CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 35-year-old male with
no known medical history who was found in his garden with a
large knife protruding from his left chest.  The patient was
completely unresponsive.  Ambulance was called and the
patient was transferred to a hospital which immediately
transferred the patient to [**Location (un) **].  The patient was
intubated in the field.  He was transferred to [**Hospital1 346**] and underwent immediate mediastinal
exploration in the operating room.  The patient was
transferred directly from the helicopter to the operating
room.  In the operating room a central line was placed and
the patient was given blood products.  He received a total of
8 units of packed red blood cells, three units of FFP, two
units of platelets and several liters of crystalloid IV
fluids.  The patient remained stable during his entire course
and also reportedly in the field.  He only had tachycardia
but never had evidence of dropping his blood pressure.  In
the operating room a median sternotomy incision was
performed.  Findings included a 3 cm laceration to the apical
portion of the left ventricle.  This was not through and
through and was not bleeding.  There was also an injury to
the diagonal I branch which was transected.  There was a
posterior mediastinal laceration which did not appear to
cause any serious injury.  There was also a small parenchymal
injury to the left lower lobe of the lung and damage to a
small branch of the pulmonary vein near the area of that
laceration which was clipped.  The patient underwent an
intraoperative esophagoscopy which revealed no esophageal
injury.  Numerous chest tubes were placed and the patient's
wounds were closed.  He was then transferred to the Intensive
Care Unit.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with his wife and three
children.  He had a motor vehicle accident on [**2180-12-29**].  He
was treated and discharged from [**Hospital3 2576**] [**Hospital3 **].  The
patient also had several debts which were unpaid.
Laceration of heart without penetration of heart chambers, with open wound into thorax,Injury to pulmonary artery,Suicide and self-inflicted injury by cutting and piercing instrument,Other convulsions,Pneumonia, organism unspecified,Depressive disorder, not elsewhere classified
Heart laceration-open,Injury pulmonary artery,Injury-cut instrument,Convulsions NEC,Pneumonia, organism NOS,Depressive disorder NEC
Admission Date:  [**2181-1-5**]       Discharge Date:  [**2181-1-19**]

Date of Birth:   [**2145-7-18**]       Sex:  M

Service:  Trauma Surgery

HISTORY OF PRESENT ILLNESS:  This is a 35-year-old male with
no known medical history who was found in his garden with a
large knife protruding from his left chest.  The patient was
completely unresponsive.  Ambulance was called and the
patient was transferred to a hospital which immediately
transferred the patient to [**Location (un) **].  The patient was
intubated in the field.  He was transferred to [**Hospital1 346**] and underwent immediate mediastinal
exploration in the operating room.  The patient was
transferred directly from the helicopter to the operating
room.  In the operating room a central line was placed and
the patient was given blood products.  He received a total of
8 units of packed red blood cells, three units of FFP, two
units of platelets and several liters of crystalloid IV
fluids.  The patient remained stable during his entire course
and also reportedly in the field.  He only had tachycardia
but never had evidence of dropping his blood pressure.  In
the operating room a median sternotomy incision was
performed.  Findings included a 3 cm laceration to the apical
portion of the left ventricle.  This was not through and
through and was not bleeding.  There was also an injury to
the diagonal I branch which was transected.  There was a
posterior mediastinal laceration which did not appear to
cause any serious injury.  There was also a small parenchymal
injury to the left lower lobe of the lung and damage to a
small branch of the pulmonary vein near the area of that
laceration which was clipped.  The patient underwent an
intraoperative esophagoscopy which revealed no esophageal
injury.  Numerous chest tubes were placed and the patient's
wounds were closed.  He was then transferred to the Intensive
Care Unit.

PAST MEDICAL HISTORY:  None.

MEDICATIONS:  None.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient lives with his wife and three
children.  He had a motor vehicle accident on [**2180-12-29**].  He
was treated and discharged from [**Hospital3 2576**] [**Hospital3 **].  The
patient also had several debts which were unpaid.

PHYSICAL EXAMINATION:  On arrival from the operating room to
the Surgical Intensive Care Unit the patient was intubated
and sedated.  He had a temperature of 96.0, heart rate 88,
blood pressure 141/90, respiratory rate 15, oxygen saturation
was 100%, central venous pressure was 9.  He had crepitus
over his chest but bilateral breath sounds were present.  He
had four chest tubes protruding from the chest. Heart was
regular rate and rhythm without murmur.  Abdomen was soft,
nontender, non distended.  Extremities were without edema and
were warm and well perfused.

LABORATORY DATA:  On arrival showed white blood cell count of
10.5, hematocrit 37.3, platelet count 139,000, PT 13.5, PTT
25.6, INR 1.3, sodium 138, potassium 3.9, chloride 108, CO2
23, BUN 18, creatinine 0.8, glucose 125, magnesium 1.2,
calcium 8.5.  Toxicology screen was negative.

HOSPITAL COURSE:  The patient was followed very closely in
the Intensive Care Unit.  He was put on Ancef for antibiotic
prophylaxis.  His chest tubes were maintained at suction and
he was on very strict blood pressure control with Esmolol
drip.  He was sedated with Propofol drips.  The patient was
monitored and found to have stable vital signs.  Attempts at
weaning were limited by increased blood pressure initially.
After several days he was able to be extubated without
raising his blood pressure.  The goal initially was to
maintain a systolic blood pressure less than 110.

On hospital day #5 the patient was extubated and his
mediastinal chest tubes were removed.  The patient remained
on Esmolol and Nipride drip in addition to Lopressor and
Clonidine patch for control of blood pressure.  Over the next
several days he slowly improved.  Initially he was quite
somnolent and non interactive.  He was given nutrition by
feeding tube.  Both psychiatry and neurology were consulted.
The patient was also followed by cardiothoracic surgery
throughout his entire hospital stay.  Slowly his IV drips
were discontinued and the patient was placed on a po pain and
blood pressure regimen which worked well.  Neurology felt
that the patient's lack of interaction could represent an
epileptic type event.  An EEG was obtained which showed
frequent runs of left temporal sharp waves and focal slowing
over the bitemporal areas which raised the question of
seizure activity.  This was confirmed on repeat EEG.  It was
also elected to perform a 24 hour EEG study which was
terminated on [**2181-1-18**].  The patient also had a left lower
lobe pneumonia that was treated by Levaquin for 7 days and
has no apparent sequela.  By hospital day #14 the patient had
markedly improved.  He had only mild tenderness on the chest
incision site.  At this time the patient has no recollection
of the events leading to his admission.  Psychiatry is
following and is addressing these issues.

By [**2181-1-19**] the patient's chest tubes, lines, feeding tube,
and all other interventions were removed.  He was able to
ambulate and eat without difficulty.  His blood pressure is
well controlled on the current regimen.  The patient is to be
discharged today.  He will likely be going to an inpatient
psychiatric facility pending psychiatry's recommendations
today.

DISCHARGE MEDICATIONS:  Percocet [**2-15**] q 4 hours prn severe
pain, Hydralazine 60 mg po tid, Captopril 25 mg po tid, hold
both for systolic blood pressure less than 100, Lopressor 75
mg po bid, hold for heart rate less than 60 or systolic blood
pressure less than 100, Clonidine patch 0.3 mg transdermal to
be changed every Thursday.  The patient will be following up
with neurology, psychiatry and Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **] from
cardiothoracic surgery.

DISCHARGE DIAGNOSIS:
1.  Stab wound to left chest.
2.  Status post open sternotomy for repair of injuries from
stab wound.
3.  Left ventricular laceration.

Cardiothoracic surgery would like to maintain the patient's
blood pressure at less than 140 systolic.  At this time,
exact etiology for the stab wound is unclear.  However, it
appears that this was self inflicted as the patient was quite
overwhelmed from his debts.  These issues will be followed up
by psychiatry.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D.  [**MD Number(1) 2214**]

Dictated By:[**Last Name (NamePattern1) 3600**]
MEDQUIST36

D:  [**2181-1-19**]  10:37
T:  [**2181-1-19**]  11:19
JOB#:  [**Job Number 36584**]
{'Laceration of heart without penetration of heart chambers, with open wound into thorax,Injury to pulmonary artery,Suicide and self-inflicted injury by cutting and piercing instrument,Other convulsions,Pneumonia, organism unspecified,Depressive disorder, not elsewhere classified'}


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: This is a 35-year-old male with
no known medical history who was found in his garden with a
large knife protruding from his left chest.  The patient was
completely unresponsive.  Ambulance was called and the
patient was transferred to a hospital which immediately
transferred the patient to [**Location (un) **].  The patient was
intubated in the field.  He was transferred to [**Hospital1 346**] and underwent immediate mediastinal
exploration in the operating room.  The patient was
transferred directly from the helicopter to the operating
room.  In the operating room a central line was placed and
the patient was given blood products.  He received a total of
8 units of packed red blood cells, three units of FFP, two
units of platelets and several liters of crystalloid IV
fluids.  The patient remained stable during his entire course
and also reportedly in the field.  He only had tachycardia
but never had evidence of dropping his blood pressure.  In
the operating room a median sternotomy incision was
performed.  Findings included a 3 cm laceration to the apical
portion of the left ventricle.  This was not through and
through and was not bleeding.  There was also an injury to
the diagonal I branch which was transected.  There was a
posterior mediastinal laceration which did not appear to
cause any serious injury.  There was also a small parenchymal
injury to the left lower lobe of the lung and damage to a
small branch of the pulmonary vein near the area of that
laceration which was clipped.  The patient underwent an
intraoperative esophagoscopy which revealed no esophageal
injury.  Numerous chest tubes were placed and the patient's
wounds were closed.  He was then transferred to the Intensive
Care Unit.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with his wife and three
children.  He had a motor vehicle accident on [**2180-12-29**].  He
was treated and discharged from [**Hospital3 2576**] [**Hospital3 **].  The
patient also had several debts which were unpaid. 

### Response:
{'Laceration of heart without penetration of heart chambers, with open wound into thorax,Injury to pulmonary artery,Suicide and self-inflicted injury by cutting and piercing instrument,Other convulsions,Pneumonia, organism unspecified,Depressive disorder, not elsewhere classified'}
