CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 25-year-old
gentleman status post multiple gunshot wounds that he
sustained in an altercation with police.  The gunshot wounds
were one to the chest, one to the right hand, and one to the
left thigh.  The patient was brought in by ambulance, where
they noted a bullet in the EMS rig.  The EMS vital signs
showed a heart rate of 120, blood pressure 100/palp, O2
saturation was 99 on room air.  He was alert, awake, and
oriented at the scene, moving all extremities.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Injury to common femoral artery,Open fracture of base of thumb [first] metacarpal,Open wound of knee, leg [except thigh], and ankle, with tendon involvement,Open wound of chest (wall), without mention of complication,Acute posthemorrhagic anemia,Injury due to legal intervention by firearms
Inj common femoral arter,Fx 1st metacarp base-opn,Opn wnd knee/leg w tendn,Open wound of chest,Ac posthemorrhag anemia,Legal intervent-firearm
Admission Date:                   Discharge Date:

Date of Birth:                    Sex:  M

Service:  Trauma

HISTORY OF PRESENT ILLNESS:  The patient is a 25-year-old
gentleman status post multiple gunshot wounds that he
sustained in an altercation with police.  The gunshot wounds
were one to the chest, one to the right hand, and one to the
left thigh.  The patient was brought in by ambulance, where
they noted a bullet in the EMS rig.  The EMS vital signs
showed a heart rate of 120, blood pressure 100/palp, O2
saturation was 99 on room air.  He was alert, awake, and
oriented at the scene, moving all extremities.

Upon arrival in the Emergency Department the patient was
maintaining alert and awake, he was complaining of pain in
the left leg and right hand, from which he was bleeding.
Vital signs were heart rate 144, blood pressure 60/39 with a
rate of 18, O2 saturation of 100% on 100% facemask.  His
head, eyes, ears, nose and throat showed tympanic membranes
to be clear.  He was pale and diaphoretic.  Pupils were
reactive.  His neck was supple, a cervical collar was in
place, trachea was midline.  His chest showed an entry
gunshot wound just superior to the chest at the manubrium; no
exit wound noted.  The lungs had good air movement.  They
were clear to auscultation bilaterally.  Heart was
tachyarrhythmic, no murmur.  Abdomen was soft, nontender, and
nondistended.  Rectal examination showed normal tone.  The
rectal was unable to be guaiac tested secondary to blood from
his leg.  His pelvis was stable.  Extremity examination
showed the right upper extremity hand entry wound at the
dorsum of the hand at the level of the thumb, and the exit
wound on the thenar eminence of the palm.  The fingers distal
to the injury site were warm, well perfused, with motor and
sensation intact.  The left lower extremity was slightly
cold, left greater than right.  There were no palpable
dorsalis pedis pulses or posterior tibial pulses on the left.
There was no palpable popliteal pulse on the left.  The
distal pulses were not Dopplerable on the left.  He had
intact femorals bilaterally.  There was an entry wound on the
anterior left thigh, no exit wound was noted.  The patient
was bleeding briskly from an arterial bleed in the left
thigh.  He was spontaneously moving the bilateral upper
extremities and the right lower extremity.

Gradually the patient had decreased alertness in the
Emergency Department.  He was intubated by Anesthesia for
airway protection.  A right femoral groin line was placed and
a left femoral arterial line was placed.  Two large-bore
peripheral intravenous lines in the right and left upper
extremity were placed.

The patient went to the operating room for control of
bleeding from the thigh.  Plastic surgery and hand were
consulted, and exploration of the chest wound was undertaken.

LABORATORY DATA:  Laboratory studies on admission showed an
hematocrit of 31, sodium 140, K 3.5, glucose 206.  After
intubation the arterial blood gases were 7.37, PCO2 32, PO2
417, base excess was -5.  Bicarbonate was 19.

Chest x-ray showed no pneumothorax, no bullet, no fracture,
no effusion.

Resuscitation in the Emergency Department included four units
of packed red blood cells, three liters of normal saline, one
liter of Ringer lactate solution, and estimated blood loss
was approximately 1,500 cc.

PLAN:  The plan for this gentleman was to go the operating
room, which he did, for repair of his femoral artery
transection, removal of the bullet from the leg, repair of
his hand injury, exploration of the wound, and then to the
Surgical Intensive Care Unit.

HOSPITAL COURSE:  During this procedure the plastic surgery
and hand findings were as follows:  The right hand had a
normal cascade, intact tendons, good capillary refill, intact
radial pulse.  There was an entrance wound in the dorsal
first web space.  There was a comminuted fracture of the
first metacarpal, and there was an exit wound in the volar
aspect of the first web space, with superficial wound
involving the base of the middle finger, radial aspect of the
ring finger at the proximal interphalangeal joint level.

X-rays showed a comminuted midshaft first metacarpal
fracture.

The gunshot wound of the right hand was irrigated
intraoperatively.  The wound edges were reapproximated.  The
thumb was put in a spica splint, and the plan was to
administer Ancef, maintain arm elevation, and to later on
reduce and fix his fracture when he was more stable.

The patient underwent a flexible esophagoscopy under general
anesthesia.  There were no injuries and no blood noted in the
stomach or esophagus.  There were no complications.

His vascular surgery postoperative diagnosis was:  1. A
transection of the left superficial femoral artery.  2. A
transection of the left superficial femoral vein.  3.
Extensive soft tissue and muscle distraction.  The procedure
included:  1. Harvesting of the right lower extremity greater
saphenous vein from the thigh.  2. They did an interposition
repair of the left superficial femoral artery with a reversed
greater saphenous vein.  3. Ligation of the left superficial
femoral vein.  4. A four-compartment fasciotomy of the left
lower extremity.  The surgeons were Dr. [**Last Name (STitle) **] and Dr.
[**Last Name (STitle) 34922**].

From a trauma surgery perspective, the patient underwent
femoral artery and vein exploration with proximal and distal
control, and a neck exploration.  The patient was found to
have in his leg a transected femoral superficial artery
complete at the proximal [**2-2**] of his thigh; a partially
transected superficial femoral vein; a divided superficial
femoral nerve.

In his neck the findings were as follows:  There was no
injury to the airway or the vascular found.  Bronchoscopy was
negative.  The bullet track went inferiorly to the
mediastinum.

The patient postoperatively was admitted to the Surgical
Intensive Care Unit.  His past medical history, allergies,
and medications were unknown.  He was continued on
intubation.

He received six units of packed red blood cells, six units of
fresh frozen plasma, one unit of platelets, one unit of
cryoprecipitate, and 13 liters of resuscitation fluids.

The patient underwent hourly pulse checks, arterial line
monitoring, mechanical ventilation, and Foley catheter.
Additional blood transfusions and additional cryoprecipitate
was given.  He was placed on levofloxacin and Flagyl.  He was
being followed by the trauma team, the vascular surgery team,
and plastic surgery.  The patient was on prophylactic
heparin.

Serial hematocrits were obtained and these were stable.
Pulses were palpable.  The patient was extubated on Surgical
Intensive Care Unit day two.  He was continued on
antibiotics.  His neck was continued in a hard collar.
Patient-controlled analgesia was given for pain.  The patient
was scheduled for a reoperation for his hand surgery, which
he underwent on [**2152-9-18**].  He was taken to the operating room
by the plastic surgeons.  The procedure was an external
fixation of the right first metacarpal with a right radial
bone graft to the metacarpal defect, repair of the extensor
pollicis longus tendon, debridement of the right palmar
wound.  The estimated blood loss was minimal, and the patient
tolerated the procedure well.  He was placed in an external
fixator with his hand elevated, and continued on antibiotics.
Perioperatively his fingertips showed good capillary refill.
The hand was warm with no edema, and dressing was clean and
dry.

On [**2152-9-20**], which was hospital day six, levofloxacin/Flagyl
day six, Kefzol day two, postoperative days five and two, the
patient had a fasciotomy closure at the bedside.  He was
continued on patient-controlled analgesia with hand
elevation.  He was continued on antibiotics, given bowel
medications, and had a brisk diuresis.

He had an uncomplicated course thereafter, and on [**2152-9-22**],
which was hospital day eight, postoperative day seven and
four, Kefzol day four, he was changed to Keflex p.o., pain
medications of OxyContin 30 mg p.o. b.i.d., Percocet p.r.n.
breakthrough.  The patient was treated with Toradol in the
hospital but no longer.

The patient was seen by physical therapy and occupational
therapy.  He had been out of bed with minimal ambulation
secondary to pain.  The vascular staff felt that he was
healing well and had given him full weight-bearing status.

On physical examination on hospital day eight, he was awake,
alert and oriented.  Lungs were clear.  He had a regular rate
and rhythm of his heart.  Abdomen was soft, nontender, and
nondistended.  Extremities were warm.  His right thigh had a
well-healing scar with staples.  The left thigh had a
well-healing T-shaped incision.  Left calf incisions on the
medial and lateral aspects were clean and dry.  He had
palpable dorsalis pedis pulses and posterior tibial pulses
bilateral and equal.  His right wrist had good capillary
refill, was warm, and he moved his fingers.

He was hospital day eight status post multiple gunshot wounds
with a right hand repair with an external fixator, with
superficial femoral artery to above-the-knee popliteal bypass
graft, fasciotomy closures, and sternal notch exploration,
which was negative.

He will be going to [**Hospital 34923**] hospital facility.

DISCHARGE MEDICATIONS:
1. Keflex 500 mg p.o. q.i.d. to be continued for at least
seven days, and that will be under the guidance of the
plastic surgery team, with whom he will follow up with next
week.
2. OxyContin 30 mg p.o. b.i.d.
3. Percocet 1-2 tablets q. three hours p.r.n. breakthrough
pain.
4. Colace 100 mg p.o. b.i.d.
5. Dulcolax suppositories p.r.n.

He needs to continue to have physical therapy and
occupational therapy with special care toward management of
his right hand mobility, and he is full weight-bearing
status.  He needs to have a dry sterile dressing on top of an
Adaptic to his left thigh and left calf wounds.  The incision
over his neck does not need to be dressed, nor does the right
thigh incision.

DISCHARGE INSTRUCTIONS:
1. The patient needs to follow up with Dr. [**Last Name (STitle) **] from
vascular surgery in [**2-1**] weeks; he should call the office for
an appointment.
2. Follow up with Dr. [**First Name (STitle) **] next Tuesday at the Hand Plastic
Surgery Clinic.
3. He also can follow up with the Trauma Clinic as needed,
phone number [**Telephone/Fax (1) 274**].

DISCHARGE CONDITION:  Stable, improved.

DISCHARGE DIAGNOSES:
1. Status post multiple gunshot wounds.
2. Status post a right superficial femoral artery to
above-the-knee popliteal bypass.
3. Status post a neck exploration.
4. Status post a right external fixation with bone graft and
extensor pollicis longus tendon repair for a comminuted
fracture of the first metacarpal.

DIET:  Regular.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

Dictated By:[**Last Name (NamePattern1) 8344**]
MEDQUIST36

D:  [**2152-9-22**]  10:37
T:  [**2152-9-22**]  11:46
JOB#:  [**Job Number 34924**]
{'Injury to common femoral artery,Open fracture of base of thumb [first] metacarpal,Open wound of knee, leg [except thigh], and ankle, with tendon involvement,Open wound of chest (wall), without mention of complication,Acute posthemorrhagic anemia,Injury due to legal intervention by firearms'}


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 25-year-old
gentleman status post multiple gunshot wounds that he
sustained in an altercation with police.  The gunshot wounds
were one to the chest, one to the right hand, and one to the
left thigh.  The patient was brought in by ambulance, where
they noted a bullet in the EMS rig.  The EMS vital signs
showed a heart rate of 120, blood pressure 100/palp, O2
saturation was 99 on room air.  He was alert, awake, and
oriented at the scene, moving all extremities.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Injury to common femoral artery,Open fracture of base of thumb [first] metacarpal,Open wound of knee, leg [except thigh], and ankle, with tendon involvement,Open wound of chest (wall), without mention of complication,Acute posthemorrhagic anemia,Injury due to legal intervention by firearms'}
