CHIEF COMPLAINT: difficult extubation after endoscopy

PRESENT ILLNESS: Pt is a 61yo f w/folicular lymnphoma, HTN, obesity and asthma,
went for repeat endoscopy today and desatted on MAC when GI
probe was put down due to laryngospasm. Probe was removed and pt
was intubated w/out difficulty. Procedure was successfully
completed but no cuff leak post op. WAs given 10mg IV decadron
but concern regarding extubation in PACU given ? pulm edema on
CXR. VSS throughout.
.
Per EGD report pt was incidentally found to have a follicular
lymphoma in the 2nd part of the duodenum adjacent to, but not
directly involving, the ampulla during an EGD [**2163-2-8**]. Pt had
initially presented w/unresolving symptoms of reflux Work-up for
metastatic disease was negative (CT, PET, bone marrow bx). Pt
underwent last EGD with Dr. [**Last Name (STitle) 64304**] [**2163-3-11**]-he re-biopsied an
area of white granular mucosal nodularity, which was negative
for lymphoma, as were biopsies of 3rd portion of duodenum beyond
the lymphoma.
.
On the transfer, initial vs were: T 95 P 90 BP 161/83 R 21 O2
sat 96% and pt intubated. When arrived, pt had cuff leak and was
able to be extubated. Throat feels scratchy but otherwise
feeling ok.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: follicular lymphoma [**2-/2163**]
HTN
Asthma
Kidney stone
D&C
sinusitis
chronic allergies

MEDICATION ON ADMISSION: ALBUTEROL SULFATE - (Prescribed by Other Provider) - Dosage
uncertain
FLUTICASONE [FLOVENT HFA] - (Prescribed by Other Provider) - 44
mcg Aerosol - 2 (Two) puffs by mouth once a day
LISINOPRIL - (Prescribed by Other Provider) - 10 mg Tablet - 1
(One) Tablet(s) by mouth once a day
LORAZEPAM - (Prescribed by Other Provider) - 0.5 mg Tablet - 1
(One) Tablet(s) by mouth as needed as needed for anxiety
OMEPRAZOLE - (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth once a day
TRIAMCINOLONE ACETONIDE - (Prescribed by Other Provider) -
Dosage uncertain

ALLERGIES: Penicillins / Percocet

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T 95 P 90 BP 161/83 R 21 O2 sat 96%
General: Alert, oriented, no acute distress after extubation
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: NC

SOCIAL HISTORY: live w/husband in [**Name (NI) **],MA. Retired.
Nodular lymphoma, intra-abdominal lymph nodes,Laryngeal spasm,Unspecified essential hypertension,Obesity, unspecified,Asthma, unspecified type, unspecified,Anxiety state, unspecified
Nodular lymphoma abdom,Laryngeal spasm,Hypertension NOS,Obesity NOS,Asthma NOS,Anxiety state NOS
Admission Date:  [**2163-6-1**]              Discharge Date:   [**2163-6-2**]

Date of Birth:  [**2101-7-20**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Percocet

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
difficult extubation after endoscopy

Major Surgical or Invasive Procedure:
endoscopy

History of Present Illness:
Pt is a 61yo f w/folicular lymnphoma, HTN, obesity and asthma,
went for repeat endoscopy today and desatted on MAC when GI
probe was put down due to laryngospasm. Probe was removed and pt
was intubated w/out difficulty. Procedure was successfully
completed but no cuff leak post op. WAs given 10mg IV decadron
but concern regarding extubation in PACU given ? pulm edema on
CXR. VSS throughout.
.
Per EGD report pt was incidentally found to have a follicular
lymphoma in the 2nd part of the duodenum adjacent to, but not
directly involving, the ampulla during an EGD [**2163-2-8**]. Pt had
initially presented w/unresolving symptoms of reflux Work-up for
metastatic disease was negative (CT, PET, bone marrow bx). Pt
underwent last EGD with Dr. [**Last Name (STitle) 64304**] [**2163-3-11**]-he re-biopsied an
area of white granular mucosal nodularity, which was negative
for lymphoma, as were biopsies of 3rd portion of duodenum beyond
the lymphoma.
.
On the transfer, initial vs were: T 95 P 90 BP 161/83 R 21 O2
sat 96% and pt intubated. When arrived, pt had cuff leak and was
able to be extubated. Throat feels scratchy but otherwise
feeling ok.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.


Past Medical History:
follicular lymphoma [**2-/2163**]
HTN
Asthma
Kidney stone
D&C
sinusitis
chronic allergies

Social History:
live w/husband in [**Name (NI) **],MA. Retired.

Family History:
NC

Physical Exam:
Admission Physical Exam:
Vitals: T 95 P 90 BP 161/83 R 21 O2 sat 96%
General: Alert, oriented, no acute distress after extubation
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema


Pertinent Results:
EGD
Findings: Esophagus: Normal esophagus.
Stomach: Normal stomach.
Duodenum:
 Mucosa: Localized discontinuous white, granular, nodularity in
a patchy distribution was noted in the area of the papilla.
Three endoclips were successfully applied to the papilla major
for the purpose of radiation therapy mapping. An small patch of
white, granular tissue was noted in the mid-jejunum. Cold
forceps biopsies were performed for histology at the
mid-jejunum.
Impression: Granularity, nodularity, and white patchy in the
area of the papilla consistent with previous biospy results that
indicated lymphoma.
 A very tiny, 1mm, white, granular patch in the mid-jejunum;
biopsy of this area was performed.
Three [**Company 2267**] resolution clips were placed around the
area of nodularity at the level of the entrum.  One clip was
place proximal, one distal and another in between to triangulate
the area.
Otherwise normal enteroscopy to third part of the duodenum.

Recommendations: Follow up with your [**Company 5564**] and radiation
[**Company 5564**] for planned therapy.
Plan discussed with Dr. [**Last Name (STitle) 64304**] prior to procedure. He will
notify radiation [**Last Name (STitle) 5564**] that clipping has been performed.
Please page the on call ERCP fellow at [**Telephone/Fax (1) 2756**], pager [**Numeric Identifier **]
with any immediate concerns such as bleeding, fever, abdominal
pain, or other problems.
Please call Dr.[**Name (NI) 2798**] office at [**Telephone/Fax (1) 2799**] with any
questions or concerns.

Additional notes: Patient will remain intubated and transferred
to PACU for observation and later extubation.  Husband was
called an informed of the need to intubate for the exam and the
above findings were explained to him.

FINAL DIAGNOSES are listed in the impression section above.
Estimated blood loss = zero. Specimens were taken for pathology
as listed above.



Brief Hospital Course:
Pt is a 61yo f w/folicular lymnphoma, HTN, obesity and asthma,
went for repeat endoscopy today and desatted on MAC when GI
probe was put down due to laryngospasm. Probe was removed and pt
was intubated w/out difficulty. Procedure was successfully
completed but no cuff leak post op. WAs given 10mg IV decadron
but concern regarding extubation in PACU given ? pulm edema on
CXR. VSS throughout.
.
# Larygnospasm: now resolved and extubated essentially on
arrival to ICU. Monitored airway, nebs prn, home flovent
continued, cepacol lozenges. Went home in AM. Recommend
consideration of possible sleep study if signs of sleep apnea
overnight
.
# Follicular lymphoma: plan per outpt onco. Clips placed for rad
therapy for localization of lymphoma, otherwise normal EGD.
Continued omperazole.
.
# Asthma: stable. Continued flovent, nebs prn and fenofexadine
(zyrtec at home) for allergy
.
#HTN: stable, continued home lisinopril
.
# Anxiety:  stable, continued home dose lorazepam


Medications on Admission:
ALBUTEROL SULFATE - (Prescribed by Other Provider) - Dosage
uncertain
FLUTICASONE [FLOVENT HFA] - (Prescribed by Other Provider) - 44
mcg Aerosol - 2 (Two) puffs by mouth once a day
LISINOPRIL - (Prescribed by Other Provider) - 10 mg Tablet - 1
(One) Tablet(s) by mouth once a day
LORAZEPAM - (Prescribed by Other Provider) - 0.5 mg Tablet - 1
(One) Tablet(s) by mouth as needed as needed for anxiety
OMEPRAZOLE - (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth once a day
TRIAMCINOLONE ACETONIDE - (Prescribed by Other Provider) -
Dosage uncertain

Medications - OTC
CALCIUM - (Prescribed by Other Provider) - Dosage uncertain
CALCIUM CITRATE-VITAMIN D3 [CITRACAL + D] - (Prescribed by Other
Provider) - 315 mg-200 unit Tablet - 2 (Two) Tablet(s) by mouth
once a day
CETIRIZINE [ZYRTEC] - (Prescribed by Other Provider) - 10 mg
Capsule - 1 (One) Capsule(s) by mouth once a day
GLUCOSAMINE-CHONDROITIN - (Prescribed by Other Provider) -
Dosage uncertain
SODIUM BICARB-SODIUM CHLORIDE [NEILMED SINUS RINSE COMPLETE] -
(Prescribed by Other Provider) - Dosage uncertain


Discharge Medications:
1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
One (1)  Inhalation prn as needed for shortness of breath or
wheezing.
2. Flovent HFA 44 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation once a day.
3. lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO once a day as
needed for anxiety.
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
6. triamcinolone acetonide  Topical
7. Citracal + D 315-200 mg-unit Tablet Sig: One (1) Tablet PO
once a day.
8. calcium  Oral
9. Zyrtec 10 mg Tablet Sig: One (1) Tablet PO once a day.
10. glucosamine-chondroitin  Oral
11. Neilmed Sinus Rinse Complete     Packet Sig: One (1)  Nasal
three times a day as needed for allergy symptoms.


Discharge Disposition:
Home

Discharge Diagnosis:
Follicular lymphoma
Laryngiospasm on intubation for endoscopy

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
You came to the hospital because you were scheduled to have an
endoscopy for further evaluation of your cancer. During the
procedure, you needed to be intubated to better protect your
airway and help you breath to ensure the oxygen levels in your
blood stayed at appropriate levels. You experienced spasm of the
muscles in you windpipe which required a dose of steroids to
help relieve them and you required slightly longer recovery time
prior to extubation. However, you were able to be successfully
extubated shortly after coming to the ICU for close monitoring.
You did well and were able to be discharged home with outpatient
follow-up planned with your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) 5564**].

No changes were made to your medications.
- Please continue to take all of your other home medications as
prescribed

Please be sure to keep all follow-up appointments with your
primary care doctor, [**Last Name (Titles) 5564**] and other health care providers.

It was a pleasure taking care of you and we wish you a speedy
recovery

Followup Instructions:
Please be sure to keep all follow-up appointments with your
primary care doctor, [**Last Name (Titles) 5564**] and other health care providers.


Completed by:[**2163-6-4**]
{'Nodular lymphoma, intra-abdominal lymph nodes,Laryngeal spasm,Unspecified essential hypertension,Obesity, unspecified,Asthma, unspecified type, unspecified,Anxiety state, unspecified'}


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: difficult extubation after endoscopy

PRESENT ILLNESS: Pt is a 61yo f w/folicular lymnphoma, HTN, obesity and asthma,
went for repeat endoscopy today and desatted on MAC when GI
probe was put down due to laryngospasm. Probe was removed and pt
was intubated w/out difficulty. Procedure was successfully
completed but no cuff leak post op. WAs given 10mg IV decadron
but concern regarding extubation in PACU given ? pulm edema on
CXR. VSS throughout.
.
Per EGD report pt was incidentally found to have a follicular
lymphoma in the 2nd part of the duodenum adjacent to, but not
directly involving, the ampulla during an EGD [**2163-2-8**]. Pt had
initially presented w/unresolving symptoms of reflux Work-up for
metastatic disease was negative (CT, PET, bone marrow bx). Pt
underwent last EGD with Dr. [**Last Name (STitle) 64304**] [**2163-3-11**]-he re-biopsied an
area of white granular mucosal nodularity, which was negative
for lymphoma, as were biopsies of 3rd portion of duodenum beyond
the lymphoma.
.
On the transfer, initial vs were: T 95 P 90 BP 161/83 R 21 O2
sat 96% and pt intubated. When arrived, pt had cuff leak and was
able to be extubated. Throat feels scratchy but otherwise
feeling ok.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: follicular lymphoma [**2-/2163**]
HTN
Asthma
Kidney stone
D&C
sinusitis
chronic allergies

MEDICATION ON ADMISSION: ALBUTEROL SULFATE - (Prescribed by Other Provider) - Dosage
uncertain
FLUTICASONE [FLOVENT HFA] - (Prescribed by Other Provider) - 44
mcg Aerosol - 2 (Two) puffs by mouth once a day
LISINOPRIL - (Prescribed by Other Provider) - 10 mg Tablet - 1
(One) Tablet(s) by mouth once a day
LORAZEPAM - (Prescribed by Other Provider) - 0.5 mg Tablet - 1
(One) Tablet(s) by mouth as needed as needed for anxiety
OMEPRAZOLE - (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth once a day
TRIAMCINOLONE ACETONIDE - (Prescribed by Other Provider) -
Dosage uncertain

ALLERGIES: Penicillins / Percocet

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T 95 P 90 BP 161/83 R 21 O2 sat 96%
General: Alert, oriented, no acute distress after extubation
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: NC

SOCIAL HISTORY: live w/husband in [**Name (NI) **],MA. Retired. 

### Response:
{'Nodular lymphoma, intra-abdominal lymph nodes,Laryngeal spasm,Unspecified essential hypertension,Obesity, unspecified,Asthma, unspecified type, unspecified,Anxiety state, unspecified'}
