CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 40-year-old male
status post gunshot wound to the right chest just below the
nipple in the fifth intercostal space.  Initially seen at
outside facility and transferred to [**Hospital6 649**] directly to the Operating Room via [**Location (un) 86**]
[**Location (un) **].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Laceration of lung with open wound into thorax,Injury to esophagus without mention of open wound into cavity,Traumatic pneumohemothorax with open wound into thorax,Assault by handgun,Sialolithiasis,Asthma, unspecified type, unspecified
Lung laceration-open,Esophagus injury-closed,Traum pneumohemothor-opn,Assault-handgun,Sialolithiasis,Asthma NOS
Name:  [**Known lastname 4815**], [**Known firstname **]                 Unit No:  [**Numeric Identifier 10219**]

Admission Date:  [**2175-2-18**]     Discharge Date:  [**2175-3-4**]

Date of Birth:   [**2134-2-17**]     Sex:  M

Service:  TRAUMA SURGERY

ADDENDUM:

Seizure disorder:  The patient's isolated seizure during his
Intensive Care Unit stay was subsequently managed with
Dilantin load with three times a day dosing per the neurology
consultation service.  The patient's Dilantin level was
serially examined and was consistently low during the
patient's stay on the general surgical floor.  Per the
nursing staff, the patient had consistently refused multiple
doses of his intravenous medications.  At the time of
discharge, the patient's level had remained subtherapeutic
with the final level being 1.8.  However, the patient
remained without seizure-like activity per discussion with
the neurology consultation service.  Given the patient's
refusal to take the antiepileptic medication and the absence
of seizure-like activity, their recommendation was to
continue the recommended dose of 200 mg three times a day
with follow-up in neurology clinic at three months
postdischarge or sooner given the occurrence of any
seizure-like activity.  This plan and the associated risk of
medicines were discussed with the patient at length prior to
discharge.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2207**], M.D.  [**MD Number(1) 3525**]

Dictated By:[**Name8 (MD) 9837**]

MEDQUIST36

D:  [**2175-3-4**]  11:22
T:  [**2175-3-4**]  13:12
JOB#:  [**Job Number 10220**]


Admission Date:  [**2175-2-18**]     Discharge Date:  [**2175-3-4**]

Date of Birth:   [**2134-2-17**]     Sex:  M

Service:  TRAU [**Doctor First Name 147**]

HISTORY OF PRESENT ILLNESS:  Patient is a 40-year-old male
status post gunshot wound to the right chest just below the
nipple in the fifth intercostal space.  Initially seen at
outside facility and transferred to [**Hospital6 649**] directly to the Operating Room via [**Location (un) 86**]
[**Location (un) **].

Per outside records the patient was found lying supine in the
street by emergency medical services with a weak radial pulse
at approximately 120 without palpable blood pressure.  The
patient received fluid resuscitation en transit with blood
pressures in the 90s systolic, was intubated in the initial
emergency department at [**Hospital6 302**], received four
units of packed red blood cells, and received bilateral chest
tubes.  Less than 200 cc drained from each chest tube.

PHYSICAL EXAMINATION ON PRESENTATION TO THE OPERATING ROOM:
Intubated and sedated with [**Location (un) 2611**] Coma Scale of 3.  HEENT
exam:  Normocephalic, atraumatic.  Oropharynx with a 7.5
endotracheal tube in place.  Cervical spine in a C-collar.
Chest:  Chest tubes bilaterally without air leak.  Bullet
hole just below the right nipple with palpable bullet at the
tip of the left scapula and clear to auscultation
bilaterally.  Abdomen:  Soft, nondistended; no masses.
Pelvis stable.  Back and spine:  Without step off or
deformity.  Extremities:  2+ pulses throughout.

INITIAL DIAGNOSTIC STUDIES:  Laboratory data:  White count
21.2, hematocrit 33, platelets 158, chemistries within normal
limits.  Coagulation studies:  15.3 PT, 28.9 PTT, INR 1.5.
ABG 735, 43, 379, 25, -1.  Lactate 2.1, calcium, magnesium,
phosphorous within normal limits.

Chest x-ray in the Operating Room reveals chest tubes in
place.  Endotracheal tube in proper position.  Orogastric
tube in the proper position.  Thoracolumbosacral spinal
series revealed irregularity of the anterior superior end
plate of L5.

Follow-up CT scan of the spine revealed no acute injury with
focal sclerotic density noticed in the left iliac [**Doctor First Name 362**] with
recommendation of a bone scan to exclude neoplastic
processes.

CT of the head on [**2175-2-22**] without evidence of acute
intracranial process.

CT of the chest on [**2175-2-22**] without evidence of
mediastinitis.

MRI [**2175-2-24**]:  No acute injury of the neck.

MRI of the head [**2175-2-24**]:  Without evidence of ischemic or
anoxic injury.

Radio contrast swallow [**2175-2-28**]:  No evidence of leak at
the esophageal repair.

Chest films [**2175-3-1**] and [**2175-3-2**] status post chest tube
removal with small apical medically insignificant
pneumothorax resolving.

Bone scan [**2175-3-2**] without evidence of malignancy or
metastatic disease.

HOSPITAL COURSE:  The patient was taken directly to the
Operating Room, as stated above, and underwent an exploratory
laparoscopy, bronchoscopy, flexible endoscopy with
gastrostomy and jejunostomy tube placement, primary repair of
the esophagus with intercostal muscle flap, repair of the
parenchyma of the left lower lobe, and left subclavian
central venous catheter placement.

The patient was then transferred to the Trauma Surgical
Intensive Care Unit.  The patient remained intubated and
sedated and was placed on Zosyn for antimicrobial coverage.

On hospital day three the patient began to spike fevers and
was pancultured.  On hospital day three tube feeds were
started through the J-tube per Nutrition's recommendations
and attempts were made at extubation, but the patient failed
and was reintubated.

On hospital day four the patient was again extubated,
subsequently became agitated and removed his own right chest
tube.  Subsequently he was noted to have transient
desaturations and approximately one-minute period of
seizure-like activity.  The patient was again intubated and
sedated and was loaded with Dilantin, and a Neurology consult
was requested.  At this time the MRI mentioned above and an
EEG were performed.  The EEG was consistent with
encephalopathic changes.  The fevers continued, and the
patient was again pancultured which, at this time, revealed
Enterobacter aerogens from the sputum which were
pansensitive.

The patient then underwent a bronchoscopy on day six which
revealed copious thick secretions with scattered clots in
both airways.  The patient was started on standing doses and
p.r.n. doses of Haldol for his increase in agitation but on
hospital day nine was noted to have an increased QTC, for
which the patient was then monitored throughout the remainder
of his hospital course.

On hospital day nine the patient's right chest tube was
subsequently discontinued and the patient was then extubated.
Tube feeds were continually advanced until at goal per
Nutrition, and the swallow study mentioned above was
performed on hospital day 10.  The patient was then
transferred to the floor, and a Physical Therapy and
Occupational Therapy consult was obtained.

The two left-sided chest tubes were discontinued on hospital
day 11 with the above-mentioned findings on chest
radiography, and the patient remained stable from a
cardiorespiratory standpoint.  The patient began to take POs
on hospital day 11, was tolerating a full soft diet by
hospital day 13, at which time the tube feeds had been
discontinued for 12 to 24 hours.  The patient continued to
work with Physical Therapy and Occupational Therapy and was
cleared for discharge to home without services.

On hospital day 14 the patient's gastric and jejunostomy
tubes were removed, and further discussion with the Neurology
service was initiated regarding appropriate dosing of the
Dilantin given the patient's persistently low levels.  Repeat
Dilantin levels were pending at the time of dictation.  Both
the Neurology and Thoracic Surgery services had felt this
patient was stable from their standpoint and had signed off
on the care of this patient while in house.

DISCHARGE CONDITION:  Good.

DISPOSITION:  To home.

DISCHARGE DIAGNOSES:
1.  Status post gunshot wound.
2.  Left lung injury.
3.  Esophageal wound.
4.  Seizure.
5.  Respiratory failure.
6.  Status post exploratory laparoscopy.
7.  Status post thoracotomy.

DISCHARGE MEDICATIONS:
1.  Albuterol metered-dose inhaler one to two puffs q. 6
hours as needed for shortness of breath or wheezing.
2.  Ipratropium bromide metered-dose inhaler one or two puffs
q. 4 to 6 as needed for shortness of breath or wheezing.
3.  Dilantin 200 mg t.i.d. times six months pending Neurology
follow up.

DISCHARGE INSTRUCTIONS:
1.  Patient instructed to call the Trauma Clinic for a
follow-up appointment within two weeks.
2.  The patient is to follow up with the [**Hospital 878**] Clinic
within three months.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9325**], M.D.  [**MD Number(1) 10637**]

Dictated By:[**Name8 (MD) 28700**]

MEDQUIST36

D:  [**2175-3-3**]  14:55
T:  [**2175-3-6**]  19:40
JOB#:  [**Job Number 54703**]
{'Laceration of lung with open wound into thorax,Injury to esophagus without mention of open wound into cavity,Traumatic pneumohemothorax with open wound into thorax,Assault by handgun,Sialolithiasis,Asthma, unspecified type, 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: 

PRESENT ILLNESS: Patient is a 40-year-old male
status post gunshot wound to the right chest just below the
nipple in the fifth intercostal space.  Initially seen at
outside facility and transferred to [**Hospital6 649**] directly to the Operating Room via [**Location (un) 86**]
[**Location (un) **].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Laceration of lung with open wound into thorax,Injury to esophagus without mention of open wound into cavity,Traumatic pneumohemothorax with open wound into thorax,Assault by handgun,Sialolithiasis,Asthma, unspecified type, unspecified'}
