CHIEF COMPLAINT: s/p Motor vehicle crash

PRESENT ILLNESS: 80 yo male unrestrained driver s/p motor vehicle crash where his
vehicle was T-boned on right side. No reported LOC; prolonged
extrication. He was Medflighted from an area hospital where he
had received FFP for INR 2.3 (on Coumadin for A-fib) to [**Hospital1 18**]
complaining of headache and vomitied x1 upon arrival.

MEDICAL HISTORY: Atrial fibrillation
Type II Diabetes
HTN

MEDICATION ON ADMISSION: Coumadin  7.5 mg for 4 days/5mg 3 day
Metformin 500 tid
Lisinopril 10 qd
Atenolol 25 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Widowed
Has 4 children
Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Injury to bladder and urethra, without mention of open wound into cavity,Other convulsions,Atrial fibrillation,Urinary tract infection, site not specified,Unspecified protein-calorie malnutrition,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Closed fracture of two ribs,Closed fracture of distal end of ulna (alone),Contusion of lower leg,Unspecified accident
Brain lacer NEC w/o coma,Bladder/urethra inj-clos,Convulsions NEC,Atrial fibrillation,Urin tract infection NOS,Protein-cal malnutr NOS,Mv collision NOS-driver,Hypertension NOS,DMII wo cmp nt st uncntr,Long-term use anticoagul,Fracture two ribs-closed,Fx distal ulna-closed,Contusion of lower leg,Accident NOS
Admission Date:  [**2179-6-24**]              Discharge Date:   [**2179-7-1**]

Date of Birth:  [**2099-3-26**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2534**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
[**2179-6-29**] PICC line placement


History of Present Illness:
80 yo male unrestrained driver s/p motor vehicle crash where his
vehicle was T-boned on right side. No reported LOC; prolonged
extrication. He was Medflighted from an area hospital where he
had received FFP for INR 2.3 (on Coumadin for A-fib) to [**Hospital1 18**]
complaining of headache and vomitied x1 upon arrival.

Past Medical History:
Atrial fibrillation
Type II Diabetes
HTN

Social History:
Widowed
Has 4 children

Family History:
Noncontributory

Pertinent Results:
[**2179-6-24**] 09:16PM   GLUCOSE-222* UREA N-18 CREAT-0.8 SODIUM-138
POTASSIUM-4.1 CHLORIDE-106 TOTAL CO2-22 ANION GAP-14
[**2179-6-24**] 07:51PM   LACTATE-2.3*
[**2179-6-24**] 07:30PM   CK(CPK)-216*
[**2179-6-24**] 07:30PM   CK-MB-7 cTropnT-<0.01
[**2179-6-24**] 07:30PM   CALCIUM-7.8* PHOSPHATE-2.0* MAGNESIUM-1.6
[**2179-6-24**] 07:30PM   PT-20.0* PTT-33.4 INR(PT)-1.9*
[**2179-6-24**] 02:34PM   WBC-9.4 RBC-4.25* HGB-13.6* HCT-40.2 MCV-95
MCH-32.1* MCHC-33.9 RDW-13.5
[**2179-6-24**] 02:34PM   PLT COUNT-142*
[**2179-6-24**] 02:34PM   PT-20.7* PTT-32.2 INR(PT)-2.0*
[**2179-6-24**] 02:34PM   FIBRINOGE-266\

MR HEAD W/O CONTRAST
IMPRESSION:
No evidence of acute infarction. Grossly stable appearance to
known left frontal intraparenchymal hemorrhage with surrounding
vasogenic edema and area of subarachnoid hemorrhage within the
right frontal lobe. Increased T2 and FLAIR signal abnormalities
within the periventricular deep white matter consistent with
chronic small vessel ischemic changes.

CHEST (PORTABLE AP)
HISTORY: Acute desaturation, rule out CHF or pneumonia.
IMPRESSION: AP chest reviewed in the absence of prior chest
radiographs:
Lungs are very low in volume. Mild interstitial edema is
present. Additionally there is more focal consolidation in the
right upper lobe and both infrahilar lungs. How much of this is
asymmetric edema and how much atelectasis or pneumonia is
radiographically indistinguishable. Right upper lobe abnormality
has a more discrete mass-like quality and warrant evaluation
with routine radiographs when feasible. Heart is top normal
size. Small left pleural effusion is present. No pneumothorax.

CT HEAD W/O CONTRAST
IMPRESSION:
1. Unchanged appearance to left frontal hemorrhagic contusion
and surrounding edema and areas of subarachnoid hemorrhage
within the superior right frontal convexity. Small hemorrhagic
fluid level noted superiorly adjacent to the right frontal lobe
likley represents hemorrhage within an arachnoid cyst.

2. Slight change in density to bilateral subdural collections
favors bilateral subdural hygromas with possible mild
hemorrhagic component rather than atrophy as suggested on prior
examination.

3. Slight redistribution to left subgaleal hematoma.


Brief Hospital Course:
He was admitted to the Trauma Service. Neurosurgery was
consulted because of his left intraparenchymal hemorrhage. This
injury was non operative. He was loaded with Dilantin and will
remain on this until follow up with Dr. [**Last Name (STitle) 548**]. Serial head CT
scans were performed and were stable. Neurology was consulted
for possible seizure related activity; he underwent MR imaging
which did not revealed any areas of infarct.

Orthopedics was consulted because of his left wrist fracture;
there was no operative intervention. A splint was applied and he
will follow up with Dr. [**Last Name (STitle) **] in 2 weeks.

Urology was consulted following traumatic Foley removal during
an episode where he was agitated. He initially required
continuous bladder irrigation; the hematuria did resolve. The
Foley was removed and is being treated for a UTI with Cipro.

Speech Language Pathology was consulted for swallowing and
language assessment. There were initially some concerns about
his ability to take in adequate nutrition given his cognitive
status; during the bedside evaluation he did not show any signs
of aspiration. He was kept NPO until his mental status improved,
which it eventually did and he was re-evaluated. He will require
ongoing Speech therapy once at rehab for language and cognitive
therapy.

His home medications were restarted with the exception of his
Coumadin; generally anticoagulants are held for 10 days or more
following a bleed and depending upon size of a head bleed.

Physical and Occupational therapy were consulted and have
recommended acute rehab for patients with brain injuries.

Medications on Admission:
Coumadin  7.5 mg for 4 days/5mg 3 day
Metformin 500 tid
Lisinopril 10 qd
Atenolol 25 qd

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
4. Potassium & Sodium Phosphates [**Telephone/Fax (3) 4228**] mg Packet Sig: One
(1) Packet PO BID (2 times a day).
5. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ML
Injection TID (3 times a day).
6. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1)
ML Intravenous DAILY (Daily).
7. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection four times a day as needed for per sliding scale.
8. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
9. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 5 days.
10. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
11. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO
three times a day: hold for HR <60; SBP <110.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
s/p Motor vehicle crash
Left Intraparenchymal Hemorrhage
Left 4th & 6th rib fracture
Left nondisplaced wrist fracture
Hematuria


Discharge Condition:
Stable


Followup Instructions:
Follow up in 2 weeks with Dr. [**Last Name (STitle) **], Orthopedics. Call
[**Telephone/Fax (1) 1228**] for an appointment.

Follow up in 4 weeks with Dr. [**Last Name (STitle) 548**], Neurosurgery. Call
[**Telephone/Fax (1) 2992**] for an appointment. Inform the office that you will
need a repeat head CT scan for this appointment.

Follow up in 4 weeks in Trauma Clinic with Dr. [**Last Name (STitle) **] by calling
[**Telephone/Fax (1) 600**] for an appointment.



Completed by:[**2179-7-1**]
{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Injury to bladder and urethra, without mention of open wound into cavity,Other convulsions,Atrial fibrillation,Urinary tract infection, site not specified,Unspecified protein-calorie malnutrition,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Closed fracture of two ribs,Closed fracture of distal end of ulna (alone),Contusion of lower leg,Unspecified accident'}


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: 80 yo male unrestrained driver s/p motor vehicle crash where his
vehicle was T-boned on right side. No reported LOC; prolonged
extrication. He was Medflighted from an area hospital where he
had received FFP for INR 2.3 (on Coumadin for A-fib) to [**Hospital1 18**]
complaining of headache and vomitied x1 upon arrival.

MEDICAL HISTORY: Atrial fibrillation
Type II Diabetes
HTN

MEDICATION ON ADMISSION: Coumadin  7.5 mg for 4 days/5mg 3 day
Metformin 500 tid
Lisinopril 10 qd
Atenolol 25 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Widowed
Has 4 children 

### Response:
{'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness,Injury to bladder and urethra, without mention of open wound into cavity,Other convulsions,Atrial fibrillation,Urinary tract infection, site not specified,Unspecified protein-calorie malnutrition,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Closed fracture of two ribs,Closed fracture of distal end of ulna (alone),Contusion of lower leg,Unspecified accident'}
