CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 72 yo male s/p motor vehicle crash, he was  hit on drivers side
at high rate of
speed, +LOC, restrained, sustaining multiple left rib fractures,
complex pelvic fractures including left acetabulum, bilateral
inf
rami and left sup rami fractures. He also sustained a small
pneumothorax on the L, noted on CT, that was not treated with a
chest tube at the time of arrival.

MEDICAL HISTORY: s/p App'y
s/p Back surgery

MEDICATION ON ADMISSION: Denies

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
     Temp (F): 98
     Heart Rate: 82
     Blood Pressure: 108/60
     Resp Rate: 16
     O2 Sat(%): 100
     Room Air/O2: 15L FT (prior 96% on 4L NC)
     Ht (in):
     Wt (lb):

FAMILY HISTORY: Nonconttributory

SOCIAL HISTORY: 
Closed fracture of acetabulum,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Pulmonary collapse,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Abrasion or friction burn of other, multiple, and unspecified sites, without mention of infection,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle
Fracture acetabulum-clos,Traum pneumohemothor-cl,Fx mult ribs NOS-closed,Pulmonary collapse,Fx sacrum/coccyx-closed,Abrasion NEC,Mv collision NOS-driver
Admission Date:  [**2175-5-19**]              Discharge Date:   [**2175-5-28**]

Date of Birth:  [**2103-4-2**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
[**2175-5-22**] Right femoral percutaneous placement of inferior vena
cava filter

[**2175-5-22**] Open reduction and internal fixation of left acetabular
fracture via lateral ilioinguinal window plus Stoppa window

[**2175-5-24**] Left video-assisted thoracoscopic surgery and
evacuation of hemothorax.


History of Present Illness:
72 yo male s/p motor vehicle crash, he was  hit on drivers side
at high rate of
speed, +LOC, restrained, sustaining multiple left rib fractures,
complex pelvic fractures including left acetabulum, bilateral
inf
rami and left sup rami fractures. He also sustained a small
pneumothorax on the L, noted on CT, that was not treated with a
chest tube at the time of arrival.

Past Medical History:
s/p App'y
s/p Back surgery

Family History:
Nonconttributory

Physical Exam:
PHYSICAL EXAM:
     Temp (F): 98
     Heart Rate: 82
     Blood Pressure: 108/60
     Resp Rate: 16
     O2 Sat(%): 100
     Room Air/O2: 15L FT (prior 96% on 4L NC)
     Ht (in):
     Wt (lb):

GENERAL    [x] ALL FINDINGS NORMAL
     [ ] WN/WD
     [ ] WD
     [ ] NAD
     [ ] AAO
     [ ] abnormal findings:

HEENT    [x] ALL FINDINGS NORMAL
     [ ] NC/AT
     [ ] EOMI
     [ ] PERRL/A
     [ ] Anicteric
     [ ] OP/NP mucosa normal
     [ ] Tongue midline
     [ ] Palate, upper symmetric
     [ ] Trachea midline
     [ ] Neck supple/NT/without mass
     [ ] Thyroid Normal size/contour
     [ ] Abnormal findings:

RESPIRATORY    [ ] ALL FINDINGS NORMAL
     [ ] Clear to auscultation and percussion
     [x] Excursion normal
     [ ] No fremitus
     [ ] No egophony
     [ ] No spine/costovertebral angle tenderness
     [x] Abnormal findings: Ecchymosis L flank and chest. TTP,
more anteriorly. Dull to percussion L base with absent breath
sounds.

CARDIOVASCULAR    [x] ALL FINDINGS NORMAL
     [ ] RRR
     [ ] No M/R/G
     [ ] No JVD
     [ ] Normal peripheral pulses
     [ ] PMI normal
     [ ] No edema
     [ ] No abdominal bruit
     [ ] No carotid bruit
     [ ] Abnormal findings:

GI    [x] ALL FINDINGS NORMAL
     [ ] Soft
     [ ] NT
     [ ] ND
     [ ] No mass/HSM
     [ ] No hernia
     [ ] Abnormal findings:

SKIN    [x] ALL FINDINGS NORMAL
     [ ] No rashes/lesions/ulcers
     [ ] No induration/nodules/tightening
     [ ] Abnormal findings:

GU    [ ] ALL FINDINGS NORMAL
     [ ] Normal external genitalia
     [ ] Normal pelvic/testicular exam
     [ ] Normal DRE
     [x] Abnormal findings: Scrotal edema and ecchymosis

NEURO    [x] ALL FINDINGS NORMAL
     [ ] Strength intact/symmetric
     [ ] Sensation intact/symmetric
     [ ] Reflexes normal
     [ ] No facial asymmetry
     [ ] Cognition intact
     [ ] Cranial nerves intact
     [ ] Abnormal findings:

LYMPH NODES    [x] ALL FINDINGS NORMAL
     [ ] Cervical normal
     [ ] Supraclav normal
     [ ] Axillary normal
     [ ] Inguinal normal
     [ ] Abnormal findings:

MS     [ ] ALL FINDINGS NORMAL
     [x] No clubbing
     [x] No cyanosis
     [x] No edema
     [ ] Gait normal
     [ ] No tenderness
     [ ] Normal tone/alignment/ROM
     [ ] Normal palpation
     [x] Normal nails
     [ ] Abnormal findings:

PSYCHIATRIC    [x] ALL FINDINGS NORMAL
     [ ] Normal judgement/insight
     [ ] Normal memory
     [ ] Normal mood/affect
     [ ] Abnormal findings


Pertinent Results:
[**2175-5-19**] 09:30PM   GLUCOSE-159* UREA N-23* CREAT-0.8 SODIUM-142
POTASSIUM-3.9 CHLORIDE-106 TOTAL CO2-25 ANION GAP-15
[**2175-5-19**] 09:30PM   CK(CPK)-535*
[**2175-5-19**] 09:30PM   CK-MB-12* MB INDX-2.2 cTropnT-<0.01
[**2175-5-19**] 09:30PM   WBC-15.3*# RBC-4.03* HGB-13.2* HCT-39.1*
MCV-97 MCH-32.8* MCHC-33.9 RDW-13.5
[**2175-5-19**] 09:30PM   PLT COUNT-181
[**2175-5-19**] 04:20PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2175-5-19**] 04:20PM   PT-11.7 PTT-24.1 INR(PT)-1.0
[**2175-5-19**] 04:20PM   PLT COUNT-230
[**2175-5-19**] 04:20PM   FIBRINOGE-436*

    [**Known lastname 16810**],[**Known firstname **] [**Medical Record Number 16811**] M  72  [**2103-4-2**]

Cardiology Report ECG Study Date of [**2175-5-19**]  4:37:16 PM


Normal sinus rhythm. RSR' pattern in leads V1-V2. Non-specific
ST-T wave
abnormalities. No previous tracing available for comparison.


Read by: [**Last Name (LF) **],[**First Name8 (NamePattern2) 2206**] [**Doctor Last Name **]

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
75 158 92 370/396 73 80 63


([**-7/3274**])

    [**Known lastname 16810**],[**Known firstname **] [**Medical Record Number 16811**] M  72  [**2103-4-2**]

Radiology Report CT HEAD W/O CONTRAST Study Date of [**2175-5-19**]
4:39 PM
FINDINGS: There is no intra- or extra-axial hemorrhage, masses,
mass effect
or shift of normally midline structures. The ventricles and
sulci are mildly
prominent appropriate for age-associated involutionary changes.
There are no
acute major vascular territorial infarcts. The osseous and soft
tissue
structures are unremarkable. Minimal anterior ethmoidal mucosal
thickening is
noted. The partially visualized right maxillary sinus is
completely
opacified.

IMPRESSION: No acute intracranial process.




Radiology Report CT C-SPINE W/O CONTRAST Study Date of [**2175-5-19**]
4:39 PM
FINDINGS: There are no acute fractures or alignment
abnormalities of the
cervical spine. There is a non-displaces hairline fracture of
the left second
posterolateral rib. There is multilevel degenerative disease
with exaggerated
kyphosis and grade 1 retrolistheses of C4 on C5 and C5 on C6.
There is
moderate central canal narrowing with a posterior disc
osteophyte complex
causing mild thecal sac indentation at C4-C5 and to a lesser
degree, at C5-C6
level. There is severe left neural foraminal narrowing at C2-C3,
C3-C4, and
C4- C5 levels.

There is no pre- or paravertebral soft tissue abnormality.
Incidental
deformity of the left thyroid laminar cartilage is noted. There
is moderate
left apical pleural thickening without appreciable pneumothorax,
which was
seen on the concurrently obtained CT torso. The right maxillary
sinus is
completely opacified. The left maxillary sinus is excluded from
the field of
view.

IMPRESSION:
1. Nondisplaced second left posterolateral rib fracture.
2. No acute fractures or alignment abnormalities of the cervical
spine.
3. Severe degenerative disease with significant central canal
narrowing
causing thecal sac indentation at C4-C5 and severe left neural
foraminal
narrowing at C2-C3, C3-C4, C4-C5.




Radiology Report CT CHEST W/CONTRAST Study Date of [**2175-5-19**] 4:40
PM
CT OF THE CHEST WITH INTRAVENOUS CONTRAST: There is no axillary
or
mediastinal adenopathy. There is no mediastinal hemorrhage. The
aortic
contour is well defined without aneurysm or dissection. The
heart and the
great vessels are unremarkable, without pericardial effusion.
The coronary
arteries are well opacified with moderate amount of left
anterior descending
artery calcification. There is a calcified right hilar lymph
node. Lung
windows demonstrate a small loculated pneumothorax at the
superomedial aspect
of the left lung with two smaller pockets of loculated air in
the lateral and
paravertebral aspects of the LUL and LLL respectively.
Additionally there is
LLL focal consolidation in subpleural aspects, part of which
could be
atelectasis, however, in the setting of multiple rib fractures,
pulmonary
contusion cannot be excluded. There is minimal atelectasis at
the right lung
base. There is no pleural effusion. The tracheobronchial tree is
patent to
the subsegmental level. Minimal ground-glass opacity at the left
lower lobe
(2:35) could reflect focal pneumonitis. There is mild lingular
scarring.

CT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST: There is no
intraperitoneal free
fluid or free air. There is no evidence of traumatic injury to
the solid
visceral organs. Mild periportal edema is noted. Otherwise the
liver,
gallbladder, kidneys, adrenals, spleen, stomach, and
intra-abdominal bowel
loops are within normal limits. There is no mesenteric or
retroperitoneal
adenopathy.

CT OF THE PELVIS WITH INTRAVENOUS CONTRAST: The rectum, sigmoid
colon,
urinary bladder, intrapelvic bowel loops are unremarkable. There
is trace
amount of pelvic free fluid. No pelvic or inguinal adenopathy.

OSSEOUS STRUCTURES: There are multiple segmental left-sided rib
fractures.
The left second to eleventh ribs demonstrate posterolateral
fractures with
additonal fractures in, at least, the fifth to ninth ribs,
anterolaterally.
There is a markedly comminuted left acetabular fracture
involving both the
anterior and posterior columns with extension into the
intervening
quadrilateral plate. It is markedly distracted with
approximately 1.6 cm of
distraction of the fractured anterior column.

Left posterior and right mid inferior pubic rami demonstrate
minimally
displaced fractures with extension of the left sided inferior
ramus fracture
into the ischium. There is also a right superior ramus and a
comminuted left
superior ramus fracture without diastasis of the symphysis. The
remainder of
bilateral iliac bones are intact. The sacral ala and the sacral
arcuate lines
are intact.

IMPRESSION:
1. Multiple left-sided rib fractures, with small multiloculated
left
pneumothorax and LLL subpleural opacity, could reflect pulmonary
contusion in
this setting.

2. Multiple pelvic fractures and communited left acetabular
fracture, as
described above. Trace amount of pelvic free fluid.

3. No other solid organ injury.

[**2175-5-22**] ECHOCARDIOGRAPHY REPORT
Age (years): 72 M  Hgt (in): 75
BP (mm Hg): 126/68  Wgt (lb): 185
HR (bpm): 54  BSA (m2): 2.12 m2
Indication: Left ventricular function. Right ventricular
function.
ICD-9 Codes: 424.0
Test Information
Date/Time: [**2175-5-22**] at 15:09    Interpret MD: [**Name6 (MD) **] [**Name8 (MD) 4082**], MD
Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**Name2 (NI) 16812**]
[**Last Name (un) 16813**], RDCS
Doppler: Full Doppler and color Doppler Test Location: West CCU
Contrast: None Tech Quality: Suboptimal
Tape #: 2008W000-0:00 Machine: Vivid i-3
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Four Chamber Length:  4.9 cm  <= 5.2 cm
Right Atrium - Four Chamber Length:  4.2 cm  <= 5.0 cm
Left Ventricle - Ejection Fraction:  >= 70%  >= 55%
Mitral Valve - E Wave:  0.8 m/sec
Mitral Valve - A Wave:  1.0 m/sec
Mitral Valve - E/A ratio:  0.80

Findings
No parasternal views available. Patient in severe pain. Scanned
supine.
LEFT ATRIUM: Normal LA and RA cavity sizes.

LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
global systolic function (LVEF>55%). Suboptimal technical
quality, a focal LV wall motion abnormality cannot be fully
excluded.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTIC VALVE: Aortic valve not well seen.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR.

TRICUSPID VALVE: Tricuspid valve not well visualized.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.
Left pleural effusion.
Conclusions
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thickness, cavity size, and global systolic
function are normal (LVEF>55%). Due to suboptimal technical
quality, a focal wall motion abnormality cannot be fully
excluded. Right ventricular chamber size and free wall motion
are normal. The aortic valve is not well seen. No definite
aortic regurgitation is seen. The mitral valve appears grossly
normal with trivial mitral regurgitation. There is no
pericardial effusion.

IMPRESSION: Suboptimal image quality. Overall normal cavity
sizes with excellent biventricular systolic function. No
definite valvular pathology identified (suboptimal views).










Brief Hospital Course:
He was admitted to the Trauma Service. Orthopedics was consulted
urgently due to his multiple fractures. he was taken to the
operating room on [**5-22**] for repair of his injuries and placement
of an IVC filter because of high [**Doctor First Name **] for pulmonary embolus
because of the long bone fractures. There were no intraoperative
complications. The Pain service was also consulted for epidural
catheter placement for managing his multiple rib fractures; the
catheter was placed without any complications. He also underwent
an ECHO and his CK-MB and troponin were cycled and were
negative.
He remained in the Trauma ICU for several days and was the
transferred to the regular nursing unit.

Thoracic surgery was consulted given the left hemothorax, he was
taken to the operating room on [**5-23**] for a VATS procedure. There
were no complications. His left chest tube remained in place for
several days following this and was eventually removed.

Pain control was ongoing throughout his hospital stay. Once the
epidural was removed he was placed on long acting narcotics with
shorter acting ones for breakthrough pain. Neurontin was also
added to his pain regimen. An aggressive bowel routine was
initiated.

Physical therapy was also consulted and have recommended acute
rehab after hospital stay.

[**2175-5-27**]: Chest tube removed and CXR post pull was good with no
pneumothorax.  Pt. was discharged to rehab.

Medications on Admission:
Denies

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ML
Injection TID (3 times a day).
3. Ipratropium Bromide 0.02 % Solution Sig: One (1) Neb
Inhalation Q6H (every 6 hours).
4. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) Neb Inhalation Q6H (every 6 hours).
5. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours).
6. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours).
7. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for breakthrough pain.
8. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).
9. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
10. Bisacodyl 10 mg Suppository Sig: One (1) supp Rectal DAILY
(Daily) as needed for constipation.
11. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 5 days.
Disp:*20 Capsule(s)* Refills:*0*
12. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H
(every 8 hours).
Disp:*3 Tablet(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital 1319**] rehab

Discharge Diagnosis:
s/p Motor vehicle crash
Injuries:
Multiple left rib fractures ([**2-14**]), some segmental
Very small left pneumothorax
Comminuted left acetabular fracture
Left sacral ala fracture
Right superior and inferior rami fractures
Left inferior ramus fracture



Discharge Condition:
Good


Discharge Instructions:
Keep Dressing on Left chest from chest tube site in place until
Monday [**5-29**]. You may shower on Monday  [**5-29**]. After shower remove
dressing. If there is clear draininage you may place a dry
bandange, otherwise leave open to air.

Followup Instructions:
Follow up in 2 weeks with Dr. [**Last Name (STitle) **], Trauma Surgery, call
[**Telephone/Fax (1) 600**] for an appointment.

Follow up in [**Hospital 5498**] clinic in 2 weeks, call [**Telephone/Fax (1) 1228**]
for an appointment.

Follow up in [**Hospital 16814**] clinic in 2 weeks, call [**Telephone/Fax (1) 170**] for
an appointment.
{'Closed fracture of acetabulum,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Pulmonary collapse,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Abrasion or friction burn of other, multiple, and unspecified sites, without mention of infection,Other motor vehicle traffic accident involving collision with motor 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: s/p Motor vehicle crash

PRESENT ILLNESS: 72 yo male s/p motor vehicle crash, he was  hit on drivers side
at high rate of
speed, +LOC, restrained, sustaining multiple left rib fractures,
complex pelvic fractures including left acetabulum, bilateral
inf
rami and left sup rami fractures. He also sustained a small
pneumothorax on the L, noted on CT, that was not treated with a
chest tube at the time of arrival.

MEDICAL HISTORY: s/p App'y
s/p Back surgery

MEDICATION ON ADMISSION: Denies

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
     Temp (F): 98
     Heart Rate: 82
     Blood Pressure: 108/60
     Resp Rate: 16
     O2 Sat(%): 100
     Room Air/O2: 15L FT (prior 96% on 4L NC)
     Ht (in):
     Wt (lb):

FAMILY HISTORY: Nonconttributory

SOCIAL HISTORY:  

### Response:
{'Closed fracture of acetabulum,Traumatic pneumohemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Pulmonary collapse,Closed fracture of sacrum and coccyx without mention of spinal cord injury,Abrasion or friction burn of other, multiple, and unspecified sites, without mention of infection,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}
