CHIEF COMPLAINT: nausea and pain

PRESENT ILLNESS: 68 yo M driver of a motorcycle was struck on the left side
by a car at low speed. He denies LOC or head trauma. Complains
of
[**9-10**] LLE pain. He was seen in the Emergency Room and
immediately taken to the Operating Room for Guillotine
amputation of the left lower extremity.

MEDICAL HISTORY: PMH
1. S/P CVA
2. Hypertension

MEDICATION ON ADMISSION: 1. Hydrochlorothiazide 50 mg PO Daily
2. ASA 81 mg PO Daily
3. Doxazosin 4 mg PO Daily
4. Plavix 75 mg PO Daily
5. Amlodipine 5 mg PO Daily
6. Gabapentin 300 mg PO TID
7. Simvastatin 20 mg PO Daily
8. Avapro 150 mg PO Daily
9. MVI 1 tab PO Daily

ALLERGIES: Atenolol

PHYSICAL EXAM: Temp 99.4 HR 76 BP 99/57 RR 20
HEENT NCAT PERRLA
Neck non tender
Chest equal breath sounds bilaterally, no deformity
COR RRR
Abd soft, non tender
Ext left leg with exposed muscle and bone, decreased sensation

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Married, lives with wife
Remote tobacco
ETOH none
Traumatic amputation of leg(s) (complete) (partial), unilateral, at or above knee, without mention of complication,Acute posthemorrhagic anemia,Closed fracture of acetabulum,Other postoperative infection,Cellulitis and abscess of leg, except foot,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Motor vehicle traffic accident involving collision with other vehicle injuring motorcyclist,Amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Phantom limb (syndrome)
Amput above knee, unilat,Ac posthemorrhag anemia,Fracture acetabulum-clos,Other postop infection,Cellulitis of leg,Hypertension NOS,Obstructive sleep apnea,Mv-oth veh coll-motcycl,Abn react-limb amputat,Hx TIA/stroke w/o resid,Phantom limb (syndrome)
Admission Date:  [**2168-9-25**]              Discharge Date:   [**2168-10-3**]

Date of Birth:  [**2100-8-22**]             Sex:   M

Service: SURGERY

Allergies:
Atenolol

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
nausea and pain

Major Surgical or Invasive Procedure:
1. Open above-knee amputation [**2168-9-25**]
2. Left above-knee amputation revision and closure [**2168-9-29**]


History of Present Illness:
68 yo M driver of a motorcycle was struck on the left side
by a car at low speed. He denies LOC or head trauma. Complains
of
[**9-10**] LLE pain. He was seen in the Emergency Room and
immediately taken to the Operating Room for Guillotine
amputation of the left lower extremity.


Past Medical History:
PMH
1. S/P CVA
2. Hypertension

PSH
1. umbilical hernia repair
2. S/P Left wrist fracture
3. S/P carpel tunnel release


Social History:
Married, lives with wife
Remote tobacco
ETOH none

Family History:
non contributory

Physical Exam:
Temp 99.4 HR 76 BP 99/57 RR 20
HEENT NCAT PERRLA
Neck non tender
Chest equal breath sounds bilaterally, no deformity
COR RRR
Abd soft, non tender
Ext left leg with exposed muscle and bone, decreased sensation

Pertinent Results:
[**2168-9-25**] 12:45PM   WBC-17.9* RBC-3.77* HGB-10.5* HCT-29.2*
MCV-78* MCH-27.8 MCHC-35.8* RDW-15.7*
[**2168-9-25**] 12:45PM   PLT COUNT-253
[**2168-9-25**] 12:45PM   PT-13.9* PTT-25.4 INR(PT)-1.2*
[**2168-9-25**] 12:45PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2168-9-25**] 12:45PM   UREA N-22* CREAT-1.1
[**2168-9-25**] 12:59PM   GLUCOSE-154* LACTATE-2.5* NA+-141 K+-3.0*
CL--103 TCO2-27
[**2168-9-25**] 03:34PM   WBC-26.4* RBC-3.59* HGB-10.4* HCT-29.1*
MCV-81* MCH-29.0 MCHC-35.8* RDW-15.5
[**2168-9-25**] 03:34PM   PLT COUNT-176
[**2168-9-25**] 03:34PM   PT-14.4* PTT-27.4 INR(PT)-1.3*

[**2168-9-25**] left tib/fib : Complete fracture of the proximal tibia
with superior medial displacement and comminuted fragments
throughout the soft tissues. Apparent dislocation of the fibula
with the talar dome, although not completely assessed on this
study.

[**2168-9-25**] left ankle/femur : Views of the left lower extremity
show the femur to be essentially within normal limits. Extremely
severe comminuted fracture about the knee is again appreciated.
Two views of the ankle are technically limited and show no
definite fracture, though this study does not clear the area.

[**2168-9-25**] left hand
No evidence of acute fracture or dislocation identified

[**2168-9-25**] CT C spine : Normal alignment. No acute fracture
identified. Prominent posterior osteophytes at level C5-6 and
C6-7 could cause spinal cord contusion in the appropriate
setting. Please correlate clinically. If suspicion persists, MRI
could be performed for further evaluation.

[**2168-9-25**] Head CT : No acute intracranial process.

[**2168-9-25**] CT Torso :
  1. Consolidation in the posterior right lower lobe may be due
to atelectasis, aspiration, and possibly contusion. No
pneumothorax or pleural fluid.
  2. No acute traumatic injury in the abdomen.
  3. Acute, comminuted fractures of the right anterior superior
acetabulum and right inferior pubic ramus.
  4. Left adrenal lesion, not incompletely characterized on this
single phase, contrast-enhanced CT. Adrenal hematoma is not
likely as there are no other surrounding signs of local organ
injury.
  5. Fully calcified lesion in the peritoneum in the left lower
abdomen of
unknown significance.
  6. L5-S1 spondylolysis and spondylolisthesis as well as
degenerative disc disease.

[**2168-10-1**] Chest Xray : This examination is limited due to
respiratory motion artifact and patient body habitus. There
appears to be a small left pleural effusion. Right lower lobe
opacities have improved. Right pleural effusion is small. Stable
cardiomegaly.




Brief Hospital Course:
Mr. [**Known lastname 18654**] was taken to the Trauma ICU following his left leg
amputation.  He remained intubated and lightly sedated. His
hemodynamics were stable after appropriate fluid and blood
resuscitation.  He did have a repeat CT of the torso due to a
persistent hematocrit drop on [**2168-9-27**] which was negative and
his hematocrit equilibrated.  He was extubated on [**2168-9-27**] and
continued vigorous pulmonary toilet including Chest PT and
incentive spirometry.

On [**2168-9-29**] he underwent completion left above knee amputation
and tolerated the procedure well.  He returned to the ICU in
stable condition and was able to be extubated that evening.. His
C spine was cleared.  His pain was initially controlled with
Dilaudid then eventually switched to Percocet with effect.  he
was transferred to the Trauma floor for further management.

The Physical Therapy service was involved on a daily basis to
help him with transfers and balance training.  Due to his non
operative right acetabular fracture and right inferior pubic
ramus fracture his weight bearing status was restricted to
partial weight bearing on the right with weight bearing as
tolerated for transfers.

He developed a temperature of 101.4 on post op day [**5-3**] and the
culprit appeared to be the left AKA incision which was
erythematous. His WBC was normal but due to the appearance of
the wound he was placed on Kefzol and eventually switched to
Vancomycin.  He remained afebrile and the wound was slowly
improving.

Mr.[**Known lastname 18654**] was discharged to rehab on [**2168-10-3**] for intense
physical therapy with the hope of increasing and maintaining his
independence.

Medications on Admission:
1. Hydrochlorothiazide 50 mg PO Daily
2. ASA 81 mg PO Daily
3. Doxazosin 4 mg PO Daily
4. Plavix 75 mg PO Daily
5. Amlodipine 5 mg PO Daily
6. Gabapentin 300 mg PO TID
7. Simvastatin 20 mg PO Daily
8. Avapro 150 mg PO Daily
9. MVI 1 tab PO Daily

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
const.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
5. Hydrochlorothiazide 12.5 mg Capsule Sig: Four (4) Capsule PO
DAILY (Daily).
6. Doxazosin 4 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

7. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
8. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

9. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
10. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

11. Irbesartan 150 mg Tablet Sig: One (1) Tablet PO daily ().
12. Dicloxacillin 500 mg Capsule Sig: One (1) Capsule PO four
times a day: Thru [**2168-10-10**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 979**] - [**Location (un) 246**]

Discharge Diagnosis:
Primary diagnosis
S/P Motorcycle accident with
1. Near complete left lower extremity amputation
2. Right inferior pubic ramus fracture
3. Comminuted right acetabular fracture
4. Acute blood loss anemia

Secondary diagnosis
1. Hypertension
2. Sleep apnea
3. S/P CVA
4. S/P Cholecystectomy
5. S/P Repair of umbilical hernia


Discharge Condition:
Stable, tolerating a regular diet, trying to assist with
transfer from bed to chair.


Discharge Instructions:
* Your activity for now is partial weight bearing for 6 weeks
but    weight bearing as tolerated for transfers.

Please call your doctor or nurse practitioner or return to the
Emergency Department for any of the following:

*You experience new chest pain, pressure, squeezing or
tightness.

*New or worsening cough, shortness of breath, or wheeze.

*If you are vomiting and cannot keep down fluids or your
medications.

*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.

*You see blood or dark/black material when you vomit or have a
bowel movement.

*You experience burning when you urinate, have blood in your
urine, or experience a discharge.

*Your pain in not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.

*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.

*Any change in your symptoms, or any new symptoms that concern
you.

Please resume all regular home medications , unless specifically
advised not to take a particular medication. Also, please take
any new medications as prescribed.

Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids. Avoid lifting
weights greater than [**4-10**] lbs until you follow-up with your
surgeon.

Avoid driving or operating heavy machinery while taking pain
medications.

Incision Care:

*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.

*Avoid swimming and baths until your follow-up appointment.

*You may shower, and wash surgical incisions with a mild soap
and warm water. Gently pat the area dry.

*If you have staples, they will be removed at your follow-up
appointment with the Vascular surgeon.


Followup Instructions:
Call the [**Hospital **] Clinic at [**Telephone/Fax (1) 1228**] for a follow up
appointment in 2 weeks.

Call the Vascular Surgery Clinic at [**Telephone/Fax (1) 1237**] for a follow up
appointment in 2 weeks.  Your staples will be removed at that
time.

Staple removal on [**2168-10-20**]



Completed by:[**2168-10-3**]
{'Traumatic amputation of leg(s) (complete) (partial), unilateral, at or above knee, without mention of complication,Acute posthemorrhagic anemia,Closed fracture of acetabulum,Other postoperative infection,Cellulitis and abscess of leg, except foot,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Motor vehicle traffic accident involving collision with other vehicle injuring motorcyclist,Amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Phantom limb (syndrome)'}


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: nausea and pain

PRESENT ILLNESS: 68 yo M driver of a motorcycle was struck on the left side
by a car at low speed. He denies LOC or head trauma. Complains
of
[**9-10**] LLE pain. He was seen in the Emergency Room and
immediately taken to the Operating Room for Guillotine
amputation of the left lower extremity.

MEDICAL HISTORY: PMH
1. S/P CVA
2. Hypertension

MEDICATION ON ADMISSION: 1. Hydrochlorothiazide 50 mg PO Daily
2. ASA 81 mg PO Daily
3. Doxazosin 4 mg PO Daily
4. Plavix 75 mg PO Daily
5. Amlodipine 5 mg PO Daily
6. Gabapentin 300 mg PO TID
7. Simvastatin 20 mg PO Daily
8. Avapro 150 mg PO Daily
9. MVI 1 tab PO Daily

ALLERGIES: Atenolol

PHYSICAL EXAM: Temp 99.4 HR 76 BP 99/57 RR 20
HEENT NCAT PERRLA
Neck non tender
Chest equal breath sounds bilaterally, no deformity
COR RRR
Abd soft, non tender
Ext left leg with exposed muscle and bone, decreased sensation

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Married, lives with wife
Remote tobacco
ETOH none 

### Response:
{'Traumatic amputation of leg(s) (complete) (partial), unilateral, at or above knee, without mention of complication,Acute posthemorrhagic anemia,Closed fracture of acetabulum,Other postoperative infection,Cellulitis and abscess of leg, except foot,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Motor vehicle traffic accident involving collision with other vehicle injuring motorcyclist,Amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Phantom limb (syndrome)'}
