CHIEF COMPLAINT: MCC

PRESENT ILLNESS: 23 y/o male involved in a high speed motorcycle crash. The
patient was wearing a helmet but was unresponsive at the scene.
He was transported to [**Hospital3 2737**] where he was noted to not
be moving his extremities on the right side on his body. He was
intubated for airway protection [**12-27**] his GCS and was transferred
to [**Hospital1 18**] for further management.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: on arrival in the trauma bay

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-contributory
Closed fracture of acetabulum,Intracranial injury of other and unspecified nature without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Sprain of thoracic,Closed fracture of olecranon process of ulna,Cerebral edema,Open wound of forehead, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist
Fracture acetabulum-clos,Brain inj NEC-brief coma,Fx dorsal vertebra-close,Hyposmolality,Retention urine NOS,Sprain thoracic region,Fx olecran proc ulna-cl,Cerebral edema,Open wound of forehead,Mv collis NOS-motorcycl
Admission Date:  [**2120-3-27**]              Discharge Date:   [**2120-4-10**]

Date of Birth:  [**2096-11-1**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
MCC

Major Surgical or Invasive Procedure:
ORIF of right acetabular fraction/dislocation


History of Present Illness:
23 y/o male involved in a high speed motorcycle crash. The
patient was wearing a helmet but was unresponsive at the scene.
He was transported to [**Hospital3 2737**] where he was noted to not
be moving his extremities on the right side on his body. He was
intubated for airway protection [**12-27**] his GCS and was transferred
to [**Hospital1 18**] for further management.

Past Medical History:
none

Social History:
non-contributory

Family History:
non-contributory

Physical Exam:
on arrival in the trauma bay

vitals: HR 91 BP 137/69 RR 16 sats 100% on AC 650 peep 5 FIO2
100%
GEN: intubated, paralyzed
HEENT: left eyebrow laceration, upper lip swelling, PERRL,
sluggish
ET tube in place, trachea midline
PULM: CTA bilaterally, no crepitus
CV: regular
ABD: soft non-distended, FAST + for fluid in RUQ
PELVIS: stable to AP and lateral compression
RECTAL: normal tone, guiac negative
BACK: no palpable step-offs
EXT: no obvious deformities

on discharge:

Pertinent Results:
[**2120-3-27**]
CT OF THE CHEST WITH IV CONTRAST: The soft tissue window images
demonstrate no fluid within the mediastinum or injury to the
great vessels. The heart and pericardium are normal. No
pathologically enlarged mediastinal or hilar lymphadenopathy is
noted. No pleural effusions. The lung window images demonstrate
no parenchymal consolidation or pulmonary nodules. The airways
are patent to the level of the segmental bronchi bilaterally.

CT OF THE ABDOMEN WITH IV CONTRAST: The liver, spleen, pancreas,
adrenal glands and kidneys are normal. No free fluid or free
intraperitoneal air is seen. There is stranding and some fluid
within the transverse mesocolon near the splenic flexure.

CT OF THE PELVIS WITH IV CONTRAST: The rectum and sigmoid colon
are normal. The bladder is normal. No free fluid or pelvic
lymphadenopathy.

BONE WINDOWS: A compression fracture on the anterior superior
aspect of T6 vertebral body is seen. There is normal alignment
of the posterior surfaces of the vertebral bodies in that area,
and there is no retropulsion of fracture fragments.
Additionally, there is a fracture of the lateral aspect of the
right acetabulum, with widening of the right hip joint space and
partial lateral subluxation of the femoral head.

CT RECONSTRUCTIONS: Coronal and sagittal reconstructions were
essential in delineating the anatomy and pathology. MPR value
equals 5.

IMPRESSION:
1) No injury to the major abdominal organs or mediastinal
vessels.
2) Focal area of stranding and fluid within the transverse
mesocolon in the left upper quadrant. This finding is suspicious
for mesenteric injury, and close clinical correlation is
recommended.
3) A fracture of the anterosuperior aspect of the T6 vertebral
body, representing a compression fracture.
4) Fracture of the lateral aspect of the right acetabulum, with
widening of the right hip joint space and partial subluxation

[**2120-3-27**] CT HEAD WITHOUT IV CONTRAST: No intraparenchymal,
subarachnoid, or subdural hemorrhage. There is diffuse sub sulci
bilaterally and narrowing of the lateral ventricles, findings,
which are concerning for cerebral edema. Additionally, the brain
parenchyma appears slightly diffusely hypoattenuating. However,
the [**Doctor Last Name 352**]-white matter differentiation is preserved. No focal
abnormalities are noted in the brain parenchymal density. There
is no shift of normally midline structures. The soft tissues are
normal. No fractures are identified. A tissue density,
representing a retention cyst, is seen in the right maxillary
sinus.

IMPRESSION: No intracranial hemorrhage. There may be slight
diffuse loss of sulci and narrowing of the lateral ventricles,
findings raising the possibility of cerebral edema- clinical
correlation is required.

[**2120-3-27**] CT C-SPINE: No fracture or dislocation identified. There
is prevertebral soft tissue swelling. The patient is intubated.
The dens is normal, without any evidence of fracture. No other
focal soft tissue abnormalities identified. There are blebs at
the lung apices.

IMPRESSION: No fracture or malalignment of the cervical spine.
Of note, there is prevertebral soft tissue swelling, which may
suggest underlying ligamentous injury.

[**2120-3-27**] AP VIEW OF THE PELVIS AND FEMURS: There is mild
subluxation of the right femoral head, which appears to be
laterally displaced from the acetabulum and externally rotated.
Additionally, there is a linear lucency running through the
inferolateral portion of the right ilium pelvic bone, which
represents a fracture through the acetabular roof. No other
fractures are identified in the pelvis or the femurs. The
surrounding soft tissues are unremarkable.

IMPRESSION: Fracture through the right inferior ilium pelvic
bone involving the acetabular roof, with mild lateral
displacement of the right femoral head.

[**2120-3-28**] left forearm x-ray IMPRESSION: Bone fragment versus soft
tissue calcification adjacent to the coronoid of the ulna.
Dedicated left elbow views are recommended for additional
evaluation.

[**2120-3-28**]
MRI of the cervical spine.
FINDINGS: There is no evidence of abnormal signal within the
cord. There is no evidence of canal stenosis or focal disk
protrusion. There is no evidence of malalignment. There is a
small amount of increased signal in the prevertebral space at
the level of C2 and C3, but this is minimal in degree and the
significance is not certain. There is some increased signal in
the soft tissues posterior to the spine at the T1-T3 consistent
with some ligamentous injury or possibly simply representing
soft tissue injury. There may be some increased signal within
the body of T1 raising the question of a small marrow bruise or
injury.
IMPRESSION: A small amount of prevertebral soft tissue signal
present. The significance is not certain. See above discussion.
Some increased signal posterior to the spine in the upper
thoracic region.

MRI of the thoracic spine.
Again, is noted increased signal in the soft tissues posterior
to the upper thoracic vertebra from T1-T3. There is no abnormal
signal within the body of T3 on the thoracic study. There is a
compression fracture of T6 and T7. There may be a minimal
increased signal also within T9. There is no evidence of canal
stenosis. There is no evidence of abnormal cord signal.
IMPRESSION: Compression fractures of T6 and T7 and possibly of
T9

CTA HEAD W&W/O C & RECONS  [**2120-3-29**] FINDINGS: There is no
intracranial hemorrhage. There is no shift of normally midline
structures, hydrocephalus, or mass effect. There is no evidence
of an aneurysm or stenosis within the major branches of the
circle of [**Location (un) 431**]. Flow is seen within the anterior and posterior
circulations.

IMPRESSION: No evidence of aneurysm or other vascular
abnormalities.

CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST [**2120-3-29**]
IMPRESSION:
1. Increased fluid and stranding in the perirenal spaces and
pericolic gutters, of unclear etiology, but possibly because of
slight fluid overload, given the presence of small effusions, or
because of a redistribution of the previously seen fluid.
2. Decreased mesenteric fluid, seen previously.
3. Free fluid in the pelvis.
4. Small bilateral pleural effusions and atelectasis.

ELBOW (AP, LAT & OBLIQUE) LEFT  [**2120-3-29**]
IMPRESSION: Equivocal evidence of minimally displaecd coranoid
and olecranon fractures. Interval reduction of radial-capitellar
dislocation.


Brief Hospital Course:
TSICU [**2120-3-27**] to [**2120-4-1**]: The patient was initially stabilized in
the trauma bay at [**Hospital1 18**] and was then imaged to determine the
extent of his injuries. The patient's head CT did not reveal any
acute bleed but did show narrowed sulci indicating the
possibility of cerebral edema and diffuse axonal injury.
Neurosurgery was consulted and recommended a repeat head CT the
following day which was performed and was stable.
.
The patient's spine was definitively imaged by MRI. MRI of the
cervical and thoracic spine showed fractures of T6, T7, and T9,
posterior ligamentous instability of T1-3, and a normal cervical
spine. There was no evidence of cord injury. Orthopedics was
consulted for management of his spine injuries. A TLSO brace was
measured and fitted for the patient. He is to wear this brace at
all times when he is out of bed. In bed he may remove the brace
when lying flat. The patient was also prescribed a soft cervical
collar for comfort.
.
His chest CT was negative and his initial abdominal CT revealed
mesocolic free fluid but no solid organ injury. A repeat
abdominal CT on [**3-29**] did not show any increase in free fluid.
.
Plain films of the patient's hips and pelvis on admission showed
a right acetabular fracture with dislocation. Orthopedics was
consulted and the patient's right lower extremity was placed in
traction. The patient was taken to the operating room on [**2120-3-29**]
for ORIF of his right acetabular fracture. He will remain NWB on
his RLE until follow up after discharge. He will also be on
lovenox for DVT prophylaxis for 4 weeks after discharge. The
patient also had x-rays of his left forearm showing a question
of an olecranon fracture. He was placed in a splint and sling
and was managed non-operatively.
.
The patient was extubated on [**2120-3-31**] and transferred to the
hospital floor on the following day.
.
The patient's facial lacerations were repaired on admission and
the sutures were removed seven days later.
.
Hospital floor [**4-1**] to [**4-10**]: The patient had daily intensive
physical therapy throughout the remaineder of his hospital stay.
The patient's mental status slowly improved from being oriented
only to himself to recognizing family and friends, following
commands and being able to ambulate with crutches. At the time
of discharge he was tolerating PO, urinating without difficulty
and having daily bowel movements. He will be discharged to his
mother's home for further rehab with his family.


Medications on Admission:
none

Discharge Medications:
1. Enoxaparin Sodium 40 mg/0.4mL Syringe Sig: One (1) injection
Subcutaneous DAILY (Daily) for 4 weeks.
Disp:*30 injection* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Facial lacs (sutured [**3-27**]--sutures out)
right acetabular fraction/dislocation
ligamentous injury T1-3
free fluid in mesentery
T6/T7/T9 compression fractures
Left olecranon fracture


Discharge Condition:
good

Discharge Instructions:
Take your medications as prescribed
Take 4 more weeks of lovenox injections
No weight bearing on your right lower extremity
Wear your back brace whenever you are not lying flat in bed
Wear your soft collar as needed for comfort
Call you doctor [**First Name (Titles) **] [**Last Name (Titles) 60968**], change in sensation ro
strength, fever to 101.4F, severe headache, or any other
worrisome symptoms.

Followup Instructions:
Follow up with Dr. [**First Name (STitle) 1022**] (spine orthopedics) in 1 week.  Please
call for an appointment [**Telephone/Fax (1) 7807**]

Follow up with Dr. [**Last Name (STitle) 1005**] (orthopedics) in 2 week.  Please
call for an appointment [**Telephone/Fax (1) 4845**]

Talk to your primary care doctor about seeing a
gastroenterologist to investigate your trouble swallowing and
keeping foods down.
{'Closed fracture of acetabulum,Intracranial injury of other and unspecified nature without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Sprain of thoracic,Closed fracture of olecranon process of ulna,Cerebral edema,Open wound of forehead, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist'}


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: MCC

PRESENT ILLNESS: 23 y/o male involved in a high speed motorcycle crash. The
patient was wearing a helmet but was unresponsive at the scene.
He was transported to [**Hospital3 2737**] where he was noted to not
be moving his extremities on the right side on his body. He was
intubated for airway protection [**12-27**] his GCS and was transferred
to [**Hospital1 18**] for further management.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: on arrival in the trauma bay

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-contributory 

### Response:
{'Closed fracture of acetabulum,Intracranial injury of other and unspecified nature without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Sprain of thoracic,Closed fracture of olecranon process of ulna,Cerebral edema,Open wound of forehead, without mention of complication,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist'}
