CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 52-year-old man
status post crush injury to bilateral thighs.  He had
positive loss of consciousness.  He was an unrestrained
passenger in a bus accident with a prolonged extrication
time.  He was hemodynamically stable in the field and
received 1 L Crystalloid.  He was transferred via [**Location (un) 7622**]
to [**Hospital6 256**] and given Ancef in
the Emergency Department.

MEDICAL HISTORY: High cholesterol.  Gastroesophageal
reflux disease.

MEDICATION ON ADMISSION: 

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Crushing injury of thigh,Closed fracture of pubis,Acute posthemorrhagic anemia,Other noncollision motor vehicle traffic accident injuring passenger in motor vehicle other than motorcycle,Crushing injury of buttock,Open wound of scalp, without mention of complication,Pain in or around eye,Esophageal reflux,Pure hypercholesterolemia
Crushing injury thigh,Fracture of pubis-closed,Ac posthemorrhag anemia,Mv traff acc NEC-pasngr,Crushing injury buttock,Open wound of scalp,Pain in or around eye,Esophageal reflux,Pure hypercholesterolem
Admission Date:  [**2143-8-30**]       Discharge Date:  [**2143-9-10**]

Date of Birth:   [**2091-3-30**]       Sex:  M

Service:  TRAUMA

HISTORY OF PRESENT ILLNESS:  The patient is a 52-year-old man
status post crush injury to bilateral thighs.  He had
positive loss of consciousness.  He was an unrestrained
passenger in a bus accident with a prolonged extrication
time.  He was hemodynamically stable in the field and
received 1 L Crystalloid.  He was transferred via [**Location (un) 7622**]
to [**Hospital6 256**] and given Ancef in
the Emergency Department.

PHYSICAL EXAMINATION:  Vital signs:  On presentation, he had
a blood pressure of 112 palpable, heart rate 96, respirations
20, temperature 95.6??????, 100% on a nonrebreather.  GCS was 15.
HEENT: It was noted that he had a small facial laceration.
His pupils were reactive bilaterally.  Extraocular movements
were intact.  Tympanic membranes were clear.  Face was
stable.  Neck was tender.  Neck was supple.  Trachea was
midline.  Lungs:  Clear to auscultation bilaterally.  Chest:
Stable.  Abdomen:  Soft, nontender and nondistended.  Fast
exam was negative.  Rectal and perineum:  Intact with normal
tone, guaiac negative.  Extremities:  There was exposed
muscle and fascia on the right posterior aspect of the thigh,
as well as on the left.  He had positive dorsalis pedis pulse
bilaterally.  Neurological:  ABI on left 0.7, right 0.7.
Sensation was intact.  Motor was intact.  Plantar flexion and
extension.

PAST MEDICAL HISTORY:  High cholesterol.  Gastroesophageal
reflux disease.

PAST SURGICAL HISTORY:  None.

MEDICATIONS:  Lipitor, Prevacid.

ALLERGIES:  NO KNOWN DRUG ALLERGIES.

LABORATORY DATA:  On admission white count was 18, platelet
count 180, hematocrit 29; sodium 138/3.8, 111/22, 17/1.1,
blood glucose 144; PT 14.4, PTT 27.9, INR 1.4; CPK 386,
lactate 4.8, amylase 41; ETOH 35; venous gas 7.20, 54, 41,
22; negative urinalysis, [**3-6**] red blood cells.

Chest x-ray negative.  Pelvis negative for fracture or
dislocation.  Head CT negative for bleed.  No step-offs on
neck.  CT was negative.  Abdominal CT showed no solid organ
injury.  Femur films were negative bilaterally.  TLS spine
was negative.  Pelvis with left superior ramus fracture,
avulsion injury of ischial tuberosity.

ASSESSMENT/PLAN:  On presentation this was a 52-year-old man
status post crush injury with extensive soft tissue damage.
He was placed on telemetry for monitoring.  An angiography of
lower extremity was planned.  Plastics was called to evaluate
the wound.  There was no peroneal injury.  It was decided to
continue formal resuscitation.  Orthopedics was consulted and
decided it was not an operative pelvic fracture with
weightbearing as tolerated and follow-up via Orthopedics
Trauma, [**Telephone/Fax (1) 5499**].

The patient was given an arteriogram of right leg with no
evidence of arterial injury.  Small vessels with
calcification, probable peripheral vascular disease noted on
the arteriograms.

Plastics came and evaluated the patient.  The right degloving
injury was noted, as was the laceration from the left.  The
plan was to take the patient to the operating room for
debridement and washout and possible split-thickness skin
graft.  This was done on [**8-30**].  The patient was prepared
preoperatively for plastic surgery with split-thickness and
possible flap.  Flaps were all normal.  Consent was obtained.
The patient was typed and crossed for 4 U.

On [**8-31**], the patient was operated on.  Irrigation and
debridement, bilateral thigh split-thickness skin graft to
right posterior thigh, placement of bilateral Vacs were
performed.  The patient tolerated the procedure well.  Please
see operative dictation from [**2143-8-31**].

On the right posterior thigh, there were superior based large
flaps that looked tenuous.  Split-thickness skin graft was
taken from flap and then this area was debrided and placed on
the wound.  A Vac was placed to the left medial thigh deep
wound.  He had adequate muscle coverage which was debrided,
and a Vac was placed.  On the left lateral there was a large
area of shear injury which again the hematoma was drained and
washed out, and a Vac was placed.

The patient did well postoperatively, and it was decided that
the patient would need further operative intervention with
debridement and washout.  Once again the patient was
consented and brought to the operative theatre on [**9-1**]
for Vac change and debridement and split-thickness skin
graft.  The patient did well and tolerated the procedure.
Please see operative dictation.

Postoperatively the patient did well.  The Vacs were working
appropriately.  It was decided that the patient would need
one further debridement.  At this juncture, he was taken back
to the operating room after consent was obtained on [**2143-9-3**], for incision and debridement of wound and Vac
change, again with Dr. [**Last Name (STitle) **].  Please see operative dictation.
Some necrotic muscle was debrided with irrigation performed.

The patient continued to do well.  Incentive spirometry was
performed.  The Vac continued to hold suction.  The patient
was continued on broad-spectrum antibiotics.

On [**9-5**], the patient complained that he felt as if
something may have potentially been in his eye with a
scratching feeling in his right eye.  Ophthalmology was
consulted, and there was no evidence of foreign body or
corneal abrasion.

On [**9-5**] the patient was again taken to the operative
theatre for debridement and closure of the left thigh with
dressing change to right thigh.  The patient did well.  The
Vacs were placed to suction.  Antibiotics were continued.  We
discontinued the central line and used the peripheral line.
Hemovacs were placed instead of Vac coverage drains, and the
patient continued to do well.

The patient was evaluated by Physical Therapy.  The patient
was seen by Social Work.

His dressings were changed.  The graft appeared to be taking.
No signs of infection were noted on the right leg.  On the
left leg, it was Ace bandaged with Tegaderm.  There was some
serosanguinous drainage.  The incision looked clean, dry, and
intact.

On [**9-7**], status post wound closure of the left thigh,
split-thickness skin graft on right leg doing well, splints
were placed to the ankles to prevent a equinus deformity.
Hemovacs were continued, as was antibiotic coverage.

The patient continued to improve after this juncture.  He was
seen by Physical Therapy on [**9-9**] and actually was out
of bed and to a chair.  On [**9-10**], it was deemed that
the patient was doing well and he would meet criteria for
discharge to a rehabilitation facility.  This was arranged,
and the patient was given a regimen of pain medication, bowel
prep and antibiotics with follow-up arranged in one week to
see Dr. [**First Name (STitle) **] in the office.  In addition, dressing changes
would be performed every other day over the site of the
split-thickness skin graft, and sutures on the left leg would
be removed in the office by Dr. [**First Name (STitle) **], and Hemovac drains would
remain in place until that juncture as well.

DISCHARGE DIAGNOSIS:  Status post multiple d??????bridements of a
right degloving injury and left penetrating injury to the
thigh.




                 DR.[**First Name (STitle) **],[**First Name3 (LF) 1216**] 24-AAA



Dictated By:[**Doctor Last Name 34575**]
MEDQUIST36

D:  [**2143-9-10**]  09:11
T:  [**2143-9-10**]  09:11
JOB#:  [**Job Number 51575**]
{'Crushing injury of thigh,Closed fracture of pubis,Acute posthemorrhagic anemia,Other noncollision motor vehicle traffic accident injuring passenger in motor vehicle other than motorcycle,Crushing injury of buttock,Open wound of scalp, without mention of complication,Pain in or around eye,Esophageal reflux,Pure hypercholesterolemia'}


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: The patient is a 52-year-old man
status post crush injury to bilateral thighs.  He had
positive loss of consciousness.  He was an unrestrained
passenger in a bus accident with a prolonged extrication
time.  He was hemodynamically stable in the field and
received 1 L Crystalloid.  He was transferred via [**Location (un) 7622**]
to [**Hospital6 256**] and given Ancef in
the Emergency Department.

MEDICAL HISTORY: High cholesterol.  Gastroesophageal
reflux disease.

MEDICATION ON ADMISSION: 

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Crushing injury of thigh,Closed fracture of pubis,Acute posthemorrhagic anemia,Other noncollision motor vehicle traffic accident injuring passenger in motor vehicle other than motorcycle,Crushing injury of buttock,Open wound of scalp, without mention of complication,Pain in or around eye,Esophageal reflux,Pure hypercholesterolemia'}
