CHIEF COMPLAINT: Status post Motor vehicle crash

PRESENT ILLNESS: 18 year old male status post motor vehicle crash; was an
unrestrained intoxicated driver of a roll over motor vehicle at
4:30AM on the day of admission which by report he was driving a
stolen vehicle at high speeds when he hit a guard rail. He was
taken to an outside hospital, where he was intubated for low
GCS. He was found to have a subdural hematoma and transferred to
[**Hospital1 18**] for trauma evaluation.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam on Admission:
Limited to sedation/paralytics
T 102.7, P 118, BP 144/65, R 28, Sat 100% vented
General: Sedated, NAD. Intubated
Neck: Cervical collar on, Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, ND, BS+
Extrem: Warm and well-perfused.

FAMILY HISTORY: Father: diabetes, hypertension, high cholesterol. Mother: not
known (adopted). No known family history of seizure,
developmental delay.

SOCIAL HISTORY: Worked in a supermarket and as a landscaper.  Heavy ETOH (all
weekend)use.  Percocet abuse. No known cocaine abuse.
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Anoxic brain damage,Dependence on respirator, status,Papilledema associated with increased intracranial pressure,Hyperosmolality and/or hypernatremia,Open fracture of mandible, multiple sites,Motor vehicle traffic accident of unspecified nature injuring driver of motor vehicle other than motorcycle,Alcohol abuse, unspecified,Other acute pain,Fever, unspecified,Other and unspecified infection due to central venous catheter,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Other and unspecified special symptoms or syndromes, not elsewhere classified,Open wound of scalp, complicated,Foreign body in larynx
Cl skul base fx-coma NOS,Anoxic brain damage,Respirator depend status,Papilledema w incr press,Hyperosmolality,Mult fx mandible-open,Traffic acc NOS-driver,Alcohol abuse-unspec,Acute pain NEC,Fever NOS,Oth/uns inf-cen ven cath,Abn react-procedure NOS,Other staphylococcus,Special symptom NEC/NOS,Open wound scalp-compl,Foreign body in larynx
Admission Date:  [**2154-5-20**]              Discharge Date:   [**2154-7-1**]

Date of Birth:  [**2135-12-11**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
Status post Motor vehicle crash

Major Surgical or Invasive Procedure:
[**2154-5-20**] Bifrontal craniotomies
[**2154-5-24**] Trach, PEG, IVC filter
[**2154-5-28**] ORIF facial fractures part I:
1. Extraction of teeth numbers 3, 10, 12, 19 and 32.
2. Placement of upper and lower arch bars.
3. Open-reduction internal fixation of right mandibular
    posterior body fracture.
4. Debridement of comminuted left mandibular body fracture.
5. Reconstruction plating of left mandibular continuity
    defect.
6. Open-reduction internal fixation of palatal fracture.
7. Layered closure of complex lower lip and oral
    lacerations measuring 10 cm in total.
[**2154-6-6**] Part II facial repair:
Second stage open reduction, internal fixation of
displaced pan facial fractures via coronal bilateral rim and
bilateral maxillary gingival buccal sulcus incisions.
[**2154-6-26**] Lumbar puncture
[**2154-6-26**] PICC placement


History of Present Illness:
18 year old male status post motor vehicle crash; was an
unrestrained intoxicated driver of a roll over motor vehicle at
4:30AM on the day of admission which by report he was driving a
stolen vehicle at high speeds when he hit a guard rail. He was
taken to an outside hospital, where he was intubated for low
GCS. He was found to have a subdural hematoma and transferred to
[**Hospital1 18**] for trauma evaluation.


Past Medical History:
None

Social History:
Worked in a supermarket and as a landscaper.  Heavy ETOH (all
weekend)use.  Percocet abuse. No known cocaine abuse.


Family History:
Father: diabetes, hypertension, high cholesterol. Mother: not
known (adopted). No known family history of seizure,
developmental delay.

Physical Exam:
Physical Exam on Admission:
Limited to sedation/paralytics
T 102.7, P 118, BP 144/65, R 28, Sat 100% vented
General: Sedated, NAD. Intubated
Neck: Cervical collar on, Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, ND, BS+
Extrem: Warm and well-perfused.


Pertinent Results:
Upon admission:
[**2154-5-20**] 11:45PM   TYPE-ART PO2-115* PCO2-34* PH-7.41 TOTAL
CO2-22 BASE XS--1
[**2154-5-20**] 11:45PM   GLUCOSE-147* LACTATE-1.5 K+-4.1
[**2154-5-20**] 06:45PM   WBC-18.3*# RBC-4.06* HGB-12.5* HCT-34.6*
MCV-85 MCH-30.9 MCHC-36.3* RDW-14.1
[**2154-5-20**] 06:45PM   WBC-18.3*# RBC-4.06* HGB-12.5* HCT-34.6*
MCV-85 MCH-30.9 MCHC-36.3* RDW-14.1
[**2154-5-20**] 06:45PM   PLT COUNT-217
[**2154-5-20**] 06:45PM   PT-14.7* PTT-25.2 INR(PT)-1.3*
[**2154-5-20**] 09:40AM   ASA-NEG ETHANOL-87* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

CT Head [**2154-5-20**]
IMPRESSION:
1. Generalized brain edema with mild effacement of the basilar
cisterns but no definite sign of herniation.
2. Small bifrontal acute subdural hemorrhages and possible
subdural blood
along the tentorium.
3. Punctate hyperdensities in the left frontal lobe may
represent developing manifestations of diffuse axonal injury or
possibly hemorrhagic contusion.
4. Extensive facial trauma, described in detail on concurrently
performed
facial bone CT.
5. 8 mm radiopaque foreign body in the left occipital scalp
subcutaneous
tissues.

CT Sinus/Mandible [**2154-5-20**]
IMPRESSION:

1. Bilateral [**Last Name (un) **]-orbital ethmoidal complex fractures.

2. Bilateral Le Fort I/II and III complex fractures.

3. Bilateral mandibular fractures, with extensive comminution of
the left
mandibular angle and ramus, with malocclusion of the teeth.

4. Small bifrontal acute subdural hemorrhages, described in
detail on
concurrently performed head CT.

5. Periorbital hematoma bilaterally, and small right extraconal
hematoma.
Intact globes.

6. Extensively comminuted nasal bone fractures.


CT cervical spine [**2154-5-20**]
IMPRESSION: No cervical spine fracture or malalignment.

POST- OP Head CT [**2154-5-20**]
IMPRESSION: Status post bifrontal craniotomy, and evacuation of
bifrontal
subdural hematomas with residual pneumocephalus. Persistent
severe
diffuse cerebral edema with evidence of diffuse axonal injury.
Status
post interval placement of right ventriculostomy catheter.

MRI Head [**2154-5-21**]
IMPRESSION:
1. Extensive post-surgical change as described above. No new
intracranial
hemorrhage is identified.
2. Slow diffusion in the parietal cortices, medial margin of the
left
occipital cortex, thalami and supratentorial white matter as
described above.
These areas of slow diffusion likely are related to cortical
contusion and
diffuse axonal injury.
3. Right-sided ventriculostomy catheter in place with
normal-sized
ventricles.
4. Nearly complete opacification of the paranasal sinuses.

MRI cervical spine [**2154-5-21**]
IMPRESSION:

1. No evidence of vertebral body fracture or ligamentous injury.

2. No spinal cord signal abnormality identified.

REPEAT HEAD CT [**2154-5-24**]
IMPRESSION: Status post craniectomies. No change in ventricular
size or
evidence of new hemorrhage. Brain edema and signs of mild
central herniation
again identified and have not changed. The vessels cisterns are
still
partially visualized.

Repeat head CT [**2154-6-23**]
IMPRESSION:

1. No acute intracranial hemorrhage.

2. Resolution of the previously noted bifrontal extra-axial
fluid collection.

3. Evaluation for infectious processes is limited on the present
study due to
lack of IV contrast.

4. S/p ORIF of facial fractures, with dense material in the
maxillary sinuses
as described above, incompletely assessed on the present study.








Brief Hospital Course:
He was admitted to the Trauma Service; Neurosurgery and Plastics
consulted given his injuries:
[**5-20**]: [**Last Name (LF) 14938**], [**First Name3 (LF) **], 23% saline started per recommendation of
Neurosurgery, Bolt placed, CPP 55-60 given high ICP was taken to
OR for bifrontal craniectomies
[**5-21**]: Dilantin 150 tid started after received loading dose;
given Mannitol and Lasix *1; underwent CT head, MRI head and
spine.
[**5-22**]: Mannitol held, last dose [**2071-4-29**] pm. cervical, thoracic and
lumbar spine cleared radiographically. Back on Labetalol gtt for
SBP > 160. Temp to 102 at [**2074**], blood, sputum and urine sent, no
CSF sent per neurosurgery.
[**5-23**]: Tmax 105; arctic sun cooling, ?central vs infectious
source,  he was pan cultured including CSF; continued shivering,
started on propofol drip; follow osms, Na 158
[**5-24**]: PEG, Trach and IVC filter placed; ventricular drain was
accessed and therefore repeat CT head done
[**5-25**]: lost a-line last night, multiple attempts at replacement
difficult and unsuccessful due to posturing/muscle rigidity. [**Month (only) 116**]
require brief paralysis if a-line necessary, currently ok to
follow cuff pressures (are reliable) per primary team and
neurosurgery, not currently on gtt for BP control. Will switch
Dilantin to Keppra due to [**Month (only) 5162**], needs multi-day titration per
Neurology. EVD raised to 15 per neurosurgery. 2 units PRBCs for
HCT 24 given head injury. Weaned to trach mask.
[**5-26**]: Restarted propofol gtt for agitation; back on PS
ventilation; cooling blanket
[**5-27**]: CT head no hydrocephalus; EVD D/ced; Pre-op for OR with
plastics in AM, Lasix *3.
[**5-28**]: Had fever to 101.6 o/n with some hypertension requiring
hydralazine x 2 and labetalol. Head CT concerning for worsening
cerebral edema s/p EVD pulled yesterday. Started on mannitol.
New fever concerning for new infection: New left subclavian [**Month/Year (2) 14938**]
placed and R SCCVL pulled with culture of catheter tip sent. Pt
was pan cultured. Also stopped dilantin (pt almost therapeutic
on Keppra.)Went to OR with plastics for repair mandibular
fracture. Was again febrile to 101.3 upon arrival. APAP and
cooling blanket. Mandible fracture path with gpcs, gnr, gpr- d/w
plastics resident who explained was basically intra-oral swab-
no concern osteo. Did recommend adding Unasyn for mandible
fracture/wire which was continued until 5 days.   Post op from
mandible fracture was hypertensive to 190s and HR 130s. ?
secondary to pain. Aggressive pain control with fentanyl,
Roxicet. Labetalol for BP -> vital signs stabilized.
[**5-29**]:CT Head with no significant changes, continue Unasyn; trach
mask, increased metoprolol, temp 100, osmol 319-322, Na 152-
held one dose of mannitol
[**5-30**]:Increased Lopressor to 75 tid, Mannitol continued.
[**5-31**]: Received Lasix 20 mg IV x 3 secondary to decreased urinary
output; off mannitol; Keppra changed to 1500 [**Hospital1 **]; transferred
from Trauma ICU to Neuro stepdown unit.
[**6-3**]: vomited in AM, large gastric bubble; GT vented; CT
head:left small extra-axial collection overlying the left
inferior frontal lobe is slightly larger, measuring 7 mm (
previously, 5 mm). No other interval change. CT Abd:No
obstruction. Two locules of free air in the upper abdomen, may
be related to instrumentation/related to G-tube.
[**6-6**]: OR phase 2; Vanc x 48 hours for BCx G+C, stopped [**6-8**] due
to growth of contaminants; PICC changed over
[**6-8**]: GNR in PICC tip culture, switched to Zosyn
[**6-9**]: 1unit of blood from JP drain, neuro status unchanged,
perrl, spontaneous movement all 4 ext RLE much less than others.
stat head CT: unchanged but motion artifact-no new hemorrhage,
similar hypodensities in frontal lobe, known cerebral edema, JP
wrapped around frontal sinus. 10 pm repeat head CT extra-axial
CSF collection
PICC tip culture +Enterobacter, pan sensitive, switched to Cipro
until [**6-16**]
[**6-14**]: JP self d/c'ed
[**6-20**]: fever, with mental status blunting, CXR, UA, urine/blood
culture
[**6-22**]: fever spike again to >102, CXR, UA, urine/blood culture;
Neurosurgery re-consulted for an LP
[**6-23**]: CT scan sinuses negative, GPC grown from  blood cultures
6/29: TTE No valvular pathology or pathologic flow identified,
Vancomycin started.
[**6-26**]:  LP performed and fluid sent for culture. Final culture
would later come back with no growth. PICC line placed
[**6-27**]:  continuing to spike [**Month/Day (2) 5162**] daily, awaiting blood culture
speciation, failed Passy Muir evaluation
[**6-30**]: Blood Culture final 1 out of the 4 bottles  with
STAPHYLOCOCCUS, COAGULASE NEGATIVE.
[**7-1**]: Vancomycin stopped. Preparation for discharge to rehab
ongoing; medically stable for transfer today to [**Hospital3 **]
if bed available.


Medications on Admission:
None

Discharge Medications:
1. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15) ML
Mucous membrane [**Hospital1 **] (2 times a day).
2. White Petrolatum-Mineral Oil 42.5-56.8 % Ointment Sig: One
(1) Appl Ophthalmic QID (4 times a day) as needed for dry eyes,
swelling: Apply to both eyes.
3. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) MG
PO BID (2 times a day): hold for loose stools.
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours): via feeding tube.
6. Levetiracetam 100 mg/mL Solution Sig: 1500 (1500) MG PO BID
(2 times a day).
7. Ibuprofen 100 mg/5 mL Suspension Sig: Four Hundred (400) MG
PO Q6H (every 6 hours) as needed for T>101: Notify MD [**First Name (Titles) **] [**Last Name (Titles) 5162**]
>101.
8. Metoprolol Tartrate 50 mg Tablet Sig: 2.5 Tablets PO TID (3
times a day): via feeding tube.
9. Hydralazine 10 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
10. Acetaminophen 160 mg/5 mL Solution Sig: Six [**Age over 90 1230**]y
(650) MG PO every 4-6 hours as needed for fever.
11. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30)
ML's PO every six (6) hours.
12. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
13. Oxycodone 5 mg/5 mL Solution Sig: 5-10 MG PO Q4H (every 4
hours) as needed for pain.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
s/p Motor vehicle crash
Bialteral subarachnoid hemorrhages
Diffuse axonal injury
LeFort II fractures
[**Location (un) **]


Discharge Condition:
Hemodynamically stable, tolerating a regular diet, pain
adequately controlled.

Followup Instructions:
Follow up in 1 month with Dr. [**First Name (STitle) **], Neurosurgery. Call
[**Telephone/Fax (1) 6429**] for an appointment.

Follow up in 2 weeks with Dr. [**First Name (STitle) **], Plastic surgery. Call
[**Telephone/Fax (1) 5343**] for an appointment.

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2154-7-3**]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Anoxic brain damage,Dependence on respirator, status,Papilledema associated with increased intracranial pressure,Hyperosmolality and/or hypernatremia,Open fracture of mandible, multiple sites,Motor vehicle traffic accident of unspecified nature injuring driver of motor vehicle other than motorcycle,Alcohol abuse, unspecified,Other acute pain,Fever, unspecified,Other and unspecified infection due to central venous catheter,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Other and unspecified special symptoms or syndromes, not elsewhere classified,Open wound of scalp, complicated,Foreign body in larynx'}


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: 18 year old male status post motor vehicle crash; was an
unrestrained intoxicated driver of a roll over motor vehicle at
4:30AM on the day of admission which by report he was driving a
stolen vehicle at high speeds when he hit a guard rail. He was
taken to an outside hospital, where he was intubated for low
GCS. He was found to have a subdural hematoma and transferred to
[**Hospital1 18**] for trauma evaluation.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam on Admission:
Limited to sedation/paralytics
T 102.7, P 118, BP 144/65, R 28, Sat 100% vented
General: Sedated, NAD. Intubated
Neck: Cervical collar on, Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, ND, BS+
Extrem: Warm and well-perfused.

FAMILY HISTORY: Father: diabetes, hypertension, high cholesterol. Mother: not
known (adopted). No known family history of seizure,
developmental delay.

SOCIAL HISTORY: Worked in a supermarket and as a landscaper.  Heavy ETOH (all
weekend)use.  Percocet abuse. No known cocaine abuse. 

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Anoxic brain damage,Dependence on respirator, status,Papilledema associated with increased intracranial pressure,Hyperosmolality and/or hypernatremia,Open fracture of mandible, multiple sites,Motor vehicle traffic accident of unspecified nature injuring driver of motor vehicle other than motorcycle,Alcohol abuse, unspecified,Other acute pain,Fever, unspecified,Other and unspecified infection due to central venous catheter,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Other and unspecified special symptoms or syndromes, not elsewhere classified,Open wound of scalp, complicated,Foreign body in larynx'}
