CHIEF COMPLAINT: Motor vehicle crash

PRESENT ILLNESS: The patient is a 30 year old Female status post motor vehicle
crash in which sehe was the restreained driver.  The patient
lost control of the vehicle, struck a boulder with the drivers
front end.  The patient crawled out of the passenger side and
then to the road where she was atttended to by EMS.  She had
loss of conciousness, and was sent to [**Doctor Last Name 15594**] [**Hospital 107**] medical
center in [**Hospital1 189**] [**State 350**] and then was transferred via
[**Location (un) **] to [**Hospital1 18**].  She was hemodynamically stable on transfer,
and  a c collar and back board was placed in trauma bay.  The
initial injury reports includ liver laceration, pnuemothorax and
pulmonary contusions

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temperature 97.8, Pulse 79, blood pressure 120/72, Respirations
25, 100% on 100% non rebreather
General: alert, GCS 15, anxious
HEENT: head atraumatic, normocephalpic. pupils equal round and
reactive to light and accomodation.  No obvious nasal or
oropharyngeal injuries
Neck: C collar in place, trachea midline, neck supple
Chest: positive for abrasions in Left upper chest and above
sternum.  Left anterior deltoid ecchymosis
Back: No obvious injuries, Postiive for distal throacic upper
lumbar spine tenderness.  NO stepoffs or deformities.
Cardiac: regular rate and rhythm
Lungs: clear to auscultation bilaterally
Abdomen: soft obese, nondistended.  slightly tender in
epigastrum.  No obvious injuries, small abrasions in right upper
quadrant
Pelvis: stable
Extremities: No obvious long bone injuries.  2+ pulses
bilaterally
Rectal: normal tone, heme negative

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Married, occ alcohol
Traumatic pneumothorax without mention of open wound into thorax,Injury to liver without mention of open wound into cavity, hematoma and contusion,Closed fracture of multiple ribs, unspecified,Pneumonia, organism unspecified,Bacteremia,Acute posthemorrhagic anemia,Contusion of lung without mention of open wound into thorax,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle
Traum pneumothorax-close,Liver hematoma/contusion,Fx mult ribs NOS-closed,Pneumonia, organism NOS,Bacteremia,Ac posthemorrhag anemia,Lung contusion-closed,Oth coll stndng obj-driv
Admission Date:  [**2158-7-17**]              Discharge Date:   [**2158-7-26**]

Date of Birth:  [**2128-5-18**]             Sex:   F

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

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
Motor vehicle crash

Major Surgical or Invasive Procedure:
Bilateral chest tube placement


History of Present Illness:
The patient is a 30 year old Female status post motor vehicle
crash in which sehe was the restreained driver.  The patient
lost control of the vehicle, struck a boulder with the drivers
front end.  The patient crawled out of the passenger side and
then to the road where she was atttended to by EMS.  She had
loss of conciousness, and was sent to [**Doctor Last Name 15594**] [**Hospital 107**] medical
center in [**Hospital1 189**] [**State 350**] and then was transferred via
[**Location (un) **] to [**Hospital1 18**].  She was hemodynamically stable on transfer,
and  a c collar and back board was placed in trauma bay.  The
initial injury reports includ liver laceration, pnuemothorax and
pulmonary contusions

Past Medical History:
None

Social History:
Married, occ alcohol

Family History:
Non contributory

Physical Exam:
Temperature 97.8, Pulse 79, blood pressure 120/72, Respirations
25, 100% on 100% non rebreather
General: alert, GCS 15, anxious
HEENT: head atraumatic, normocephalpic. pupils equal round and
reactive to light and accomodation.  No obvious nasal or
oropharyngeal injuries
Neck: C collar in place, trachea midline, neck supple
Chest: positive for abrasions in Left upper chest and above
sternum.  Left anterior deltoid ecchymosis
Back: No obvious injuries, Postiive for distal throacic upper
lumbar spine tenderness.  NO stepoffs or deformities.
Cardiac: regular rate and rhythm
Lungs: clear to auscultation bilaterally
Abdomen: soft obese, nondistended.  slightly tender in
epigastrum.  No obvious injuries, small abrasions in right upper
quadrant
Pelvis: stable
Extremities: No obvious long bone injuries.  2+ pulses
bilaterally
Rectal: normal tone, heme negative

Pertinent Results:
Chest Xray [**2158-7-17**]:
Comparison is made to a prior study from the previous day. There
has been interval placement of a right sided subclavian central
venous line. Distal tip of this catheter is positioned crossing
the midline with its tip in the region of the proximal left
subclavian vein. An endotracheal tube is in satisfactory
position 4 cm above the carina. Bilateral chest tubes are in
place with their tips near the lung apices. There is widening of
the mediastinum consistent with the patient's known history of
mediastinal hematoma. Pulmonary parenchymal opacity within both
lungs is unchanged consistent with the patient's known bilateral
pulmonary contusions. Multiple right sided lower rib fractures
are present and appear unchanged when compared to the prior
study. There is no evidence of large pneumothorax. An NG tube is
in position with its distal tip within the mid stomach. Excreted
contrast is present within both renal collecting systems.

IMPRESSION:
1) Right sided subclavian line with its distal tip crossing the
midline into the proximal left subclavian vein. This finding was
called to the surgical team caring for this patient shortly
after interpretation.

2) Widening of the mediastinum consistent with the patient's
known mediastinal hematoma, multiple right sided rib fractures
with associated opacites in both lungs consistent with pulmonary
contusion.

[**2158-7-17**]:
LEFT SHOULDER, THREE VIEWS.

No fracture is detected involving the left proximal humerus or
scapula. Visualized portion of distal clavicle and the AC joint
are within normal limits. On the Y view obtained, it is
difficult to exclude some posterior subluxation of the humeral
head, though I suspect this is positional rather than real. If
clinically indicated, a repeat Y view could be obtained at no
additional charge to the patient.

[**2158-7-17**]: AORTOGRAM, mesenteric angiogram:
The thoracic aorta appears normal, without evidence of acute
injuries. The arch vessels are also normal. Selective abdominal
arteriogram reveals a replaced right hepatic artery from the
superior mesenteric artery. No lacerated liver vessels are
present. There are several areas within the liver that
demonstrate an unusual blush on late arterial phase imaging.
This may be due to liver contusion.

CT abdomen [**2158-7-17**]:
IMPRESSION:
1) New small amount of perisplenic fluid, without evidence of
identifiable splenic lacerations, contusions or active bleeding.
This finding may represent splenic laceration that was not
apparent on the initial exam.

2) Small right-sided pneumothorax which appears to have slightly
increased in size since the previous exam.

3) Evolving hepatic contusions, not significantly changed from
previous exam.

CT Head [**2158-7-17**]:
There is no intraparenchymal or extra-axial hemorrhage. There is
no shift of normally midline structures, mass effect or
hyrocephalus. The ventricles, sulci and cisterns are within
normal limits. The density values of the brain parenchyma are
unremarkable. The visualized paranasal sinuses and osseous
structures are unremarkable.


Brief Hospital Course:
The patient was intubated electively for airway protection, and
bilateral chest tubes were placed for bilateral pneumothoraces.
She was sent to teh IR angiography suite to rule out aortic
injury per the cardiothoracic surgery consult service.  She had
serial hematocrits, and was weaned to extubate after being
admitted to the trauma surgical intensive care unit.  A thoracic
epidural was placed on Juy 27th for pain management.  Her left
chest tube was removed on [**7-19**] after resolving of the
pneumothorax.  She was also started on niferex for blood loss
anemia, however her hematocrit remained stable (22.7) and she
remained hemodynamically stable.  Her central ine was removed on
hospital day 5.  On hospital day 6 the patient began having
fevers.  Eventual blood cultures grew out methicillin sensitive
staph aureus, and the patient had some infiltrate on chest xray,
and she was started on levofloxacin for a 2 week course.  The
epidural was removed on [**7-22**].  Her right chest tube was
removed on [**7-24**] (hospital day 8) and a post procedure xray
demonstrated resolved pneumothroraces.  She was tolerating
regular food, her pain was well controlled on an oral regimen,
she had a bowel movement, and was in stable condition be
discharged to home.  The patient still had some rib pain, but
was ambulating well without shortness of breath on discharge

Medications on Admission:
None

Discharge Medications:
1. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO BID (2 times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours).
Disp:*180 Tablet(s)* Refills:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: Two (2) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*1*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
6. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
1.  bilateral pneumothoraces
2.  bilateral pulmonary contusions
3.  multiple liver contustions
4.  Multiple rib fractures
5.  Bacteremia
6.  pneumonia
7.  status post motor vehicle crash
8.  Blood loss anemia
9.  Respiratory failure requiring intubation
10.  mediastinal hematoma


Discharge Condition:
Good

Discharge Instructions:
Please [**Name8 (MD) **] MD [**First Name (Titles) 151**] [**Last Name (Titles) 152**] fevers, inability to tolerate food,
increase in abdominal pain, severe weakness or dizziness,
increasing shortness of breath.

You can resume your regular diet.

Please resume taking any medications you were taking prior to
your admission

Followup Instructions:
Follow-up in the trauma clinic with Dr. [**Last Name (STitle) **] on [**2158-8-8**]
@ 1pm.
The clinic is located on the [**Location (un) 470**] of the [**Hospital Unit Name **] in
dept 3A on [**Last Name (NamePattern1) 439**] in the [**Hospital1 1426**]


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]
{'Traumatic pneumothorax without mention of open wound into thorax,Injury to liver without mention of open wound into cavity, hematoma and contusion,Closed fracture of multiple ribs, unspecified,Pneumonia, organism unspecified,Bacteremia,Acute posthemorrhagic anemia,Contusion of lung without mention of open wound into thorax,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than 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: Motor vehicle crash

PRESENT ILLNESS: The patient is a 30 year old Female status post motor vehicle
crash in which sehe was the restreained driver.  The patient
lost control of the vehicle, struck a boulder with the drivers
front end.  The patient crawled out of the passenger side and
then to the road where she was atttended to by EMS.  She had
loss of conciousness, and was sent to [**Doctor Last Name 15594**] [**Hospital 107**] medical
center in [**Hospital1 189**] [**State 350**] and then was transferred via
[**Location (un) **] to [**Hospital1 18**].  She was hemodynamically stable on transfer,
and  a c collar and back board was placed in trauma bay.  The
initial injury reports includ liver laceration, pnuemothorax and
pulmonary contusions

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temperature 97.8, Pulse 79, blood pressure 120/72, Respirations
25, 100% on 100% non rebreather
General: alert, GCS 15, anxious
HEENT: head atraumatic, normocephalpic. pupils equal round and
reactive to light and accomodation.  No obvious nasal or
oropharyngeal injuries
Neck: C collar in place, trachea midline, neck supple
Chest: positive for abrasions in Left upper chest and above
sternum.  Left anterior deltoid ecchymosis
Back: No obvious injuries, Postiive for distal throacic upper
lumbar spine tenderness.  NO stepoffs or deformities.
Cardiac: regular rate and rhythm
Lungs: clear to auscultation bilaterally
Abdomen: soft obese, nondistended.  slightly tender in
epigastrum.  No obvious injuries, small abrasions in right upper
quadrant
Pelvis: stable
Extremities: No obvious long bone injuries.  2+ pulses
bilaterally
Rectal: normal tone, heme negative

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Married, occ alcohol 

### Response:
{'Traumatic pneumothorax without mention of open wound into thorax,Injury to liver without mention of open wound into cavity, hematoma and contusion,Closed fracture of multiple ribs, unspecified,Pneumonia, organism unspecified,Bacteremia,Acute posthemorrhagic anemia,Contusion of lung without mention of open wound into thorax,Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle'}
