CHIEF COMPLAINT: Motor vehicle crash

PRESENT ILLNESS: Mr. [**Known lastname 44505**] is a 17-year-old
unrestrained driver of a car who hit a tree at approximately
70 miles per hour.  He was ejected from a vehicle and was
emergently transferred to [**Hospital **] Hospital.  He was found to
have [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Scale of 3.  At [**Hospital **] Hospital,
intravenous access was achieved and the patient was
intubated.  He received 4 liters of fluid and 2 units of
blood prior to this transfer to [**Hospital1 **] for
further emergent care.  He was accepted at [**Hospital1 **] as a trauma plus.  In the trauma bay at [**Hospital1 **], Mr. [**Known lastname 44505**] received bilateral chest tubes,
diagnostic peritoneal lavage which was negative, emergent
stapling of a bleeding forehead laceration and tightening of
pelvis.  He received 4 liters of crystalloid and 4 units of
blood.  Portable films were obtained in the trauma room and
from the trauma room the patient was transferred to the
Intensive Care Unit for further stabilization.

MEDICAL HISTORY: Seizure disorder with no seizures for
the last three years.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Traumatic pneumothorax without mention of open wound into thorax,Cerebral artery occlusion, unspecified with cerebral infarction,Infection and inflammatory reaction due to other vascular device, implant, and graft,Congenital deficiency of other clotting factors,Closed fracture of multiple cervical vertebrae,Pneumonia, organism unspecified,Closed fracture of other specified part of pelvis,Motor vehicle traffic accident involving collision with other vehicle injuring driver of motor vehicle other than motorcycle
Cl skul/oth fx-deep coma,Traum pneumothorax-close,Crbl art ocl NOS w infrc,React-oth vasc dev/graft,Cong def clot factor NEC,Fx mult cervical vert-cl,Pneumonia, organism NOS,Pelvic fracture NEC-clos,Mv-oth veh coll-driver
Admission Date:  [**2123-9-8**]       Discharge Date:  [**2123-10-11**]

Date of Birth:   [**2105-11-18**]       Sex:  M

ervice:  Trauma Surgery

CHIEF COMPLAINT:  Motor vehicle crash

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 44505**] is a 17-year-old
unrestrained driver of a car who hit a tree at approximately
70 miles per hour.  He was ejected from a vehicle and was
emergently transferred to [**Hospital **] Hospital.  He was found to
have [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Scale of 3.  At [**Hospital **] Hospital,
intravenous access was achieved and the patient was
intubated.  He received 4 liters of fluid and 2 units of
blood prior to this transfer to [**Hospital1 **] for
further emergent care.  He was accepted at [**Hospital1 **] as a trauma plus.  In the trauma bay at [**Hospital1 **], Mr. [**Known lastname 44505**] received bilateral chest tubes,
diagnostic peritoneal lavage which was negative, emergent
stapling of a bleeding forehead laceration and tightening of
pelvis.  He received 4 liters of crystalloid and 4 units of
blood.  Portable films were obtained in the trauma room and
from the trauma room the patient was transferred to the
Intensive Care Unit for further stabilization.

PAST MEDICAL HISTORY:  Seizure disorder with no seizures for
the last three years.

PAST SURGICAL HISTORY:  None

MEDICATIONS:  Tegretol

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION RECORDED IN TRAUMA BAY:
VITAL SIGNS:  Heart rate from 90 to 130, blood pressure from
108 to 113 or palpable, temperature of 35?????? Celsius.
GENERAL:  The patient is intubated, unresponsive with a large
bleeding laceration over his forehead.
HEAD, EARS, EYES, NOSE AND THROAT:  He has multiple abrasions
over the face.  His trachea is midline.
BACK:  There are no deformities of the back or spine.
CHEST:  Crepitus over the right chest with decreased breath
sounds bilaterally.
ABDOMEN:  Distended.  Pelvis is stable.
EXTREMITIES:  The left thigh shows deformity and the left
ankle shows deformity.  There is a laceration over the left
knee.  Both pulses on the feet are palpable.

EXAM ON DISCHARGE:
Temperature 99.6??????, pulse 110, pressure 137/80, respirations
22, O2 saturation 99%.  [**Known firstname 3403**] [**Known lastname 44505**] is a young man who
spontaneously opened his eyes and occasionally is able to
track a family member entering the room.  He does close his
eyes to threat.  He makes some lip movements, however has no
other movements of his body spontaneously or on command.  He
has a small puncture wound on his head which is the old drain
site.  He has a tracheostomy tube which is clean with a
midline trachea.  He has a C-collar in place.  His heart is
regular.  He has mild rhonchi on both sides.  He has palpable
radial pulses.  His abdomen is soft, nontender, nondistended.
He has a PEG tube at its insertion site, clean, dry and
intact.  He has a condom catheter and his extremities are all
warm.  He has palpable DP pulses on both legs.  He has a
peripheral intravenous for intravenous access.

LABORATORIES ON DISCHARGE:  White count of 15, hematocrit of
30, platelet count 490.  PT of 14, PTT of 26, INR of 1.4.
Electrolytes:  Sodium 138, potassium 4.4, chloride 101,
bicarbonate 24, BUN 20, creatinine 0.4, glucose 122.  His
Tegretol level is 6.4 on discharge.

CONCISE SUMMARY OF INJURIES:  Mr. [**Known lastname 44505**] was initially
evaluated and was found to have the following injuries:

1.  Right temporal and frontal contusion.
2.  Small subdural overlying the occipital lobe.
3.  Left first and second rib fractures, right first and
second rib fractures.
4.  Bilateral scapular fractures.
5.  Large bilateral pulmonary contusions.
6.  Left clavicular fracture.
7.  C6 to T1 posterior process fracture.
8.  T1 transverse process fracture.
9.  Right MCA stroke diagnosed on [**9-14**].
10. Bilateral pneumothoraces, status post test tubes.
11. Multiple skull fractures and pneumocephalus.
12. Right zygomatic arch fracture, right maxillary sinus and
lateral [**Doctor First Name 362**] of the pterygoid bone fracture.
13. Mild diaphysis of the pelvis.
14. Pneumopericardium.

CONCISE SUMMARY OF HOSPITAL COURSE:  Mr. [**Known lastname 44505**] was
brought to [**Hospital1 **] emergently after he was an
unrestrained driver in an accident with his car hitting a
tree at 70 miles per hour.  On arrival, he was intubated and
had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Scale of 3T.  He received aggressive
resuscitation and management over his hospital course which,
for the sake of understanding, is described below by systems.

Neurologic:  By history, prior to the accident, Mr.
[**Known lastname 44505**] is a 17-year-old young man with no neurological
deficits.  His GCS on arrival was 3 and his evaluation showed
that he had temporal and frontal contusions, subarachnoid
hemorrhage, subdural hemorrhage and pneumocephalus.  He was
aggressively treated on arrival and received Mannitol,
Dilantin, PCO2 control, elevation of head and ICP drain
placement by neurosurgery and monitoring of cerebral venous
flow through a jugular catheter pointing toward the cephalad
region.  Despite this aggressive management, Mr. [**Known lastname 44505**]
[**Last Name (Titles) 44506**] continued to rise which can be attributed to his initial
injury.  This was confirmed by repeat CT scans.  Given this,
he received a pentobarbital coma which was continued for one
week.  During this coma, his ICP drain continued to drain and
[**Last Name (Titles) 44506**] consistently came down to a level of 16 or below.  After
this, the pentobarbital was withdrawn and he was allowed to
clear as much as he would.  Over the last two weeks of
admission after the pentobarbital was withdrawn, Mr.
[**Known lastname 44507**] neurological status has slightly improved.  He
has awakened from his coma to the level where he opens his
eyes and occasionally is tracking by his eyes.  He does not
follow commands and does not have any purposeful movement of
his extremities.  His pain medications and sedation have been
weaned to off and he is on Tegretol as he was prior to his
accident.  An MRI scan at discharge shows improvement from
his initial scans on arrival.  The recommended plan from a
neurosurgical perspective is to continue to monitor his
mental status for improvement.  He is to continue on Tegretol
with levels being monitored.  His last level at discharge is
6.4 which is therapeutic.  Of note, during his hospital
course, Mr. [**Known lastname 44505**] also received a four vessel angiogram
of his head to rule out a vascular injury.  He had normal
carotid and vertebral arteries during the study.  Finally, as
a rule out study, an EMG was obtained which was negative for
any neuropathy.  His ICP drainage catheter was removed 1.5
weeks prior to discharge and since then he has been stable.

Cardiovascular:  On hospital day 1 to 2 of his arrival, Mr.
[**Known lastname 44505**] was found to be slightly hypotensive, requiring
pressor support to maintain his blood pressure.  His
evaluation included a chest CT and chest x-ray, both
confirming pneumopericardium.  Suspecting that this
pneumopericardium may be causing a tamponade, an emergent
cardiac catheterization was obtained.  This cardiac
catheterization was consistent with tamponade and pericardial
drain was placed.  This pericardial drain was weaned and
taken off and follow up echocardiogram show an ejection
fraction of 55% with a normal ventricular function with mild
left ventricular hypertrophy.  Once he recovered from the
pneumopericardium, Mr. [**Known lastname 44505**] remained stable from a
cardiovascular perspective.  On discharge, he is not on any
cardiac medications.  Of note, during his hospital course, he
received intermittent hydralazine to treat occasional
hypertension.  This hypertension was attributed to episodes
of possible agitation during his awakening and at discharge
his blood pressure was stable and normal without any
medications.

Respiratory:  Mr. [**Known lastname 44505**] arrived in the trauma bay with
bilateral pulmonary contusions which were severe.  He
received emergent chest tubes on both sides and was managed
per ARDS protocol, criteria of which he met.  Due to
prolonged intubation of three weeks, he received tracheostomy
tube placement in early [**Month (only) **].  He has slowly recovered
from his ARDS and at discharge has been weaned off the
ventilator and is tolerating trach mask for greater than 48
hours.  The plan is to do routine trach care and routine
trach weaning.  He did receive a course of vancomycin and
Zosyn for gram positive cocci and gram negative rods in the
sputum.  At discharge, he is off antibiotics and has been
able to wean off the ventilator.  Of note, on imaging, he
also has a left clavicle fracture and bilateral scapular
fractures, all of which are deemed nonoperative by the
orthopedic service.

Gastrointestinal:  Mr. [**Known lastname 44505**] was not found to have
injury to his GI tract.  This was initially confirmed by
diagnostic tracheal lavage during trauma resuscitation which
was negative and has further been confirmed by ability to
tolerate tube feeds at goal.  For the first three weeks of
his hospital course, he received parenteral nutrition.  This,
after his pentobarbital coma was removed, had been switched
to tube feeds.  At discharge, he has been tolerating Impact
with fiber at goal of 95 cc per hour for multiple days.  He
received a PEG tube placement along with his tracheostomy
tube placement and is being fed by this PEG tube.  He has
bowel movements and a soft abdomen and the PEG tube site is
clean, dry and intact.  At discharge, he is not on any GI
prophylaxis.

Infectious disease:  Mr. [**Known lastname 44505**] hospital course has been
significant for blood cultures which showed coagulase
negative Staphylococcus which were determined to be from a
line infection.  He also had Enterobacter, Escherichia coli
and gram negative rods from his sputum.  These organisms were
treated with courses of oxacillin, Zosyn and vancomycin in
that order.  On discharge, he is finishing a course of
vancomycin for coagulase negative Staphylococcus from a
central line.  The central line has been removed.  His white
count at discharge is 15 and is being followed closely.

Renal:  Mr. [**Known lastname 44505**] has had normal renal function through
his hospital course.  Initially, he received Mannitol for his
ICP management.  His electrolytes were closely monitored.  At
discharge, he is urinating spontaneously through a condom
catheter.  His creatinine was stable and normal.  There are
no signs of injuries to the kidneys on CT scans.

Heme:  During hospitalization, it was revealed to the trauma
team that Mr. [**Known lastname 44505**] has factor VII deficiency.  This
manifests in slightly INR of approximately 2.  Initially,
during unstable period, this INR was managed by fresh frozen
plasma transfusions to maintain INR below 2.0.  Factor VII
levels were also followed.  Over time, however, as Mr.
[**Known lastname 44505**] went through multiple pros, it became evident that
he is able to clot his blood adequately.  We decided to not
[**Male First Name (un) **] his INR and tolerate INR of less than or equal to 2.
At discharge, he has not received any fresh frozen plasma
transfusions for more than a week and continues to maintain
INR below 2 without any signs of bleeding.  Due to the factor
VII deficiency and due to his head injury, we have opted to
hold heparin subcutaneous.  This will be discussed with
neurosurgery to elucidate whether to restart heparin
subcutaneous for Mr. [**Known lastname 44505**].

Genitourinary:  On arrival to the trauma bay, Mr. [**Known lastname 44505**]
was found to have gross hematuria.  This hematuria cleared
over time without any intervention.  He did receive a
cystogram which was negative for any bladder injury.

Endocrine:  Mr. [**Known lastname 44505**] has no history of diabetes and has
maintained normal blood sugars on tube feeds without insulin.

Nutrition:  As described above, Mr. [**Known lastname 44505**] was given
parenteral nutrition for the first three weeks of his
admission and is now tolerating tube feeds at goal of 95 an
hour which is confirmed by a nutrition consult.  He receives
Impact with fiber by his tube feeds along with free water
flushes.  He is expected to continue this course of nutrition
until his mental status improves to a point where he can
qualify for a swallow study.

Prophylaxis:  Mr. [**Known lastname 44505**] was given proton pump inhibitor
for prophylaxis until his tube feeds were started, at which
time this prophylaxis was stopped.  He was also kept on [**Last Name (un) **]
boots without heparin subcutaneous secondary to his brain
injury and secondary to his factor VII deficiency and
slightly elevated INR.  To prevent pulmonary embolus on early
[**Month (only) **], Mr. [**Known lastname 44505**] had an IVC filter placed.  This is
a permanent IVC filter placed by radiology.  The question of
whether to restart heparin subcutaneous needs to be discussed
with neurosurgery.

Activity status:  Mr. [**Known lastname 44505**] has been cleared by
neurosurgery and orthopedic surgery to be allowed to get from
his bed to chair.  He is to remain in C-collar until
neurosurgery evaluation.  The C-collar is to stay at least
for six weeks from his injury.

Dermatology:  During his hospitalization, Mr. [**Known lastname 44505**] was
found to have a diffuse rash over his extremity which was
biopsied as per dermatology consult.  This biopsy showed
benign folliculitis.  This rash has improved since then and
at discharge he has no skin rash.  Of note, he does have a
decubitus ulcer over his sacrum and over back of his head.
Both of his ulcers have been debrided and are clean and
require protective dressing care.  The ulcers are stage 1 to
2 in their progression.  He needs meticulous care for these
ulcers to heal.

DISCHARGE MEDICATIONS:
1.  Tegretol 400 mg per G-tube tid
2.  Tylenol prn

DISCHARGE DIAGNOSES:
1.  Motor vehicle trauma
2.  Closed head injury
3.  Tracheostomy placement
4.  PEG tube placement

DISCHARGE DISPOSITION:  Rehabilitation

FOLLOW UP:  Trauma clinic at [**Hospital1 **] within two
weeks of discharge.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 6066**]

Dictated By:[**Name8 (MD) 180**]
MEDQUIST36

D:  [**2123-10-9**]  21:43
T:  [**2123-10-11**]  13:48
JOB#:  [**Job Number 44508**]
{'Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Traumatic pneumothorax without mention of open wound into thorax,Cerebral artery occlusion, unspecified with cerebral infarction,Infection and inflammatory reaction due to other vascular device, implant, and graft,Congenital deficiency of other clotting factors,Closed fracture of multiple cervical vertebrae,Pneumonia, organism unspecified,Closed fracture of other specified part of pelvis,Motor vehicle traffic accident involving collision with other vehicle injuring driver of motor vehicle other than motorcycle'}


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: Motor vehicle crash

PRESENT ILLNESS: Mr. [**Known lastname 44505**] is a 17-year-old
unrestrained driver of a car who hit a tree at approximately
70 miles per hour.  He was ejected from a vehicle and was
emergently transferred to [**Hospital **] Hospital.  He was found to
have [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Scale of 3.  At [**Hospital **] Hospital,
intravenous access was achieved and the patient was
intubated.  He received 4 liters of fluid and 2 units of
blood prior to this transfer to [**Hospital1 **] for
further emergent care.  He was accepted at [**Hospital1 **] as a trauma plus.  In the trauma bay at [**Hospital1 **], Mr. [**Known lastname 44505**] received bilateral chest tubes,
diagnostic peritoneal lavage which was negative, emergent
stapling of a bleeding forehead laceration and tightening of
pelvis.  He received 4 liters of crystalloid and 4 units of
blood.  Portable films were obtained in the trauma room and
from the trauma room the patient was transferred to the
Intensive Care Unit for further stabilization.

MEDICAL HISTORY: Seizure disorder with no seizures for
the last three years.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Traumatic pneumothorax without mention of open wound into thorax,Cerebral artery occlusion, unspecified with cerebral infarction,Infection and inflammatory reaction due to other vascular device, implant, and graft,Congenital deficiency of other clotting factors,Closed fracture of multiple cervical vertebrae,Pneumonia, organism unspecified,Closed fracture of other specified part of pelvis,Motor vehicle traffic accident involving collision with other vehicle injuring driver of motor vehicle other than motorcycle'}
