CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 49 year old
male who fell on a scaffold at his construction job, lost his
balance and put his right arm through a plate glass window.
He presented to the Emergency Room with a 10 to 12 cm
laceration of the proximal forearm through his flexor
compartment.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: None.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a Haitian immigrant, came to
the country approximately three months ago.  He denies any
smoking or alcohol use.
Injury to unspecified nerve of shoulder girdle and upper limb,Open wound of hand except finger(s) alone, complicated,Injury to unspecified blood vessel of upper extremity,Fall resulting in striking against sharp object,Accidents caused by other specified cutting and piercing instruments or objects
Inj nerve shldr/arm NOS,Opn wound hand-complicat,Injury arm vessel NOS,Fall striking sharp obj,Acc-cutting instrum NEC
Admission Date:  [**2156-10-8**]     Discharge Date:  [**2156-10-11**]

Date of Birth:   [**2107-9-27**]     Sex:  M

Service:  Plastic Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 49 year old
male who fell on a scaffold at his construction job, lost his
balance and put his right arm through a plate glass window.
He presented to the Emergency Room with a 10 to 12 cm
laceration of the proximal forearm through his flexor
compartment.

Per report at the scene, the patient immediately complained
of burning pain to the fourth and fifth right digits,
followed by numbness in these digits.  He also complains of
severe flexion weakness in the hand.  Compression bandage was
applied at the scene and the patient was transferred to the
Emergency Room. In the Emergency Room, the patient complained
of extreme pain with the laceration.

PAST MEDICAL HISTORY:  None.

MEDICATIONS ON ADMISSION:  None.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  The patient is a Haitian immigrant, came to
the country approximately three months ago.  He denies any
smoking or alcohol use.

PHYSICAL EXAMINATION:  On physical examination, the patient
had a pulse of 75, blood pressure 154/88, respiratory rate 21
and oxygen saturation 99% in room air.  General:  Agitated
male in distress complaining of increased pain despite
narcotics.  Lungs:  Clear to auscultation bilaterally.
Cardiovascular:  Regular rate and rhythm, S1 and S2
appreciated.  Abdomen:  Soft, nontender, nondistended.
Extremities:  Right upper extremity approximately 12 cm
laceration across the volar forearm, running from the ulna to
approximately the middle of the volar surface; there was a
large amount of exposed muscle belly; there was oozing of
venous blood; additionally, there was bright red arterial
blood which came out once the compression bandage was
removed; the patient had no sensation throughout the fourth
and fifth digits and he had very poor flexor function
throughout the entire hand; radial and ulnar pulses were
palpable; there was good capillary refill of all fingers;
flexor function, while impaired, was somewhat present in the
first through fourth digits; patient had no extensor function
of the fingers secondary to pain; difficult to obtain a
lumbar column or osseous examination on the patient.

LABORATORY DATA:  Admission white blood cell count was 8.4,
hematocrit 41.6, platelet count 336,000.

RADIOLOGIC DATA:  X-rays showed no fracture and no evidence
of foreign bodies.

Given that the patient had a traumatic laceration of his
right forearm with arterial bleeding as well as severe
disruption of the flexor compartment and an exam consistent
with disruption of the ulnar nerve, the patient was
transferred immediately to the Operating Room for ulnar nerve
repair, incision and drainage and vascular exploration.

HOSPITAL COURSE:  The patient underwent an ulnar nerve repair
on [**2156-10-8**] as well as ligation of bleeding.
During the operation, the ulnar artery was found to be intact
with laceration of one of the major branches of that artery
throughout the flexor compartment.  Approximately 11 of the
patient's flexor forearm muscles were noted to be completely
or partially lacerated.  These were additionally repaired
during this operation.

The patient tolerated the procedure well, however, following
the operation, during anesthesia, the patient was extubated
prematurely and bag masked and went into pulmonary edema in
the Operating Room with saturations dropping into the 70s.
It was decided at that time to reintubate the patient.  He
was found to be in laryngospasm and his tracheal tube was
passed over a guiding stilette.  The patient's saturations
improved after that.

The patient was transferred to the Post Anesthesia Care Unit
intubated, sedated and paralyzed.  In the Post Anesthesia
Care Unit, the Surgical Intensive Care Unit team was
consulted given that the patient had a chief complaint of
pulmonary edema.  He was admitted to the Surgical Intensive
Care Unit service.  Arterial blood gases obtained immediately
postoperatively revealed a pH of 7.35, pCO2 46 and pO2 63.
The patient remained intubated and sedated on the ventilator
throughout the night of postoperative day zero to
postoperative day one.

On postoperative day number one, the patient continued to do
well.  He was weaned from the ventilator and extubated on
[**2156-10-9**] in the evening.  Overnight events from
[**10-8**] also included decreased blood
pressure, which responded well to fluid boluses.  The patient
was diuresed with Lasix once on [**2156-10-9**].

Overnight from [**10-9**], the patient did
well.  He was extubated, however, he was noted to have a
hypertensive episode with blood pressures ranging up into the
160s and 170s.  The patient was begun on Lopressor 25 mg
three times a day, which controlled his blood pressure
adequately.  Also on [**2156-10-10**], the patient was
again diuresed with Lasix.  He responded well and was able to
decrease his oxygen requirement.  From [**10-10**], the patient continued to do well.  It was decided at
that time to transfer the patient back to the Plastic Surgery
Service, however, he was unable to be discharged from the
Unit due to bed availability.

On [**2156-10-11**], with the patient tolerating oral pain
medications and an oral diet, it was decided at that point
that it was possible to discharge the patient to home.  The
orthopedic technician was consulted, who applied a cast to
the patient's right upper extremity holding the elbow in 20
degrees of flexion, approximately 45 degrees of wrist
flexion, 90 degrees of MP flexion and PIP extension, with the
wrist supinated as well so as to prevent tension on the ulnar
nerve.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSE:
1.  Laceration of the right forearm, status post ulnar nerve
repair, status post 11 flexor muscle repairs.
2.  Pulmonary edema, status post intubation and diuresis.

FOLLOW-UP:  The patient was instructed to follow up with his
primary care physician within the week, to evaluate him for
long term blood pressure control.  The patient is also to
follow up with Dr. [**Last Name (STitle) **] in the Plastic Surgery Clinic in
approximately one week from Tuesday for cast removal and
evaluation of the wound.  It is expected that the ulnar nerve
repair should be stable in the cast that is presently
applied.

DISCHARGE MEDICATIONS:
Lopressor 25 mg p.o.b.i.d. for blood pressure control.


                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2647**], M.D.  [**MD Number(1) 2648**]

Dictated By:[**Name8 (MD) 16207**]

MEDQUIST36

D:  [**2156-10-11**]  15:31
T:  [**2156-10-16**]  13:31
JOB#:  [**Job Number 45230**]
{'Injury to unspecified nerve of shoulder girdle and upper limb,Open wound of hand except finger(s) alone, complicated,Injury to unspecified blood vessel of upper extremity,Fall resulting in striking against sharp object,Accidents caused by other specified cutting and piercing instruments or objects'}


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 49 year old
male who fell on a scaffold at his construction job, lost his
balance and put his right arm through a plate glass window.
He presented to the Emergency Room with a 10 to 12 cm
laceration of the proximal forearm through his flexor
compartment.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: None.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a Haitian immigrant, came to
the country approximately three months ago.  He denies any
smoking or alcohol use. 

### Response:
{'Injury to unspecified nerve of shoulder girdle and upper limb,Open wound of hand except finger(s) alone, complicated,Injury to unspecified blood vessel of upper extremity,Fall resulting in striking against sharp object,Accidents caused by other specified cutting and piercing instruments or objects'}
