CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 62 yo F restrained driver in rollover auto crash. Reportedly
+LOC; GCS15 upon EMS arrival. She was taken to an area hospital
where found to have multiple left rib fractures and left
clavicle fracture; she was then transferred to [**Hospital1 18**] for further
care.

MEDICAL HISTORY: HTN
Hypothyroid
PSH: s/p Hysterectomy

MEDICATION ON ADMISSION: levothyroxine 245 mcg, minoxipril, spironolactone, tylenol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Lives with husband
Closed fracture of seven ribs,Urinary tract infection, site not specified,Concussion, with loss of consciousness of 30 minutes or less,Unspecified pleural effusion,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Closed fracture of sternal end of clavicle,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Acute pain due to trauma
Fracture seven ribs-clos,Urin tract infection NOS,Concus-brief coma <31 mn,Pleural effusion NOS,Loss control mv acc-driv,Fx clavicl, stern end-cl,Hypertension NOS,Hypothyroidism NOS,Acute pain due to trauma
Admission Date:  [**2200-12-22**]              Discharge Date:   [**2200-12-29**]

Date of Birth:  [**2138-5-5**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
Epidural catheter placement

History of Present Illness:
62 yo F restrained driver in rollover auto crash. Reportedly
+LOC; GCS15 upon EMS arrival. She was taken to an area hospital
where found to have multiple left rib fractures and left
clavicle fracture; she was then transferred to [**Hospital1 18**] for further
care.


Past Medical History:
HTN
Hypothyroid
PSH: s/p Hysterectomy

Social History:
Lives with husband

Family History:
Noncontributory

Pertinent Results:
[**2200-12-22**] 04:20PM   GLUCOSE-101 UREA N-12 CREAT-0.7 SODIUM-141
POTASSIUM-3.9 CHLORIDE-107 TOTAL CO2-29 ANION GAP-9
[**2200-12-22**] 04:20PM   CALCIUM-8.7 PHOSPHATE-3.0 MAGNESIUM-1.9
[**2200-12-22**] 04:20PM   WBC-11.0 RBC-3.78* HGB-12.4 HCT-34.0* MCV-90
MCH-32.8* MCHC-36.5* RDW-13.0
[**2200-12-22**] 04:20PM   PLT COUNT-163
[**2200-12-22**] 04:20PM   PT-13.7* PTT-23.4 INR(PT)-1.2*
[**2200-12-22**] 12:48AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

CT Abdomen/Pelvis [**2200-12-22**]
IMPRESSION:

1. No solid organ injury is detected in the abdomen and pelvis.

2. Nondisplaced fracture of posterior element of left 10th, 9th
and 8th ribs.

3. Small bibasilar effusion and bibasilar atelectasis, left
greater than
right.

Chest AP [**2200-12-25**]
IMPRESSION:
1. Multiple rib fractures.
2. Left lower lobe collapse and/or consolidation, unchanged.
3. Left apical capping (pleural fluid) adjacent to the left 2nd
rib fracture
and indistinctness of the left aortic knob, unchanged compared
with [**2200-12-23**].
Further assessment with chest CT would be recommended to exclude
a mediastinal
hematoma.

Left clavicle [**2200-12-22**]
Fracture involving the middle third of the left clavicle is
associated with inferior displacement of the lateral fracture
fragment. Fractures involving the posterior parts of left second
and third ribs are noted. The left humeral head is in the
glenoid fossa with no fracture.





Brief Hospital Course:
She was admitted to the Trauma Service and transferred to the
Trauma SICU for close monitoring given her multiple rib
fractures. Acute pain service was consulted given her injuries
and difficulty with adequate pain control with PCA. An epidural
catheter was placed; her PCA dose was increased; prn IV
narcotics for breakthrough pain were also added to her regimen.
A long acting narcotic was later added; the epidural was
removed. Instruction regarding coughing, deep breathing and use
of incentive spirometer were provided; she does require ongoing
encouragement with this. She continued to have pain but to a
much lesser degree than she did initially. MSIR was added for
breakthrough and this was changed to oral Dilaudid with the
addition of Toradol. She was started on a bowel regimen early
on.

Her clavicle fracture was managed non operatively; she was
placed in a sling for comfort. She will follow up in 2 weeks in
[**Hospital 5498**] clinic for follow up films.

She did develop a UTI and is being treated with a 5 day course
of Cipro which was started on [**2200-12-26**].

Physical and Occupational therapy were consulted and have
recommended short term rehab after her acute hospitalization.

Medications on Admission:
levothyroxine 245 mcg, minoxipril, spironolactone, tylenol



Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO QID (4 times a day).
3. Levothyroxine 200 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO once a
day: to be taken with the 200mcg tablet to total dose of 225mcg
daily.
5. Moexipril 7.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).
7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
8. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
9. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for fever or pain.
10. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
11. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ML
Injection TID (3 times a day).
12. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 3 days.
13. Morphine 15 mg Tablet Sustained Release Sig: Three (3)
Tablet Sustained Release PO Q12H (every 12 hours).
14. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for breakthrough pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 25759**] & Rehab Center - [**Location (un) **]

Discharge Diagnosis:
s/p Motor vehicle crash
Left clavicle fracture
Multiple left rib fractures
Urinary tract infection

Discharge Condition:
Hemodynamically stable, tolerating a regular diet, pain
adequately controlled.

Discharge Instructions:
Continue to wear the sling for comfort.

Followup Instructions:
Follow up in 2 weeks with Dr. [**Last Name (STitle) **], Trauma Surgery. Call
[**Telephone/Fax (1) 600**] for an appointment. Inform the office that you will
need an AP chest xray on the day of your appointment just prior
to seeing Dr. [**Last Name (STitle) **].

Follow up in 2 weeks in [**Hospital 5498**] clinic with Dr. [**Last Name (STitle) **] for
your clavicle fracture; call [**Telephone/Fax (1) 1228**] for an appointment.

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2200-12-31**]
{'Closed fracture of seven ribs,Urinary tract infection, site not specified,Concussion, with loss of consciousness of 30 minutes or less,Unspecified pleural effusion,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Closed fracture of sternal end of clavicle,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Acute pain due to trauma'}


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 Motor vehicle crash

PRESENT ILLNESS: 62 yo F restrained driver in rollover auto crash. Reportedly
+LOC; GCS15 upon EMS arrival. She was taken to an area hospital
where found to have multiple left rib fractures and left
clavicle fracture; she was then transferred to [**Hospital1 18**] for further
care.

MEDICAL HISTORY: HTN
Hypothyroid
PSH: s/p Hysterectomy

MEDICATION ON ADMISSION: levothyroxine 245 mcg, minoxipril, spironolactone, tylenol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Lives with husband 

### Response:
{'Closed fracture of seven ribs,Urinary tract infection, site not specified,Concussion, with loss of consciousness of 30 minutes or less,Unspecified pleural effusion,Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle,Closed fracture of sternal end of clavicle,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Acute pain due to trauma'}
