CHIEF COMPLAINT: Thank you for consulting on this 68 year old male struck by a
vehicle on [**2123-11-12**]. Pt has GCS of 13 on the scene, 8 in the ED
and was intubated for airway protection. Pt sustained small R
occipital L frontal SAH, L temporal IPH, small R SDH, R
occipital/temporal bone fx, R rib fx [**4-3**] and small liver
lesions.

PRESENT ILLNESS: Thank you for consulting on this 68 year old male struck by a
vehicle on [**2123-11-12**]. Pt has GCS of 13 on the scene, 8 in the ED
and was intubated for airway protection. Pt sustained small R
occipital L frontal SAH, L temporal IPH, small R SDH, R
occipital/temporal bone fx, R rib fx [**4-3**] and small liver
lesions.

MEDICAL HISTORY: PMH: diverticulosis, diverticulitis, hypercholesterinemia
PSH: appy

MEDICATION ON ADMISSION: . 3. 1000 ml D5 1/2NS 4. Acetaminophen (Liquid) 5.
Albuterol-Ipratropium 6. Ascorbic Acid (Liquid)
7. Bisacodyl 8. Docusate Sodium (Liquid) 9. Fentanyl Citrate 10.
Guaifenesin 11. Haloperidol 12. Heparin
13. HydrALAZINE HCl 14. Insulin 15. Lansoprazole Oral Suspension
16. Lorazepam 17. Metoprolol 18. Metoclopramide
19. Milk of Magnesia 20. Multivitamins 21. Propofol 22. Sodium
Chloride 0.9% Flush 23. Sodium Chloride 0.9% Flush
24. Zinc Sulfate

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: .Injuries
head lac
L frontal SAH
R occipital/temporal fx leading into carotid canal
R rib fx 3-5m nondisplaced
small liver lac vs. 3 nodules, no hematoma

FAMILY HISTORY: nc

SOCIAL HISTORY: SH: no ETOH, >80 PY tob
Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Contusion of lung without mention of open wound into thorax,Closed fracture of three ribs,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Pressure ulcer, lower back,Other specified disorders of liver,Pure hypercholesterolemia,Personal history of other diseases of digestive system
Cl skull fx NEC w/o coma,Lung contusion-closed,Fracture three ribs-clos,Mv coll w pedest-pedest,Acute respiratry failure,Meth sus pneum d/t Staph,Pressure ulcer, low back,Liver disorders NEC,Pure hypercholesterolem,Prsnl hst ot spf dgst ds
Admission Date:  [**2123-11-12**]              Discharge Date:   [**2123-12-6**]

Date of Birth:  [**2055-8-5**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
Thank you for consulting on this 68 year old male struck by a
vehicle on [**2123-11-12**]. Pt has GCS of 13 on the scene, 8 in the ED
and was intubated for airway protection. Pt sustained small R
occipital L frontal SAH, L temporal IPH, small R SDH, R
occipital/temporal bone fx, R rib fx [**4-3**] and small liver
lesions.

Major Surgical or Invasive Procedure:
Pt was extubated [**2123-11-16**] and transfered to floor on [**11-18**], but
had respiratory distress due to pna on [**11-20**] and was intubated
and transfered back to TSICU. Pt received a trach (#8 Shilley)
and PEG [**2123-12-1**]. recovered from Pnuemonia

History of Present Illness:
Thank you for consulting on this 68 year old male struck by a
vehicle on [**2123-11-12**]. Pt has GCS of 13 on the scene, 8 in the ED
and was intubated for airway protection. Pt sustained small R
occipital L frontal SAH, L temporal IPH, small R SDH, R
occipital/temporal bone fx, R rib fx [**4-3**] and small liver
lesions.

Pt was extubated [**2123-11-16**] and transfered to FA 5 on [**11-18**], but
had respiratory distress due to pna on [**11-20**] and was intubated
and transfered back to TSICU. Pt received a trach (#8 Shilley)
and PEG [**2123-12-1**]. rehab screen and placement undeway currently

Past Medical History:
PMH: diverticulosis, diverticulitis, hypercholesterinemia
PSH: appy

Social History:
SH: no ETOH, >80 PY tob

Family History:
nc

Physical Exam:
.Injuries
head lac
L frontal SAH
R occipital/temporal fx leading into carotid canal
R rib fx 3-5m nondisplaced
small liver lac vs. 3 nodules, no hematoma

MAE left greater than right will intermittently fc on left
able to handle secretionskung clear
ABd: S-NT ND and no erythema at G tube site
EXt non swollen and MAE

Pertinent Results:
[**2123-11-26**] 11:29 am BRONCHOALVEOLAR LAVAGE

                            **FINAL REPORT [**2123-11-28**]**

   GRAM STAIN (Final [**2123-11-26**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   RESPIRATORY CULTURE (Final [**2123-11-28**]):    NO GROWTH.
[**2123-11-22**] 11:01 pm SPUTUM      Source: Endotracheal.

                            **FINAL REPORT [**2123-11-26**]**

   GRAM STAIN (Final [**2123-11-23**]):
      >25 PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.

   RESPIRATORY CULTURE (Final [**2123-11-26**]):
      SPARSE GROWTH OROPHARYNGEAL FLORA.
      STAPH AUREUS COAG +.    SPARSE GROWTH OF TWO COLONIAL
MORPHOLOGIES.
         SENSITIVITIES PERFORMED ON CULTURE # [**Numeric Identifier 105704**]
([**2123-11-16**]).
[**2123-11-23**] 12:19 am BLOOD CULTURE

                            **FINAL REPORT [**2123-11-29**]**

   AEROBIC BOTTLE (Final [**2123-11-29**]):    NO GROWTH.

   ANAEROBIC BOTTLE (Final [**2123-11-29**]):    NO GROWTH.

[**2123-11-20**] 8:10 pm CATHETER TIP-IV      Source: arterial line.

                            **FINAL REPORT [**2123-11-23**]**

   WOUND CULTURE (Final [**2123-11-23**]):
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    >15 colonies.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPHYLOCOCCUS, COAGULASE NEGATIVE
                             |
CLINDAMYCIN-----------   =>8 R
ERYTHROMYCIN----------   =>8 R
GENTAMICIN------------     1 S
LEVOFLOXACIN----------   =>8 R
OXACILLIN-------------   =>4 R
PENICILLIN------------ =>0.5 R
RIFAMPIN-------------- <=0.5 S
TETRACYCLINE----------     2 S
VANCOMYCIN------------     2 S

[**2123-11-28**] 02:55PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.019
[**2123-11-28**] 02:55PM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.019
[**2123-12-6**] 01:30AM BLOOD WBC-13.1* RBC-3.28* Hgb-9.7* Hct-30.4*
MCV-93 MCH-29.5 MCHC-31.9 RDW-15.1 Plt Ct-528*

[**Known lastname **],[**Known firstname **]:[**Hospital1 18**] Radiology Detail - CCC Record #[**Numeric Identifier 105705**]
FINAL REPORT


INDICATION 68-year-old male with left subarachnoid hemorrhage
and continued
mental status changes. Evaluate for interval change.

TECHNIQUE: Serial axial CT images were obtained from the skull
base to the
vertex without intravenous contrast.

FINDINGS: Compared to the prior study of [**2123-11-18**], there
has been no
significant interval change in a large left temporal
intraparenchymal
hemorrhage with area of associated edema. There is no evidence
of midline
shift or hydrocephalus. A small left subdural hematoma is again
identified,
unchanged. There is stable subarachnoid hemorrhage. No new areas
of acute
hemorrhage are identified. Previously seen bilateral scalp
hematomas are
unchanged. Opacification of the maxillary and paranasal sinuses
are again
identified. The osseous structures and multiple fractures are
unchanged.

IMPRESSION: Stable appearance of the brain with no new areas of
hemorrhage or
mass effect.
THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) 7415**]

[**Known lastname **],[**Known firstname **]:[**Hospital1 18**] Radiology Detail - CCC Record #[**Numeric Identifier 105705**]
FINAL REPORT


INDICATIONS: Intraparenchymal hemorrhage. Assess for carotid
traumatic
injury.

Note, this study was initially interpreted on [**11-13**], but is
being
dictated on the 17th now that multiplanar reformatted images
have become
available.

TECHNIQUE: Volumetric CT imaging of the head was performed
before and
following the administration of 100 cc of Optiray contrast, per
CTA protocol.
Multiplanar reconstructions were made.

COMPARISON: Head CT from [**2123-11-12**].

CT OF THE HEAD WITHOUT AND WITH IV CONTRAST: The area of
parenchymal
hemorrhage in the left anterior temporal lobe is slightly
larger. There is a
questionable tiny right frontal subdural hematoma, and
questionable
parafalcine hematoma posteriorly, which is not significantly
changed since the
previous study. New subarachnoid blood is seen over multiple
sulci and in the
interpeduncular fossa. Possible evolving frontal contusions are
present. At
this time, there is no shift of normally midline structures.
[**Doctor Last Name **]-white
matter differentiation remains preserved. There is no
hydrocephalus, and
basal cisterns are not effaced. There is no evidence of
intraventricular
hemorrhage.

CAROTID CT ANGIOGRAPHY: Evaluation of the proximal right common
carotid
artery is limited due to extensive beam hardening artifact from
dense contrast
within the right subclavian vein. The more distal right common,
external and
internal carotid artery are widely patent. Atherosclerotic
plaque is present
in both carotid bulbs, much more so on the right than on the
left. Both
vertebral arteries are patent. There is no evidence of cervical
carotid or
vertebral dissection. Both petrous carotid segments and portions
of the
carotid arteries within the carotid canal are unremarkable.
Supraclinoid
internal carotid arteries are normal. The middle cerebral
arteries and
anterior cerebral arteries are unremarkable. The anterior
communicating artery
is visualized and is normal in caliber. Both posterior
communicating arteries
are probably visualized. The right posterior communicating
artery is larger
than the left. Both posterior cerebral arteries are normal in
course and
caliber.

There is near complete opacification of the sphenoid sinus and a
large fluid
level within the right maxillary sinus and a right scalp
hematoma as described
on prior studies.

IMPRESSION:
1. Increasing amount of left temporal parenchymal hemorrhage.
Increasing
amount of subarachnoid hemorrhage. No hydrocephalus or
ventricular
effacement. Basal cisterns remain patent. No shift of normally
midline
structures.
2. No evidence of traumatic injury to the internal carotid
arteries. No
aneurysm visualized.

Results were discussed with Dr. [**Last Name (STitle) 62533**] at 6:45 a.m. on [**11-13**], [**2123**].

THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name11 (Name Pattern1) 640**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 9987**]
[**Known lastname **],[**Known firstname **]:[**Hospital1 18**] Radiology Detail - CCC Record #[**Numeric Identifier 105705**]
FINAL REPORT


INDICATION: MVA.
COMPARISON: None.

TECHNIQUE: Axial MDCT images were obtained through cervical
spine without
intravenous contrast. Additional coronal and sagittal
reformations are
provided.

CONTRAST: No contrast was administered.

CT OF THE CERVICAL SPINE WITHOUT INTRAVENOUS CONTRAST: The
cervical spine is
imaged from C1 through T2. No definite fractures are identified
within the
cervical spine. A questionable lucency within the right
transverse process of
C6 likely relates to degenerative change or artifact as no
definite
correlative abnormalities are identified on the sagittal and
coronal
reformations. There is grade I retrolisthesis of C3 on C4. There
is
multilevel degenerative change of the cervical spine, with loss
of
intervertebral disc space height and anterior and posterior
osteophytosis,
most prominent at C5-6 and C6-7. The visualized outlines of the
thecal sac
appear unremarkable. CT is limited in its ability to provide
intrathecal
detail. The prevertebral soft tissues appear unremarkable and
endotracheal
tube and nasogastric tube are in place.

Again seen are fractures of the right temporal bone and right
sphenoid [**Doctor First Name 362**]
with questionable extension to the right carotid canal, as
demonstrated on the
CT of the head of same date. There is blood within the sphenoid
and right
maxillary sinuses as well as within the ethmoid air cells.

IMPRESSION:
1. No definite fracture of the cervical spine.

2. Fracture of the right temporal and sphenoid bones with
possible extension
to the right carotid canal. These findings were discussed with
the trauma
team caring for the patient at the time of interpretation (9:25
p.m.).

3. Grade I retrolisthesis of C3 on C4, finding that could relate
to
degenerative change, although MR of cervical spine is
recommended for further
evaluation of ligamentous structures if clinically indicated.


THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name (STitle) 8913**] R.M. SUN

DR. [**First Name (STitle) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
[**Known lastname **],[**Known firstname **]:[**Hospital1 18**] Radiology Detail - CCC Record #[**Numeric Identifier 105705**]
FINAL REPORT


INDICATION: Status post MVC. Evaluate for injury.

COMPARISON: None.

TECHNIQUE: Axial MDCT images were obtained from the lung apices
to the pubic
symphysis following the administration of 150 cc of intravenous
Optiray.
Additional coronal and sagittal reformations are provided.

CONTRAST: Intravenous nonionic contrast was administered due to
the rapid
rate of bolus injection required for this examination.

CT OF THE CHEST WITH INTRAVENOUS CONTRAST: An endotracheal tube
and
nasogastric tube are in place. There is a small amount of fluid
within the
trachea superior to the endotracheal tube cuff. There is no
mediastinal
hematoma. The aorta is normal in caliber and contour. There is
no
pathologic-appearing mediastinal, hilar, or axillary
lymphadenopathy. The
heart and pericardium appear unremarkable. Two 2 mm nodular
opacities are
seen within the left lower lobe. There are minimally displaced
fractures of
the right third, fourth, and fifth ribs.

CT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST: Within segment VI
of the liver,
there is a wedge-shaped peripheral hypodensity that extends to
the hepatic
capsule. There are two additional rounded and oblong
hypodensities within
segment VII, the larger of which measures 11.2 x 2.1 cm. These
are
nonspecific in appearance and could represent hypodense hepatic
lesions versus
focal hepatic contusions. There is no evidence of perihepatic
hematoma or
fluid collection. The gallbladder is nondistended and contains
calcified
gallstones. The spleen, pancreas, and adrenal glands appear
unremarkable.
There are symmetric nephrograms bilaterally without evidence of
perinephric
hematoma. Tiny, rounded, hypodense lesions are seen within the
upper pole of
the right kidney and within the upper and lower poles of the
left kidney. Two
additional simple cysts are seen within the interpolar region
and lower pole
of the left kidney. The aorta is normal in caliber throughout
with mural
calcifications consistent with atheromatous disease. The celiac
trunk,
superior mesenteric artery, and inferior mesenteric artery
appear patent
proximally. There is no free intraperitoneal air. The large and
small bowel
loops are normal in caliber. There is diverticulosis of the
colon.

CT OF THE PELVIS WITH INTRAVENOUS CONTRAST: The bladder contains
a Foley
catheter. The prostate and seminal vesicles, rectum and sigmoid
colon appear
unremarkable. There is no pathologic-appearing pelvic or
inguinal
lymphadenopathy.

BONE WINDOWS: Bone windows demonstrate nondisplaced fractures of
3 right-
sided ribs. No other fractures are identified.

MULTIPLANAR REFORMATS: Coronal and sagittal reformations
demonstrate three
hypodense regions within the right lobe of the liver, within
segments VI and
VII. The right-sided rib fractures are well delineated on the
sagittal
reformations. No fractures are appreciated elsewhere within the
osseous
structures, with no obvious displaced fractures of the thoracic
or lumbar
spine.

IMPRESSION:

1. Three focal hypodensities within segments VI and VII of the
liver,
including a peripherally based hypodensity within segment VI
that may
represent hepatic contusion versus hypodense hepatic lesions. No
perihepatic
hematoma is identified.

2. No other evidence of solid organ injury or free air or free
fluid within
the abdomen.

3. Three right-sided rib fractures and questionable mild right
upper lobe
pulmonary contusion.

4. Two simple cysts within the left kidney and additional tiny,
rounded,
hypodense lesions, which are too small to accurately
characterize.

5. Results discussed with the trauma team at the time of
interpretation (9:45
p.m.).
THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name (STitle) 8913**] R.M. SUN

DR. [**First Name8 (NamePattern2) 4075**] [**Last Name (NamePattern1) 5999**]



Brief Hospital Course:
[**Known lastname **],[**Known firstname **]: [**Hospital1 18**] Neurophysiology Detail - CCC Record #[**/0-0-**]J - CCC
REPORT APPROVED DATE:[**2123-11-29**]
TEST DATE: [**2123-11-28**]
INTERPRETED BY: [**Last Name (LF) **],[**First Name3 (LF) 20**] C.

FINDINGS:
ABNORMALITY #1: Throughout the tracing the background was slowed
and
disorganized generally in the [**7-6**] Hz theta range. With tactile
stimulation, the patient was noted clinically to grimace but no
change
in the EEG rhythms was consistently seen with tactile
stimulation.
HYPERVENTILATION: Was contraindicated.
INTERMITTENT PHOTIC STIMULATION: Was not performed because this
was a
portable study.
SLEEP: Was not obtained.
CARDIAC MONITOR: Showed a borderline tachycardia.
IMPRESSION: Abnormal awake EEG due to diffuse background slowing
suggestive of a mild to moderate encephalopathic process. No
focal,
lateralized, or epileptiform features were seen.
OBJECT: R/O EPILEPSY IN A PATIENT WITH SUBARACHNOID HEMORRHAGE

68 year old male struck by a
vehicle on [**2123-11-12**]. Pt has GCS of 13 on the scene, 8 in the ED
and was intubated for airway protection. Pt sustained small R
occipital L frontal SAH, L temporal IPH, small R SDH, R
occipital/temporal bone fx, R rib fx [**4-3**] and small liver
lesions.
Pt was extubated [**2123-11-16**] and transfered to FA 5 on [**11-18**], but
had respiratory distress due to pna on [**11-20**] and was intubated
and transfered back to TSICU. Pt received a trach (#8 Shilley)
and PEG yesterday, [**2123-11-30**].

Reintubated
[**2123-11-30**]: Tracheostomy and PEG tube placement without
complications.

Medications on Admission:
. 3. 1000 ml D5 1/2NS 4. Acetaminophen (Liquid) 5.
Albuterol-Ipratropium 6. Ascorbic Acid (Liquid)
7. Bisacodyl 8. Docusate Sodium (Liquid) 9. Fentanyl Citrate 10.
Guaifenesin 11. Haloperidol 12. Heparin
13. HydrALAZINE HCl 14. Insulin 15. Lansoprazole Oral Suspension
16. Lorazepam 17. Metoprolol 18. Metoclopramide
19. Milk of Magnesia 20. Multivitamins 21. Propofol 22. Sodium
Chloride 0.9% Flush 23. Sodium Chloride 0.9% Flush
24. Zinc Sulfate


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
2. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
3. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO BID (2
times a day).
4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
5. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
6. Acetaminophen 160 mg/5 mL Solution Sig: One (1)  PO Q4-6H
(every 4 to 6 hours) as needed for fever.
7. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**1-31**]
Puffs Inhalation Q4H (every 4 hours) as needed.
9. Therapeutic Multivitamin     Liquid Sig: Five (5) ML PO DAILY
(Daily).
10. Ascorbic Acid 90 mg/mL Drops Sig: One (1)  PO BID (2 times a
day).
11. Zinc Sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
12. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
13. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
14. Haloperidol Lactate 5 mg/mL Solution Sig: One (1)  Injection
[**Hospital1 **] (2 times a day) as needed.
15. Metoclopramide 5 mg/mL Solution Sig: One (1)  Injection Q6H
(every 6 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Intraparenchymal bleed, subarachnoid bleed, traumatic head
injury
68M pedestrian struck by car, head hit windshield, LOC?,
combative on scene and on transport, GCS 13 -> 8, intubated in
[**Last Name (LF) **], [**First Name3 (LF) 2995**]; c/b respiratory failure/re-intubation ([**2123-11-20**]) +BCltx
r/o sepsis/pneumonia
traumatic brain injury


Discharge Condition:
stable with residual head injury
stable


Discharge Instructions:
neurologic rceovery is progressing slowly with left side moving
forward in function expectant recovery pending
D/c to rehab facility

Followup Instructions:
F/U with neurologic team 2-3 weeks  NEUROLOGY n/a  [**Telephone/Fax (1) 16748**]
F/U in 4 weeks in trauma clinicInstitution
&#9830; TRAUMA CLINIC
 SURGICAL SPECIALTIES n/a  [**Telephone/Fax (1) 2359**]
f/U in 2- 3 weeks with neurology [**First Name9 (NamePattern2) 105706**]
[**Last Name (LF) **], [**First Name3 (LF) **]
 MEDICINE/ [**Numeric Identifier 22728**]



Completed by:[**2123-12-6**]
{'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Contusion of lung without mention of open wound into thorax,Closed fracture of three ribs,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Pressure ulcer, lower back,Other specified disorders of liver,Pure hypercholesterolemia,Personal history of other diseases of digestive system'}


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: Thank you for consulting on this 68 year old male struck by a
vehicle on [**2123-11-12**]. Pt has GCS of 13 on the scene, 8 in the ED
and was intubated for airway protection. Pt sustained small R
occipital L frontal SAH, L temporal IPH, small R SDH, R
occipital/temporal bone fx, R rib fx [**4-3**] and small liver
lesions.

PRESENT ILLNESS: Thank you for consulting on this 68 year old male struck by a
vehicle on [**2123-11-12**]. Pt has GCS of 13 on the scene, 8 in the ED
and was intubated for airway protection. Pt sustained small R
occipital L frontal SAH, L temporal IPH, small R SDH, R
occipital/temporal bone fx, R rib fx [**4-3**] and small liver
lesions.

MEDICAL HISTORY: PMH: diverticulosis, diverticulitis, hypercholesterinemia
PSH: appy

MEDICATION ON ADMISSION: . 3. 1000 ml D5 1/2NS 4. Acetaminophen (Liquid) 5.
Albuterol-Ipratropium 6. Ascorbic Acid (Liquid)
7. Bisacodyl 8. Docusate Sodium (Liquid) 9. Fentanyl Citrate 10.
Guaifenesin 11. Haloperidol 12. Heparin
13. HydrALAZINE HCl 14. Insulin 15. Lansoprazole Oral Suspension
16. Lorazepam 17. Metoprolol 18. Metoclopramide
19. Milk of Magnesia 20. Multivitamins 21. Propofol 22. Sodium
Chloride 0.9% Flush 23. Sodium Chloride 0.9% Flush
24. Zinc Sulfate

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: .Injuries
head lac
L frontal SAH
R occipital/temporal fx leading into carotid canal
R rib fx 3-5m nondisplaced
small liver lac vs. 3 nodules, no hematoma

FAMILY HISTORY: nc

SOCIAL HISTORY: SH: no ETOH, >80 PY tob 

### Response:
{'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Contusion of lung without mention of open wound into thorax,Closed fracture of three ribs,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Acute respiratory failure,Methicillin susceptible pneumonia due to Staphylococcus aureus,Pressure ulcer, lower back,Other specified disorders of liver,Pure hypercholesterolemia,Personal history of other diseases of digestive system'}
