CHIEF COMPLAINT: 

PRESENT ILLNESS: On [**2135-7-29**], the patient
presented.  He is a 39-year-old male with a history of
alcohol abuse.  Reportedly fell down from a [**Location (un) 10043**]
height with a questionable loss of consciousness.  He was
evaluated at an outside hospital and he was found to have
bilateral wrist fractures, a right superior and inferior
pubic ramus fracture, a L1 compression fracture.  Therefore,
he was transferred to [**Hospital1 69**]
Emergency Department as an inebriated, although
hemodynamically stable trauma patient.

MEDICAL HISTORY: Only alcohol abuse.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient was later discovered to have
allergies to Heparin.  Apparently, he has Heparin induced
thrombocytopenia.  Also allergies to lobster and ragweed.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other closed fractures of distal end of radius (alone),Injury to other gastrointestinal sites, without mention of open wound into cavity,Closed fracture of pubis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Malunion of fracture,Alcohol withdrawal delirium,Accidental fall from ladder,Iatrogenic pulmonary embolism and infarction
Fx distal radius NEC-cl,GI injury NEC-closed,Fracture of pubis-closed,Fx lumbar vertebra-close,Malunion of fracture,Delirium tremens,Fall from ladder,Iatrogen pulm emb/infarc
Admission Date:  [**2135-7-29**]     Discharge Date:  [**2135-9-10**]

Date of Birth:   [**2096-6-28**]     Sex:  M

Service:  Trauma Surgery

DISCHARGE DATE:  Yet to be determined.  This is an interim
summary of the patient's progress while on the Trauma Surgery
Service.  The patient has not been discharged yet, but this
will serve as the initial discharge summary up until the
patient's discharge which should be within the next day or
two.

HISTORY OF PRESENT ILLNESS:  On [**2135-7-29**], the patient
presented.  He is a 39-year-old male with a history of
alcohol abuse.  Reportedly fell down from a [**Location (un) 10043**]
height with a questionable loss of consciousness.  He was
evaluated at an outside hospital and he was found to have
bilateral wrist fractures, a right superior and inferior
pubic ramus fracture, a L1 compression fracture.  Therefore,
he was transferred to [**Hospital1 69**]
Emergency Department as an inebriated, although
hemodynamically stable trauma patient.

PAST MEDICAL HISTORY:  Only alcohol abuse.

PAST SURGICAL HISTORY:  Split thickness skin graft to his
right arm.

MEDICATIONS:  He reportedly takes no medications at home.

ALLERGIES:  The patient was later discovered to have
allergies to Heparin.  Apparently, he has Heparin induced
thrombocytopenia.  Also allergies to lobster and ragweed.

PHYSICAL EXAM UPON PRESENTATION TO THE TRAUMA CENTER:
Patient was awake and alert, but in mild distress.  Vital
signs initially:  Heart rate of 103, blood pressure 122/74,
respiratory rate of 16, breathing 98% on 3 liters nasal
cannula.  HEENT examination showed his tympanic membranes to
be clear bilaterally.  His extraocular motion was intact.
His head was normocephalic, atraumatic.  His trachea was
midline.  There was no jugular venous distention noted.  His
chest examination showed a stable chest without any external
trauma.  His lungs were clear to auscultation bilaterally.
His heart was a regular, rate, and rhythm without any
murmurs.  His abdomen was soft, nontender, nondistended and
active bowel sounds were heard.  His pelvis was stable to
[**Doctor Last Name **] anterior, posterior, and laterally.  Extremities:  There
were deformities of the bilateral wrists noted on both upper
extremities.  There were 2+ palpable pulses on both upper and
lower extremities.  His rectal examination showed normal
tone, and normal prostate.  Heme and guaiac were negative.
His back examination showed no stepoffs, but positive lumbar
tenderness.

X-RAYS:  The following films were obtained from the outside
hospital:  A chest x-ray showed the mediastinum to be within
normal limits.  There was no hemothorax.  There was no
pneumothorax.  There was a question of a L1 fracture.  His
pelvic x-ray showed a superior and inferior right pubic rami
fracture.

LABORATORY DATA ON THE DAY OF ADMISSION:  White count of
17.4, hematocrit of 35.1, platelets of 127.  Electrolytes
showed a sodium of 139, potassium of 3.6, chloride of 106,
bicarb of 17, BUN of 5, and a creatinine of 0.8, glucose is
122.  Patient's coagulation studies were a PT of 15.2, INR of
1.5, and a PTT of 30.7.  His tox screen showed alcohol at
0.108.  He was positive for cocaine, opiates, and
benzodiazepines.  His urinalysis showed [**7-26**] red blood cells,
otherwise negative.  His liver function tests were not
recorded.

Studies that were obtained at [**Hospital1 **] on the
day of admission included a CT scan of the head which was
negative for any acute injury.  A CT scan of the cervical
spine which was negative.  A CT scan of the thoracic, lumbar,
and sacral areas show a L1 burst fracture with question of a
posterior wedge fracture.  The L1 pedicle was involved as
well as left L1 foramina.

CT scan of abdomen and pelvis showed fatty liver with
diverticula were noted.  There was no free fluid noted in the
abdomen.  Right and left wrist x-rays on both upper
extremities showed distal radius fractures in both wrists.

Patient was admitted to the Trauma Surgery Service, made NPO,
put on flat bed rest, and C spine, and logroll precautions.
An Orthopedic consultation was obtained.  Patient remained
hemodynamically stable throughout his presentation and workup
in the Emergency Department, although he was intoxicated.

A blood gas was also drawn showing a pH of 7.28, pCO2 of 29,
pO2 of 81, bicarb of 14, and a base deficit of -11.  Patient
was aggressively hydrated, and his hematocrits and arterial
blood gages were then ordered and followed.  As mentioned,
Orthopedic Surgery was consulted for his pelvic fractures as
well as his bilateral wrist fractures.

The patient's left distal radius fracture was reduced under
conscious sedation and films were obtained.  The patient's
right upper extremity was splinted, and had good perfusion.
His left upper extremity was also splinted, and showed good
perfusion with capillary refill time less than two seconds as
well as palpable pulses.  Patient's right iliac fracture
extended into the acetabulum.  He also had right sacral
fractures and a right superoinferior pubic ramus fracture as
previously mentioned.  He was placed on logroll precautions
because of these fractures.

Patient was taken to the operating room with Dr. [**Last Name (STitle) **] on [**2135-8-1**] for an open reduction internal fixation of his right
distal radius fracture.  Patient's left distal radius
fracture after splinting and reduction films showed good
alignment, however, the right distal radius fracture was
taken to the operating room for open reduction internal
fixation.

The patient did receive 2 units of packed red blood cells
perioperatively for some anemia that was occurring.  Patient
was also fitted with a TLSO brace to stabilize his thoracic
and lumbar spine.  Also during his hospital course, on
approximately [**2135-8-5**], patient began having increasing
abdominal pain, distention in his right lower quadrant.  An
upright chest x-ray showed air to be underneath the diaphragm
on the right side suggesting a hollow viscus perforation.
With re-examination, it was determined the patient had severe
right lower quadrant guarding as well as peritoneal signs
suggestive of a perforation viscus and subsequent
peritonitis.

The patient was taken to the operating room approximately the
night of [**8-5**] for an exploratory laparotomy.  The
patient underwent also a right hemicolectomy for a perforated
right colon.  The surgeon was Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) 7820**].
The patient was started on regimen of empiric antibiotics
also at this time including ampicillin, levofloxacin, and
Flagyl.  His hematocrits were followed for any signs of
bleeding.  He was aggressively resuscitated with intravenous
fluids approximately 5 liters and had good urine output.
He was given Pepcid for DVT prophylaxis as well as Venodyne
leg stockings for DVT prophylaxis.

Postoperatively, the next several days the patient continued
to have a tachycardia.  Central line was placed, and
patient's CVP was analyzed to be approximately 17.  The
patient continued to have good urine output and a patient's
history of alcoholism suggested DT's etiology, and the
patient was treated with Ativan for his agitation and
tachycardia.  He was also treated for his pain.  He did
remain hemodynamically stable besides the tachycardia which
was in the 130s to 140s.  He did spike a fever during this
time, and had blood cultures drawn and had his antibiotic
regimen continued.  He was reintubated in the PACU for airway
protection and agitation.  But this was only temporary and he
was subsequently extubated the following day.

The suspicion of a possible pulmonary embolism led to the
order of a chest CT angiogram, which did show a positive left
lower lobe pulmonary artery thrombus.  The patient's history
of having Heparin-induced antibody positive did not allow him
to be Heparinized, and therefore a Hematology consultation
was obtained to aide in anticoagulation for the patient's
pulmonary embolism.  The patient was started on Hirudin drip
to continue his anticoagulation for the pulmonary embolism
per Hematology.  The patient also underwent a screen for
rehabilitation at this time, as well as visits from Physical
Therapy and Occupational Therapy.

A Nutrition consult was also obtained at this time.  The
patient was started on TPN, and was kept NPO while his belly
remained distended postoperatively.  The patient was started
on Coumadin while he remained in the Trauma Intensive Care
Unit.  He remained on Hirudin as well per Hematology to
continue his anticoagulation for his pulmonary embolism.  He
was transferred to the floor on approximately [**2135-8-11**].

Over the next few days on the floor, the patient's belly
remained quite distended, and he began having some nausea.  A
nasogastric tube was placed several times because the patient
pulled it out several times.  He was kept on nasogastric tube
suction which drained quite a bit of bilious fluid from his
stomach.  This was kept on suction for several days while the
patient's belly remained distended.  He was kept NPO during
this time and TPN was continued.  Also his antibiotic regimen
continued during this time.  Again, the patient was kept on
maintenance fluids during his NPO time, and TPN continued
while his ileus and distended bowel began to resolve.

Over the course of several days, the patient began to have
less and less output through his nasogastric tube.  His
abdomen became less and less distended, and returned to a
normal soft abdomen with active bowel sounds.  He was then
advanced on a clear liquid diet, eventually to a full diet,
and was having bowel movements regularly at this point.
Physical Therapy and Occupational Therapy continued to work
with the patient, and his Coumadin was reaching therapeutic
levels.  The patient's Coumadin finally reached therapeutic
levels.

Orthopedic Surgery requested repeat films of his bilateral
upper extremities at this time, this was approximately [**8-25**].  The Orthopedic Surgery team then determined that
patient would require surgery on approximately [**9-1**], and
that would be an open reduction internal fixation of his left
wrist because the left wrist films showed a loss of length
and increased dorsal angulation, which would require surgery.
At this time, the patient's Coumadin was stopped, and his
Hirudin was continued to keep him anticoagulated for
treatment of his pulmonary embolism.  It was then requested
by pharmacy that the Hirudin be discontinued due to the risk
of possible anaphylactic reaction to the ongoing use of
Hirudin, and the patient was then started on Argatroban for
continuation of his anticoagulation needs.  He was then
transferred to the Orthopedic Surgery team for further
hospital care leading up into his open reduction internal
fixation of his left distal radius fracture.

This ends the interim summary of Mr. [**Known firstname 2092**] [**Known lastname 732**].  The
Orthopedic team will be doing the formal discharge on this
patient.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D.  [**MD Number(1) 521**]

Dictated By:[**Name8 (MD) 5541**]

MEDQUIST36

D:  [**2135-9-1**]  17:28
T:  [**2135-9-2**]  05:19
JOB#:  [**Job Number 48707**]


Name:  [**Known lastname **], [**Known firstname **]                        Unit No:  [**Numeric Identifier 9022**]

Admission Date:  [**2135-9-1**]     Discharge Date:  [**2135-9-10**]

Date of Birth:                  Sex:  M

Service:  ORTHOPEDIC

ADDENDUM:  The patient remained without complaints, remained
afebrile and vital signs were stable.  Wound was clean, dry
and intact.  Serous fluid on left fingers and forearm.
Bilateral upper extremities are nasogastrically intact.
Hematocrit was 27.3.  The patient continued on Argatroban and
Coumadin with goal of INR greater then 4 and Argatroban could
be stopped with goal INR after that from 2 to 2.5.  Dressing
was changed on left upper extremity on [**2135-9-3**].  The patient
was cleared by physical therapy on [**2135-9-4**].  The patient was
waiting clearance by physical therapy as well as INR of
greater then 4 per medicine recommendations.  The patient
continued to receive occupational therapy with a plan for the
patient to be discharged to home once cleared by occupational
therapy, physical therapy and INR goals as stated previously.
The rest of the [**Hospital 1325**] hospital course was uneventful.
The patient continued bilateral upper extremities clean, dry
and intact.  Neurovascularly intact.  Fingers were warm and
well perfuse bilaterally.  Bilateral lower extremities
neurovascularly intact.  Capillary refill less then 2
seconds. Dorsalis pedis pulse 2+.  On [**2135-9-10**] Argatroban was
stopped.  Follow up INR was 2.7 within goal range.  The
patient was then discharged to home to follow up with Dr. [**Last Name (STitle) **]
two weeks postop for left distal radius fracture as well as
two weeks postop right distal radius fractures status post
open reduction and internal fixation bilateral distal radius
fractures.  The patient was to follow up with plastic team
per recommendations.  The patient is to follow up with his
primary care physician or [**Hospital 1209**] Clinic on Monday [**9-12**] to
check INR and to adjust Coumadin as needed.  The patient
should follow up with the Trauma Clinic in one or two weeks
at the [**Last Name (un) 9023**] Building.  He should come in on Tuesday after
next for reevaluation of his previous injuries.  Call
[**Telephone/Fax (1) 3594**] for an appointment.  Call Dr.[**Name (NI) 9024**] office on
Monday [**2135-9-12**] for a follow up appointment at the following
number [**Telephone/Fax (1) 4344**].  The patient should follow up with Dr.
[**First Name (STitle) **] in the [**Hospital 4504**] Clinic in two to three weeks
[**Telephone/Fax (1) 5972**].  The patient needs to follow closely with the
[**Hospital 1209**] Clinic to have INR and laboratories drawn and
adjusted.

The patient is status post open reduction and internal
fixation bilateral distal radius fractures as well as
exploratory laparotomy and hemicolectomy.

CONDITION ON DISCHARGE:  Good.  The patient is being
discharged home with VNA nursing assistance.  The patient
needs to wear a TLSO brace when out of bed.  Right lower
extremity partial weight bearing, left lower extremity full
weight bearing, continue prehospital medications plus
additional ones listed.






                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4341**]

Dictated By:[**Last Name (NamePattern1) 9025**]

MEDQUIST36

D:  [**2135-9-12**]  12:23
T:  [**2135-9-12**]  13:05
JOB#:  [**Job Number 9026**]
{'Other closed fractures of distal end of radius (alone),Injury to other gastrointestinal sites, without mention of open wound into cavity,Closed fracture of pubis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Malunion of fracture,Alcohol withdrawal delirium,Accidental fall from ladder,Iatrogenic pulmonary embolism and infarction'}


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: On [**2135-7-29**], the patient
presented.  He is a 39-year-old male with a history of
alcohol abuse.  Reportedly fell down from a [**Location (un) 10043**]
height with a questionable loss of consciousness.  He was
evaluated at an outside hospital and he was found to have
bilateral wrist fractures, a right superior and inferior
pubic ramus fracture, a L1 compression fracture.  Therefore,
he was transferred to [**Hospital1 69**]
Emergency Department as an inebriated, although
hemodynamically stable trauma patient.

MEDICAL HISTORY: Only alcohol abuse.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient was later discovered to have
allergies to Heparin.  Apparently, he has Heparin induced
thrombocytopenia.  Also allergies to lobster and ragweed.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other closed fractures of distal end of radius (alone),Injury to other gastrointestinal sites, without mention of open wound into cavity,Closed fracture of pubis,Closed fracture of lumbar vertebra without mention of spinal cord injury,Malunion of fracture,Alcohol withdrawal delirium,Accidental fall from ladder,Iatrogenic pulmonary embolism and infarction'}
