CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient was a 32 year old
passenger on a motorcycle in a motorcycle collision versus
automobile.  The patient was thrown from the motorcycle, with
unknown loss of consciousness.  She was taken to an outside
hospital and transferred to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **]
[**Last Name (Titles) **] by [**Location (un) 7622**] with a report of multiple rib fractures,
and open left tibia-fibula.

MEDICAL HISTORY: Depression.

MEDICATION ON ADMISSION: Zoloft.

ALLERGIES: Codeine and sulfa.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Open fracture of unspecified part of fibula with tibia,Closed fracture of seven ribs,Injury to liver without mention of open wound into cavity, hematoma and contusion,Injury to spleen without mention of open wound into cavity, laceration extending into parenchyma,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Other postoperative infection,Cellulitis and abscess of leg, except foot,Closed fracture of clavicle, unspecified part,Motor vehicle traffic accident involving collision with other vehicle injuring passenger on motorcycle
Fx tibia w fib NOS-open,Fracture seven ribs-clos,Liver hematoma/contusion,Spleen parenchyma lacer,Fx dorsal vertebra-close,Other postop infection,Cellulitis of leg,Fx clavicle NOS-closed,Mv-oth veh coll-mcyc psg
Admission Date:  [**2155-7-19**]     Discharge Date:  [**2155-7-26**]

Date of Birth:   [**2123-2-27**]     Sex:  F

Service:  Trauma [**Last Name (un) **]

HISTORY OF PRESENT ILLNESS:  The patient was a 32 year old
passenger on a motorcycle in a motorcycle collision versus
automobile.  The patient was thrown from the motorcycle, with
unknown loss of consciousness.  She was taken to an outside
hospital and transferred to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **]
[**Last Name (Titles) **] by [**Location (un) 7622**] with a report of multiple rib fractures,
and open left tibia-fibula.

PAST MEDICAL HISTORY:  Depression.

MEDICATIONS ON ADMISSION:  Zoloft.

ALLERGIES:  Codeine and sulfa.

PHYSICAL EXAMINATION:  On physical examination on admission,
the patient had a temperature of 36, blood pressure 131/77,
heart rate 95 and respiratory rate 20.  General:  Patient was
on a board with a cervical spine collar; she was awake and
responsive to verbal commands.  Head, eyes, ears, nose and
throat:  Atraumatic, pupils equal, round, and reactive to
light, tympanic membranes clear bilaterally, no malocclusion
of teeth.  Neck:  Trachea midline, no crepitus.  Lungs:
Clear to auscultation bilaterally with equal breath sounds
bilaterally.  Cardiovascular:  Regular rate and rhythm,
positive chest tenderness of the left anterior chest.
Abdomen:  Soft, nontender, nondistended.  Rectal:  Positive
tone, negative guaiac.  Back:  No wounds, no step-offs.
Extremities:  Upper extremities without deformity or wounds,
left lower extremity had two irregularly shaped 1.5 cm
lacerations of the anterior chin; it was unclear if these
communicated with the bone; there was ecchymosis and
deformity of the lower leg, dorsalis pedis pulses positive
bilaterally.  Neurologic:  [**Location (un) 2611**] coma score 15.

LABORATORY DATA:  Admission white blood cell count was 16.3,
hematocrit 37.6, platelet count 374,000, INR 1.2, sodium 138,
potassium 4.1, chloride 106, bicarbonate 26, BUN 13 and
creatinine 0.7.  Toxicology screen was positive for opiates.
The first blood gas was suspected to be venous with a pH of
7.26, pCO2 56, pO2 46, bicarbonate 26 and base deficit
negative two; blood gas number two, pH 7.37, pCO2 38, pO2
132, bicarbonate 23 and base deficit negative two.

RADIOLOGIC DATA:  Chest x-ray was negative.  Chest CT scan
showed a left first rib fracture and rib fractures in the
left ribs three through eight, also a left mid-clavicular
fracture.  Head CT scan was negative.  Abdominal CT scan
showed a liver contusion and a grade I splenic laceration.
Cervical spine CT scan showed transverse process fracture on
the right at T1.

HOSPITAL COURSE:  The patient was taken from the Emergency
Room to the Operating Room for repair of the left leg tib-fib
fracture.  The patient was then transferred to the CRSU for
observation over time due to her splenic laceration and liver
contusion.

The patient was followed with serial hematocrit checks given
her splenic injury.  The patient made slow gradual
improvement during her hospital course.  She was eventually
transferred to the floor.  Her hematocrit stabilized and she
was evaluated by physical and occupational therapy for
mobility and activities of daily living given her leg
fracture and clavicle fracture.

The patient gradually progressed with the use of a walker.
The patient was given a sling for use for comfort with her
clavicle fracture, but generally found that she did not need
it.  The [**Hospital 228**] hospital course was otherwise without
complications.

DISCHARGE DIAGNOSES:
1.  Left clavicle fracture.
2.  Fractures of left ribs number one, three, four, five,
six, seven and eight.
3.  Fracture of left tibia and fibula.
4.  Liver contusion.
5.  Grade I splenic laceration.

DISCHARGE PLAN:  The plan is to discharge home upon physical
therapy and occupational therapy clearance for safety for
living at home.  Discharge is anticipated on [**7-26**] or 4,
[**2154**].

DISCHARGE MEDICATIONS:
Percocet one to two tablets p.o.q.4-6h.p.r.n. pain.

FOLLOW-UP PLAN:  The patient should follow up with the
[**Hospital **] Clinic and the Trauma Clinic.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 11889**]

Dictated By:[**Name8 (MD) 29946**]

MEDQUIST36

D:  [**2155-7-26**]  10:33
T:  [**2155-8-2**]  14:18
JOB#:  [**Job Number **]


Name:  [**Known lastname 2109**], [**Known firstname 850**]                    Unit No:  [**Numeric Identifier 8077**]

Admission Date:  [**2155-7-19**]     Discharge Date: [**2155-7-30**]

Date of Birth:   [**2123-2-27**]     Sex:  F

Service:  Trauma [**Last Name (un) **]

ANTICIPATED DISCHARGE DATE: [**2155-7-31**]

DISCHARGE SUMMARY ADDENDUM:

HOSPITAL COURSE UPDATE:  On hospital day nine, postoperative
day eight the patient developed fracture blisters over her
left anterior lower leg at the operative site from her Open
reduction internal fixation from tib fib fracture. The
patient was evaluated by Orthopedics and the Trauma team and
was started on IV Cefzil for prophylaxis of cellulitis
developing at the wound site. The patient had her leg
elevated and was observed for 48 hours during which time the
leg wound did not appear to improve appreciably and a
Plastics consult was ordered on hospital day eleven.

The patient was switched to po antibiotics with Keflex 500 mg
qid in anticipation of being sent home. The patient would not
have the ability to have IV antibiotic treatment at home due
to lack of insurance.

The plan pending Plastics consultation will be to discharge
home with plan for dressing changes performed by family,
Lovenox injections performed by patient and family and with
the patient planning to observe the wound closely and return
immediately if the would should begin to appear worse. The
patient should also follow up in four to five days with the
Trauma clinic or the [**Hospital 8078**] clinic as determined before
she is ready to leave. She will be sent home on seven days of
Keflex 500 mg po qid as well as Lovenox injections.

The patient understands that if she is discharged home at
this time it is with orders for strict bed rest. She will
need family members to care for her at this time. It is
understood her children will stay with their father in a
separate house until she is recovered enough to take care of
them. They are not to be there under her care at this point
in her recovery. The patient is aware of this and understands
fully. The patient will not have further Physical Therapy
evaluation before discharge since the plan is for her to be
on strict bed rest at home.





                          [**First Name11 (Name Pattern1) 1080**] [**Last Name (NamePattern4) 3711**], M.D.  [**MD Number(1) 3712**]

Dictated By:[**Last Name (NamePattern1) 8079**]

MEDQUIST36

D:  [**2155-7-30**]  09:14
T:  [**2155-8-4**]  08:54
JOB#:  [**Job Number 8080**]


Name:  [**Known lastname 2109**], [**Known firstname 850**]                    Unit No:  [**Numeric Identifier 8077**]

Admission Date:  [**2155-7-19**]     Discharge Date:  [**2155-8-22**]

Date of Birth:   [**2123-2-27**]     Sex:  F

Service:  ORTHO [**Doctor First Name 1379**]
The left distal tibia had granulation tissue surrounded by
full-thickness scar in the region of the pretibial fracture
site.

The patient was placed on Silvadene dressings.  There were
Cultures, however, came back negative.  The patient had been
treated with oral Levaquin.  Despite these attempts, the
patient developed erythematous skin around the wound.  It was
decided to bring the patient back to the operating room for
open irrigation and debridement of the area.  This was done
on [**Month (only) **] 15ht, [**2154**].  Surgeon was Dr. [**First Name8 (NamePattern2) 8081**] [**Last Name (NamePattern1) 8082**].  At the
end of the surgery, split-thickness VAC dressing was applied
It was decided that the patient will need to go back to the
operating room in a few days for further evaluation of the
soft tissue and the skin underlying to VAC dressing.  Further
debridement is necessary.  During this operation,
Dr.  [**Last Name (STitle) 2023**] from the Department of Plastic Surgery was
contact[**Name (NI) **] for an intraoperative consultation.  Upon viewing
the debrided area, he agreed to have a free flap applied to
affected area after debridement

The patient tolerated the procedure well.  In three days on
[**2155-8-10**] the patient returned to the operating room.
This time, the patient had a more extensive debridement with
complete resection of the eschar.  The patient had excellent
granulation tissue.  There was no evidence of infection
around the fracture.  The patient also had bone debrided to
the viable bleeding.  Dr. [**Last Name (STitle) 8083**], from the Plastic Department
inspected the wound and decided that the patient should
follow up with the Plastic Surgery Department.  The patient
tolerated this procedure well.  Three days later she went to
the last surgery on [**2155-8-13**].  The patient underwent
free gracilis muscle transfer to open wound on left leg with
split-thickness skin graft, transferred from the left thigh.
The oeration was done by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5111**].  The patient was
transferred to the Medical/Surgical floor.  After surgery,
the patient was started on IV Vancomyucin from [**8-13**].
This needed to be continued for the next six weeks from the
day of this last surgery.  Very close attention was pain to
the graft area.  Pulses were assessed several times a day and
found to be present.  Donor site on the left thigh has a
Xeroform patch on it.  This area needs to stay dried and open
to the air.  The patient was mobilized out of bed to chair.
The patient continued to be nonweightbearing on the left.  IV
antibiotics were given through a central line.

The patient had a neurological consultation for her
longstanding migraine headaches.  The patient was prescribed
Fioricet with good improvement in headaches.

MEDICATIONS ON DISCHARGE:
1.  Enteric coated aspirin 325 mg PO q.d.
2.  Bisacodyl 10 mg PO or p.r./q.d.p.r.n.
3.  Docusate sodium 100 mg PO b.i.d.
4.  Droperidol 0.625 mg IV q.6h.p.r.n.
5.  Folic acid 1 mg PO q.d.
6.  Heparin flush 200 units VP p.r.n.q.d.
7.  Heparin sodium 5000 units every 12 hours subcutaneously.
8.  Iron complex polysaccharide 150 mg PO q.d.
9. Milk of Magnesia 30 ml PO q.6h.p.r.n.  10. Ondansetron 4 mg
IV q.6h.
11. Oxycodone 20 mg PO q.12h.
12. Oxycodone 5 mg PO q. 3h. to 4h.p.r.n.
13. Pantoprazole 40 mg PO q.24h.
14. Sertraline 100 mg PO q.d.
15. Acetaminophen.
16. Butalbital caffeine one tablet PO q.4h. to 6h.p.r.m.
migraine headaches.
17. Vancomycin 1.25 g IV q.12h
DISCHARGE DIAGNOSES:
1.  Status post free gracilis muscle transfer to open wound,
left leg, [**2155-8-13**].
2.  [**2155-8-10**] irrigation and debridement of infected
wound and VAC dressing application.
3.  [**2155-8-7**], irrigation and debridement of eschar of
skin and debridement of the bone.
4.  Left leg fracture.
5.  Fractures of the left ribs, 1, 3, 4, 5, 6, 7, and 8.
6.  Fracture of the left tibia and fibula.
7.  Liver contusion.
8.  Splenic laceration status post motorcycle versus motor
vehicle accident on [**2155-7-19**].

DISCHARGE PLAN:  The patient is being reviewed by the
rehabilitation facillities.  The patient is expected to be
discharged in the next few days.

CONDITION ON DISCHARGE:  Stable.

The patient is nonweightbearing on the left leg.


FOLLOW-UP PLAN:  The patient should follow up in seven days
to ten days with the [**Hospital 4504**] Clinic, Dr. [**First Name8 (NamePattern2) 8081**] [**Last Name (NamePattern1) 8082**] and
with the Department of Plastic Surgery, Dr. [**Last Name (STitle) 5111**].




                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 8084**]

Dictated By:[**Last Name (NamePattern1) 8085**]



MEDQUIST36

D:  [**2155-8-22**]  15:21
T:  [**2155-8-22**]  16:01
JOB#:  [**Job Number 8086**]



Name:  [**Known lastname 2109**], [**Known firstname 850**]                    Unit No:  [**Numeric Identifier 8077**]

Admission Date:  [**2155-7-19**]       Discharge Date:  [**2155-8-28**]

Date of Birth:   [**2123-2-27**]       Sex:  F

Service:  Ortho [**Doctor First Name **]

Stat addendum

The patient was seen by infectious disease fellow.  They
decided to continue vancomycin therapy for six weeks from
date of debridement, [**2155-8-7**] for another four weeks
from the time of this dictation.  Please check peak and
trough with a goal for trough between 10 and 15, should be
checked one hour before vancomycin dose.  Vancomycin dose
currently 1.25 gm.  If trough dose is above 15, please
decrease the dose back to 1 gm.  The patient has a follow up
appointment in Infectious Disease Clinic, [**Doctor Last Name **] Six
Building, [**Hospital6 2003**], on [**9-16**], at 11 a.m.  Infectious disease suggested a repeat ESR
and if it is still elevated, repeat imaging.  This should be
done at the end of antibiotic therapy.

The patient was evaluated by hematology for work up of
anemia.  They felt that etiology of anemia was
multifactorial, related to chronic inflammatory disease,
blood loss and a follow up appointment with hematology should
be made in six to eight weeks.

The patient's wounds graft site and derm site look well.  It
was recommended by Plastics to gradually increase activity to
dependent position up to 10 minutes every hour for two days
and then increase slowly thereafter.  If swelling or cyanosis
occur, the patient needs to be brought back to bed and
elevated left lower extremity.  The patient will need to
follow up Plastics in one week.  Same appointment needs to be
scheduled with Orthopedics for the follow up in one week
also.




                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 8105**]

Dictated By:[**Doctor Last Name 8106**]
MEDQUIST36

D:  [**2155-8-28**]  10:54
T:  [**2155-8-28**]  11:08
JOB#:  [**Job Number 8107**]
{'Open fracture of unspecified part of fibula with tibia,Closed fracture of seven ribs,Injury to liver without mention of open wound into cavity, hematoma and contusion,Injury to spleen without mention of open wound into cavity, laceration extending into parenchyma,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Other postoperative infection,Cellulitis and abscess of leg, except foot,Closed fracture of clavicle, unspecified part,Motor vehicle traffic accident involving collision with other vehicle injuring passenger on motorcycle'}


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 was a 32 year old
passenger on a motorcycle in a motorcycle collision versus
automobile.  The patient was thrown from the motorcycle, with
unknown loss of consciousness.  She was taken to an outside
hospital and transferred to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **]
[**Last Name (Titles) **] by [**Location (un) 7622**] with a report of multiple rib fractures,
and open left tibia-fibula.

MEDICAL HISTORY: Depression.

MEDICATION ON ADMISSION: Zoloft.

ALLERGIES: Codeine and sulfa.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Open fracture of unspecified part of fibula with tibia,Closed fracture of seven ribs,Injury to liver without mention of open wound into cavity, hematoma and contusion,Injury to spleen without mention of open wound into cavity, laceration extending into parenchyma,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Other postoperative infection,Cellulitis and abscess of leg, except foot,Closed fracture of clavicle, unspecified part,Motor vehicle traffic accident involving collision with other vehicle injuring passenger on motorcycle'}
