CHIEF COMPLAINT: s/p MVA

PRESENT ILLNESS: Mr. [**Known lastname **] is a 23yoM med-flighted to [**Hospital1 18**] following MVC.  Pt
was restrained driver in a high speed rollover accident with the
car veering 100ft across median into the nearby [**Doctor Last Name 6641**].  A CT was
placed at an
OSH, pt send reportedly with splenic fracture . +2inch R
wrist lac with tendon exposure, sutured for transfer with intact
pulse. + ETOH, cannibis reported.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: BP:133/51 HR:110 RR:15  O2 94 %NRB
Gen: Parents at bedside, pt lying on stretcher, intoxicated
Neuro: intact, PRN dilaudid, tylenol
CV: RRR NL s1s2
Pulm: R CT to sxn (repositioned), + BS b/l
Abd: soft, NT/ND + BS
GU: Foley in place
Extremity: intact pulses, 2 inch deep laceration near wrist and
"anatomic snuff box", pt with loss of 1st compartment extensors,
abductor pollicis tendons, possible ECR damage, hand is ulnarly
displaced. no c/c/e

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: + ETOh
+ marijuana use
Injury to spleen without mention of open wound into cavity, unspecified injury,Open wound of wrist, with tendon involvement,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sternum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Closed fracture of scapula, unspecified part,Volume depletion, unspecified,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Contusion of lung without mention of open wound into thorax
Spleen injury NOS-closed,Opn wound wrist w tendon,Traum pneumothorax-close,Fracture of sternum-clos,Loss control mv acc-driv,Fx scapula NOS-closed,Volume depletion NOS,Phlbts sprfc vn up extrm,Lung contusion-closed
Admission Date:  [**2188-11-29**]              Discharge Date:   [**2188-12-2**]

Date of Birth:  [**2165-5-7**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
s/p MVA

Major Surgical or Invasive Procedure:
chest tube (placed at outside hospital).


History of Present Illness:
Mr. [**Known lastname **] is a 23yoM med-flighted to [**Hospital1 18**] following MVC.  Pt
was restrained driver in a high speed rollover accident with the
car veering 100ft across median into the nearby [**Doctor Last Name 6641**].  A CT was
placed at an
OSH, pt send reportedly with splenic fracture . +2inch R
wrist lac with tendon exposure, sutured for transfer with intact
pulse. + ETOH, cannibis reported.


Past Medical History:
none

Social History:
+ ETOh
+ marijuana use

Family History:
noncontributory

Physical Exam:
PE: BP:133/51 HR:110 RR:15  O2 94 %NRB
Gen: Parents at bedside, pt lying on stretcher, intoxicated
Neuro: intact, PRN dilaudid, tylenol
CV: RRR NL s1s2
Pulm: R CT to sxn (repositioned), + BS b/l
Abd: soft, NT/ND + BS
GU: Foley in place
Extremity: intact pulses, 2 inch deep laceration near wrist and
"anatomic snuff box", pt with loss of 1st compartment extensors,
abductor pollicis tendons, possible ECR damage, hand is ulnarly
displaced. no c/c/e


Pertinent Results:
[**2188-11-29**] 04:40AM   ASA-NEG ETHANOL-206* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

[**11-29**]: CT- 1. The area of interest in the body of the pancreas
on previous study does not demonstrate any abnormality on the
present examination. The finding of low density on the previous
study may have been related to artifact caused by a distended
air-filled stomach.
2. Stable-appearing grade 3 splenic injury without evidence of
free fluid.
3. Stable bibasilar atelectasis.
CT [**11-29**]: IMPRESSION:

1. Grade III splenic injury, without evidence of perisplenic
fluid or hemoperitoneum.

2. Focal hypodense area in the pancreatic body without
laceration, peripancreatic fluid or mesenteric abnormalities is
nonetheless concerning for acute traumatic injury. Follow up CT
is recommended.

3. Small right-sided pneumothorax. Right-sided chest tube
terminates in the anterior mediastinum. Repositioning is
recommended.

4. Patchy opacities within the right upper lobe consistent with
contusion.

4. Minimally displaced fracture through the right aspect of the
sternal manubrium.

5. Non-displaced extra-articular left scapular fracture.

[**11-29**] CT OF THE HEAD WITHOUT CONTRAST: There is no intracranial
mass lesion, hydrocephalus, shift of normally midline
structures, major territorial infarct, intra- or extra-axial
hemorrhage. The [**Doctor Last Name 352**]-white matter differentiation is preserved.
The visualized paranasal sinuses demonstrate minimal air-fluid
levels in the sphenoid sinus. The surrounding osseous structures
are unremarkable. There is soft-tissue swelling parietal region.

[**11-30**]- PA AND LATERAL CHEST x-ray: Decreased size of the small
right apical pneumothorax. The lungs are otherwise clear. Chest
tube is slightly more lateral than on prior examination. The
cardiomediastinal silhouette is within normal limits.


Brief Hospital Course:
The patient was admitted to the trauma team after primary survey
in the trauma bay at [**Hospital1 **] MC.  The patient was stabilized and
brought to CT for radiographic evaluation initially with CT and
CXR.  His chest tube was repositioned in the trauma bay as it
appeared to be abutting the mediastinum; repeat chest x-rays
showed the chest tube to be in the appropriate position.
Plastic surgery was consulted for evaluation of the right hand
laceration with tendon exposure who splinted the extremity, and
closed the skin where appropriate.  Following discharge, the
patient will return for outpatient surgery for ultimate repair.


Orthopedic surgery was also consulted for evaluation of the
patient's manubrium, and scapular fracture.

     The patient was appropriately resuscitated for volume
depletion, and had serial hematocrits checked for possible
anemia/splenic bleed.  His vital signs were also closely
monitored, however the patient remained stable with no
tachycardia or hypotension.
The patient's chest tube was eventually removed on [**12-1**] with no
interval increase in pneumothorax.  The patient was constantly
monitored for signs of respiratory distress and changes in
symptomatology.  While the chest tube was in place, the patient
was on telemetry for cardiac monitoring.

Mr. [**Known lastname 75709**] stay was complicated by superficial thrombophlebitis
that was symptomatic; the patient was put on a 5 day course of
cephalexin and instructed to use hot packs and elevate the
extremity.

The patient received adequate pain medications throughout his
stay for pain management.  He was also put on DVT prophylaxis
and GI prophylaxis as needed.  Physical therapy and social work
were consulted for evaluation and treatment of the patient.
On discharge, the patient was afebrile, tolerating a regular
diet, ambulating, voiding, with pain well controlled.  He
received instructions for follow up with trauma and plastic
surgery for subsequent operative repair of his right hand.


Medications on Admission:
none

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q3-4H () as needed.
Disp:*35 Tablet(s)* Refills:*0*
3. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*30 Capsule(s)* Refills:*3*
5. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 5 days.
Disp:*9 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
sternal fracture, R wrist laceration, tendon injury, scapular
fracture, pneumothorax


Discharge Condition:
good


Discharge Instructions:
Please call Plastic Surgery to verify your time for the OR at
[**Telephone/Fax (1) 274**] later today.

Incision Care:  Keep clean and dry.
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.
-No contact sports for 4-6 weeks.
-Keep dressing on chest tube site for 2-3 days.

.
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
diarrhea or other reasons.
* Signs of dehydration include dry mouth, rapid heartbeat or
feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.


Followup Instructions:
Please follow up with Plastic surgery at [**Telephone/Fax (1) 274**] following
discharge.

Please follow up with Dr. [**Last Name (STitle) **] in [**1-15**] weeks at [**Telephone/Fax (1) 600**]
(trauma clinic).
{'Injury to spleen without mention of open wound into cavity, unspecified injury,Open wound of wrist, with tendon involvement,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sternum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Closed fracture of scapula, unspecified part,Volume depletion, unspecified,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Contusion of lung without mention of open wound into thorax'}


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: s/p MVA

PRESENT ILLNESS: Mr. [**Known lastname **] is a 23yoM med-flighted to [**Hospital1 18**] following MVC.  Pt
was restrained driver in a high speed rollover accident with the
car veering 100ft across median into the nearby [**Doctor Last Name 6641**].  A CT was
placed at an
OSH, pt send reportedly with splenic fracture . +2inch R
wrist lac with tendon exposure, sutured for transfer with intact
pulse. + ETOH, cannibis reported.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: BP:133/51 HR:110 RR:15  O2 94 %NRB
Gen: Parents at bedside, pt lying on stretcher, intoxicated
Neuro: intact, PRN dilaudid, tylenol
CV: RRR NL s1s2
Pulm: R CT to sxn (repositioned), + BS b/l
Abd: soft, NT/ND + BS
GU: Foley in place
Extremity: intact pulses, 2 inch deep laceration near wrist and
"anatomic snuff box", pt with loss of 1st compartment extensors,
abductor pollicis tendons, possible ECR damage, hand is ulnarly
displaced. no c/c/e

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: + ETOh
+ marijuana use 

### Response:
{'Injury to spleen without mention of open wound into cavity, unspecified injury,Open wound of wrist, with tendon involvement,Traumatic pneumothorax without mention of open wound into thorax,Closed fracture of sternum,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Closed fracture of scapula, unspecified part,Volume depletion, unspecified,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Contusion of lung without mention of open wound into thorax'}
