CHIEF COMPLAINT: Tracheal stenosis

PRESENT ILLNESS: 80 year old woman with severe upper cervical myelopathy s/p
cervical spine surgery and trach and PEG placement in [**10-14**]
presents from rehab after bronchoscopy revealed a question of
tracheal stenosis.
.
Her problems began in [**2190-6-10**] when she presented with
bilateral paresthesias. She had an MRI done which showed a large
mass perhaps arising from the clivus impinging on the ventral
medulla, and extending all the way down to the dens and arch of
C1, encroaching on the ventral cord, with posterior thecal sac
and cord impingement, and abnormal cord signal. It also showed
evidence of C3-C4 cord impingement due to a herniated disk also
contributing to her myelopathy.
.
From [**2191-11-17**] - [**2191-11-22**] she was admitted for hypotension, fevers
and mental status change presumably secondary to an aspiration
pneumonia.  She spend her first 2 days in the MICU and was then
transferred to the floor.  She was treated with levaquin and
flagyl for a 14 day course, and was discharged back to rehab on
[**11-22**].

MEDICAL HISTORY: 1. s/p C-spine operation (as above) for subluxation with pannus
around odontoid
2. Tracheostomy [**2190-11-2**]
3. PEG placement [**2190-11-1**]
4. HIT, diagnosed [**10-14**]
5. IVC filter placement [**2190-10-28**]
6. Bipolar d/o, on lithium
7. c-section x3
8. cervical myelopathy [**1-12**] rhematoid arthritis since [**2186**]
9. hx or bowel obstruction

MEDICATION ON ADMISSION: Colace
Senna
Hydralizine 10 Q6
Prevacid
Lithium 150 [**Hospital1 **]
MOM
Lopressor 50 [**Hospital1 **]
Nystatin S&S
Tylenol

ALLERGIES: Penicillins / Demerol / Heparin Agents

PHYSICAL EXAM: VS- T= 98.4 BP= 126/67 P= 86 RR= 18 O2= 100% on 35% TM
HEENT- NC/AT. EOMI. Unable to move neck.
Chest- referred sounds from upper airway heard throughout
anterior and posterior fields. Equal bilaterally. No wheezes,
crackles.
CV- normal rate, regular rhythm. Normal S1, S2. No M/R/G
Abd- PEG in place, dressing C/D/I. BS present. Soft, nontender,
nondistended.
Ext- no edema. DP pulses 2+ bilaterally. nontender. Right arm in
brace.
Neuro- AAOx3. Motor: LLE- [**1-15**], RLE- [**12-15**].

FAMILY HISTORY: Parents with CAD

SOCIAL HISTORY: Came from rehab, married, husband is also sick at times per
daughters, has 2 daughters and 1 son, children very
involved.Communication:  Husband/daughter at ([**Telephone/Fax (2) 23974**]Son at
([**Telephone/Fax (1) 23975**]
Mechanical complication of tracheostomy,Cardiac arrest,Bacteremia,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Rheumatoid arthritis,Unspecified essential hypertension,Gastrostomy status,Anemia, unspecified,Bipolar disorder, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins
Tracheostomy - mech comp,Cardiac arrest,Bacteremia,Abn react-external stoma,Accid in resident instit,Rheumatoid arthritis,Hypertension NOS,Gastrostomy status,Anemia NOS,Bipolar disorder NOS,Mth sus Stph aur els/NOS,Inf mcrg rstn pncllins
Admission Date:  [**2191-1-4**]              Discharge Date:   [**2191-1-12**]


Service: MEDICINE

Allergies:
Penicillins / Demerol / Heparin Agents

Attending:[**First Name3 (LF) 1377**]
Chief Complaint:
Tracheal stenosis

Major Surgical or Invasive Procedure:
Flexible bronchoscopy
Rigid bronchoscopy
Intubation
CRP


History of Present Illness:
80 year old woman with severe upper cervical myelopathy s/p
cervical spine surgery and trach and PEG placement in [**10-14**]
presents from rehab after bronchoscopy revealed a question of
tracheal stenosis.
.
Her problems began in [**2190-6-10**] when she presented with
bilateral paresthesias. She had an MRI done which showed a large
mass perhaps arising from the clivus impinging on the ventral
medulla, and extending all the way down to the dens and arch of
C1, encroaching on the ventral cord, with posterior thecal sac
and cord impingement, and abnormal cord signal. It also showed
evidence of C3-C4 cord impingement due to a herniated disk also
contributing to her myelopathy.
.
From [**2191-11-17**] - [**2191-11-22**] she was admitted for hypotension, fevers
and mental status change presumably secondary to an aspiration
pneumonia.  She spend her first 2 days in the MICU and was then
transferred to the floor.  She was treated with levaquin and
flagyl for a 14 day course, and was discharged back to rehab on
[**11-22**].

She reports a recent cough but denies any fevers, chills,
abdominal pain, nausea, vomiting, headache.

Past Medical History:
1. s/p C-spine operation (as above) for subluxation with pannus
around odontoid
2. Tracheostomy [**2190-11-2**]
3. PEG placement [**2190-11-1**]
4. HIT, diagnosed [**10-14**]
5. IVC filter placement [**2190-10-28**]
6. Bipolar d/o, on lithium
7. c-section x3
8. cervical myelopathy [**1-12**] rhematoid arthritis since [**2186**]
9. hx or bowel obstruction


Social History:
Came from rehab, married, husband is also sick at times per
daughters, has 2 daughters and 1 son, children very
involved.Communication:  Husband/daughter at ([**Telephone/Fax (2) 23974**]Son at
([**Telephone/Fax (1) 23975**]

Family History:
Parents with CAD

Physical Exam:
VS- T= 98.4 BP= 126/67 P= 86 RR= 18 O2= 100% on 35% TM
HEENT- NC/AT. EOMI. Unable to move neck.
Chest- referred sounds from upper airway heard throughout
anterior and posterior fields. Equal bilaterally. No wheezes,
crackles.
CV- normal rate, regular rhythm. Normal S1, S2. No M/R/G
Abd- PEG in place, dressing C/D/I. BS present. Soft, nontender,
nondistended.
Ext- no edema. DP pulses 2+ bilaterally. nontender. Right arm in
brace.
Neuro- AAOx3. Motor: LLE- [**1-15**], RLE- [**12-15**].

Pertinent Results:
Admission labs:

[**2191-1-4**] 11:46PM   GLUCOSE-94 UREA N-30* CREAT-0.6 SODIUM-144
POTASSIUM-4.4 CHLORIDE-109* TOTAL CO2-31* ANION GAP-8
[**2191-1-4**] 11:46PM   CALCIUM-9.7 PHOSPHATE-4.2 MAGNESIUM-2.4
[**2191-1-4**] 11:46PM   WBC-15.0* RBC-3.82* HGB-11.8* HCT-36.3 MCV-95
MCH-30.8 MCHC-32.4 RDW-15.7*
[**2191-1-4**] 11:46PM   PLT COUNT-289
[**2191-1-4**] 11:46PM   PT-12.6 PTT-22.7 INR(PT)-1.0

Brief Hospital Course:
A/P: 80 yo F with cervical myelopathy s/p tracheostomy who
presents from rehab for evaluation of tracheal stenosis.
.
#Tracheal stenosis / Respiratory - On [**2191-1-5**] a flexible
bronchoscopy showed subglottic/tracheal stenosis with 100%
collapse of the trachea and mainstem bronchi with mild
suctioning consistent with severe tracheal bronchomalacia. No
endobronchial lesions were seen and the vocal cords could not be
observed.  On [**2191-1-6**] a CT neck showed high-grade narrowing of
the subglottic airway above tracheostomy, 4 mm in greatest
diameter. Focus of opacity between the superior segmental LLL
bronchus and aorta which could represent focal atelectasis.
Nonspecific opacities within both upper lobes.  On [**2191-1-7**] the
patient sufferred cardiac arrest likely due to respiratory
arrest from a mucus plugging.  She required CPR x 5-10 min and
aggressive suctioning.  She was maintained on a ventilator
overnight and weaned in the AM.  She was ruled out for MI and
monitored on telemetry.  She remained stable after this event
and on [**2191-1-10**] a rigid bronchoscopy showed subglottic stenosis.
Due to severe stiffness of her cervical spine and extension of
her cervical spine could not be obtained for adequate rigid
intubation and, therefore, the vocal cords or the epiglottis
could not be visualized.   After the rigid bronchoscopy, no
further testing was recommended by interventional pulmonology.
She was transferred from the MICU to the floor on [**2191-1-11**] and
remained stable for the rest of hospital stay.

#ID:  On [**2191-1-7**] the patient patient had a positive blood
cluture which grew MRSA, and a positive sputum culture which
grew MRSA, pseudomonas, gram negative rods.  She was started on
cefipime and vancomycin on [**2191-1-9**] with the plan of completing a
14 day course of antibiotics.  She had a cardiac echo on [**2191-1-12**]
which did not show any vegetations.
.
Bipolar disorder:  The patient was continued on her home dose of
lithium 150 mg [**Hospital1 **]
.
HTN:  The patient was continued on her home dose of lopressor
and her hydralazine was discontinued.


Medications on Admission:
Colace
Senna
Hydralizine 10 Q6
Prevacid
Lithium 150 [**Hospital1 **]
MOM
Lopressor 50 [**Hospital1 **]
Nystatin S&S
Tylenol


Discharge Medications:
1. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily) as needed
for daily.
2. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
3. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
4. Docusate Sodium 150 mg/15 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
5. Lithium Citrate 8 mEq/5 mL Syrup Sig: One [**Age over 90 1230**]y (150)
mg PO BID (2 times a day). mg
6. Cefepime HCl 1 g Recon Soln Sig: 1000 (1000) mg Intravenous
Q12H (every 12 hours) as needed for pseudomonal pneumonia
resistant to other medications. Last dose on [**2191-1-15**] PM.
7. Vancomycin HCl 10 g Recon Soln Sig: 1000 (1000) mg
Intravenous  Q12H (every 12 hours).  Last dose on [**2191-1-22**].
8. Senna 8.8 mg/5 mL Syrup Sig: One (1) Tablet PO BID (2 times a
day) as needed.
9. Acetaminophen 160 mg/5 mL Elixir Sig: Six [**Age over 90 1230**]y (650)
mg PO Q4-6H (every 4 to 6 hours) as needed.
10. Sodium Chloride 0.9 % Solution Sig: Three (3) ML Injection
DAILY (Daily) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Tracheal stenosis

Secondary:
-cervical myelopathy [**1-12**] rhematoid arthritis since [**2186**]
-bipolar disorder
-hx of HIT
-hx or bowel obstruction
-s/p c-spine operation
-s/p trach and PEG
-s/p IVC filter placement


Discharge Condition:
Stable

Discharge Instructions:
Take all your medications as prescribed.

Call your doctor or come to the ER if you are having shortness
of breath, fevers, chest pain, trouble clearing your secretions,
or any other worrisome symptoms.


Followup Instructions:
After discharge from [**Hospital1 13199**], please call Dr [**First Name (STitle) 679**] to make a
follow up appointment: [**Telephone/Fax (1) 682**]


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 1379**]
{'Mechanical complication of tracheostomy,Cardiac arrest,Bacteremia,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Rheumatoid arthritis,Unspecified essential hypertension,Gastrostomy status,Anemia, unspecified,Bipolar disorder, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins'}


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: Tracheal stenosis

PRESENT ILLNESS: 80 year old woman with severe upper cervical myelopathy s/p
cervical spine surgery and trach and PEG placement in [**10-14**]
presents from rehab after bronchoscopy revealed a question of
tracheal stenosis.
.
Her problems began in [**2190-6-10**] when she presented with
bilateral paresthesias. She had an MRI done which showed a large
mass perhaps arising from the clivus impinging on the ventral
medulla, and extending all the way down to the dens and arch of
C1, encroaching on the ventral cord, with posterior thecal sac
and cord impingement, and abnormal cord signal. It also showed
evidence of C3-C4 cord impingement due to a herniated disk also
contributing to her myelopathy.
.
From [**2191-11-17**] - [**2191-11-22**] she was admitted for hypotension, fevers
and mental status change presumably secondary to an aspiration
pneumonia.  She spend her first 2 days in the MICU and was then
transferred to the floor.  She was treated with levaquin and
flagyl for a 14 day course, and was discharged back to rehab on
[**11-22**].

MEDICAL HISTORY: 1. s/p C-spine operation (as above) for subluxation with pannus
around odontoid
2. Tracheostomy [**2190-11-2**]
3. PEG placement [**2190-11-1**]
4. HIT, diagnosed [**10-14**]
5. IVC filter placement [**2190-10-28**]
6. Bipolar d/o, on lithium
7. c-section x3
8. cervical myelopathy [**1-12**] rhematoid arthritis since [**2186**]
9. hx or bowel obstruction

MEDICATION ON ADMISSION: Colace
Senna
Hydralizine 10 Q6
Prevacid
Lithium 150 [**Hospital1 **]
MOM
Lopressor 50 [**Hospital1 **]
Nystatin S&S
Tylenol

ALLERGIES: Penicillins / Demerol / Heparin Agents

PHYSICAL EXAM: VS- T= 98.4 BP= 126/67 P= 86 RR= 18 O2= 100% on 35% TM
HEENT- NC/AT. EOMI. Unable to move neck.
Chest- referred sounds from upper airway heard throughout
anterior and posterior fields. Equal bilaterally. No wheezes,
crackles.
CV- normal rate, regular rhythm. Normal S1, S2. No M/R/G
Abd- PEG in place, dressing C/D/I. BS present. Soft, nontender,
nondistended.
Ext- no edema. DP pulses 2+ bilaterally. nontender. Right arm in
brace.
Neuro- AAOx3. Motor: LLE- [**1-15**], RLE- [**12-15**].

FAMILY HISTORY: Parents with CAD

SOCIAL HISTORY: Came from rehab, married, husband is also sick at times per
daughters, has 2 daughters and 1 son, children very
involved.Communication:  Husband/daughter at ([**Telephone/Fax (2) 23974**]Son at
([**Telephone/Fax (1) 23975**] 

### Response:
{'Mechanical complication of tracheostomy,Cardiac arrest,Bacteremia,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Rheumatoid arthritis,Unspecified essential hypertension,Gastrostomy status,Anemia, unspecified,Bipolar disorder, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins'}
