CHIEF COMPLAINT: s/p Bicycle crash vs. auto

PRESENT ILLNESS: 78 yo male with h/o DM, HTN, A-fib on Coumadin who while riding
his bicycle was reportedly cut off by car and struck the vehicle
with +LOC. He was brought to an area hospital where he was found
to have a right subdural hemorrhage, left clavicle fracture and
left hip fracture. He was given FFP and Vit K at the referring
hospital. He was the transferred to [**Hospital1 18**] for definitive care.

MEDICAL HISTORY: AFib - on Coumadin
Type II DM - on Metformin
HTN

MEDICATION ON ADMISSION: Coumadin [**4-18**], Metformin 1000'', Acarbose 25'', Lisinopril 20',
Lipitor 20', Centrum MVI, Glucosamine 1500', Chondroitin 1200'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:
T:98.1  BP:168/88    HR:66    RR:17       O2Sats:99%
Gen: Awake, lying in trauma bay 23 in NAD.
HEENT:Normocephalic  Pupils:PERRL         EOMs intact
Neck: Supple.
Extrem: No knumbness or tingling, Warm and well-perfused.
Swelling over L clavicle, swellinf and redness noted over L hip,
PP+ bilat in LE.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Closed fracture of unspecified part of neck of femur,Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Motor vehicle traffic accident involving collision with other vehicle injuring pedal cyclist,Closed fracture of clavicle, unspecified part,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants
Fx neck of femur NOS-cl,Subdural hemorr-coma NOS,Mv-oth veh coll-ped cycl,Fx clavicle NOS-closed,Atrial fibrillation,Hypertension NOS,DMII wo cmp nt st uncntr,Long-term use anticoagul
Admission Date:  [**2109-9-23**]              [**Month/Day/Year **] Date:   [**2109-9-26**]

Date of Birth:  [**2031-5-31**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
s/p Bicycle crash vs. auto

Major Surgical or Invasive Procedure:
[**2109-9-24**]
Closed reduction and percutaneous pinning, left hip fracture
site.

[**2109-9-25**]
IVC filter


History of Present Illness:
78 yo male with h/o DM, HTN, A-fib on Coumadin who while riding
his bicycle was reportedly cut off by car and struck the vehicle
with +LOC. He was brought to an area hospital where he was found
to have a right subdural hemorrhage, left clavicle fracture and
left hip fracture. He was given FFP and Vit K at the referring
hospital. He was the transferred to [**Hospital1 18**] for definitive care.

Past Medical History:
AFib - on Coumadin
Type II DM - on Metformin
HTN

Family History:
Noncontributory

Physical Exam:
Upon admission:
T:98.1  BP:168/88    HR:66    RR:17       O2Sats:99%
Gen: Awake, lying in trauma bay 23 in NAD.
HEENT:Normocephalic  Pupils:PERRL         EOMs intact
Neck: Supple.
Extrem: No knumbness or tingling, Warm and well-perfused.
Swelling over L clavicle, swellinf and redness noted over L hip,
PP+ bilat in LE.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 1.5 to 1
mm bilaterally.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal on R, difficult to
assess on L due to clavicle fx.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. Strength full power [**5-13**]
on the Right with no abnormal movements. Difficult to assess LUE
and LLE due clavicle fx and L hip fx. Grips on the Left [**5-13**],
unable to fully test [**2-9**] pain. Pronator drift not tested [**2-9**] fx
of L clavicle.

Sensation: Intact to light touch, pinprick and
vibration bilaterally.

Reflexes: B T Br Pa Ac
Right     2 2  2  2  2
Left     NT 2  2  NT 2

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger





Pertinent Results:
[**2109-9-23**] Head CT scan:
IMPRESSION:

Small acute subdural hematoma layering along the right tentorium
is unchanged
from imaging performed at outside hospital earlier on the same
day. These
findings were discussed with Dr. [**Last Name (STitle) 14135**] upon completion of the
study.

Cardiology Report ECG Study Date of [**2109-9-24**]  9:13:42 AM
Atrial fibrillation with wide complex beats probably in a
bigeminal pattern, probably ventricular. Since the previous
tracing ventricular premature beats are new. Clinical
correlation is suggested.
TRACING #2
Intervals Axes
Rate PR QRS QT/QTc P QRS T
70 0 94 454/471 0 16 -10



[**2109-9-23**] 04:29PM   GLUCOSE-246* LACTATE-1.5 NA+-143 K+-3.7
CL--96* TCO2-23
[**2109-9-23**] 04:29PM   HGB-11.6* calcHCT-35
[**2109-9-23**] 04:20PM   AMYLASE-76
[**2109-9-23**] 04:20PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2109-9-23**] 04:20PM   WBC-10.2 RBC-3.14* HGB-9.3* HCT-27.7* MCV-88
MCH-29.7 MCHC-33.6 RDW-14.2
[**2109-9-23**] 04:20PM   PT-19.2* PTT-26.4 INR(PT)-1.8*
[**2109-9-23**] 04:20PM   PLT COUNT-159
[**2109-9-23**] 04:20PM   FIBRINOGE-402*

Brief Hospital Course:
He was admitted to the Trauma Service; Orthopedics and
Neurosurgery were consulted given his injuries. Serial head CT
scans were followed and were stable. His mental status has
remained intact; he will follow up in [**Hospital 4695**] clinic in 4
weeks fore repeat head imaging. His Coumadin was stopped. He was
started on Heparin 5,000 units [**Hospital1 **]; Coumadin may be restarted in
2 weeks.

He was taken to the operating room for repair of his left
femoral neck fracture; there were no intraoperative
complications. Postoperatively he has done well, he was
transferred to the regular nursing unit. An IVC filter was
placed given his increased risk of thrombus; this was performed
without any complications.  He was initially receiving PCA
narcotics and was changed to oral narcotics. His home
medications were restarted; including his Metformin. His blood
sugars were slightly elevated as well and he was covered with a
regular sliding scale.

He was evaluated by Physical and Occupational therapy and is
being recommended for rehab after his acute hospital stay.

Medications on Admission:
Coumadin [**4-18**], Metformin 1000'', Acarbose 25'', Lisinopril 20',
Lipitor 20', Centrum MVI, Glucosamine 1500', Chondroitin 1200'




[**Month/Year (2) **] Medications:
1. Insulin Regular Human 100 unit/mL Solution Sig: One (1) DOSE
Injection four times a day as needed for per sliding scale: See
attached sliding scale.
2. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day.
9. Acarbose 50 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day).

10. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
11. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
12. Heparin 5,000 units subcutaneously [**Hospital1 **]


[**Hospital1 **] Disposition:
Extended Care

Facility:
[**Hospital6 979**] - [**Location (un) 246**]

[**Location (un) **] Diagnosis:
s/p Bicycle crash vs. auto
Subdural hemorrhage
Left femoral neck fracture
Left clavicular fracture

[**Location (un) **] Condition:
Hemodynamically stable, tolerating a regular diet, pain
adequately controlled.

[**Location (un) **] Instructions:
You may resume your Coumadin in 2 weeks.

Followup Instructions:
Follow up in 4 weeks with Dr. [**Last Name (STitle) 4696**], Neurosurgery, call
[**Telephone/Fax (1) 1669**] for an appointment. Inform the office that you will
need a repeat non contrast head CT and non contrast head MRI
prior to this appointment.

Follow up in 2 weeks with Dr. [**Last Name (STitle) **], Orthopedics, call
[**Telephone/Fax (1) 1228**] for an appointment.

Follow up with your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **] from
rehab; you will need to call for an appointment.


Completed by:[**2109-10-2**]
{'Closed fracture of unspecified part of neck of femur,Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Motor vehicle traffic accident involving collision with other vehicle injuring pedal cyclist,Closed fracture of clavicle, unspecified part,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants'}


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 Bicycle crash vs. auto

PRESENT ILLNESS: 78 yo male with h/o DM, HTN, A-fib on Coumadin who while riding
his bicycle was reportedly cut off by car and struck the vehicle
with +LOC. He was brought to an area hospital where he was found
to have a right subdural hemorrhage, left clavicle fracture and
left hip fracture. He was given FFP and Vit K at the referring
hospital. He was the transferred to [**Hospital1 18**] for definitive care.

MEDICAL HISTORY: AFib - on Coumadin
Type II DM - on Metformin
HTN

MEDICATION ON ADMISSION: Coumadin [**4-18**], Metformin 1000'', Acarbose 25'', Lisinopril 20',
Lipitor 20', Centrum MVI, Glucosamine 1500', Chondroitin 1200'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:
T:98.1  BP:168/88    HR:66    RR:17       O2Sats:99%
Gen: Awake, lying in trauma bay 23 in NAD.
HEENT:Normocephalic  Pupils:PERRL         EOMs intact
Neck: Supple.
Extrem: No knumbness or tingling, Warm and well-perfused.
Swelling over L clavicle, swellinf and redness noted over L hip,
PP+ bilat in LE.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Closed fracture of unspecified part of neck of femur,Subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Motor vehicle traffic accident involving collision with other vehicle injuring pedal cyclist,Closed fracture of clavicle, unspecified part,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants'}
