CHIEF COMPLAINT: Motor cycle collision

PRESENT ILLNESS: 47 year old male involved in a motor cycle collision on [**2169-4-6**]
resulting in an open left segmental tibia fracture, left fibula
fracture, left calcaneous fracture, left cunieform fracture and
fractures of the 1st through 3rd left metatarsals and a left
clavicle fracture.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical examination on admission:

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Denies tobacco and drug use. Occasional alcohol use.
Open fracture of shaft of fibula with tibia,Traumatic compartment syndrome of lower extremity,Acute posthemorrhagic anemia,Fracture of calcaneus, open,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Closed fracture of clavicle, unspecified part,Hypocalcemia,Other iatrogenic hypotension,Postprocedural fever,Tachycardia, unspecified,Volume depletion, unspecified
Fx shaft tibia w fib-opn,Trauma comp synd low ext,Ac posthemorrhag anemia,Fracture calcaneus-open,SIRS-noninf w/o ac or ds,Mv collis NOS-motorcycl,Fx clavicle NOS-closed,Hypocalcemia,Iatrogenc hypotnsion NEC,Postprocedural fever,Tachycardia NOS,Volume depletion NOS
Admission Date:  [**2169-4-6**]              Discharge Date:   [**2169-5-12**]

Date of Birth:  [**2121-11-12**]             Sex:   M

Service: ORTHOPAEDICS

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 11415**]
Chief Complaint:
Motor cycle collision

Major Surgical or Invasive Procedure:
[**2169-4-6**]: s/p irrigation and debridement of left open tibial
wound.
[**2169-4-6**]: s/p left lower extremity fasciotomy.
[**2169-4-6**]: s/p application of spanning external fixator, left
leg.
[**2169-4-6**]: s/p open reduction internal fixation, left mid-shaft
tibia.
[**2169-4-6**]: s/p percutaneous pinning of left talus.
[**2169-4-6**]: s/p percutaneous pinning of left calcaneous.
[**2169-4-6**]: s/p percutaneous pinning of left cuneiform.
[**2169-4-10**]: s/p Removal of external fixator with open reduction
internal fixation, left tibial plateau and wound vac
application.
[**2169-4-17**]: s/p irrigation and debridement of left tibial
fasciotomy wound with placement of split thickness skin graft.


History of Present Illness:
47 year old male involved in a motor cycle collision on [**2169-4-6**]
resulting in an open left segmental tibia fracture, left fibula
fracture, left calcaneous fracture, left cunieform fracture and
fractures of the 1st through 3rd left metatarsals and a left
clavicle fracture.

Past Medical History:
None

Social History:
Denies tobacco and drug use. Occasional alcohol use.

Family History:
Non-contributory.

Physical Exam:
Physical examination on admission:

Afebrile with stable vital signs.
General: Pleasant male. Awake and interactive.
HEENT: Normal cephalic atraumatic, pupils equal round reactive
to light accommodation, extra ocular motions intact bilaterally.
Oral mucosa moist.
NECK: No lymphadenopathy, no jugular venous distention, no
bruit.
Cardiac: Regular rate and rhythm, no murmurs, no gallops, no
rubs.
RESP: Clear, no wheezes, no crackles, no rhonchi.
Abdomen: + Bowel sounds, soft, non-distended, non-tender, no
masses, no guarding or rebound tenderness.
Spine & Extremities: No mid-line tenderness. No focal
neurological deficits.
  -Left lower extremity: Large skin laceration over left tibia.
Multiple abrasion of left leg and foot. Gross deformity of tibia
and knee. Large knee effusion. Tenderness to palpation over
tibia, hind foot and mid-foot. 2+ ankle and pedal edema.
Compartments firm but compressible. Dorsal pedialis absent by
doppler. Strong anterior tibialis pulse by doppler and strong
tibialis posterior pulse by doppler.  Capillary refill greater
than 2 seconds but less than 4 seconds.  Motor and sensory
grossly intact. Patella tendon deep reflex 2+. Achilles tendon
deep reflex not tested.
  -Right lower extremity: Skin intact. No deformity.
Compartments soft and compressible. Absent dorsal pedialis pulse
on doppler. Strong anterior tibialis pulse & tibialis posterior
pulse on doppler. Capillary refill less than 2 seconds. Motor
and sensory grossly intact.  Patella tendon deep reflex 2+.
Achilles tendon deep reflex 2+.
  -Left upper extremity: Skin intact. No skin tenting. Mild
deformity over clavicle. Eccymosis and swelling noted over
clavicular area. Tenderness to palpation over clavicle.
Compartments soft and compressible. 2+ radial & ulna pulses.
Motor and sensory grossly intact. Tricep tendon deep reflex 2+.
Bicep tendon deep reflex 2+.  Brachioradialis tendon deep reflex
2+.
  -Right upper extremity: Skin intact. No deformity.
Compartments soft and compressible. 2+ radial & ulna pulses.
Motor and sensory grossly intact.  Tricep tendon deep reflex 2+.
 Bicep tendon deep reflex 2+.  Brachioradialis tendon deep
reflex 2+.
SKIN : No rashes.
Neurological: Alert and oriented to person, place and date.
Cranial nerves [**2-24**] intact

Pertinent Results:
[**2169-4-6**] 02:45PM BLOOD WBC-19.1* RBC-4.11* Hgb-13.3* Hct-39.1*
MCV-95 MCH-32.5* MCHC-34.1 RDW-14.2 Plt Ct-275
[**2169-4-6**] 07:45PM BLOOD WBC-13.5* RBC-3.03*# Hgb-9.4*# Hct-27.1*#
MCV-89 MCH-31.1 MCHC-34.8 RDW-15.1 Plt Ct-201
[**2169-4-7**] 06:00AM BLOOD WBC-9.7 RBC-2.70* Hgb-8.4* Hct-25.1*
MCV-93 MCH-30.9 MCHC-33.3 RDW-15.9* Plt Ct-225
[**2169-4-11**] 03:38AM BLOOD WBC-8.7 RBC-2.95* Hgb-9.0* Hct-26.4*
MCV-90 MCH-30.5 MCHC-34.0 RDW-15.7* Plt Ct-259
[**2169-4-16**] 01:10PM BLOOD WBC-8.3 RBC-3.37* Hgb-9.5* Hct-30.3*
MCV-90 MCH-28.3 MCHC-31.4 RDW-15.1 Plt Ct-690*#
[**2169-4-6**] 07:45PM BLOOD Glucose-158* UreaN-13 Creat-1.0 Na-138
K-4.9 Cl-112* HCO3-22 AnGap-9
[**2169-4-7**] 06:00AM BLOOD Glucose-117* UreaN-13 Creat-1.0 Na-139
K-4.9 Cl-108 HCO3-24 AnGap-12
[**2169-4-10**] 05:53PM BLOOD Glucose-169* UreaN-6 Creat-0.6 Na-138
K-4.0 Cl-104 HCO3-25 AnGap-13
[**2169-4-16**] 01:10PM BLOOD Glucose-100 UreaN-6 Creat-0.7 Na-133
K-5.3* Cl-94* HCO3-32 AnGap-12
[**2169-4-18**] 04:30PM BLOOD Glucose-96 UreaN-9 Creat-0.8 Na-134 K-5.1
Cl-97 HCO3-30 AnGap-12
[**2169-4-18**] 04:30PM BLOOD Calcium-8.9 Phos-4.0# Mg-2.2

Brief Hospital Course:
Mr. [**Known lastname 41684**] was admitted to the General surgery trauma service on
[**2169-4-6**] after being involved in a motor cycle [**Last Name (un) 8886**] which
resulted in multiple fractures of the left lower extremity
including a left open segmental tibial fracture, fibula
fracture, calcaneal fracture, talus fracture, cuneiform fracture
and fractures of his 1st - 3rd metatarsals.  He also sustained a
left clavicle fracture.  Mr. [**Known lastname 41684**] was seen and examined in the
emergency room by the Orthopedic service and brought to the
operating room from the emergency room and underwent irrigation
and debridement with application of spanning external fixator
for his open left segmental tibia fracture.  He also underwent
open reduction internal fixation of the left tibia and
percutaneous pinning of the left calcaneous, left talus and left
cuneiform without complication on [**2169-4-6**]. Intra-operatively he
was transfused two units of packed red blood cells for blood
loss anemia.  He was extubated without difficulty and
transferred to the recovery room in stable condition.  In the
early post-operative course Mr. [**Known lastname 41684**] was given magnesium 4
grams IV once for post operative hypomagnesemia and calcium
gluconate 2 grams IV once for post operative hypocalcemia.  He
was given a 500 cc fluid bolus of lactated ringers for post
operative fluid deficit.  His hemodynamics and vital signs were
closely monitored in the recovery room and was transferred to
the floor on the night of surgery in stable condition.  On the
night of surgery there were no overnight events. On hospital day
one he was transferred to the Orthopedic service.  On hospital
day two he was transfused two units of packed red blood cells
for a Hct of 17.  On hospital day three his hematocrit only
increased to 21.9 and he was again transfused one additional
unit for ongoing post operative anemia.  On [**2169-4-10**] he was
taken back to the operating room and underwent open reduction
internal fixation of his left tibial plateau with removal of the
external fixator and application of fasciotomy wound VAC
dressing without complication.  He was extubated without
difficulty and transferred to the recovery room in stable
condition.  In the recovery room he developed mental status
changes with fevers to 103 and tachycardia to 130's.  A full
infectious work-up was started which included a chest x-ray that
was negative for infection, Blood cultures, CBC with
differential and urine analysis which was all negative.  A
repeat head CT was negative for injury or bleed and a chest CT
angiogram was negative for pulmonary embolism.  He as given
Potassium Phosphate 30 mmol / 500 ml NS IV ONCE for
post-operative hypophosphatemia.  He was transferred to the
trauma ICU for close monitoring.  In the ICU his hemodynamics
were closely monitored and he continued his mental status
improved.  His fever decreased to 101.  On hospital day five the
Acute pain service was consulted for pain management while the
patient was in the trauma ICU and an epidural with hydromorphone
and bupivacaine was placed without complication.  On hospital
day six, Mr [**Known lastname 41684**] was transferred out of the trauma ICU back to
the floor and his mental status continued to improve.  His fever
remained low ranging from 99.1 to 100.1.  He has a transient
episode of hypotension 90/60 on the evening of hospital day six
and he was given a 500 cc fluid bolus of lactated ringers.  On
hospital day ten he was taken back to the operating room and
underwent irrigation and debridement with placement of split
thickness skin graft without complication.  He was extubated
without difficulty and transferred to the recovery room in
stable condition and subsequently transferred to the floor in
stable condition. He remained stable on the floor. His  vac
bolster remained for 5 days over his STSG and was taken down on
floor on [**2169-4-21**]. Plastics were consulted to comment on some
possible necrotic lesions of his left foot.  Plastic surgery
monitored his foot and also noted eschar in the pre tibia area
of his split thickness skin graft.  He returned to the operating
room on [**2169-4-26**] for an I&D of his pre tibia eschar area.  On
[**2169-5-3**] he returned to the operating room and underwent a split
thickness skin graft by plastic surgery.  A VAC was placed over
the graft and he was on bedrest for 5 days.  He was started on
oral cipro on [**2169-5-7**] for a 7 day course for erythemia/drainage
around graft.  On [**2169-5-8**] his VAC was removed and he was taken
off bed rest.
He had adequate pain management and worked with physical therapy
while in the hospital.  The remainder of his hospital course was
uneventful and Mr. [**Known lastname 41684**] is being discharged to home on [**2169-5-12**]


Medications on Admission:
None

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*100 Capsule(s)* Refills:*2*
2. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous Q
24H (Every 24 Hours) for 2 weeks.
Disp:*14 syringes* Refills:*0*
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*60 Tablet(s)* Refills:*0*
4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*100 Capsule(s)* Refills:*2*
5. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 7 days: Started [**2169-5-7**].
Disp:*4 Tablet(s)* Refills:*0*
6. Lovenox 40 mg/0.4 mL Syringe Sig: One (1) syringe
Subcutaneous once a day for 2 weeks.
Disp:*14 syringes* Refills:*0*


Discharge Disposition:
Home

Facility:
[**Hospital6 2222**] - [**Location (un) 538**]

Discharge Diagnosis:
1. Left open segmental tibial fracture.
2. Left fibula fracture.
3. Left clavicle fracture.
4. Left calcaneous fracture.
5. Left talus fracture.
6. Left cuneiform fracture.
7. Left 1st - 3rd metatarsal fractures.
8. Left lower extremity compartment syndrone.
9. post operative fluid volume deficit
10. post operative hypocalcemia
11. post operative hypomagnesemia
12. post operative blood loss anemia
13. post operative hypophosphotemia


Discharge Condition:
Mental Status: Clear and coherent
Level of Consciousness: Alert and interactive
Activity Status: Ambulatory - requires assistance or aid (walker
or cane)

Discharge Instructions:
Wound Care:
-Keep Incisions dry.
-Do not soak the incision in a bath or pool.
-Keep external fixator pin sites clean and dry.
-Sutures & staples will be removed at your first post-operative
visit.

Activity:
-Continue to be non weight bearing on your left leg.
-You should not lift anything greater than 5 pounds with left
arm.
-Elevate left leg to reduce swelling and pain.
-Wear your sling when out of bed for comfort.
-Avoid overhead motions with your left arm.

Other Instructions
- Resume your regular diet.
- Avoid nicotine products to optimize healing.
- Resume your home medications. Take all medications as
instructed.
- Continue taking the Lovenox to prevent blood clots.

-You have also been given Additional Medications to control your
pain.  Please allow 72 hours for refill of narcotic
prescriptions, so plan ahead.  You can either have them mailed
to your home or pick them up at the clinic located on [**Hospital Ward Name 23**] 2.
 We are not allowed to call in narcotic (oxycontin, oxycodone,
percocet) prescriptions to the pharmacy.   In addition, we are
only allowed to write for pain medications for 90 days from the
date of surgery.

- Narcotic pain medication may cause drowsiness.  Do not drink
alcohol while taking narcotic medications.  Do not operate any
motor vehicle or machinery while taking narcotic pain
medications.  Taking more than recommended may cause serious
breathing problems.

If you have questions, concerns or experience any of the below
danger signs then please call your doctor at [**Telephone/Fax (1) 1228**] or go
to your local emergency room.

Physical Therapy:
1. Non weight bearing left leg.
2. Non weight bearing left arm.
3. Wear sling to left arm when out of bed.
4. Range of motion to left elbow, wrist and fingers.
5. Pendulum exercises for left shoulder.

Treatment Frequency:
1. Daily dry sterile dressing changes.
2. Pin care daily with half strength hydrogen peroxide.
3. Elevation to left leg
4. Staples and sutures can be removed 14 days from date of
surgery.
5. Xeroform, kerlix, and ACE wrap to STSG site daily

Followup Instructions:
2 weeks in the [**Hospital **] clinic with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], NP.
Please call [**Telephone/Fax (1) 1228**] to make this appointment.

Please follow up with Dr. [**First Name (STitle) **] in plastic surgery clinic this
Friday [**2169-5-12**], please call [**Telephone/Fax (1) 5343**] to make that
appointment.

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**] MD, [**MD Number(3) 11417**]

Completed by:[**2169-5-13**]
{'Open fracture of shaft of fibula with tibia,Traumatic compartment syndrome of lower extremity,Acute posthemorrhagic anemia,Fracture of calcaneus, open,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Closed fracture of clavicle, unspecified part,Hypocalcemia,Other iatrogenic hypotension,Postprocedural fever,Tachycardia, unspecified,Volume depletion, unspecified'}


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: Motor cycle collision

PRESENT ILLNESS: 47 year old male involved in a motor cycle collision on [**2169-4-6**]
resulting in an open left segmental tibia fracture, left fibula
fracture, left calcaneous fracture, left cunieform fracture and
fractures of the 1st through 3rd left metatarsals and a left
clavicle fracture.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical examination on admission:

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Denies tobacco and drug use. Occasional alcohol use. 

### Response:
{'Open fracture of shaft of fibula with tibia,Traumatic compartment syndrome of lower extremity,Acute posthemorrhagic anemia,Fracture of calcaneus, open,Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Closed fracture of clavicle, unspecified part,Hypocalcemia,Other iatrogenic hypotension,Postprocedural fever,Tachycardia, unspecified,Volume depletion, unspecified'}
