmental comminuted fracture through the mid
and distal
fibula. There is one shaft with medial displacement of the
distal fracture
fragment. For further details, please see the intraoperative
report.

[**2103-8-24**]
INDICATION: ORIF RIGHT TIBIA/FIBULA
COMPARISON: [**2103-8-17**].

Fifteen intraoperative fluoroscopic views were submitted for
review. These
demonstrate interval removal of an external fixator and
placement of a long intramedullary rod and interlocking screws
transfixing a markedly comminuted segmental fracture of the mid
and distal fibula. Again seen are laterally displaced fracture
fragments. Alignment otherwise appears good. Again seen is a
comminuted segmental fracture of the fibula which appears
unchanged.  Total fluoroscopic time was 296.4 seconds. For
further details, please see the intraoperative report.

[**2103-8-30**] 05:49AM BLOOD Hct-25.7*
[**2103-8-29**] 05:20AM BLOOD Hct-24.9*
[**2103-8-28**] 06:19AM BLOOD WBC-12.2* RBC-2.84* Hgb-8.2* Hct-25.2*
MCV-89 MCH-29.0 MCHC-32.7 RDW-14.9 Plt Ct-389
[**2103-8-27**] 05:04AM BLOOD WBC-14.2* RBC-2.87* Hgb-8.4* Hct-25.9*
MCV-90 MCH-29.3 MCHC-32.4 RDW-15.5 Plt Ct-368
[**2103-8-26**] 05:35AM BLOOD WBC-14.1* RBC-2.71* Hgb-8.2* Hct-24.1*
MCV-89 MCH-30.2 MCHC-33.9 RDW-15.6* Plt Ct-303
[**2103-8-25**] 05:31AM BLOOD WBC-13.5* RBC-2.43* Hgb-7.2* Hct-21.4*
MCV-88 MCH-29.4 MCHC-33.4 RDW-15.8* Plt Ct-333
[**2103-8-24**] 04:41PM BLOOD WBC-19.7* RBC-2.82* Hgb-8.2* Hct-25.2*
MCV-89 MCH-29.1 MCHC-32.7 RDW-15.7* Plt Ct-414
[**2103-8-21**] 11:00AM BLOOD WBC-12.3* RBC-2.88* Hgb-8.4* Hct-25.4*
MCV-88 MCH-29.3 MCHC-33.2 RDW-15.4 Plt Ct-190#
[**2103-8-20**] 10:00AM BLOOD WBC-13.9* RBC-2.45* Hgb-7.1* Hct-21.5*
MCV-88 MCH-29.2 MCHC-33.2 RDW-14.8 Plt Ct-112*
[**2103-8-18**] 06:05AM BLOOD WBC-16.7* RBC-2.64* Hgb-7.8* Hct-22.9*
MCV-87 MCH-29.4 MCHC-33.9 RDW-14.5 Plt Ct-240
[**2103-8-18**] 03:00AM BLOOD WBC-17.2* RBC-2.72* Hgb-7.7* Hct-23.4*
MCV-86 MCH-28.4 MCHC-32.9 RDW-14.6 Plt Ct-224
[**2103-8-17**] 09:55AM BLOOD Hct-28.0*
[**2103-8-17**] 02:39AM BLOOD WBC-16.5* RBC-3.47* Hgb-9.9* Hct-29.0*
MCV-84 MCH-28.5 MCHC-34.1 RDW-14.1 Plt Ct-300
[**2103-8-16**] 08:41PM BLOOD WBC-17.1* RBC-3.96* Hgb-11.5* Hct-33.4*
MCV-84 MCH-29.2 MCHC-34.6 RDW-13.7 Plt Ct-261
[**2103-8-16**] 04:52PM BLOOD WBC-15.9* RBC-4.75 Hgb-13.5* Hct-39.7*
MCV-84 MCH-28.4 MCHC-33.9 RDW-14.0 Plt Ct-314
[**2103-8-25**] 05:31AM BLOOD Glucose-109* UreaN-12 Creat-0.8 Na-140
K-4.3 Cl-104 HCO3-30 AnGap-10
[**2103-8-24**] 04:41PM BLOOD Glucose-127* UreaN-16 Creat-0.9 Na-140
K-4.6 Cl-105 HCO3-28 AnGap-12
[**2103-8-20**] 10:00AM BLOOD Glucose-128* UreaN-11 Creat-0.9 Na-142
K-3.7 Cl-107 HCO3-30 AnGap-9
[**2103-8-18**] 03:00AM BLOOD Glucose-120* UreaN-18 Creat-1.0 Na-140
K-4.3 Cl-106 HCO3-28 AnGap-10
[**2103-8-17**] 02:39AM BLOOD Glucose-145* UreaN-15 Creat-0.7 Na-137
K-4.2 Cl-108 HCO3-24 AnGap-9
[**2103-8-16**] 08:41PM BLOOD Glucose-115* UreaN-16 Creat-0.9 Na-141
K-5.4* Cl-105 HCO3-27 AnGap-14
[**2103-8-16**] 08:41PM BLOOD ALT-48* AST-62* LD(LDH)-426* AlkPhos-67
TotBili-0.4

Brief Hospital Course:
Mr. [**Known lastname 20118**] presented to the [**Hospital1 18**] via [**Location (un) **] transfer on
[**2103-8-16**] from the scene where his motorcycle was in a crash with
a car.  He was evaluated by the orthopaedic surgery service and
the trauma surgery service.  He was found to have a right open
tibia fracture.  He was intubated for aggitation in the
emergency department and admitted to the Trauma ICU.  On [**2103-8-17**]
he was taken to the operating room with orthopaedics for an I&D
of his right open tibia fracture, closed reduction, external
fixator placement, and 4 compartment fasciotomies.  He tolerated
the procedure well, was transferred back to the ICU.  In the ICU
he was extubated without difficulty.  On [**2103-8-18**] patient was
weaned off the vent and extubated.  He was transferred out of
the ICU to a regular nursing floor on [**2103-8-18**].  Later that day
he was transfused with 2 units of packed red blood cells due to
acute blood loss anemia.  On [**2103-8-19**] he returned to the
operating room and underwent an I&D of his open wound and
fasciotomies.  He tolerated the procedure well, was extubated,
transferred to the recovery room, and then to the floor.   On
[**2103-8-20**] he was again transfused with 2 units of packed red blood
cells due to acute blood loss anemia.  On [**2103-8-22**] he underwent
an I&D of his wound with VAC change.  On [**2103-8-25**] he returned to
the operating room and underwent an I&D with IM nail and removal
of his external fixator.  He also underwent split thickness skin
graft by plastic surgery.  A VAC was placed over the graft and
he was placed on bedrest for 5 days.  He was also transfused
with 2 units of packed red blood cells due to acute blood loss
anemia.  On [**2103-8-29**] his VAC was removed and xeroform was placed
over his skin graft site.  He did have some potentially unviable
tissue at the medial edge of his wound, which was debrided at
the bedsite by plastic surgery on [**8-31**] and [**9-1**].  Thereafter,
daily silvadene was placed over the wound and the wound edges
improved significantly.

Throughout his stay he was seen by physical therapy to improve
his strength and mobility.  The rest of his hospital stay was
uneventful with his lab data and vital signs within normal
limits and his pain controlled.  He is being discahrged today in
stable condition.

Medications on Admission:
methadone

Discharge Medications:
1. Methadone 40 mg Tablet, Soluble Sig: Three (3) Tablet,
Soluble PO DAILY (Daily).
2. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours)
as needed for Pain.
Disp:*80 Tablet(s)* Refills:*0*
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Silver Sulfadiazine 1 % Cream Sig: One (1) Appl Topical DAILY
(Daily).
Disp:*1 tube* Refills:*0*
7. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
8. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
Q12H (every 12 hours).
Disp:*56 syringes* Refills:*0*
9. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours).


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
s/p Motorcycle crash
Left open tibia fracture
Compartment syndrome left leg
Acute blood loss anemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were started on new medications.  Please take as directed.

If you notice any of the following symptoms, please contact your
physician:  [**Name10 (NameIs) **] over 101.5F, redness or purulence from your
wound
Physical Therapy:
Activity:  Out of bed to chair
 Right lower extremity:  Full weight bearing

Treatments Frequency:
Staples and sutures should be removed 14 days after surgery.

Please apply silvadene to the edges of the RLE skin graft site
daily, and cover with a dry dressing.

Please keep leg elevated as much as possible while not
ambulating.

Followup Instructions:
Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP in orthopaedics in 2
weeks, please call [**Telephone/Fax (1) 1228**] to schedule that appointment.
.
Your Plastic Surgeon is Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 6742**]) and this
is who you will normally follow up with.  However, Dr. [**First Name (STitle) **] is
away this week so you will follow up in Dr. [**First Name (STitle) **] Lee's clinic
on Friday, [**2103-9-7**]
at 10 AM.  Dr.[**Last Name (STitle) 17650**] office number is ([**Telephone/Fax (1) 23796**].  The
clinic
is located on the [**Hospital Ward Name **], [**Hospital Unit Name **], [**Location (un) 442**], [**Hospital Unit Name 85182**].
{'Open fracture of shaft of fibula with tibia,Acute posthemorrhagic anemia,Traumatic compartment syndrome of lower extremity,Injury to posterior tibial artery,Fracture of lateral malleolus, closed,Motor vehicle traffic accident involving collision with other vehicle injuring motorcyclist,Contusion of lower leg,Opioid abuse, 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: Motorcycle crash

PRESENT ILLNESS: Mr. [**Known lastname 20118**] is a 43 year old man who was a motorcycle drive who
was involved in a crash with a car.  He was taken by [**Location (un) **]
from the scene to the [**Hospital1 18**] with a suspected right open tibia
fracture.

MEDICAL HISTORY: History of Heroin abuse (snorting)

MEDICATION ON ADMISSION: methadone

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION

FAMILY HISTORY: n/a

SOCIAL HISTORY: Lives with wife and children
Unemployed
Lives in [**Location **] with 3 flights of stairs to enter 

### Response:
{'Open fracture of shaft of fibula with tibia,Acute posthemorrhagic anemia,Traumatic compartment syndrome of lower extremity,Injury to posterior tibial artery,Fracture of lateral malleolus, closed,Motor vehicle traffic accident involving collision with other vehicle injuring motorcyclist,Contusion of lower leg,Opioid abuse, unspecified'}
