Model: nishut/setfit-all-mpnet-189b_189g_v3
Author: nishut
Pipeline: text-classification
Library: setfit
Tags: setfit, pytorch, mpnet, sentence-transformers, text-classification, generated_from_setfit_trainer, arxiv:2209.11055, base_model:sentence-transformers/all-mpnet-base-v2, base_model:finetune:sentence-transformers/all-mpnet-base-v2, region:us
Base models (finetune): id: sentence-transformers/all-mpnet-base-v2
Card metadata: library_name: setfit
tags: setfit, sentence-transformers, text-classification, generated_from_setfit_trainer
metrics: accuracy
widget: ed_course section: 
 11/24/23 1442    Fri Nov 24, 2023     1050 X rays of the right hand independently reviewed and are negative for acute fracture          Clinical Impressions as of 11/24/23  1442    Crushing injury of finger, initial encounter    Subungual hematoma of digit of hand, initial encounter
Disposition: Discharge

10 year old male presented with a crush injury between the door hinge in the garage.  Sustained injuries to the tips of the 3rd  and 4th fingers on the right hand.  Patient was soft tissue swelling noted on exam with small subungual hematoma on the 3rd nail.  No obvious bony abnormalities noted.  Neurovascularly intact without any open wounds.  Has an obvious bruise adjacent to  the lateral nail fold of the 3rd finger.  X rays of the right hand independently reviewed and are negative.  Radiation interpretation is in agreement.  A cage splint was applied over the 3rd finger given that this is the most prominent pain source.  Will  continue rest, ice, immobilization, splint for protection and NSAIDs at home.  No evidence of acute fracture, dislocation, laceration, or intra articular injury.  Possible underlying osseous contusion.  Supportive care discussed with his parents.

After my initial evaluation, the patient requires testing, treatment
and/or serial reevaluations to rule in or out the need for admission or emergency surgery.

I reviewed Outside records: none

I independently interpreted the following studies: diagnostic imaging

I spoke with a family member, healthcare worker, or other source to obtain history: no

I spoke with these other providers/staff about patient management: None

This patient has these chronic conditions that will impact their recovery and risk of serious illness: none

The following social determinants of health directly affected my ability to evaluate or manage this patient: none

Drug Therapies: I instructed the patient to obtain over the counter drugs.

Amount and/or Complexity of Data Reviewed
Independent Historian: parent
Radiology: ordered and independent interpretation performed. Decision making details documented in EMERGENCY DEPARTMENT Course.

Risk
OTC drugs.







No data recorded

ed_diagnosis section: 
None
physical examination section: 

EMERGENCY DEPARTMENT Triage Vitals [11/24/23 1021]       Temperature Heart Rate Resp BLOOD PRESSURE  36.4 °C (97.5 °F) 100 24 (!) 126/69           SpO2 Temp Source Heart Rate/Pulse Source Patient Position  91 % Oral                 BLOOD PRESSURE Location FiO2 (%)

Vitals and nursing note reviewed.
Constitutional:
General: He is active.
Appearance: Normal appearance. He is well developed.
HENT:
Head: Normocephalic and atraumatic.
Eyes:
Extraocular Movements: Extraocular movements intact.
Pupils: Pupils are equal, round, and reactive to light.
Cardiovascular:
Pulses: Normal pulses.
Pulmonary:
Effort: Pulmonary effort is normal.
Musculoskeletal:
General: Swelling and tenderness  present. No deformity. Normal range of motion.
Cervical back: Normal range of motion.
Comments: Soft tissue swelling noted to the tips of the right 3rd and 4th fingers along the distal phalanx.  There is a less than 5% subungual hematoma to the 3rd fingernail.  No open wounds noted.   No active bleeding.  Mild bruising noted to the medial nail fold of the right 3rd finger.  Tenderness across the distal phalanx of the 3rd and 4th finger more prominently in the 3rd finger.  Range of motion is intact with normal flexion and extension.   Normal sensory exam.  No foreign bodies noted.  No obvious bony deformity.
Skin:
General: Skin is warm and dry.
Capillary Refill: Capillary refill takes less than 2 seconds.
Neurological:
Mental Status: He is alert and oriented for age.



EMERGENCY DEPARTMENT Course  MDM

History of present illness section: 

History reviewed. No pertinent past medical history.

Past Surgical History:      Procedure Laterality Date       • TONSILLECTOMY

No family history on file.

Tobacco Use      • Smoking status: Never      • Smokeless tobacco: Never

Procedure: 
None
Review of System: 

Musculoskeletal:  Positive for myalgias.
Skin:  Positive for color change. Negative for wound.
Neurological:  Negative for weakness and numbness.

.
Lab Results: 
None
Medications: 
    ibuprofen (ADVIL,MOTRIN) 100 mg/5 mL suspension 400 mg (400 mg oral Given 11/24/23 1033)

Results:
Labs Reviewed   No data to display
X ray hand 3+ views right    EMERGENCY DEPARTMENT Interpretation  Neg
BMU    Final Result  No acute osseous findings.
No orders to display



Follow Up:
Lisa Samuelson, MD
400 McCaslin
Louisville CO 80027
303 666 7337





EMERGENCY DEPARTMENT Discharge Orders (From admission,  onward)
None



Electronically signed by

Brandon Uttley, PA C
11/24/23 1445


bmk


, ed_course section: 
38 year old female with uncontrolled pain to her right ankle status post ORIF.  Patient had extensive workup as an outpatient  recently with ultrasound performed.  On exam there is no evidence of wound infection, DVT, compartment syndrome, arterial occlusion, abscess or any other acute findings.  Suspect this is pain related to her recent surgical repair by Dr. Leland.  Small  course of pain medication was given along with muscle relaxers as she has excellent follow up on Tuesday with Orthopedics.  Cast padding and Ace wrap was reapplied along with her 3 way splint.  Neurovascularly intact pre and post splint application.   No indication clinically for any imaging or other diagnostics at this time.

After my initial evaluation, the patient requires testing, treatment
and/or serial reevaluations to rule in or out the need for admission or emergency surgery.

I reviewed Outside records: PDMP and last admission

I independently interpreted the following studies: none

I spoke with a family member, healthcare worker, or other source to obtain history: no

I spoke with these other providers/staff about patient management: None

This patient has these chronic conditions that will impact their recovery and risk of serious illness: psychiatric disease

The following social determinants of health directly affected my ability to evaluate or manage this patient: none

Drug Therapies: I instructed the patient to obtain over the counter drugs. and I initiated or managed prescription drugs.

Amount and/or Complexity of Data Reviewed
External Data Reviewed: radiology and notes.

Risk
OTC drugs.
Prescription drug management.







No data recorded

ed_diagnosis section: 
None
physical examination section: 

EMERGENCY DEPARTMENT Triage Vitals [06/09/23 0919]       Temperature Heart Rate Resp BLOOD PRESSURE       36.8 °C (98.3 °F) 91 16 103/76           SpO2 Temp Source Heart Rate/Pulse Source Patient Position  92 % Oral    Sitting           BLOOD PRESSURE Location FiO2 (%)         Right arm

Vitals and nursing note reviewed.
Constitutional:
General: She is not in acute distress.
Appearance: Normal appearance. She is well developed. She is not ill appearing.
HENT:
Head: Normocephalic and atraumatic.
Eyes:
Conjunctiva/sclera: Conjunctivae normal.
Cardiovascular:
Rate and Rhythm: Normal rate and regular rhythm.
Pulses: Normal pulses.
Heart sounds: No murmur heard.
Pulmonary:
Effort: Pulmonary effort is normal. No respiratory distress.
Breath sounds: Normal breath sounds.
Musculoskeletal:
General: Swelling and tenderness  present. No deformity.
Cervical back: Normal range of motion and neck supple.
Comments: Incision to the medial right ankle noted without wound dehiscence.  Sutures are clean dry and intact without discharge.  There is no erythema, induration or fluctuance.  Bruising around  the ankle noted with swelling into the foot.  There is bruising to the lateral lower calf.  No palpable venous cords.  Sensory exam diminished to the entirety of the foot however intact to the lower leg.  No edema to the calf.  No adductor canal tenderness.   2+ DP and POSTERIOR TIBIAL pulses are intact.  Good capillary refill less than 2 seconds.  Able to wiggle toes.  Full range motion of the knee intact.  Limited range of motion of the ankle.  No obvious joint effusion or increased warmth across the right ankle joint
Skin:
General: Skin is warm and dry.
Capillary Refill: Capillary refill takes less than 2 seconds.
Neurological:
General: No focal deficit present.
Mental Status: She is alert and oriented to person, place, and time. Mental status is at baseline.
Psychiatric:
Mood and Affect: Mood normal.


EMERGENCY DEPARTMENT Course  MDM

Clinical Impressions as of 06/09/23  1651    Postoperative pain    Acute right ankle pain
Disposition: Discharge

History of present illness section: 

Chief Complaint    Patient presents with     • Ankle Pain        Posterior Tibial BIBA with c/o 9/10 pain in her right ankle.  Posterior Tibial fractured ankle 3 weeks ago, requiring surgical fixation, and was sent home with a splinted leg and  crutches.  She reports running out of oxy 1 week ago.  Has been taking tylenol, ibuprofen, and RICE without relief.  States she has been putting more weight on the leg than she is supposed to and thinks that is making the pain worse.

38 year old female postoperative day 4 from ORIF right ankle trimalleolar fracture with repair by Dr. Leland presents  to the emergency department with continuation of pain.  Patient states that her pain has not been well managed at home.  She is been nonweightbearing with crutches however states that the pain is intense and not well controlled with OTC meds.  She ran  out of her oxycodone that was prescribed to her on her surgical day on Monday.  Patient had an ultrasound performed 4 days ago which was negative.  She denies any fevers, chills but does endorse increasing swelling to the foot and ankle causing numbness.   This has been present since she had a fall and tripped over her dog on 05/19.  No prior history of DVT.  Denies any chest pain, shortness of breath, fevers, chills or notable discharge from the wound.  Has a follow up next Tuesday with Dr. Leland.  States  that her foot has been swollen and numb since the injury occurred in May.  Pain is sharp and constant with radiation up the leg.



Past Medical History:     Diagnosis Date      • Anxiety       • Anxiety attack

Past Surgical History:      Procedure Laterality Date       • ABDOMINAL SURGERY    • CESAREAN SECTION, LOW TRANSVERSE    • FRACTURE SURGERY         • HERNIA REPAIR

Family History    Family history unknown: Yes

Tobacco Use      • Smoking status: Every Day         Packs/day: 0.50    Years: 19.00    Pack years: 9.50    Types: Cigarettes      • Smokeless tobacco: Never    Vaping Use      • Vaping Use: Never used    Substance Use Topics      • Alcohol use: Yes         Alcohol/week: 28.0 standard drinks    Types: 28 Cans of beer per week        Comment: 3 4 tall boys/day      • Drug use: Not Currently

Procedure: 
None
Review of System: 

Constitutional:  Negative for fever.
Respiratory:  Negative for shortness of breath.
Cardiovascular:  Negative for chest pain.
Musculoskeletal:  Positive for arthralgias and joint swelling .
Skin:  Positive for wound.
Neurological:  Positive for numbness. Negative for weakness.
Hematological:  Does not bruise/bleed easily.
.
Lab Results: 
None
Medications: 
   No data to display

Results:
Labs Reviewed   No data to display
No orders to display
No orders to display



Follow Up:
No follow up provider specified.

EMERGENCY DEPARTMENT Discharge Orders (From admission,  onward)
Start Ordered     Status Ordering User           06/09/23 0000 06/09/23 0954  methocarbamoL (ROBAXIN) 500 mg tablet  4 times daily PRN

Ordered UTTLEY, BRANDON           06/09/23 0000 06/09/23 0954  oxyCODONE acetaminophen (PERCOCET) 5 325 mg per tablet  Every 6 hours PRN

Ordered UTTLEY, BRANDON



Electronically signed by

Brandon Uttley, PA C
06/09/23 1652


bmk


, ed_course section: 
Amount  and/or Complexity of Data Reviewed
Radiology: ordered and independent interpretation performed. Decision making details documented in EMERGENCY DEPARTMENT Course.

Risk
Prescription drug management.


Vital signs reviewed and stable upon arrival
Left foot x ray ordered

No signs of neurovascular compromise/tenting of skin/compartment syndrome/extremities and joints examined above and below area of concern and are neurovascularly intact.


Left foot x ray my read via PAC shows no fracture, no dislocation

Placed in Sampson boot, podiatry follow up


Clinical Impressions as of 09/18/23  1612    Foot injury, left, initial encounter
ed_diagnosis section: 
1. Foot injury, left, initial encounter
physical examination section: 
Vitals:      09/15/23 2244     BLOOD PRESSURE: 147/87  Pulse: 108  Resp: 18  Temp: 36.8 °C (98.2 °F)  TempSrc: Tympanic  SpO2: 95%  Weight: 113 kg (250 lb)     Height: 1.829 m (6)


Vital signs reviewed and triage nurse notes reviewed
General Appearance/VS:  awake, alert, non toxic, no distress, polite and cooperative teenage female
Eyes: EOMI, no icterus
ENT: moist mucous membranes, nares patent
Lungs:  Symmetric with no chest wall rise, no respiratory distress, no tachypnea
CARDIOVASCULAR: no pedal edema, good capillary refill, tachycardia
GASTROINTESTINAL: no abdominal distention, no wincing upon palpation
Musculoskeletal: 2/2 pedal pulses, strength 5/5, left foot tenderness at the base of the 5th metatarsal with bruising.  DIP/MTP flexion/extension intact with good light touch sensation. no deformities, no clubbing, no cyanosis, no edema.  Compartments  are soft.
Left Ankle: Plantar flexion to 50°, dorsiflexion to 20°.  Foot inversion to 35 degree.  No tenderness/swelling Anterior talofibular ligament.  No tenderness/swelling Calcaneofibular ligament, no tenderness/swelling posterior talofibular ligament,  no tenderness/swelling posterior inferior tibiofibular ligament. Achilles tendon intact.  Plantar flexion and dorsiflexion intact.
Neuro: normal speech, 5/5 strength throughout, ambulatory without deficits
Psych: normal mood/affect
Skin: pink, no rash on exposed skin, good capillary refill

History of present illness section: 

Patient is a 19 year old female who presents via walk in with left lateral aspect of left foot at the base of her left little toe pain and bruising.  She is requesting x ray.  Patient states that she "banged" her foot into a metal shoe rack.  Was not  wearing shoes.  Worked all day serving food and had increased pain.

Acuity:  Acute
Severity:  4/10
Modifying Factors:  Supportive measures with transient relief

Signs and Symptoms:  No bleeding, no radiation, no numbness, no weakness, no tingling, no incontinence, no decreased range of motion, no swelling, + pain, no fever


Past Medical History:     Diagnosis Date      • Bipolar disorder (CMS/HCC)

Past Surgical History:      Procedure Laterality Date       • TONSILLECTOMY         • WISDOM TOOTH EXTRACTION

Socioeconomic History      • Marital status: Single         Spouse name: None      • Number of children: None  • Years of education: None  • Highest education level: None    Occupational History     • None    Tobacco Use      • Smoking status: Never  • Smokeless tobacco: Never    Substance and Sexual Activity      • Alcohol use: None        Comment: occasional      • Drug use: Yes         Types: Marijuana      • Sexual activity: None     Other Topics Concern     • None    Social History Narrative     • None
Social Determinants of Health
Financial Resource Strain: Not on file  Food Insecurity: Not on file  Transportation Needs: Not on file  Physical Activity: Not on file  Stress: Not on file  Social Connections: Not on file  Intimate Partner Violence: Not on file    Housing Stability: Not on file


Family History:No family history on file.

Allergies:Patient has no known allergies.




Procedure: 


Review of System: 
None
Lab Results: 
Labs Reviewed   No data to display



Medications: 
XR foot left 3+ views    Final Result  Negative. No acute fracture.



   No data to display



This Chart was Electronically Signed by Stephen MacDade, MD




EMERGENCY DEPARTMENT Prescriptions   None

This patient was seen under the supervision of my secondary supervising physician.  I evaluated and cared for this patient independently.


Terra Rudd, PA C
09/15/23 2349


Stephen MacDade, MD
09/18/23 1612


bmk


, ed_course section: 
 01/13/23 1651    Fri Jan 13, 2023     1648 X ray: Reviewed by myself.  No fracture.          Clinical Impressions as of 01/13/23  1651    Sprain of right ankle, initial encounter
Disposition: Data Unavailable

MDM

ed_diagnosis section: 
None
physical examination section: 

EMERGENCY DEPARTMENT Triage Vitals [01/13/23 1556]       Temperature Heart Rate Resp BLOOD PRESSURE  36.7 °C (98.1 °F) 75 20 (!) 153/97           SpO2 Temp src Heart Rate/Pulse Source Patient Position  99 %       Sitting           BLOOD PRESSURE Location FiO2 (%)         Right arm

Vitals and nursing note reviewed. Constitutional:
General: She is not in acute distress.   Appearance: Normal appearance.    Comments: Alert, oriented x3, able to describe the events.  HENT :
Head: Normocephalic and atraumatic.  Musculoskeletal:
General: Swelling and tenderness  present. Normal range of motion.    Comments: Significant swelling over the right lateral malleoli as well as slightly anterior.  No discomfort at the fibular head.  No discomfort or tenderness  at the head of the 5th metatarsal.  Dorsalis pedis and posterior tibial pulses are intact.
Neurological:
Mental Status: She is alert.


EMERGENCY DEPARTMENT Course  MDM


History of present illness section: 

Past Medical History:     Diagnosis Date      • Depression   • Dermatitis   • Developmental delay   • Hyperlipidemia   • Obesity       • Seizures (CMS/HCC)

Past Surgical History:      Procedure Laterality Date       • BREAST BIOPSY Right 2019

No family history on file.

Tobacco Use      • Smoking status: Never  • Smokeless tobacco: Never    Vaping Use      • Vaping Use: Never used    Substance Use Topics      • Alcohol use: Never      • Drug use: Never

Procedure: 
None
Review of System: 

Unable to perform ROS: Other  (History of developmental delay.)
Constitutional: Negative for chills and fever.
HENT: Negative for congestion, rhinorrhea and sore throat.
Eyes: Negative for pain and visual disturbance.
Respiratory: Negative for cough and shortness of breath.
Cardiovascular: Negative for chest pain and palpitations.
Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting.
Genitourinary: Negative for dysuria, hematuria and vaginal discharge.
Skin: Negative for color change and rash.
Neurological: Negative for dizziness, seizures, syncope, light headedness and headaches.
All other systems reviewed and are negative.

.
Lab Results: 
None
Medications: 
   No data to display

Results:
Labs Reviewed   No data to display
XR ankle right 3+ views    Final Result  1. Negative. No acute fracture or ankle arthropathy.  2. Chronic Achilles tendinopathy with dystrophic calcification and enthesophyte formation.
No orders to display



Follow Up:
No follow up provider specified.

EMERGENCY DEPARTMENT Discharge Orders  (From admission, onward)      None


Electronically signed by

Kim Feldhaus, MD
01/13/23 1651


bmk


, ed_course section: 

Clinical Impressions as of 03/16/23  0857    Non recurrent acute serous otitis media of right ear    Viral URI
No data recorded

MDM/DISCUSSION:

ed_diagnosis section: 
1. Non recurrent acute serous otitis media of right ear      2. Viral URI

Disposition: Discharge


physical examination section: 

EMERGENCY DEPARTMENT Triage Vitals       Temp Pulse Resp BLOOD PRESSURE                        SpO2 Temp src Heart Rate/Pulse Source Patient Position                             BLOOD PRESSURE Location FiO2 (%)

Vital signs are normal.
General:  No acute distress
HEENT:  Nose:  Clear discharge bilaterally. No sinus tenderness to percussion.
Ears:  Right ear:  Right external canals clear right TM has mild erythema and a clear effusion.  Left ear:  Left external canal and TM are clear
Oropharynx:  No erythema or exudates. No dysphonia.  No drooling or stridor.  No dental tenderness to percussion no mandible tenderness or TMJ tenderness.  No crepitance with opening closing mouth the TMJ
Eyes:  Pupils equal and react to light.  Extraocular motions are intact.
Neck:  Supple with no meningismus.  No lymphadenopathy
Lungs:  Normal respiratory effort.
Cardiac:  Appears well perfused.  Cap refills intact bilaterally
Skin:  No rash or pallor.
Neuro:  Alert with no focal deficits noted.



History of present illness section: 


PAST HISTORIES / Medications
 / ALLERGIES
History reviewed. No pertinent past medical history.
Otherwise healthy
History reviewed. No pertinent surgical history.
No family history on file.
Tobacco Use      • Smoking status: Never  • Smokeless tobacco: Never    Substance Use Topics      • Alcohol use: Not Currently  • Drug use: Yes         Types: Marijuana
Patient has no known allergies.

Procedure: 
None
Review of System: 
HEENT:  She denies any facial pressure.  No sore throat
GASTROINTESTINAL: No vomiting diarrhea
Lab Results: 
None
Medications: 
 given at discharge:

EMERGENCY DEPARTMENT Prescriptions   None


Michael Thompson, MD


Michael Thompson, MD
03/16/23 0857


bmk



pipeline_tag: text-classification
inference: yes
base_model: sentence-transformers/all-mpnet-base-v2
Likes: 0 | All-time downloads: 8
Created: 2024-04-10 12:10:23