CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 21-year-old male
involved in a motor vehicle accident, car versus telephone
pole, with deployment of airbag.  Extrication time was
approximately 15 minutes.  The passenger was unrestrained
with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Scale of 8 in the field.  He was
transferred to an outside hospital, where he was intubated
for airway protection.  He was moving all four extremities at
the time.  The patient was then air-lifted to the [**Hospital6 1760**] after a depressed skull
fracture was noted.  He arrived in the emergency room with a
cervical collar on.  He was boarded.  He was intubated,
sedated, not responding to stimuli.  He had unknown past
medical and surgical history; unknown medications; The
patient has no known drug allergies.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness and return to pre-existing conscious level,Pulmonary collapse,Pneumonia, organism unspecified,Open fracture of mandible, body, other and unspecified,Other and unspecified intracranial hemorrhage following injury with open intracranial wound, with prolonged [more than 24 hours] loss of consciousness and return to pre-existing conscious level,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Optic nerve injury
Op skl base fx-prol coma,Pulmonary collapse,Pneumonia, organism NOS,Fx mandible body NEC-opn,Brain hem opn-proln coma,Mv coll w oth obj-driver,Optic nerve injury
Admission Date:  [**2184-10-16**]       Discharge Date:  [**2184-10-26**]

Date of Birth:   [**2163-1-19**]       Sex:  M

Service:  Trauma Surgery

ADMITTING DIAGNOSIS:
Motor vehicle accident.

HISTORY OF PRESENT ILLNESS:  This is a 21-year-old male
involved in a motor vehicle accident, car versus telephone
pole, with deployment of airbag.  Extrication time was
approximately 15 minutes.  The passenger was unrestrained
with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Scale of 8 in the field.  He was
transferred to an outside hospital, where he was intubated
for airway protection.  He was moving all four extremities at
the time.  The patient was then air-lifted to the [**Hospital6 1760**] after a depressed skull
fracture was noted.  He arrived in the emergency room with a
cervical collar on.  He was boarded.  He was intubated,
sedated, not responding to stimuli.  He had unknown past
medical and surgical history; unknown medications; The
patient has no known drug allergies.

In the emergency room his physical examination was as
follows:  He had a large laceration wound over his right
temporal region with a depressed skull fracture.  His pupils
were 3 mm and unresponsive.  He had lacerations on his chin
with what appeared to be a dislocated mandible.  His cardiac
examination was S1 and S2, regular rate and rhythm.  His
chest was clear to auscultation.  His abdomen was soft with
active bowel sounds.  His pelvis was stable.  Extremities
showed no obvious deformities.  His back had no step-offs.

A chest x-ray was obtained immediately that demonstrated an
endotracheal tube in the appropriate position.  There was no
pleural effusion or pneumothorax.

AP pelvis was obtained that showed no gross fractures,
although it was an inadequate study.

At that point the patient was taken to the CT scanner, where
a CT of the head was performed demonstrating comminuted and
depressed fracture of the right temporal region with
extensive area of intracranial hemorrhage measuring 3.5 cm in
maximum diameter with innumerable bone fragments within the
temporal lobe, the largest one measuring approximately 2 cm.
There were tiny areas of pneumocephalus.  There was partial
collapse of the right lateral ventricle and midline shift
toward the left.  There was an area of high attenuation in
the left frontal region, which may have represented another
area of hemorrhagic contusion.  There were small high
attentuations and subdural collections extending toward the
right frontal region and the right temporal region.  The
fourth ventricle was patent with the ambient cistern slightly
effaced.  The suprasellar cistern was unremarkable.  There
was also distortion of the right orbital apex with a probable
fracture that needed to be evaluated further; air/fluid level
within the right maxillary sinus and disruption of the medial
wall of the sinus with extensive soft tissue density within
the right ethmoidal sinuses.

CT of the neck was performed that demonstrated no evidence of
fractures or dislocations of the cervical spine.  The
prevertebral soft tissues were normal.

He also underwent a CT of the abdomen and pelvis, as well as
the chest.  CT of the chest was significant for complete
collapse of the left lower lobe with patchy opacification of
the lingula.  There was no evidence of intra-abdominal or
intrapelvic injuries.

HOSPITAL COURSE:  The patient was felt to have sustained a
severe neurologic trauma.  He was taken emergently to the
operating room where an elevation of a depressed skull
fracture was performed with evacuation of contusion and onlay
of a dural substitute.  This operation was performed by Dr.
[**Last Name (STitle) 1327**].  The patient was transferred postoperatively to the
Surgical Intensive Care Unit.  He was placed on Ancef,
Mannitol, and Dilantin given that he had evidence of midline
shift and cranial hypertension.  He was also noted to have a
left mandible fracture.

At this time a repeat CT scan of the head was performed with
coronal reconstructions several hours after the surgery.
This demonstrated elevation of the region of the right
pterion.  There was a small mass of the dural area.  There
was a shallow subdural hematoma adjacent to the anterior
right frontal lobe and parenchymal hemorrhage deep to the
fracture site.  Again, there were fracture fragments
involving the apex of the right orbit affecting the superior
orbital fissure and optic canal.  Fractures extended through
the right anterior clinoid process.

Specifically, CT of the orbits demonstrated a complex
fracture involving the right orbital apex including the
anterior clinoid process.  Multiple mandibular fractures were
also noted as follows:  Oblique fracture through the right
anterior portion of the mandible, as well as a fracture of
the condylar process on the left.

At this point a magnetic resonance imaging scan of the
cervical spine was also obtained that demonstrated normal
soft tissue structures with no evidence of ligamentous
injury.

An oromaxillofacial surgery consultation was obtained given
the mandibular fractures.  It was felt that the patient would
benefit from an open reduction and internal fixation of his
mandible when more stable.

He also underwent a bronchoscopy in the intensive care unit
for his left lower lobe collapse.  There were signs of left
lower contusions with evidence of blood aspiration.

He also received an ophthalmology consultation given the
involvement of the orbit, and there was no evidence of ocular
muscle entrapment.

He subsequently remained intubated.  Clindamycin was added to
his antibiotic regimen.  He was also started on Nipride for
control of hypertension and propofol was used for sedation.

He was subsequently taken to the operating room again on
[**2184-10-18**], first by trauma surgery, where a tracheostomy was
performed and a Shiley #8 tracheostomy was placed.  This
allowed for airway protection given the fact that he required
oromaxillofacial surgery with mandibular fixation.  He then
underwent an open reduction and rigid fixation of his right
parasymphyseal fracture of the mandible, and a closed
reduction of the left subcondylar fracture with elastic
banding to maintain the closed reduction and prevent him from
opening his jaw.  He tolerated this procedure well, however
he did remain persistently febrile.  Throughout this portion
of his hospital course he was running temperatures from
101-102.  He had a fluoroscopically placed feeding tube.

We began to wean his sedation to evaluate his neurological
status.  On Surgical Intensive Care Unit day number four he
was noted to have an afferent pupillary defect for which
ophthalmology was asked to reevaluate him.  They felt that
this was secondary to traumatic optic neuropathy.

By Surgical Intensive Care Unit day five, postoperative days
four and two, he was tolerating tracheostomy collar.  His
sedation was off.  He was on Lopressor and hydralazine for
blood pressure control.  He remained on clindamycin and
Kefzol for antibiotic prophylaxis, and he was arousable,
following commands.  He did move the right side of his body
greater than the left, however he was able to move all four
extremities.  He was receiving tube feeds and doing well.

By postoperative day number seven and five, he was doing
extremely well, trying to speak.  He had increased vision in
his right eye.  He was moving all four extremities with
increasing strength in the left side of his body.  He was,
however, placed on Levaquin for what was felt to be a
potential hospital-acquired pneumonia, given a temperature
spike.

He was transferred to the floor on a tracheostomy collar at
which point aggressive physical therapy was begun.  He was
making a speedy recovery, able to write sentences coherently,
ambulating on his own.  His Foley catheter was removed at
which point he was voiding on his own, however he did pull
out his feeding tube several times during coughing fits, for
which he required repeated replacement of a postpyloric
feeding tube.  Speech and swallow evaluation felt that his
coughing fits and difficulty swallowing, as well as phonating
and tolerating a Passy-Muir valve were secondary to the size
of the tracheostomy that was in place, that was causing
subglottic pressure.  Transfer the tracheostomy was changed
to a 7-0 Portex, at which point he was able to phonate, and
his coughing fits resolved.  He was able to tolerate sips of
clear liquids, however, a formal video swallow study was
pending.

Oromaxillofacial surgery felt that his elastic banding could
be removed somewhere around [**2184-11-1**], and that at that point
he would be able to be evaluated for potentially taking soft
solids.

By postoperative day ten and eight he had completed his
course of clindamycin and had two more days to complete a
seven-day course of levofloxacin.  He was felt stable for
discharge.  He was alert, oriented, and conversant.  He did
lack vision in his right eye.  His tracheostomy site was
clear.  His chest was clear to auscultation.  He was in a
regular rate and rhythm, with a soft abdomen, warm and well
perfused, moving all four extremities with good and equal
strength bilaterally.  He was tolerating tube feeds at a rate
of 40-50 cc/hour with a target goal of 100 cc/hour of Impact
with fiber.  He was receiving intravenous fluids at
approximately 50-60 cc/hour to maintain the total intake of
100 cc/hour.

DISCHARGE MEDICATIONS:
1. Reglan 10 mg per gastrostomy tube q.i.d.
2. Levaquin 400 mg per gastrostomy tube once daily for two
days.
3. Dilantin 100 mg per gastrostomy tube t.i.d.
4. Lacri-Lube Tears to each eye t.i.d.
5. Peridex swish and spit q.i.d.
6. Zantac elixir 150 mg per gastrostomy tube b.i.d.
7. Nicoderm transdermal patch.
8. Tylenol 650 mg per gastrostomy tube q. 4-6 hours p.r.n.
9. Percocet elixir 5-10 cc q. 4-6 hours p.r.n.
10. He was also receiving Lopressor 25 mg p.o. b.i.d.

FOLLOW UP:  He was instructed to follow up with neurosurgery
as well as with Dr. [**Last Name (STitle) 23170**], and with trauma surgery.

DISCHARGE DIAGNOSES:
1. Motor vehicle accident.
2. Depressed skull fracture status post elevation.
3. Status post tracheostomy.
4. Status post open reduction and internal fixation of
mandibular fractures as well as closed reduction and external
fixation.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D.  [**MD Number(1) 2214**]

Dictated By:[**Name8 (MD) 4720**]
MEDQUIST36

D:  [**2184-10-26**]  11:43
T:  [**2184-10-26**]  12:18
JOB#:  [**Job Number **]
{'Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness and return to pre-existing conscious level,Pulmonary collapse,Pneumonia, organism unspecified,Open fracture of mandible, body, other and unspecified,Other and unspecified intracranial hemorrhage following injury with open intracranial wound, with prolonged [more than 24 hours] loss of consciousness and return to pre-existing conscious level,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Optic nerve injury'}


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: This is a 21-year-old male
involved in a motor vehicle accident, car versus telephone
pole, with deployment of airbag.  Extrication time was
approximately 15 minutes.  The passenger was unrestrained
with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Scale of 8 in the field.  He was
transferred to an outside hospital, where he was intubated
for airway protection.  He was moving all four extremities at
the time.  The patient was then air-lifted to the [**Hospital6 1760**] after a depressed skull
fracture was noted.  He arrived in the emergency room with a
cervical collar on.  He was boarded.  He was intubated,
sedated, not responding to stimuli.  He had unknown past
medical and surgical history; unknown medications; The
patient has no known drug allergies.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness and return to pre-existing conscious level,Pulmonary collapse,Pneumonia, organism unspecified,Open fracture of mandible, body, other and unspecified,Other and unspecified intracranial hemorrhage following injury with open intracranial wound, with prolonged [more than 24 hours] loss of consciousness and return to pre-existing conscious level,Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle,Optic nerve injury'}
