CHIEF COMPLAINT: Pedestrian struck by motor vehicle

PRESENT ILLNESS: 48 yo M pedestrian struck by vehicle at approx 40mph. No LOC.
ETOH level 430 upon admission.

MEDICAL HISTORY: Denies

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 108/73 104  13 (intubated)
Gen: (intubated)
HEENT:No TTP C-spine.  In collar.  R forehead lac.
Chest: BS bilat, no palpable crepitus or eccymoses
Abd: S/NT
Ext: LLE 7cm lac with protruding tibia prox anterior leg.
     RLE deformity/crepitus R ankle.  Compartments
swollen/somewhat firm, swelling R proximal fibula. 2+ DP pulse
bilat.
Neuro: normal rectal tone, guiaic neg.  [**4-24**] motor strength all
extrem.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: ETOH
Closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness,Open fracture of upper end of fibula with tibia,Closed fracture of malar and maxillary bones,Bimalleolar fracture, closed,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Other and unspecified open wound of head without mention of complication
Cl skul base fx w/o coma,Fx up tibia w fibula-opn,Fx malar/maxillary-close,Fx bimalleolar-closed,Mv coll w pedest-pedest,Open wound of head NEC
Admission Date:  [**2141-1-15**]              Discharge Date:   [**2141-1-31**]

Date of Birth:  [**2092-10-24**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
Pedestrian struck by motor vehicle

Major Surgical or Invasive Procedure:
L lower extremity exfix, L tib/fib ORIF, R fibular ORIF, facial
fx repair.


History of Present Illness:
48 yo M pedestrian struck by vehicle at approx 40mph. No LOC.
ETOH level 430 upon admission.

Past Medical History:
Denies

Social History:
ETOH

Family History:
Noncontributory

Physical Exam:
VS: 108/73 104  13 (intubated)
Gen: (intubated)
HEENT:No TTP C-spine.  In collar.  R forehead lac.
Chest: BS bilat, no palpable crepitus or eccymoses
Abd: S/NT
Ext: LLE 7cm lac with protruding tibia prox anterior leg.
     RLE deformity/crepitus R ankle.  Compartments
swollen/somewhat firm, swelling R proximal fibula. 2+ DP pulse
bilat.
Neuro: normal rectal tone, guiaic neg.  [**4-24**] motor strength all
extrem.


Pertinent Results:
[**2141-1-15**] 09:00PM BLOOD WBC-4.7 RBC-3.47* Hgb-12.6* Hct-35.8*
MCV-103* MCH-36.3* MCHC-35.1* RDW-13.4 Plt Ct-157
[**2141-1-16**] 07:47AM BLOOD Hct-19.4*#
[**2141-1-16**] 10:24AM BLOOD Hct-24.1*
[**2141-1-20**] 04:56AM BLOOD WBC-5.1 RBC-2.07* Hgb-7.0* Hct-20.2*
MCV-97 MCH-33.9* MCHC-34.8 RDW-15.1 Plt Ct-220#
[**2141-1-23**] 06:20AM BLOOD Hct-23.2*
[**2141-1-23**] 10:25AM BLOOD WBC-6.3 RBC-2.43* Hgb-8.2* Hct-24.7*
MCV-101* MCH-33.6* MCHC-33.1 RDW-16.0* Plt Ct-591*#
[**2141-1-24**] 06:15AM BLOOD WBC-6.7 RBC-2.29* Hgb-7.7* Hct-23.1*
MCV-101* MCH-33.7* MCHC-33.3 RDW-15.7* Plt Ct-552*
[**2141-1-15**] 09:00PM BLOOD Plt Ct-157
[**2141-1-17**] 12:40AM BLOOD Plt Ct-69*
[**2141-1-23**] 10:25AM BLOOD Plt Ct-591*#
[**2141-1-15**] 09:00PM BLOOD Fibrino-375
[**2141-1-15**] 09:00PM BLOOD Glucose-134* UreaN-10 Creat-0.8 Na-139
K-4.0 Cl-98 HCO3-29 AnGap-16
[**2141-1-24**] 06:15AM BLOOD Glucose-101 UreaN-6 Creat-0.5 Na-134
K-4.1 Cl-98 HCO3-28 AnGap-12
[**2141-1-15**] 09:00PM BLOOD Amylase-73
[**2141-1-16**] 04:05PM BLOOD ALT-202* AST-327* LD(LDH)-288* AlkPhos-61
Amylase-192* TotBili-0.4
[**2141-1-23**] 06:20AM BLOOD Amylase-267*
[**2141-1-24**] 06:15AM BLOOD Amylase-206*
[**2141-1-16**] 04:05PM BLOOD Lipase-473*
[**2141-1-19**] 01:04AM BLOOD Lipase-97*
[**2141-1-24**] 06:15AM BLOOD Lipase-273*
[**2141-1-16**] 04:05PM BLOOD Albumin-2.7*
[**2141-1-24**] 06:15AM BLOOD Calcium-8.5 Phos-3.0 Mg-1.8
[**2141-1-15**] 09:00PM BLOOD ASA-NEG Ethanol-430* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

[**1-15**] CT lower extremities: IMPRESSION:
1. RIGHT LOWER EXTREMITY: Non-displaced medial and lateral
tibial plateau fractures extending into tibial eminence with
probable associated ACL injury. Lipohemarthrosis. Bimalleolar
fracture with extension into the tibiotalar joint and proximal
and distal fibular diaphyseal fractures.

2. LEFT LOWER EXTREMITY: Open comminuted proximal tibial
fracture with extension of fracture into the lateral tibial
plateau articular surface and blood products/ gas in the joint
space. Comminuted proximal fibular diaphyseal fracture and
extensive subcutaneous and intramuscular emphysema.
3. Occult left talar neck fracture. Dedicated LEFT ankle CT may
be helpful for further evaluation.

[**1-15**] R ankle film: Distal fibular fracture.
[**1-15**] CT face: IMPRESSION:
1. Comminuted, mildly displaced nasal bone fractures.
2. Minimal to nondisplaced fractures of the posterior and
anterior walls of the left maxillary sinus with extension to the
left inferior orbital rim. The inferior orbital wall on the left
appears intact.
[**1-15**] CT chest/abd/pelvis: 1. Inflammatory stranding and a small
amount of abnormal low-density fluid within the retroperitoneum
abutting the duodenum and right psoas and surrounding the IVC.
Findings are thought more likely secondary to a duodenal or
possibly venous injury. IVC, right kidney, and pancreas appear
intact. 2. Coronary artery calcifications.
[**1-15**] CT c-spine: 1. Non-displaced fracture of the left superior
articulating facet of C4 with extension into the facet joint.
2. Grade 1 anterolisthesis of C4 over C5 is age indeterminate
but could be chronic and degenerative. If there is concern for
ligamentous injury or to assess acuity of C4 superior facet
abnormality, MR of the cervical spine could be performed.
[**1-15**] CT head: No intracranial hemorrhage or cerebral edema.
[**1-17**] R knee film:1. Transversely oriented high fibular shaft
fracture, distal fibular fracture just above the level of the
ankle mortise, and transversely oriented medial malleolar
fracture. Widening of the medial ankle mortise is suggestive of
ligamentous injury. Anterior tibial plafond fracture. 2.
Additional faint lucency in the proximal tibia extending into
the medial tibial plateau could reflect the site of an
additional nondisplaced fracture; consider further evaluation
with cross-sectional imaging such as CT to further evaluate.
Ill-defined lucency on the lateral radiograph projecting over
the distal tibial metaphysis could reflect the overlying cast
material, although nondisplaced fracture in this location is
also difficult to exclude. This could also be further evaluated
with CT.
[**1-21**] MRI C-spine:1. No evidence of disruption of the ligamentous
structures or signs of unstable cervical spine injury. 2.
Degenerative changes at multiple levels with bilateral
mild-to-moderate foraminal narrowing at C5-6 level. 3. Abnormal
signal within the left articular processes and facet joint at
C3-4 level could be due to degenerative change or due to trauma.
However, in absence of associated soft tissue abnormality, this
could be more likely to be degenerative in nature.
[**1-21**] repeat CT abd/pelvis: 1. Atelectasis and effusions at the
lung bases as described above. 2. The previously seen
inflammatory change and free fluid in the upper abdomen has
resolved. The upper abdominal viscera appear intact. There is no
free fluid or free air in the abdomen or pelvis.
[**1-23**] bilat ankle films: FINDINGS: Views from the operating suite
show placement of metallic fixation device about fractures of
the distal tibia and fibula. Views of the left leg show
extensive metallic fixation about a comminuted fracture of the
proximal tibia with associated more distal fibular fracture.


Brief Hospital Course:
Patient was admitted as a trauma s/p ped struck on [**1-15**].
Intubated in ED. Head lac stapled. Nasal fx reduced. Radiology
demonstrated L comminuted, open tib/fib fx, R ankle bimalleolar
fx and R tibial plateau fx, C4 superior facet fracture (?
whether may be chronic by radiologist).  Initial ETOH level was
430.  Patient was taken to the OR with orthopedics for exfix of
LLE fractures.  Started on ancef/gent for multiple fractures.
Admitted to TSICU. Follow up MRI of C-spine revealed no unstable
fracture and C-spine was cleared by ortho-spine attending.
Opthalmology ruled out entrapment/ocular injury given orbital
injury. Taken to OR with ortho on [**1-18**] for ORIF L tib/fib.
Extubated [**1-18**]. Return to OR with ortho on [**1-23**] for repair of R
fibular fracture. Return to OR on [**1-25**] with plastic surgery for
repair of facial fractures.  Physical therapy followed with
patient and recommended rehab. Staples/sutures removed from
forehead lac. Sutures removed from facial repair by plastic
surgery. Brief delerium post-operatively resolved with haldol.
EKG benign.  Stable for discharge to rehab facility with
orthopedic/plastic surgery follow up.   DVT precautions
throughout stay. Patient is to continue lovenox for 6 months
following discharge.

Medications on Admission:
none

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day)Hold for heart rate less than 60 or systolic BP less
than 110.
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
5. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Enoxaparin 30 mg/0.3 mL Syringe Sig: 0.3 ml Subcutaneous Q12H
(every 12 hours) for 6 months.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

11. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
12. Hydromorphone 4 mg Tablet Sig: 4-6 Tablets PO Q4H (every 4
hours) as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2222**] - [**Location (un) 538**]

Discharge Diagnosis:
C4 superior facet fracture with anterolisthesis C4 on C5
Nasal bone fracture
minimally displaced fracture posterior and anterior walls of
Left maxillary sinus
Left inferior orbital rim fracture
Left comminuted fracture proximal tib/fib
Right ankle fibular fracture


Discharge Condition:
stable


Discharge Instructions:
You were treated in the hospital after being struck by a
vehicle.  You had operative repair of leg fractures and facial
fractures and were also evaluated for a neck injury.  Take all
medicines as directed.  Do not bear weight on either of your
legs until follow up appointment with the orthopedics doctors.
Please be advised that your alcohol level was dangerously high
at the time of your accident and that you should seek support in
your effort to refrain from alcohol in the future.
You should continue the Lovenox for 6 months.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] in clinic in [**1-23**] weeks
[**Telephone/Fax (1) 1228**]
Please also follow up in plastic surgery clinic in 2 weeks by
calling [**Telephone/Fax (1) 4652**] for an appointment.  Call to schedule
appointment in trauma clinic [**Telephone/Fax (1) 6429**] in [**1-23**] weeks with Dr.
[**Last Name (STitle) **].
{'Closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness,Open fracture of upper end of fibula with tibia,Closed fracture of malar and maxillary bones,Bimalleolar fracture, closed,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Other and unspecified open wound of head without mention of complication'}


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 by motor vehicle

PRESENT ILLNESS: 48 yo M pedestrian struck by vehicle at approx 40mph. No LOC.
ETOH level 430 upon admission.

MEDICAL HISTORY: Denies

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 108/73 104  13 (intubated)
Gen: (intubated)
HEENT:No TTP C-spine.  In collar.  R forehead lac.
Chest: BS bilat, no palpable crepitus or eccymoses
Abd: S/NT
Ext: LLE 7cm lac with protruding tibia prox anterior leg.
     RLE deformity/crepitus R ankle.  Compartments
swollen/somewhat firm, swelling R proximal fibula. 2+ DP pulse
bilat.
Neuro: normal rectal tone, guiaic neg.  [**4-24**] motor strength all
extrem.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: ETOH 

### Response:
{'Closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness,Open fracture of upper end of fibula with tibia,Closed fracture of malar and maxillary bones,Bimalleolar fracture, closed,Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian,Other and unspecified open wound of head without mention of complication'}
