CHIEF COMPLAINT: MVC

PRESENT ILLNESS: 56 yo F s/p single car MVC with significant damage to passenger
side of vehicle. Pt has history of depression, was found with
multiple pill bottles in the car, as well as suicide note. In
the field, pt resposive, moving all extremities. On arrival to
the [**Name (NI) **], pt not speaking or breathing. Intubated for airway
protection. FSG normal. EKG unremarkable. ETOH level 212, tox
screen otherwise negative. Imaging showed no acute process. Pt
given activated charcoal via OGT for possible overdose.  Pills
found in her belongings included seroquel, amphetamine,
citalopram, metadate (methylphenidate).

MEDICAL HISTORY: unknown

MEDICATION ON ADMISSION: unknown

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: 97.8, 76, 112/70, 18, 97 % room air
alert, oriented, flat affect
RRR
CTA BL
abdomen soft nontender nondistended
no peripheral edema

FAMILY HISTORY: unknown

SOCIAL HISTORY: unknown
Apnea,Pneumonitis due to inhalation of food or vomitus,Altered mental status,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Suicide and self-inflicted injury by crashing of motor vehicle,Alcohol abuse, unspecified,Attention deficit disorder with hyperactivity,Unspecified episodic mood disorder
Apnea,Food/vomit pneumonitis,Altered mental status,Loss control mv acc-driv,Injury-motor veh crash,Alcohol abuse-unspec,Attn deficit w hyperact,Episodic mood disord NOS
Admission Date:  [**2166-10-23**]              Discharge Date:   [**2166-10-25**]

Date of Birth:  [**2112-12-23**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
MVC

Major Surgical or Invasive Procedure:
none

History of Present Illness:
56 yo F s/p single car MVC with significant damage to passenger
side of vehicle. Pt has history of depression, was found with
multiple pill bottles in the car, as well as suicide note. In
the field, pt resposive, moving all extremities. On arrival to
the [**Name (NI) **], pt not speaking or breathing. Intubated for airway
protection. FSG normal. EKG unremarkable. ETOH level 212, tox
screen otherwise negative. Imaging showed no acute process. Pt
given activated charcoal via OGT for possible overdose.  Pills
found in her belongings included seroquel, amphetamine,
citalopram, metadate (methylphenidate).


Past Medical History:
unknown

Social History:
unknown

Family History:
unknown

Physical Exam:
97.8, 76, 112/70, 18, 97 % room air
alert, oriented, flat affect
RRR
CTA BL
abdomen soft nontender nondistended
no peripheral edema

Pertinent Results:
[**2166-10-23**] CT C-spine FINDINGS: No acute cervical spine fracture or
malalignment is present. Mild degenerative changes are present
with disc osteophyte complexes at C5-C6 causing mild canal
narrowing at these levels. Pre- and paravertebral soft tissues
are not thickened. Retained secretions in the nasopharynx are
likely secondary to recent intubation. The visualized lung
apices are clear.

[**2166-10-23**] CT Head: FINDINGS: No acute intracranial hemorrhage,
major vascular territorial infarction, edema, or shift of
normally midline structures is present. The ventricles and sulci
have normal size and configuration. Secretions in the
nasopharynx are likely secondary to recent intubation. Minimal
mucosal thickening is seen in the ethmoid sinuses. Mastoid air
cells are well pneumatized. No acute fracture is seen

[**2166-10-23**] CT abdomen/pelvis: IMPRESSION: 1. No evidence of acute
traumatic injury in the torso. 2. Bibasilar opacities consistent
with aspiration which may be related to recent intubation. 3.
Apparent filling defect in the SMV is most consistent with
mixing artifact rather than thrombosis.

[**2166-10-23**] CT chest: IMPRESSION: 1. No evidence of acute traumatic
injury in the torso. 2. Bibasilar opacities consistent with
aspiration which may be related to recent intubation. 3.
Apparent filling defect in the SMV is most consistent with
mixing artifact rather than thrombosis.


Brief Hospital Course:
The patient was brought to [**Hospital1 18**] after her MVC. She had a GCS 15
but was reportedly apneic in the truama bay so was intubated and
tranferred to the TSICU. In the TSICU she was hemodynamically
stable and extubated uneventfully. She was then transferred to
the hospital floor. She had a 1:1 sitter throughout her stay on
the floor. Her foley was removed, she voided, tolerated a diet,
and vitals remained stable. On [**10-25**] in the morning, her sitter
observed the patient grab her personal belongings and ingest
three pills from her large bag of multiple prescription bottles
and loose pills. It is unclear why the patient had access to her
belongings and why she was not stopped. She ingested three of
her "daily pills" per patient but we could not confirm which
pills they were. She remained  hemodynamically stable and was
asymptomatic. Physical exam was unremarkable. The patient was
reevaluated by psychiatry who arranged for a transfer to the
inpatient psychiatry floor for continued management.

Medications on Admission:
unknown

Discharge Medications:
1. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

2. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
5. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] 4

Discharge Diagnosis:
MVC
Suicide attempt


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Ms. [**Known lastname **] has not sustained any injuries from her recent suicide
attempt.  She does not require follow up with the surgical
service. We recommend close psychiatric monitoring to address
her suicidality as well as her polypharmacy and alcohol use and
follow up with her primary care provider after discharge from
psychiatry inpatient

Followup Instructions:
Psychiatry inpatient care
Primary Care Provider after discharge from psychiatry


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2166-10-25**]
{'Apnea,Pneumonitis due to inhalation of food or vomitus,Altered mental status,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Suicide and self-inflicted injury by crashing of motor vehicle,Alcohol abuse, unspecified,Attention deficit disorder with hyperactivity,Unspecified episodic mood disorder'}


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: MVC

PRESENT ILLNESS: 56 yo F s/p single car MVC with significant damage to passenger
side of vehicle. Pt has history of depression, was found with
multiple pill bottles in the car, as well as suicide note. In
the field, pt resposive, moving all extremities. On arrival to
the [**Name (NI) **], pt not speaking or breathing. Intubated for airway
protection. FSG normal. EKG unremarkable. ETOH level 212, tox
screen otherwise negative. Imaging showed no acute process. Pt
given activated charcoal via OGT for possible overdose.  Pills
found in her belongings included seroquel, amphetamine,
citalopram, metadate (methylphenidate).

MEDICAL HISTORY: unknown

MEDICATION ON ADMISSION: unknown

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: 97.8, 76, 112/70, 18, 97 % room air
alert, oriented, flat affect
RRR
CTA BL
abdomen soft nontender nondistended
no peripheral edema

FAMILY HISTORY: unknown

SOCIAL HISTORY: unknown 

### Response:
{'Apnea,Pneumonitis due to inhalation of food or vomitus,Altered mental status,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Suicide and self-inflicted injury by crashing of motor vehicle,Alcohol abuse, unspecified,Attention deficit disorder with hyperactivity,Unspecified episodic mood disorder'}
