allergies: patient recorded as having no known allergies to drugs attending: chief complaint: s/p motor vehicle crash major surgical or invasive procedure: closed reduction of left mandible fracture; wiring of jaws history of present illness: 25m driver s/p high-speed motor vehicle crash (car vs tree), +seatbelt, +airbag, initially unresponsive for 3-4min on scene but gcs14 at osh; agitated/combative upon arrival to . past medical history: undescended testicle, inguinal hernias . psh: bilateral hernia repair as infant; right cryptorchidism s/p removal and prosthesis placement; recurrent hernia repair at age 19 family history: noncontributory pertinent results: 06:41pm glucose-133* na+-139 k+-3.9 cl--100 tco2-22 06:35pm urea n-15 creat-1.1 06:35pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 06:35pm wbc-23.1* rbc-4.78 hgb-14.0 hct-41.3 mcv-86 mch-29.3 mchc-33.9 rdw-12.6 06:35pm plt count-158 06:35pm pt-12.9 ptt-22.6 inr(pt)-1.1 imaging ct sinus/max/: complete fracture of left mandibular process with medial angulation of the condyle and dislocation of the tmj. additional nondisplaced comminuted fracture is noted in the ramus of left mandible. . ct head: small hyperdensity within septum pellucidum slightly changed in appearance as compared to one day prior, suggestive of presence of small amount of blood in this region . xr r ankle/knee: right knee: the lateral view is obliqued. allowing for this, there is a small joint effusion. noobvious fat-fludi level. no discrete fracture or dislocation is identified. however, subtle density projecting anterior to the tibial spine could reflect the presence of subtle bony avulsion. remote from the knee, a phalanx is noted on this film. right ankle, two views. no obvious fracture or dislocation on this exam. linear density seen in the inferiro calcaneus may represent normal variation. calcaneal bone island noted. . xr r shoulder/elbow: right shoulder, two views. no axillary y view is available. allowing for this, no fracture or dislocation is detected about the right shoulder. elbow side not indicated, 2 vws the lateral view is obliqued. allowing for this, there is soft tissue swelling. no fracture, dislocation, or effusion is detected about the elbow. punctate densities project in the soft tissues anterior to the proximal radius on the lateral view -- ? artifact versus small foreign bodies. if symptoms persist, consider repeat lateral view when the patient is able to accommodate more conventional positioning. . ct head: no acute intracranial abnormality. findings concerning for left mandible fx with tmj dislocation, not fully imaged or well evaluated. . ct c-spine: no acute fracture or subluxation of the cervical spine. displaced, angulated fx of the left mandible, in region of left mandibular neck/proximal ramus, and left tmj dislocation, not optimally evaluated. suggest max/face ct for better evaluation. . ct torso: tiny bilat pneumothoraces. very mild peripheral ggos peripheral anterolat rul, may = contusions. nondisplaced lat right 7th rib fx. soft tissue density in anterior mediastinum, may = residual thymic tissue. no vascular injury seen. focus of air in right shoulder joint ? post trauma. 5 x 4 cm ovoid dense structure in the right scrotum, likely postsurgical. clin correlate. brief hospital course: he was admitted to the trauma service. he was initially transferred to the trauma icu for close monitoring and frequent neurologic checks. his mental status remained intact and he was eventually transferred to the regular nursing unit. omfs was consulted given his mandible fracture; he was taken to the operating room on for closed reduction of left mandible fracture and wiring of jaws. there were no intraoperative complications; postoperatively he has done well. he is tolerating a soft diet, his pain is adequately controlled and he is ambulating independently. his post op mandible series with panorex films were done prior to discharge. medications on admission: denies discharge medications: 1. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4h (every 4 hours) as needed for pain. disp:*500 ml(s)* refills:*0* 2. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane tid (3 times a day): rinse and spit. disp:*1350 ml(s)* refills:*2* 3. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml's po bid (2 times a day) as needed for constipation. 4. milk of magnesia 800 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. discharge disposition: home discharge diagnosis: s/p motor vehicle crash left mandible fracture left tmj dislocation right lateral 7th rib fracture tiny bilateral pneumomediastinum discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were hospitalized following a motor vehicle crash where you sustained a fracture of your jaw. you were taken to the operating room for repair of your jaw; your jaw is wired shut. you will have to adhere to a soft diet; foods that do not require chewing such as soups, mashed potatoes, oatmeal, ice cream, soft rice. it is also advisable that you drink carnation instant breakfast at least 2x/day. you have been given wire cutters to use in the event that you become acutely short of breath or nauseous with vomiting. if this happens you should cut the wires on both sides to release them and return to the emergency room immediately. take your medication as prescribed. avoid alcohol or other illicit drugs while taking narcotics for pain. you should also take a stool softener and laxative to avoid becoming constipated from the narcotics. followup instructions: follow up next week with dr. in clinic. call for an appointment. Procedure: Closed reduction of mandibular fracture Diagnoses: Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle Closed fracture of one rib Traumatic pneumothorax without mention of open wound into thorax Contusion of lung without mention of open wound into thorax Closed fracture of mandible, subcondylar Closed dislocation of jaw