CHIEF COMPLAINT: respiratory failure

PRESENT ILLNESS: This is a 63 year-old man who is well known to the Transplant
service.   He underwent a liver transplant in [**5-/2158**] for EtOH
and HCV cirrhosis.  His post operative course was complicated by
a wound dehiscence and respiratory failure.

MEDICAL HISTORY: OLT [**2158-5-22**] c/b wound infection
HCV
DM II
Esophageal varices
BPH
Bipolar d/o
Heart Failure

MEDICATION ON ADMISSION: rapamune 5', MMF 500'''', prednisone 5', risperidol 1.5 HS,
amlodipine 10', lorazepam 0.5'' PRN

ALLERGIES: Penicillins / Nsaids

PHYSICAL EXAM: On admission to the [**Hospital1 18**], the patient was afebrile.  He was
intubated and in no apparent distress or discomfort.  His chest
was clear to auscultation bilaterally.  His abdomen was soft and
non tender.   His extremities were warm and well perfused.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Quit ETOH 17yrs ago
Quit tobacco 8yrs ago
No illicit drug use
Divorced, lives alone
Acute respiratory failure,Liver replaced by transplant,Pneumonia, organism unspecified,Chronic diastolic heart failure,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Bipolar I disorder, most recent episode (or current) unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Acute respiratry failure,Liver transplant status,Pneumonia, organism NOS,Chr diastolic hrt fail,Chr airway obstruct NEC,Hypertension NOS,Bipolor I current NOS,BPH w/o urinary obs/LUTS
Admission Date:  [**2159-10-15**]              Discharge Date:   [**2159-10-23**]

Date of Birth:  [**2096-4-23**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Nsaids

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
respiratory failure

Major Surgical or Invasive Procedure:
tracheostomy

History of Present Illness:
This is a 63 year-old man who is well known to the Transplant
service.   He underwent a liver transplant in [**5-/2158**] for EtOH
and HCV cirrhosis.  His post operative course was complicated by
a wound dehiscence and respiratory failure.

At rehabilitation he had his tracheostomy tube removed over the
subsequent 48 hours  developed respiratory failure.  He
presented to an outside hospital where an endotracheal tube was
place and was transfered to the [**Hospital1 18**] for management.  Of note
he had a tracheal stenosis identified at bronchoscopy in [**Month (only) 216**]
of [**2158**] which was due to subglottic grannulation tissue.  The
stenosis was determined to have caused a 90% stenosis.  The
granulation tissue was resected by the interventional
pulmonoology service at the [**Hospital1 18**].

Past Medical History:
OLT [**2158-5-22**] c/b wound infection
HCV
DM II
Esophageal varices
BPH
Bipolar d/o
Heart Failure

Social History:
Quit ETOH 17yrs ago
Quit tobacco 8yrs ago
No illicit drug use
Divorced, lives alone


Family History:
Noncontributory

Physical Exam:
On admission to the [**Hospital1 18**], the patient was afebrile.  He was
intubated and in no apparent distress or discomfort.  His chest
was clear to auscultation bilaterally.  His abdomen was soft and
non tender.   His extremities were warm and well perfused.

Pertinent Results:
[**2159-10-15**] 08:18PM   TYPE-ART PO2-97 PCO2-30* PH-7.40 TOTAL
CO2-19* BASE XS--4 INTUBATED-INTUBATED
[**2159-10-15**] 08:18PM   TYPE-ART PO2-97 PCO2-30* PH-7.40 TOTAL
CO2-19* BASE XS--4 INTUBATED-INTUBATED
[**2159-10-15**] 06:48PM   ALT(SGPT)-20 AST(SGOT)-15 ALK PHOS-148*
AMYLASE-67 TOT BILI-0.3
[**2159-10-15**] 06:48PM   WBC-5.1 RBC-3.57* HGB-10.3* HCT-29.8* MCV-83#
MCH-28.9 MCHC-34.6 RDW-14.7
[**2159-10-23**] 05:13AM BLOOD WBC-3.6* RBC-3.27* Hgb-9.1* Hct-27.5*
MCV-84 MCH-28.0 MCHC-33.1 RDW-13.9 Plt Ct-95*
[**2159-10-23**] 05:13AM BLOOD Glucose-180* UreaN-24* Creat-1.3* Na-145
K-4.3 Cl-106 HCO3-32 AnGap-11
[**2159-10-23**] 05:13AM BLOOD ALT-23 AST-15 AlkPhos-352* TotBili-0.2

Brief Hospital Course:
The patient was admitted to the [**Hospital1 18**] surgical ICU on [**2159-10-15**].
During his hospitalization a Thoracic Surgery consult was
obtained.  It was likely that the cause of his respiratory
failure was due to mechanical obstruction.  A sputum culture
from HD 2 showed Pseudomonas, which was considered to be a
contaminant.  On HD 3, a post-pyloric feeding tube was placed
for nutritional support.  His goal feeding rate was determined
to be 65 cc/hour of Respolar, which would give him 2371 kcals,
and 117g protein.  On HD 4, the patient underwent an open
tracheostomy by the Thoracic surgery service.  His tube feeds
were restarted on POD 1.  The patient was kept at [**Hospital1 18**] for
increased secretions requiring frequent suction.  On POD 4, the
patient was started on Ceftazidime for presumed pneumonia
diagnosed by chest X-ray and clinical presentation (low grade
temperature of 100.1 and no WBC count, but increased
secretions).  On POD 5, he was evaluated for a Passy-muir valve
but he did not tolerate the procedure well because of excessive
coughing and difficulty swallowing his secretions.  Please see
the recommendations of the speech and swallow team for more
detail.  The remainder of his post-operative course was
uneventful and he returned to rehabilitation in stable condition
on POD 5.

Medications on Admission:
rapamune 5', MMF 500'''', prednisone 5', risperidol 1.5 HS,
amlodipine 10', lorazepam 0.5'' PRN

Discharge Medications:
1. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO BID (2 times a
day).
2. Loperamide 1 mg/5 mL Liquid Sig: One (1)  PO DAILY (Daily).
3. Guaifenesin 100 mg/5 mL Syrup Sig: Ten (10) ML PO BID (2
times a day).
4. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.
5. Risperidone 1 mg/mL Solution Sig: One (1)  PO HS (at
bedtime).
6. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. Albuterol Sulfate 0.083 % Solution Sig: [**12-10**]  Inhalation Q4H
(every 4 hours) as needed.
8. Scopolamine Base 1.5 mg Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
10. Zinc Sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
11. Sirolimus 1 mg/mL Solution Sig: One (1)  PO DAILY (Daily).
12. Prednisone 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
13. Mycophenolate Mofetil 200 mg/mL Suspension for
Reconstitution Sig: One (1)  PO QID (4 times a day).
14. Lansoprazole  Oral
15. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for fever.
16. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
17. Acetylcysteine 20 % (200 mg/mL) Solution Sig: One (1) ML
Miscell.  Q4-6H (every 4 to 6 hours) as needed.
18. Morphine 2 mg/mL Syringe Sig: One (1)  Injection Q4H (every
4 hours) as needed.
19. Metoclopramide 5 mg/mL Solution Sig: One (1)  Injection Q6H
(every 6 hours).
20. Ceftazidime-Dextrose (Iso-osm) 2 g/50 mL Piggyback Sig: One
(1)  Intravenous  Q12H (every 12 hours) for 8 days.
Disp:*16 32g* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
respiratory failure
liver failure; s/p liver transplant

Discharge Condition:
stable

Discharge Instructions:
Tracheostomy tube is to remain in place.

A speaking valve may be used.


Followup Instructions:
Please call Dr/ [**Doctor Last Name **] office as needed with any questions



Completed by:[**2159-10-23**]
{'Acute respiratory failure,Liver replaced by transplant,Pneumonia, organism unspecified,Chronic diastolic heart failure,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Bipolar I disorder, most recent episode (or current) unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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: respiratory failure

PRESENT ILLNESS: This is a 63 year-old man who is well known to the Transplant
service.   He underwent a liver transplant in [**5-/2158**] for EtOH
and HCV cirrhosis.  His post operative course was complicated by
a wound dehiscence and respiratory failure.

MEDICAL HISTORY: OLT [**2158-5-22**] c/b wound infection
HCV
DM II
Esophageal varices
BPH
Bipolar d/o
Heart Failure

MEDICATION ON ADMISSION: rapamune 5', MMF 500'''', prednisone 5', risperidol 1.5 HS,
amlodipine 10', lorazepam 0.5'' PRN

ALLERGIES: Penicillins / Nsaids

PHYSICAL EXAM: On admission to the [**Hospital1 18**], the patient was afebrile.  He was
intubated and in no apparent distress or discomfort.  His chest
was clear to auscultation bilaterally.  His abdomen was soft and
non tender.   His extremities were warm and well perfused.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Quit ETOH 17yrs ago
Quit tobacco 8yrs ago
No illicit drug use
Divorced, lives alone 

### Response:
{'Acute respiratory failure,Liver replaced by transplant,Pneumonia, organism unspecified,Chronic diastolic heart failure,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Bipolar I disorder, most recent episode (or current) unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
