CHIEF COMPLAINT: Pedestrian Struck

PRESENT ILLNESS: Mr. [**Known lastname 75087**] is a 56 year-old man who was transferred from St.
[**Hospital 11042**] Hospital in [**Location (un) 8117**], NH after being struck by a car
traveling approximately 35 mph. There was no loss of
consciousness.  Imaging at St. [**Doctor Last Name 11042**] demonstrated multiple
bilateral facial fractures, dislocated left shoulder, left chest
wall hematoma.  He was transferred to [**Hospital1 18**] for further
evaluation and treatment. Notable, physical exam and
radiological injury demonstrated the following injuries:

MEDICAL HISTORY: Anxiety
Depression
?Bipolar/schizo
Substance abuse

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam on Admission:
Vitals: HR 83 BP: 160/70 RR: 14 O2: 100% FM
HEENT: L pupil 3mm, R eye closed
Chest: Equal breath sounds bilaterally.
Abd: Soft, NT/ND.
MSK: R hip tender to palpation.
Vasc: Decreased femoral pulse on Right.
GU: + Foley
Skin: Right eye ecchymoses, edema.  Left shoulder abrasions.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives alone, works on a farm.  He has children.
1 ppd x 30 years.  Occasional drink every few weeks.
Closed fracture of greater tuberosity of humerus,Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Closed fracture of subtrochanteric section of neck of femur,Closed fracture of orbital floor (blow-out),Closed fracture of unspecified part of fibula with tibia,Closed anterior dislocation of humerus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tobacco use disorder,Unspecified schizophrenia, unspecified,Other and unspecified alcohol dependence, continuous,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian
Fx gr tuberos humerus-cl,Cl skull fx NEC w/o coma,Subtrochanteric fx-close,Fx orbital floor-closed,Fx tibia w fibula NOS-cl,Ant disloc humerus-close,DMII wo cmp nt st uncntr,Tobacco use disorder,Schizophrenia NOS-unspec,Alcoh dep NEC/NOS-contin,Mv coll w pedest-pedest
Admission Date:  [**2113-10-3**]              Discharge Date:   [**2113-10-20**]

Date of Birth:  [**2057-4-23**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
Pedestrian Struck

Major Surgical or Invasive Procedure:
First Operation
1. [**10-3**] TFN R Subtroch fx; IM Nail R tibia Fx ([**10-3**]) - [**Location (un) **]
Second operation [**10-9**]
1. Arthroscopic subacromial decompression.
2. Open reduction internal rotation greater tuberosity
    fracture.
Third operation [**10-10**]
1. ORIF of right zygomaticomaxillary complex fracture.
2. ORIF of right orbital floor fracture.
3. Complex wound closure right upper eyelid.


History of Present Illness:
Mr. [**Known lastname 75087**] is a 56 year-old man who was transferred from St.
[**Hospital 11042**] Hospital in [**Location (un) 8117**], NH after being struck by a car
traveling approximately 35 mph. There was no loss of
consciousness.  Imaging at St. [**Doctor Last Name 11042**] demonstrated multiple
bilateral facial fractures, dislocated left shoulder, left chest
wall hematoma.  He was transferred to [**Hospital1 18**] for further
evaluation and treatment. Notable, physical exam and
radiological injury demonstrated the following injuries:

1. R zygoma & zygomatic arch fx
2. fx roof, lateral, medial R orbit
3. anterior, medial, lateral R maxillary sinus fxs
4. L sphenoid bone fx extending into post/inf wall L orbit
5. superior L maxillary sinus fx
6. B/L medial & lateral pterygoid plate fxs
7. fx [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] coronoid process fx with maintained mandibular
integrity
8. Small subarachnoid hemmorhage L sylvian fissure
9. R femur fx
10. R tib/fib fx
11. L shoulder dislocation
12. L Greater tuberosity fx


Past Medical History:
Anxiety
Depression
?Bipolar/schizo
Substance abuse

Social History:
Lives alone, works on a farm.  He has children.
1 ppd x 30 years.  Occasional drink every few weeks.


Family History:
non-contributory


Physical Exam:
Physical Exam on Admission:
Vitals: HR 83 BP: 160/70 RR: 14 O2: 100% FM
HEENT: L pupil 3mm, R eye closed
Chest: Equal breath sounds bilaterally.
Abd: Soft, NT/ND.
MSK: R hip tender to palpation.
Vasc: Decreased femoral pulse on Right.
GU: + Foley
Skin: Right eye ecchymoses, edema.  Left shoulder abrasions.

Pertinent Results:
[**2113-10-3**] 02:35AM BLOOD WBC-28.6* RBC-4.12* Hgb-13.2* Hct-37.7*
MCV-91 MCH-31.9 MCHC-34.9 RDW-13.9 Plt Ct-344
[**2113-10-3**] 12:38PM BLOOD WBC-19.7* RBC-3.53* Hgb-11.1* Hct-34.3*
MCV-97 MCH-31.4 MCHC-32.4 RDW-13.7 Plt Ct-294
[**2113-10-3**] 08:42PM BLOOD WBC-12.3* RBC-2.51*# Hgb-8.0*# Hct-23.6*#
MCV-94 MCH-32.0 MCHC-34.1 RDW-13.9 Plt Ct-193
[**2113-10-4**] 02:00AM BLOOD WBC-12.1* RBC-2.37* Hgb-7.4* Hct-21.9*
MCV-92 MCH-31.0 MCHC-33.6 RDW-13.9 Plt Ct-184
[**2113-10-5**] 12:53AM BLOOD WBC-12.4* RBC-2.82* Hgb-8.9* Hct-25.9*#
MCV-92 MCH-31.4 MCHC-34.1 RDW-14.7 Plt Ct-170
[**2113-10-10**] 07:00AM BLOOD WBC-16.0*# RBC-2.85* Hgb-8.6* Hct-25.8*
MCV-91 MCH-30.3 MCHC-33.3 RDW-14.0 Plt Ct-666*#
[**2113-10-3**] 02:35AM BLOOD PT-11.7 PTT-21.8* INR(PT)-1.0
[**2113-10-6**] 07:15AM BLOOD Plt Ct-185
[**2113-10-3**] 02:35AM BLOOD UreaN-23* Creat-0.8
[**2113-10-5**] 12:53AM BLOOD Glucose-91 UreaN-11 Creat-0.7 Na-144
K-3.8 Cl-110* HCO3-29 AnGap-9
[**2113-10-10**] 07:00AM BLOOD Glucose-160* UreaN-10 Creat-0.6 Na-137
K-4.5 Cl-103 HCO3-28 AnGap-11
[**2113-10-3**] 02:35AM BLOOD ALT-34 AST-51* AlkPhos-86 Amylase-56
TotBili-0.2
[**2113-10-3**] 02:35AM BLOOD Lipase-19
[**2113-10-10**] 07:00AM BLOOD Calcium-8.2* Phos-4.2 Mg-2.4
[**2113-10-13**] 04:00PM BLOOD VitB12-328 Folate-8.5
[**2113-10-13**] 04:00PM BLOOD TSH-2.5
[**2113-10-3**] 02:35AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2113-10-3**] 02:38AM BLOOD Glucose-222* Lactate-2.0 Na-144 K-3.9
Cl-107 calHCO3-24
[**2113-10-3**] 04:10AM BLOOD Hgb-13.1* calcHCT-39
[**2113-10-3**] 02:38AM BLOOD freeCa-1.04*

CT HEAD W/O CONTRAST

Reason: eval for change in SAH

[**Hospital 93**] MEDICAL CONDITION:
56 year old man with MVC
REASON FOR THIS EXAMINATION:
eval for change in SAH
CONTRAINDICATIONS for IV CONTRAST: None.

HEAD CT

ADDENDUM: There is a small hypodensity within the central pons,
which may represent an infarct of indeterminate chronicity.
INDICATION: 56-year-old man with motor vehicle collision.
Evaluate for change in subarachnoid hemorrhage.

COMPARISON: Outside hospital CT head.

TECHNIQUE: Non-contrast CT of the head.

FINDINGS: There is a small hyperdense linear area within the
left sylvian fissure, similar in size compared to outside
hospital study consistent with subarachnoid hemorrhage. No
additional intracranial hemorrhage is identified. There is no
mass effect, shift of midline structures. The ventricles are
normal in size and symmetric. [**Doctor Last Name **]-white matter differentiation
is preserved.

There are fractures of the anterior, medial, and lateral wall of
the right maxillary sinus. There are fractures of the zygoma and
zygomatic arch on the right. There are fractures of the medial,
lateral, superior, and inferior and posterior orbital wall.
There are fractures of the medial and lateral pterygoid plates
bilaterally. There is a sliver of bone fractured off of the
right coranoid process of the mandible. There is a left sphenoid
fracture at the junction of the left temporal bone. All of these
fractures have been previously described in prior facial CT.

The mastoid air cells are clear.

IMPRESSION:
1. Stable left sylvian fissure subarachnoid hemorrhage.
2. Multiple facial fractures as previously described on facial
CT.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10270**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST  [**2113-10-3**] 3:28 AM

CT SINUS/MANDIBLE/MAXILLOFACIA

Reason: evaluate facial fractures

[**Hospital 93**] MEDICAL CONDITION:
56 year old man peds struck w/ multiple facial fractures, incl
temporal bones as well
REASON FOR THIS EXAMINATION:
evaluate facial fractures
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 56-year-old man with multiple facial fractures.
Please evaluate.

No comparison studies.

TECHNIQUE: MDCT acquired axial images of the facial bones were
obtained without IV contrast with soft tissue and bone windows.
Coronal and sagittal reformations were obtained.

FINDINGS: There is a comminuted blowout fracture of the floor of
the right orbit with the fractures involving the infraorbital
canal. There is herniation of obital fat inferiorly and the
inferior rectus muscle is abutting bony fragments. There is a
comminuted fracture of the lateral wall of the right orbit.
Multiple fractures of the superior wall with intracranial and
right frontal sinus extension is also noted. A tiny bubble of
gas is noted intracranially. Medial blowout fracture with
herniation of orbital fat is present. Blood is seen along the
superolateral orbit. There is no evidence of nerve impingement.

There are comminuted fractures of the anterior, medial, and
lateral walls of the right maxillary sinus. There are multiple
fractures of the right zygoma and zygomatic arch. A nondisplaced
fracture of the posterior wall of the left maxillary sinus is
noted.

There are bilateral lateral and medial pterygoid plate
fractures.

There is a small approximately 1 cm fracture fragment of the
right coranoid process of the mandible with preserved integrity
of the entire mandible.

Nasal bone fractures are noted, which may be old.

There is marked soft tissue swelling overlying the entire right
side of the face and to a lesser extent over the left face.
There is moderate subcutaneous emphysema distributed over the
orbit and maxilla. There is a tiny amount of right retroorbital
air along with a small approximately 1 cm right retroorbital
hematoma.

At the junction of the left sphenoid and temporal bones, there
is a minimally displaced fracture with adjacent subcutaneous
emphysema, best appreciated on series 2, image 65. The fracture
extends to the posterior/inferior wall of the left orbit.

Air/fluid levels are seen in the frontal sinuses and the left
maxillary sinus are seen. Fluid/soft tissue change of the
ethmoid, sphenoid, and right maxillary sinuses are also noted.

There is a 1.2 x 0.8 cm cystic lesion of the maxilla to the
right of midline which may represent an incisive canal cyst.

IMPRESSION:

1. Fractures of all walls of the right orbit and right maxilla.
Small bubble of air intracranially adjacent to a fracture of the
superior wall.

2. Right retroorbital hematoma and inferior rectus muscle
abutting fracture fragments.

3. Fractures of the right zygoma and zygomatic arch.

4. Bilateral medial and lateral pterygoid plate fractures.

5. Right mandibular coronoid process fracture with maintained
mandibular integrity.

6. Left sphenoid bone fracture at the junction of the temporal
and sphenoid bones with extension into posterior/inferior wall
of the left orbit and the left maxillary sinus.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10270**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

CT UP EXT W/O C  [**2113-10-5**] 9:11 AM

CT UP EXT W/O C

Reason: eval for L shoulder hematoma

[**Hospital 93**] MEDICAL CONDITION:
56 year old man admitted with left shoulder dislocation
REASON FOR THIS EXAMINATION:
eval for L shoulder hematoma
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Pedestrian struck with left shoulder dislocation.
Please evaluate for left shoulder fracture.

TECHNIQUE: Multidetector CT images were obtained through the
left shoulder without contrast. Coronal and sagittal reformatted
images were obtained.

CT LEFT SHOULDER WITHOUT CONTRAST: There is a comminuted
fracture through the superolateral humeral head. There are
multiple fracture fragments located superiorly and medially
within the glenohumeral joint. The humeral head is posteriorly
subluxed with respect to the glenoid. The imaged portion of the
scapula and clavicle are unremarkable. There is blood tracking
within the teres major muscle without a discrete hematoma. There
is a large amount of edema within the axilla which tracks along
the neurovascular bundle, along the left lateral chest wall and
within the subcutaneous tissues.

Within the imaged portion of the left lung is seen peripheral
tree-in-[**Male First Name (un) 239**] airspace opacities which may represent
bronchiolitis. Additionally, there are dependent changes seen
along the path posterior lung fields. Atherosclerotic
calcifications are seen within the imaged portion of the left
common carotid artery.

IMPRESSION:
1. Comminuted fracture of the superolateral humeral head with
fracture fragments around and within the glenohumeral joint.

2. Posterior subluxation of the humeral head.

3. Marked soft tissue edema about the left shoulder as described
above. Blood tracking within the teres major muscle.

4. Tree-in-[**Male First Name (un) 239**] opacities within the visualized portion of the
left lung suggest acute bronchiolitis.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) 5998**]
DR. [**First Name (STitle) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]

FEMUR (AP & LAT) RIGHT; TIB/FIB (AP & LAT) RIGHT

Reason: r/o fractures

[**Hospital 93**] MEDICAL CONDITION:
56 year old man s/p peds struck, severe R leg pain
REASON FOR THIS EXAMINATION:
r/o fractures
INDICATION: 56-year-old man with severe right leg pain. Rule out
fractures.

COMPARISON: Portable pelvic plain film from one hour prior.

THREE VIEWS OF THE RIGHT FEMUR: There is a fracture of the
prioximal shaft extending from the subtrochanteric region. There
are three fracture line visualized, with medial displacement and
varus angulation of the distal fragment.

FIVE VIEWS OF THE RIGHT KNEE AND TIBIA AND FIBULA: There is
mildly displaced oblique tibial fracture. There is mildly
displaced comminuted high fibular fracture.

Three views of the right foot demonstrate no evidence of acute
bony injury. Evaluation of the lateral malleolous is limited due
to overlying metallic fixation hardware.

SINGLE VIEW OF THE PELVIS: Aside from the right proximal femoral
fracture, no additional acute bony injury is demonstrated.
Contrast is present within the urinary bladder.

he study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10270**]
DR. [**First Name8 (NamePattern2) 814**] [**Name (STitle) 815**]

SHOULDER 1 VIEW LEFT  [**2113-10-13**] 11:40 AM

SHOULDER 1 VIEW LEFT

Reason: post op eval.just AP view please, pt's L arm cannot be
moved

[**Hospital 93**] MEDICAL CONDITION:
56 year old man with 56M s/p ped struck, no LOC, transferred
from St. [**Hospital 11042**] hospital with multiple facial fractures, R
tib/fib fxs, L shoulder fx, SAH.
REASON FOR THIS EXAMINATION:
post op eval.just AP view please, pt's L arm cannot be
movedplease do not allow pt to move L arm during shooting, so
pure AP view can be obtained
HISTORY: Trauma, to compare with previous study.

FINDING: In comparison with the study of [**2113-10-10**], there is no
significant change. Again there is an avulsed bony fragment from
left greater tuberosity fracture that is projecting in the
acromiohumeral interval. No metallic fixation device is seen.

IMPRESSION: No significant interval change.

DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]


Brief Hospital Course:
Pt. was a transfer from St. [**Hospital 11042**] Hospital in [**Location (un) 8117**], NH via
EMS.  As noted above, Mr. [**Known lastname 75087**] was brought into the trauma
bay by EMS with a number of notable orthopaedic injuries.  He
was AOx3 at the time and hemodynamically stable.  After initial
stabilization, he was taken to radiology for further
investigation of his injuries.  Pertinent films are listed
above.  His treatment, organized by problems, consisted of:

#SAH-->  Pt was noted to have a small-moderate Subarachnoid
hemmorhage with a normal neurological exam.  Neurosurgery was
emergently consulted, and the patient was loaded with IV
dilantin and continued on a stable PO regimen of this
medication.  Serial examinations were normal, and a repeat CT
showed no worsening of his hemmorhage.  After a 10 day course
his Dilantin was discontinued.  He has had no further
neurological events.

#Leg--> Pt. had comminuted fractures in his L LE, treated via
ORIF of femur, tib as noted above.  Pt. had no complications of
this surgery, and has been improving with PT in the post-op
period.

#Shoulder--> Pt initially maintained on a sling for comfort.
Eventually on [**10-9**] he was taken to the OR for repair of his
aforementioned shoulder injuries.  Please see the detailed op
note for full proceding of this operation.  He had no post-op
complications and has been participating with PT.  He is
maintained in a abduction sling currently, and will need ortho
f/u as indicated in his discharge paperwork.

#Facial Fractures-->  The pt. was seen emergently by plastic
surgery in response to his multiple facial fractures.  He was
initially maintained on sinus precautions and amoxicilln.  On
[**10-10**] he was taken to the OR for repair, as described above.  He
was treated with post-op augmentin and has completed that
course.  He will f/u with plastics as described.  Ophthalmology
saw the patient before his operation, and cleared him from the
standpoint of intra-ocular lesions.

#Pysch-->  Psych has followed the patient in house.  At no time
was he section 12 or suffering from suicidal or homicidal
ideation.  He has had no behavioural problems while in house.
Psychiatry felt that his psychosis was stable; it required no
further medications, and he required no specialized psychiatric
hospitalization.  He did well in a shared room on an open floor.
 A number of labs were sent, including folate, b12, tsh; all of
these were normal.  Please see his psychiatric and social work
notes for extensive details of his history.  he will need local
psych f/u in NH.

#FEN--> at time of discharge patient is able to tolerate a PO
diet without difficulty; he is taking a diabetic diet and has
recieved diabetic teaching from the nutritionist.

#DM---> [**Last Name (un) **] was involved in his DM care.  He was initially
started on a SS regimen, but this had to be increased twice due
to continually high FSG.  He was started on Metformin on [**10-17**],
and his FSG began to decrease.  [**Last Name (un) **] suggested that his
sliding scale insulin be decreased and possibly discontinued at
rehab, as his metformin will take a week for full effect to be
realized.

He was discharged from [**Hospital1 18**] today with his vital signs within
normal limits and he will follow up as previously described.


Medications on Admission:
Unknown

Discharge Medications:
1. Bacitracin-Polymyxin B 500-10,000 unit/g Ointment Sig: One
(1) Appl Ophthalmic Q8H (every 8 hours).
2. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
Inhalation Q6H (every 6 hours) as needed.
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
4. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: 1-2 MLs Mucous
membrane QID (4 times a day).
5. Hydromorphone 2 mg Tablet Sig: 3-4 Tablets PO Q3H (every 3
hours) as needed for pain.
6. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1)  Subcutaneous
Q12H (every 12 hours): give for a total of 4 weeks.
7. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
10. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
11. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Menthol-Cetylpyridinium Cl 2 mg Lozenge Sig: One (1) Lozenge
Mucous membrane Q6H (every 6 hours) as needed.
13. Fentanyl 100 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
14. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
15. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
16. Insulin Lispro 100 unit/mL Solution Sig: One (1)
Subcutaneous ASDIR (AS DIRECTED).
17. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
18. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 **] hospital

Discharge Diagnosis:
1. R zygoma & zygomatic arch fx
2. fx roof, lateral, medial R orbit
3. anterior, medial, lateral R maxillary sinus fxs
4. L sphenoid bone fx extending into post/inf wall L orbit
5. superior L maxillary sinus fx
6. B/L medial & lateral pterygoid plate fxs
7. fx [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] coronoid process fx with maintained mandibular
integrity
8. Small subarachnoid L sylvian fissure
9. R femur fx
10. R tib/fib fx
11. L shoulder dislocation
12. L Greater tuberosity fx


Discharge Condition:
stable


Discharge Instructions:
Keep your left arm in the sling and do not bear weight on it.
You may bear full weight on your right leg as tolerated.

You will require a decrease in your regular insulin sliding
scale within 1-2 days given your current dosage of po metformin.

Continue taking lovenox for a total of 4 weeks.

[**Name8 (MD) **] MD for chest pain, shortness of breath, increased pain,
redness or drainage around your surgical wounds, or for any
other symptoms that concern you or your family.

Followup Instructions:
F/u Dr. [**Last Name (STitle) 2719**] and Dr. [**Last Name (STitle) **] of Orthopaedic Surgery in 2
weeks. Call [**Telephone/Fax (1) 1228**] to schedule this appointment.

Follow up with a mental health provider (Social Work,
psychiatry, or psychology) at rehab.

Pt will need to be set up with a PCP in [**Name9 (PRE) **].
{'Closed fracture of greater tuberosity of humerus,Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Closed fracture of subtrochanteric section of neck of femur,Closed fracture of orbital floor (blow-out),Closed fracture of unspecified part of fibula with tibia,Closed anterior dislocation of humerus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tobacco use disorder,Unspecified schizophrenia, unspecified,Other and unspecified alcohol dependence, continuous,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian'}


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: Pedestrian Struck

PRESENT ILLNESS: Mr. [**Known lastname 75087**] is a 56 year-old man who was transferred from St.
[**Hospital 11042**] Hospital in [**Location (un) 8117**], NH after being struck by a car
traveling approximately 35 mph. There was no loss of
consciousness.  Imaging at St. [**Doctor Last Name 11042**] demonstrated multiple
bilateral facial fractures, dislocated left shoulder, left chest
wall hematoma.  He was transferred to [**Hospital1 18**] for further
evaluation and treatment. Notable, physical exam and
radiological injury demonstrated the following injuries:

MEDICAL HISTORY: Anxiety
Depression
?Bipolar/schizo
Substance abuse

MEDICATION ON ADMISSION: Unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam on Admission:
Vitals: HR 83 BP: 160/70 RR: 14 O2: 100% FM
HEENT: L pupil 3mm, R eye closed
Chest: Equal breath sounds bilaterally.
Abd: Soft, NT/ND.
MSK: R hip tender to palpation.
Vasc: Decreased femoral pulse on Right.
GU: + Foley
Skin: Right eye ecchymoses, edema.  Left shoulder abrasions.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives alone, works on a farm.  He has children.
1 ppd x 30 years.  Occasional drink every few weeks. 

### Response:
{'Closed fracture of greater tuberosity of humerus,Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness,Closed fracture of subtrochanteric section of neck of femur,Closed fracture of orbital floor (blow-out),Closed fracture of unspecified part of fibula with tibia,Closed anterior dislocation of humerus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tobacco use disorder,Unspecified schizophrenia, unspecified,Other and unspecified alcohol dependence, continuous,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian'}
