CHIEF COMPLAINT: Pt presents with recurrent increasing shortness of breath and
was found to have stridor and was urgently transferred to the
Complex Airway Service at [**Hospital1 **].

PRESENT ILLNESS: Mrs. [**Known firstname 50528**] [**Known lastname 67192**] was received in urgent transfer on [**6-3**], [**2112**].  This is a 78-year-old female with a recent history of
a four-vessel
CABG with a complicated postoperative course that included
prolonged intubation and tracheostomy from which she recovered
at
a rehabilitation facility.  She was found to have a subglottic
stenosis, and a surgical procedure was performed, the details of
which are not available to me.  She presents now again with
increasing shortness of breath and was found to have stridor and
was urgently transferred to the Complex Airway Service at [**Hospital1 **].  We performed a rigid endoscopy today and
found
a typical triangular-shaped high-grade tracheal stenosis at the
level of the first and second tracheal ring.  There was no
tracheal web per se and the left lateral as well as the
posterior
wall, as well as the posterior membrane were freely mobile.  The
lesion is not amenable to endoscopic intervention but does
require surgical resection.

MEDICAL HISTORY: Diabetes Mellitus 2, Coronary artery disease s/p Myocardial
infarction s/p Coronary artery bypass graft x4, repair of
ventricular aneurysm compicated by pneumonia and adult
respiratory distress syndrome, Congestive Heart failure, Atrial
fibrillation,hypertension, acute renal failure, chronic renal
insufficiency, hyperthyroidism, depression, gastric esophogeal
reflux disease, peptic ulcer disease, hypercholesterolemia, h/o
syphillis;
high tracheal stenosis s/p tracheal resection and reconstruction
([**6-6**]),

MEDICATION ON ADMISSION: lasix 60', enalapril 20'', lipitor 10', paxil 10', norvasc10',
prilosec 20', ASA 325', zantac 150', colace, FeSO4, combivent
INH.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: She is an overweight elderly female who is
anxious presently and on heliox.  She is placed with on heliox
overnight due to severe stridor and dyspnea, which was felt to
be
anxiety provoked.
VS: 98.2, 68 SR, 120/51, 29, sat 99% on 6 liters with heliox.
HEENT: PERRLA. Sclerae are anicteric.  Cervical exam, there is
no
supraclavicular or cervical adenopathy.  Her cervical exam
reveals a relatively short neck with a tracheostomy scar just
above the sternal notch below
the cricoid where we previously witnessed a rigid bronchoscopy
by
Dr. [**Last Name (STitle) **], which places the region just below the cricoid and
measuring less than 1 cm in width.
 Lungs: Clear to auscultation.
Chest: Thorax is symmetrical without lesions, masses.  She has a
well-healed
sternotomy scar.  She is stridorous with a respiratory rate of
29.
Cor: Heart is regular without murmur.
Abd: abdomen is benign without masses or tenderness.
Extremities show no clubbing or edema.
Neurologic is grossly nonfocal with intact and appropriate
mental
status, although she is anxious.

FAMILY HISTORY: Pt has supportive daughter, son and grand-daughter

SOCIAL HISTORY: Pt is french creole speaking. Lives w/ daughter, [**Name (NI) 67193**]
[**Name2 (NI) 67194**] ([**Telephone/Fax (1) 67195**]- cell/ home-[**Telephone/Fax (1) 67196**]in [**Location (un) **] apt.
Daughter works 6a-2p, Son is w/ her until 12:30 pm. No tobacco
history
Home services w/ VNA from PACE Program, HHA
uses walker and nebulizer
Mechanical complication of tracheostomy,Acute respiratory failure,Congestive heart failure, unspecified,Stenosis of larynx,Aortocoronary bypass status,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation
Tracheostomy - mech comp,Acute respiratry failure,CHF NOS,Stenosis of larynx,Aortocoronary bypass,Hypothyroidism NOS,DMII wo cmp nt st uncntr,Obesity NOS,Resp obstr-inhal obj NEC
Admission Date:  [**2112-6-2**]              Discharge Date:   [**2112-6-23**]

Date of Birth:  [**2033-5-25**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 1561**]
Chief Complaint:
Pt presents with recurrent increasing shortness of breath and
was found to have stridor and was urgently transferred to the
Complex Airway Service at [**Hospital1 **].

Major Surgical or Invasive Procedure:
[**6-3**] OR- rigid bronchocscopy w/ ballloon dilitation &
microdebridement
s/p bronchoscopy, tracheal resection and reconstruction ([**6-6**]),


History of Present Illness:
 Mrs. [**Known firstname 50528**] [**Known lastname 67192**] was received in urgent transfer on [**6-3**], [**2112**].  This is a 78-year-old female with a recent history of
a four-vessel
CABG with a complicated postoperative course that included
prolonged intubation and tracheostomy from which she recovered
at
a rehabilitation facility.  She was found to have a subglottic
stenosis, and a surgical procedure was performed, the details of
which are not available to me.  She presents now again with
increasing shortness of breath and was found to have stridor and
was urgently transferred to the Complex Airway Service at [**Hospital1 **].  We performed a rigid endoscopy today and
found
a typical triangular-shaped high-grade tracheal stenosis at the
level of the first and second tracheal ring.  There was no
tracheal web per se and the left lateral as well as the
posterior
wall, as well as the posterior membrane were freely mobile.  The
lesion is not amenable to endoscopic intervention but does
require surgical resection.

Past Medical History:
Diabetes Mellitus 2, Coronary artery disease s/p Myocardial
infarction s/p Coronary artery bypass graft x4, repair of
ventricular aneurysm compicated by pneumonia and adult
respiratory distress syndrome, Congestive Heart failure, Atrial
fibrillation,hypertension, acute renal failure, chronic renal
insufficiency, hyperthyroidism, depression, gastric esophogeal
reflux disease, peptic ulcer disease, hypercholesterolemia, h/o
syphillis;
high tracheal stenosis s/p tracheal resection and reconstruction
([**6-6**]),


Social History:
Pt is french creole speaking. Lives w/ daughter, [**Name (NI) 67193**]
[**Name2 (NI) 67194**] ([**Telephone/Fax (1) 67195**]- cell/ home-[**Telephone/Fax (1) 67196**]in [**Location (un) **] apt.
Daughter works 6a-2p, Son is w/ her until 12:30 pm. No tobacco
history
Home services w/ VNA from PACE Program, HHA
uses walker and nebulizer

Family History:
Pt has supportive daughter, son and grand-daughter

Physical Exam:
General: She is an overweight elderly female who is
anxious presently and on heliox.  She is placed with on heliox
overnight due to severe stridor and dyspnea, which was felt to
be
anxiety provoked.
VS: 98.2, 68 SR, 120/51, 29, sat 99% on 6 liters with heliox.
HEENT: PERRLA. Sclerae are anicteric.  Cervical exam, there is
no
supraclavicular or cervical adenopathy.  Her cervical exam
reveals a relatively short neck with a tracheostomy scar just
above the sternal notch below
the cricoid where we previously witnessed a rigid bronchoscopy
by
Dr. [**Last Name (STitle) **], which places the region just below the cricoid and
measuring less than 1 cm in width.
 Lungs: Clear to auscultation.
Chest: Thorax is symmetrical without lesions, masses.  She has a
well-healed
sternotomy scar.  She is stridorous with a respiratory rate of
29.
Cor: Heart is regular without murmur.
Abd: abdomen is benign without masses or tenderness.
Extremities show no clubbing or edema.
Neurologic is grossly nonfocal with intact and appropriate
mental
status, although she is anxious.


Pertinent Results:
CXR [**2112-6-19**]:  Moderate-to-severe cardiomegaly and borderline
interstitial edema are unchanged. There is no pneumothorax or
appreciable pleural effusion.

Cardiology Report ECG Study Date of [**2112-6-15**]  9:09:40 AM
Sinus rhythm. Borderline first degree A-V block. Borderline left
axis
deviation with possible left anterior fascicular block. Lateral
myocardial
infarction. Possible old inferior wall myocardial infarction.
Compared to the
previous tracing of [**2112-6-6**] multiple abnormalties persist and
there is no
significant diagnostic change.

ECHO:
Conclusions:  [**2112-6-14**]
The left atrium is moderately dilated. There is moderate
symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall  left ventricular systolic function is
moderately depressed (ejection fraction 30-40 percent) secondary
to extensive severe apical hypokinesis. An apical  left
ventricular mass/thrombus cannot be excluded. There is no
ventricular  septal defect. Right ventricular chamber size and
free wall motion are normal.
The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not  present. No aortic regurgitation is seen. The
mitral valve leaflets are mildly  thickened. There is no mitral
valve prolapse. Trivial mitral regurgitation is  seen. The
pulmonary artery systolic pressure could not be determined.
There is  no pericardial effusion.



Brief Hospital Course:
79 y/o female w/ Hx CAD, CABG x4, complicated by pna and ARDS
requiring prolonged intubation and tracheostomy ([**2111-11-4**])
admitted to [**Hospital6 28728**] Center w/ severe SOB and chest
pain. Found to have tracheal stenosis and transferred to [**Hospital1 18**]
ICU [**2112-6-2**] for evaluation and treatment.
[**2112-6-3**]- OR for rigid bronch ([**Name8 (MD) 67197**] MD) for the purposes of
tracheal ballon dilation to 12mm and microdebridement of complex
subglottic stenosis of trachea of the first and second ring
which requires surgical resection and repair.
[**2112-6-6**]-tracheal resection and recontruction on [**2112-6-6**] by [**First Name4 (NamePattern1) 951**]
[**Last Name (NamePattern1) 952**], MS.
Febrile 101 post-op and started on antibiotics of levo, kefsol,
flagyl, zosyn [**Date range (1) 33871**].
Bronchoscopy x3 post-op for secretions clearance and evaluation
of anastamosis ([**6-8**], [**6-14**] and [**6-17**]). Course compicated by
respiratory distress requiring reintubation [**2112-6-8**] for upper
airway stridor/ tracheal edema and remained intubated x5 days
until tracheal edema subsided and diuresed. Pt extubated [**2112-6-14**]
and reintubated urgently for secretion/mucoous plugging. Bronch
done for secretion clearance. Pt sedated, rested,diuresed and
r/o MI for hypotension w/ intubation. Pt r/o'd, pulse dose
steroids [**6-16**] in preparation for successful wean and extubation
[**2112-6-17**]. Bronch pre-extubation w/ min secretions and good
anastamosis. Pt remained in ICU for close monitoring, doboff
placed for nutritional support in preparation for swallow eval
[**6-21**]- passed- ground solids, thin liquids, doboff d/c. Physical
Therapy consulted for evaluation and treatment.
Transferred to floor [**2112-6-19**]. Sitter for patient while on floor
to maintain safety of lines and tubes.
[**6-21**]- Antbiotics d/c after 10 day course.
Physical Therapy following patient, now ambulating w/o
difficulty on room air. Disposition planning initiated and PT
evaluation indicates pt sfe to reutrn home w/ daughter.
[**Date range (1) **]- PT and nursing increasing ambulation frequency. Cane
added for support and balance w/ improved steadiness in gait.
PT approved home discharge. Pt discharged in stable condition to
home w/ daughter accompanied by daughter. Services provided by
VNA Pace in pt local area.

Medications on Admission:
lasix 60', enalapril 20'', lipitor 10', paxil 10', norvasc10',
prilosec 20', ASA 325', zantac 150', colace, FeSO4, combivent
INH.

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
2. Paroxetine HCl 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
3. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO BID (2
times a day).
4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
5. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Six (6)
Puff Inhalation Q2-3H (every 2-3 hours) as needed.
Disp:*1 1* Refills:*0*
6. Albuterol 90 mcg/Actuation Aerosol Sig: Six (6) Puff
Inhalation Q2-3H (every 2-3 hours) as needed.
Disp:*1 1* Refills:*1*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
8. Furosemide 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*1*
9. Enalapril Maleate 10 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*1*
10. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*1*
11. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
13. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q4H (every 4 hours) as needed.
Disp:*50 50* Refills:*1*
14. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
Disp:*100 100* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
School of Pace Program

Discharge Diagnosis:
Diabetes Mellitis 2, Coronary artery disease s/p Myocardial
infarction s/p Coronary artery bypass graft x4, repair of
ventricular aneurysm compicated by pneumonia and adult
respiratory distress syndrome, Congestive Heart failure, Atrial
fibrillation,hypertension, acute renal failure, chronic renal
insufficiency, hyperthyroidism, depression, gastric esophogeal
reflux disease, peptic ulcer disease, hypercholesterolemia, h/o
syphillis;
high tracheal stenosis s/p tracheal resection and reconstruction
([**6-6**]),

Discharge Condition:
good

Discharge Instructions:
Call Dr.[**Name (NI) 1816**]/ Thoracic Surgery office ([**Telephone/Fax (1) 170**]) for:
fever, shortness of breath, chest pain, difficulty getting
secretions up w/ coughing.
Take medication as stated on discharge instructions.
Ambulation 3-4 times per day for 15-20 minutes each episode.
Continue w/ your walking and exercises ongoing.

Followup Instructions:
Call Dr.[**Name (NI) 1816**]/ Thoracic Surgery office ([**Telephone/Fax (1) 170**]) for an
appointment in 14 days.


Completed by:[**2112-6-24**]
{'Mechanical complication of tracheostomy,Acute respiratory failure,Congestive heart failure, unspecified,Stenosis of larynx,Aortocoronary bypass status,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation'}


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: Pt presents with recurrent increasing shortness of breath and
was found to have stridor and was urgently transferred to the
Complex Airway Service at [**Hospital1 **].

PRESENT ILLNESS: Mrs. [**Known firstname 50528**] [**Known lastname 67192**] was received in urgent transfer on [**6-3**], [**2112**].  This is a 78-year-old female with a recent history of
a four-vessel
CABG with a complicated postoperative course that included
prolonged intubation and tracheostomy from which she recovered
at
a rehabilitation facility.  She was found to have a subglottic
stenosis, and a surgical procedure was performed, the details of
which are not available to me.  She presents now again with
increasing shortness of breath and was found to have stridor and
was urgently transferred to the Complex Airway Service at [**Hospital1 **].  We performed a rigid endoscopy today and
found
a typical triangular-shaped high-grade tracheal stenosis at the
level of the first and second tracheal ring.  There was no
tracheal web per se and the left lateral as well as the
posterior
wall, as well as the posterior membrane were freely mobile.  The
lesion is not amenable to endoscopic intervention but does
require surgical resection.

MEDICAL HISTORY: Diabetes Mellitus 2, Coronary artery disease s/p Myocardial
infarction s/p Coronary artery bypass graft x4, repair of
ventricular aneurysm compicated by pneumonia and adult
respiratory distress syndrome, Congestive Heart failure, Atrial
fibrillation,hypertension, acute renal failure, chronic renal
insufficiency, hyperthyroidism, depression, gastric esophogeal
reflux disease, peptic ulcer disease, hypercholesterolemia, h/o
syphillis;
high tracheal stenosis s/p tracheal resection and reconstruction
([**6-6**]),

MEDICATION ON ADMISSION: lasix 60', enalapril 20'', lipitor 10', paxil 10', norvasc10',
prilosec 20', ASA 325', zantac 150', colace, FeSO4, combivent
INH.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: She is an overweight elderly female who is
anxious presently and on heliox.  She is placed with on heliox
overnight due to severe stridor and dyspnea, which was felt to
be
anxiety provoked.
VS: 98.2, 68 SR, 120/51, 29, sat 99% on 6 liters with heliox.
HEENT: PERRLA. Sclerae are anicteric.  Cervical exam, there is
no
supraclavicular or cervical adenopathy.  Her cervical exam
reveals a relatively short neck with a tracheostomy scar just
above the sternal notch below
the cricoid where we previously witnessed a rigid bronchoscopy
by
Dr. [**Last Name (STitle) **], which places the region just below the cricoid and
measuring less than 1 cm in width.
 Lungs: Clear to auscultation.
Chest: Thorax is symmetrical without lesions, masses.  She has a
well-healed
sternotomy scar.  She is stridorous with a respiratory rate of
29.
Cor: Heart is regular without murmur.
Abd: abdomen is benign without masses or tenderness.
Extremities show no clubbing or edema.
Neurologic is grossly nonfocal with intact and appropriate
mental
status, although she is anxious.

FAMILY HISTORY: Pt has supportive daughter, son and grand-daughter

SOCIAL HISTORY: Pt is french creole speaking. Lives w/ daughter, [**Name (NI) 67193**]
[**Name2 (NI) 67194**] ([**Telephone/Fax (1) 67195**]- cell/ home-[**Telephone/Fax (1) 67196**]in [**Location (un) **] apt.
Daughter works 6a-2p, Son is w/ her until 12:30 pm. No tobacco
history
Home services w/ VNA from PACE Program, HHA
uses walker and nebulizer 

### Response:
{'Mechanical complication of tracheostomy,Acute respiratory failure,Congestive heart failure, unspecified,Stenosis of larynx,Aortocoronary bypass status,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation'}
