CHIEF COMPLAINT: Status post motor vehicle crash

PRESENT ILLNESS: The patient is a 36-year-old
African-American female, who was a passenger in a high-speed
motor vehicle accident, thrown from the car approximately 20
feet.  Initial [**Location (un) 2611**] Coma Scale at the scene was 3.  The
patient was intubated by EMS.  The patient was transported
by [**Location (un) **] to [**Hospital1 69**] with
systolic blood pressure in the 110 range and heart rate in
the 120s.

MEDICAL HISTORY: No past medical history.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Positive tobacco.  The patient is a social
drinker alcohol.
Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of multiple cervical vertebrae,Other specified open wounds of ocular adnexa,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Closed fracture of scapula, unspecified part,Injury of face and neck
Traum subarachnoid hem,Traum pneumothorax-close,Fx mult cervical vert-cl,Opn wnd ocular adnex NEC,Fx clavicle NOS-closed,Fracture one rib-closed,Fx scapula NOS-closed,Face & neck injury
Admission Date:  [**2183-7-24**]       Discharge Date:  [**2183-8-26**]

Date of Birth:   [**2147-7-20**]       Sex:  F

Service:  TRAUMA S.

HISTORY OF THE PRESENT ILLNESS:  The patient is a 36-year-old
African-American female, who was a passenger in a high-speed
motor vehicle accident, thrown from the car approximately 20
feet.  Initial [**Location (un) 2611**] Coma Scale at the scene was 3.  The
patient was intubated by EMS.  The patient was transported
by [**Location (un) **] to [**Hospital1 69**] with
systolic blood pressure in the 110 range and heart rate in
the 120s.

PAST MEDICAL HISTORY:  No past medical history.

MEDICATIONS:  No medications.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Positive tobacco.  The patient is a social
drinker alcohol.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 98.2, blood
pressure 82/45, increasing to 110/63 subsequently.  Heart
rate 141, decreasing to 128 subsequently.  Oxygen saturation
98%, decreased to 95%.  There was a multiple, approximately
2  cm laceration of the scalp, partially to the bone.  There
was extensive galeal hematoma of the entire scalp.  There was
tissue loss, maceration around the left eye with intact
globe.  Pupils equal, round, and reactive to light bilateral
2 mm.  Tympanic membranes were clear bilateral.  Right
serosanguinous fluid in canal.  CARDIAC:  Regular rate and
rhythm.  PULMONARY:  Breath sound equal bilaterally.
ABDOMEN:  Distended, nontender.  PELVIS:  Stable.  BACK:  No
stepoffs, no abrasions.  RECTAL:  Normal tone, guaiac
negative.  Right wrist deformity, positive skin loss.  Right
shin revealed superficial lacerations.  No deformities.  The
patient moves all four extremities.

LABORATORY DATA:  Laboratory data:  WBC 20, hematocrit
originally 30.7 trending to 32, down to 29, back to 32.
Platelet count 303,000.  PT 15.3, PTT 37.7.  INR 1.6.  Sodium
135, potassium 4.3, chloride 117, BUN 10, creatinine 1.2,
glucose 171, amylase 346, lactate 6.1, toxicology screen
positive for alcohol at 116, otherwise, negative.  ABGs:
First set drawn revealed 7.26, 30, 78, 14, negative 12.
Second set drawn revealed 7.20, 35, 88, 14, negative 13.
Third set drawn revealed pH 7.30, 20, 241, 14, negative 9.

X-ray of the chest showed bilateral clavicular fractures.  No
pneumothorax.  Endotracheal tube in the right bronchus,
subsequently pulled back 2 cm.  Pelvis film was negative.  CT
of the head showed a right temporoparietal bleed, question of
edema, positive subgaleal hematoma with left frontal and
subarachnoid bleed.  No shift.  Right nasal orbit fracture
C5-6.  Chest showed the small right anterior pneumothorax.
Multiple C-spine fractures of C5-C6 and T1 to T4 spinal
fractures.  Positive post mediastinal hematoma with bilateral
....................fractures; right scapular fracture;
thyroid hematoma; pericardial air; positive atelectasis.

CT of the abdomen and pelvis showed fluid, as well as air,
from DPL.  No pelvic fractures.  Examination was negative.
DPL negative.  Pericardial bleed was negative.

The patient was transferred to the SICU.  Cardiothoracic
Department was consulted on the 15th regarding anterior
thyroid hematoma management and surrounding ascending aorta.
They recommended aortogram to discover the source of the
bleed that could be from spinal fractures or aortic injury.
Surgery was consulted for ICP monitoring as well as multiple
spinal pressures.  Ophthalmology Department was consulted for
the right eye laceration evaluation.  Surgery was consulted,
as mentioned previously, and recommended angiogram of the
descending aorta to rule out bleed with potential
embolization of the vertebral vessels if bleeding was noted.
Ophthalmology was consulted knowing that there was risk of
excess corneal exposure.  They recommended Erythromycin
ointment q.i.d. to the right and left eyes and to protect the
eyes, in the meantime by taping eyelids down to cover both
corners and a metal eye shield to protect the eyes.  Vascular
Surgery was consulted noted that the patient needed to be
stabilized before further be done and agreed with Orthopedic
recommendations regarding corneal protection.  Results of the
angiogram done showed no injury to the thoracic aorta, intact
intercostal arteries and thyrocervical trunk, left vertebral
proximally mildly compressed




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

Dictated By:[**Last Name (NamePattern1) 17322**]
MEDQUIST36

D:  [**2183-8-25**]  09:15
T:  [**2183-8-25**]  09:22
JOB#:[**Job Number 109473**]


Admission Date:  [**2183-7-24**]       Discharge Date:  [**2183-8-26**]

Date of Birth:   [**2147-7-20**]       Sex:  F

Service:  TRAUMA S.
HISTORY OF THE PRESENT ILLNESS:  The patient is a 36-year-old
African-American female, who was a passenger in a high-speed
motor vehicle accident, thrown from the car approximately 20
feet.  Initial [**Location (un) 2611**] Coma Scale at the scene was 3.  The
patient was intubated by EMS.  The patient was transported
systolic blood pressure in the 110 range and heart rate in
the 120s.

PAST MEDICAL HISTORY:  No past medical history.

MEDICATIONS:  No medications.


SOCIAL HISTORY:  Positive tobacco.  The patient is a social
drinker alcohol.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 98.2, blood
pressure 82/45, increasing to 110/63 subsequently.  Heart
rate 141, decreasing to 128 subsequently.  Oxygen saturation
98%, decreased to 95%.  There was a multiple, approximately
2  cm laceration of the scalp, partially to the bone.  There
was extensive galeal hematoma of the entire scalp.  There was
tissue loss, maceration around the left eye with intact
globe.  Pupils equal, round, and reactive to light bilateral
2 mm.  Tympanic membranes were clear bilateral.  Right
serosanguinous fluid in canal.  CARDIAC:  Regular rate and
rhythm.  PULMONARY:  Breath sound equal bilaterally.
ABDOMEN:  Distended, nontender.  PELVIS:  Stable.  BACK:  No
stepoffs, no abrasions.  RECTAL:  Normal tone, guaiac
negative.  Right wrist deformity, positive skin loss.  Right
shin revealed superficial lacerations.  No deformities.  The
patient moves all four extremities.

LABORATORY DATA:  Laboratory data:  WBC 20, hematocrit
originally 30.7 trending to 32, down to 29, back to 32.
Platelet count 303,000.  PT 15.3, PTT 37.7.  INR 1.6.  Sodium
135, potassium 4.3, chloride 117, BUN 10, creatinine 1.2,
glucose 171, amylase 346, lactate 6.1, toxicology screen
positive for alcohol at 116, otherwise, negative.  ABGs:
First set drawn revealed 7.26, 30, 78, 14, negative 12.
Second set drawn revealed 7.20, 35, 88, 14, negative 13.
Third set drawn revealed pH 7.30, 20, 241, 14, negative 9.

X-ray of the chest showed bilateral clavicular fractures.  No
pneumothorax.  Endotracheal tube in the right bronchus,
subsequently pulled back 2 cm.  Pelvis film was negative.  CT
of the head showed a right temporoparietal bleed, question of
edema, positive subgaleal hematoma with left frontal and
subarachnoid bleed.  No shift.  Right nasal orbit fracture
C5-6.  Chest showed the small right anterior pneumothorax.
Multiple C-spine fractures of C5-C6 and T1 to T4 spinal
fractures.  Positive post mediastinal hematoma with bilateral
clavicular fractures; right scapular fracture;
thyroid hematoma; pericardial air; positive atelectasis.

CT of the abdomen and pelvis showed fluid, as well as air,
from DPL.  No pelvic fractures.  Examination was negative.
DPL negative.  Pericardial bleed was negative.

The patient was transferred to the SICU.  Cardiothoracic
Department was consulted on the 15th regarding anterior
thyroid hematoma management and surrounding ascending aorta.
They recommended aortogram to discover the source of the
bleed that could be from spinal fractures or aortic injury.
Surgery was consulted for ICP monitoring as well as multiple
spinal pressures.  Ophthalmology Department was consulted for
the right eye laceration evaluation.  Surgery was consulted,
as mentioned previously, and recommended angiogram of the
descending aorta to rule out bleed with potential
embolization of the vertebral vessels if bleeding was noted.
Ophthalmology was consulted knowing that there was risk of
excess corneal exposure.  They recommended Erythromycin
ointment q.i.d. to the right and left eyes and to protect the
eyes, in the meantime by taping eyelids down to cover both
corners and a metal eye shield to protect the eyes.  Vascular
Surgery was consulted noted that the patient needed to be
stabilized before further be done and agreed with Orthopedic
recommendations regarding corneal protection.  Results of the
angiogram done showed no injury to the thoracic aorta, intact
intercostal arteries and thyrocervical trunk, left vertebral
proximally mildly compressed




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

Dictated By:[**Last Name (NamePattern1) 17322**]
MEDQUIST36

D:  [**2183-8-25**]  09:15
T:  [**2183-8-25**]  09:22
JOB#:





Admission Date:                   Discharge Date: [**2183-8-27**]

Date of Birth:   [**2147-7-20**]       Sex:  F

Service:

CHIEF COMPLAINT:  Status post motor vehicle crash

ADDENDUM:  Following the [**8-26**] discharge summary.  The
patient, on the night of [**8-25**] and morning of [**8-26**], became
agitated, requiring Haldol and also the use of a sitter.  The
patient responded well to the Haldol, with decreased
agitation.  The sitter was subsequently removed without
incident, and it was decided that the patient could be
discharged to rehabilitation services without any issues.

During that time, the patient also had a speech and swallow
consult, in which a barium video swallow was performed.  The
speech and swallow department concluded that the patient
could be safely advanced to a clear liquid diet with
aspiration precautions and assistance.

Plastic Surgery also concluded that the wound was stable from
a Plastic Surgery perspective, referring to the right eye,
and that the patient should follow up in Plastic Surgery
Clinic in roughly two weeks for evaluation of the external
fixation of the right arm.  The patient or rehabilitation is
to call for an appointment at [**Telephone/Fax (1) 274**].

Orthopaedics also stated that the right clavicular hardware
was stable, and the patient is to be weight bearing as
tolerated bilaterally at the elbows.

Speech and swallow also recommended the maintenance of the
gastrostomy tube feeds for the primary source of nutrition,
to begin a one-to-one assistance straw sip of water or
Ensure, that the patient should cough and swallow after every
three to four sips.  The patient should be positioned upright
for all oral intake, and monitored for aspiration.

DISCHARGE DIAGNOSIS:
1.  36-year-old female status post unrestrained motor vehicle
crash with polytrauma
2.  Left frontal and right temporal lobe contusions
3.  Bilateral pulmonary contusions
4.  C4-T4 fractures
5.  Bilateral clavicular fractures
6.  Right scapular fracture
7.  Right-sided rib fracture
8.  Right wrist fracture requiring Plastic Surgery open
reduction and internal fixation with external fixation
9.  Multiple facial fractures requiring outpatient
reconstructive surgery through Plastics
10. Decreased mobility requiring an inferior vena cava filter
placement during admission
11. The patient is also status post a percutaneous endoscopic
gastrostomy tube placement for tube feeds.
12. Status post C1-T1 spinal fixation
13. Status post open reduction and internal fixation of right
clavicular fracture
14. Status post full thickness skin graft to right eyelid
laceration

DISCHARGE MEDICATIONS:
1.  Haldol 2 mg by mouth three times a day
2.  Nystatin ointment applied topically four times a day as
needed to perianal area
3.  Clonidine TTS one patch topically every Sunday
4.  Zantac 150 mg via nasogastric tube twice a day
5.  Colace 100 mg liquid by mouth twice a day
6.  Heparin 5000 units subcutaneously twice a day
7.  Bacitracin ointment applied topically four times a day to
open wounds
8.  Nystatin oral suspension 5 mg by mouth four times a day
as needed
9.  Tylenol 650 mg by mouth/per rectum every four to six
hours as needed
10. Erythromycin .5% ophthalmic solution to both eyes four
times a day
11. Regular insulin sliding scale:  140-160, 5 units;
160-180, 10 units; 180-200, 15 units; 201-220, 20 units;
221-240, 25 units; 241-260, 30 units; 261-280, 35 units;
281-300, 40 units.  Give juice if glucose less than 60.
Notify physician if glucose is greater than 300.

NUTRITION:  The patient is to continue with tube feedings,
Promote with fiber full strength at 75 cc/hour.  The patient
should have the nasogastric tube flushed with 50 ml of water
every eight hours.  The patient will continue with a clear
diet with aspiration precautions and assistance as stated
above.

DISCHARGE INSTRUCTIONS:  The patient's right eye should be
covered with a Xeroform dressing to the right upper eyelid
twice per day, with appropriate dry dressings over the
Xeroform.  The patient is to continue with pneumatic boots
when in bed, and the patient's activity status is out of bed
with assistance.

FOLLOW UP:
1.  The patient will follow up in the Trauma Clinic at [**Hospital1 1444**], [**Hospital Ward Name 23**] Building/Surgical
subspecialties, in roughly two weeks, phone number
[**Telephone/Fax (1) 2756**].  Please make an appointment with the Trauma
Clinic.
2.  The patient will follow up with Plastic Surgery in
roughly two weeks for evaluation of external fixation, facial
fractures and also the right eye closure.  The patient or
rehabilitation services to call [**Telephone/Fax (1) 274**] to make an
appointment.
3.  The patient is also to follow up with Orthopaedic Surgery
at [**Hospital1 69**] in roughly one to two
weeks.  The patient will follow up with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 1022**].

DISCHARGE CONDITION:  Good and stable to rehabilitation
services, in stable condition.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

Dictated By:[**Last Name (NamePattern4) 959**]
MEDQUIST36

D:  [**2183-8-27**]  22:35
T:  [**2183-8-28**]  01:29
JOB#:  [**Job Number **]


Name: [**Known lastname 14859**],[**Known firstname 17954**]              Unit No:  [**Numeric Identifier 17955**]

Admission Date: [**2183-7-24**]        Discharge Date: [**2183-9-2**]

Date of Birth:   [**2147-7-20**]       Sex:

Service:

DISCHARGE ADDENDUM:  Since the last addendum to the discharge
summary the patient had an uneventful day at the hospital.
The patient has required a sitter intermittently for safety
precautions during the night, but not related to agitation or
neurologic changes.  The patient is stable and ready for
discharge to rehabilitation services.  Please see the above
dictation for medications and follow up.

DISCHARGE PHYSICAL EXAMINATION:  Temperature max 98.6, 98,
120, 118/88, 99% on room air, in 1800, out 1500, 700 last
shift.  She is alert and in no acute distress.  No pain.
Collar intact.  Pupils are equal, round, and reactive to
light and accommodation.  Cardiovascular regular rate and
rhythm.  Respirations clear to auscultation bilaterally.  No
signs of crackles or rhonchi.  Abdomen is soft, nontender,
nondistended.  Extremities no peripheral edema.  External
fixation of the right upper extremity is intact.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 206**], M.D.
[**MD Number(1) 207**]

Dictated By:[**Last Name (NamePattern4) 5598**]
MEDQUIST36

D:  [**2183-9-2**]  09:54
T:  [**2183-9-2**]  10:30
JOB#:  [**Job Number 17956**]
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of multiple cervical vertebrae,Other specified open wounds of ocular adnexa,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Closed fracture of scapula, unspecified part,Injury of face and neck'}


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: Status post motor vehicle crash

PRESENT ILLNESS: The patient is a 36-year-old
African-American female, who was a passenger in a high-speed
motor vehicle accident, thrown from the car approximately 20
feet.  Initial [**Location (un) 2611**] Coma Scale at the scene was 3.  The
patient was intubated by EMS.  The patient was transported
by [**Location (un) **] to [**Hospital1 69**] with
systolic blood pressure in the 110 range and heart rate in
the 120s.

MEDICAL HISTORY: No past medical history.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Positive tobacco.  The patient is a social
drinker alcohol. 

### Response:
{'Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of multiple cervical vertebrae,Other specified open wounds of ocular adnexa,Closed fracture of clavicle, unspecified part,Closed fracture of one rib,Closed fracture of scapula, unspecified part,Injury of face and neck'}
