CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 34-year-old
lady status post motorcycle versus car motor vehicle
accident.  The patient was the motorcycle rider with a
helmet.  The patient was initially brought to a [**Hospital3 **] area
hospital with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Score of 18 at the scene and was
intubated at the scene.

MEDICAL HISTORY: Unknown.

MEDICATION ON ADMISSION: Unknown.

ALLERGIES: INTRAVENOUS DYE, SULFA, TEGRETOL, MOTRIN,
DILANTIN, and PERCOCET.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Unknown.
Open supracondylar fracture of femur,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Other convulsions,Open fracture of upper end of fibula with tibia,Closed fracture of shaft of humerus,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist
Supracondyl fx femur-opn,Brain hem NEC-coma NOS,Convulsions NEC,Fx up tibia w fibula-opn,Fx humerus shaft-closed,Mv collis NOS-motorcycl
Admission Date: [**2193-5-29**]        Discharge Date: [**2193-6-3**]

Date of Birth:  [**2148-6-12**]        Sex:  F

Service:  TRA


HISTORY OF PRESENT ILLNESS:  The patient is a 34-year-old
lady status post motorcycle versus car motor vehicle
accident.  The patient was the motorcycle rider with a
helmet.  The patient was initially brought to a [**Hospital3 **] area
hospital with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Score of 18 at the scene and was
intubated at the scene.

The patient was transferred to [**Hospital1 188**] Emergency Room in hemodynamically stable condition.
The patient was noted to have a left open femur and tib/fib
fracture as well as a left humerus fracture.

The patient was taken to the operating room from the
Emergency Room by the Orthopaedic Department.  Thereafter,
the patient was admitted to the Intensive Care Unit in stable
condition.

PAST MEDICAL HISTORY:  Unknown.

PAST SURGICAL HISTORY:  Unknown.

MEDICATIONS ON ADMISSION:  Unknown.

ALLERGIES:  INTRAVENOUS DYE, SULFA, TEGRETOL, MOTRIN,
DILANTIN, and PERCOCET.

SOCIAL HISTORY:  Unknown.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs revealed a
temperature of 99.6, her heart rate was 115, her blood
pressure was 105/58, her respiratory rate was 16, and 100
percent intubated.  Head, eyes, ears, nose, and throat
examination revealed the pupils equal, round and reactive to
light (2 mm to 1 mm) bilaterally.  Cervical spine revealed no
step off noted.  The patient was in a cervical collar.  The
chest was clear to auscultation bilaterally.  The abdomen was
soft and nondistended.  FAST examination was negative.  The
pelvis was stable.  Perineum/rectal was guaiac negative.  No
masses.  Back revealed no step off.  The left lower extremity
revealed an obvious large deformity at the distal femur and
proximal tibia.  There was a 2 mm opening at the distal femur
with a palpable fracture noted underneath.  There was a 2-cm
laceration over the proximal tibia.  Palpable dorsalis pedis
and posterior tibial pulses.  The right lower extremity
revealed no obvious deformity or crepitus with range of
motion.  Dorsalis pedis and posterior tibial pulses were 2
plus.  Right upper extremity with no obvious deformity or
crepitus with range of motion.  Radial pulse was 2 plus.  The
left upper extremity revealed an obvious deformity at the
midshaft humerus.  Radial pulse was 2 plus.  No break in
skin.

LABORATORY DATA ON ADMISSION:  Complete blood count revealed
a white blood cell count of 13.6, her hematocrit was 33.4,
and her platelets were 215.  Chemistry panel revealed sodium
was 141, potassium was 4.9, chloride was 111, bicarbonate was
21, blood urea nitrogen was 15, creatinine was 0.7, and blood
glucose was 114.  INR was 1.4.  Urinalysis was negative.
Amylase was 162.  Serum toxicology screen was negative.
Urine toxicology screen was positive for benzodiazepines and
opiates.

SUMMARY OF HOSPITAL COURSE:  The patient was admitted to the
Intensive Care Unit postoperatively in stable condition.  The
patient had undergone an open reduction internal fixation of
her left distal open femur fracture.  During the Intensive
Care Unit stay, the patient also returned to the Operating
Room on [**5-31**] for a left humerus midshaft fracture.  Please
see the operative note for further details of the procedures.
The patient was extubated without difficulty.

The patient was transferred to the floor on hospital day four
in stable condition.  The patient's course on the floor was
unremarkable.  The patient was somewhat agitated, but her
mental status cleared significantly with the weaning of
sedation.  The patient was screened by Physical Therapy for
likely disposition to a rehabilitation center.  The patient
was followed throughout her hospital course by the
Orthopaedic Service in consultation who deemed the patient to
need no further operative intervention during this hospital
stay.

DISCHARGE DISPOSITION:  Therefore, the patient was discharged
to a rehabilitation center on [**2193-6-4**] in stable
condition.

MEDICATIONS ON DISCHARGE:
1. Colace 100 mg by mouth twice per day.
2. Combivent nebulizer q.6h. as needed.
3. Lovenox 40 mg subcutaneously once per day.
4. Trazodone 25 mg by mouth at hour of sleep as needed.
5. Morphine sulfate 254 mg intravenously q.4h. as needed.


DISCHARGE FOLLOW UP:  The patient was to follow up after
discharge with Orthopaedics and Trauma.  Please see discharge
work sheet for further details.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5732**], [**MD Number(1) 5733**]

Dictated By:[**Last Name (NamePattern1) 27758**]
MEDQUIST36
D:  [**2193-6-3**] 12:16:04
T:  [**2193-6-3**] 13:23:54
Job#:  [**Job Number 56177**]


Admission Date:[**2193-5-29**]       Discharge Date: [**2193-6-3**]

Date of Birth:                    Sex:

Service:


ADDENDUM

IMAGING DURING HOSPITAL COURSE:  MRI of the head on [**2193-6-1**]
revealed hyperintensities in the corpus callosum and
subcortical white matter suggesting diffuse axonal injury.
The patient also underwent an MRI of the C-spine on [**2193-6-2**]
which revealed severely limited exam due to motion artifact.
No gross abnormalities were detected.  The study was not
adequate to assess a possibility of ligamentous injury.  In
light of these findings, the patient's C-collar was attempted
to be cleared clinically, as the patient's mental status
improved significantly by the end of hospital course.

DISCHARGE DIAGNOSES:  Left occipital intraventricular
hemorrhage, in context with findings consistent with diffuse
axonal injury.

Left midshaft humerus fracture.

Left distal femur fracture.

Left proximal fibula fracture.



                     DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 02-211

Dictated By:[**Last Name (NamePattern1) 27758**]
MEDQUIST36
D:  [**2193-6-3**] 13:12:42
T:  [**2193-6-3**] 13:31:20
Job#:  [**Job Number 56340**]


Admission Date: [**2193-5-29**]        Discharge Date: [**2193-6-5**]

Date of Birth:  [**2148-6-12**]        Sex:  F

Service:  TRA


ADDENDUM:  This woman was tolerating POs on [**2193-6-3**], needing
assistance with eating and drinking Boost.  She was confused
overnight, on the night of [**2193-6-1**], and a neurobehavioral
consult was obtained.  The plan was to discharge her to the
rehabilitation center after the neurorehabilitation consult
was obtained.  She remained in the hospital and it was
thought that on [**2193-6-5**], she should be discharged with
outpatient followup in the Trauma Surgery Service on
[**2193-6-5**].  She will be also following up with Orthopedics.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5732**], MD

Dictated By:[**Last Name (NamePattern4) 42577**]
MEDQUIST36
D:  [**2193-7-18**] 13:16:19
T:  [**2193-7-19**] 09:40:06
Job#:  [**Job Number **]
{'Open supracondylar fracture of femur,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Other convulsions,Open fracture of upper end of fibula with tibia,Closed fracture of shaft of humerus,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist'}


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 34-year-old
lady status post motorcycle versus car motor vehicle
accident.  The patient was the motorcycle rider with a
helmet.  The patient was initially brought to a [**Hospital3 **] area
hospital with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] Coma Score of 18 at the scene and was
intubated at the scene.

MEDICAL HISTORY: Unknown.

MEDICATION ON ADMISSION: Unknown.

ALLERGIES: INTRAVENOUS DYE, SULFA, TEGRETOL, MOTRIN,
DILANTIN, and PERCOCET.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Unknown. 

### Response:
{'Open supracondylar fracture of femur,Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Other convulsions,Open fracture of upper end of fibula with tibia,Closed fracture of shaft of humerus,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist'}
