CHIEF COMPLAINT: CC:[**CC Contact Info 62774**]
Major Surgical or Invasive Procedure:
Bronchoalveolar Lavage

PRESENT ILLNESS: 55 yo man with Hx of extensive tobacco use, metastatic
esophageal cancer s/p stent placement x 2, course complicated by
pain from acid reflux, unable to control at home with Tagamet,
Protonix, and Carafate. He was admitted to the hospital for pain
mgmnt, and poor po intake leading to acute renal failure. He
complains of pain, burning and severe gas after placement of his
esophageal stent on [**2142-2-15**].He denies any vomiting or hematemesis
and complains of occassional nausea. He was evaluated by ICU
team for progressive SOB x 3 days and increased work of
breathing. His pulse oximetry dropped to as low as 85% on 6L NC
and recovered to low 90's on 100% NRB. At that time he had a
resp rate of 24, ABG was  7.43/ 36/82 on 100%NRB. in addition he
was found to have tachycardia to 130's a lactate of 4.6 and WBC
increase to 16.2. Received IV lasix 40 mg x 2, Nebs x 1.

MEDICAL HISTORY: 1)Hypertension
2)Metastatic Esophageal cancer s/p 6 cycles of cisplatin and
Irinotecan. Mets to mediastinal and Abd lymph nodes, Liver,
Adrenal
3)Severe GERD

MEDICATION ON ADMISSION: Levaquin 500 mg po qd
Flagyl 500 po tid
Maalox QID
Anzemet PRN
Colace 100 mg po bid
Fentanyl patch 75 mcg q72
Heparin 5000 sq tid
Reglan 5 mg qid
Metoprolol 50 [**Hospital1 **]
Morphine PCA
Morphine SE 30 mg [**Hospital1 **]
Nexium 40 [**Hospital1 **]
Zantac 300 mg qhs
Sucralfate 1 qid
Simethicone 40 qid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals: 99.1 130 140/83 26 87-90% on 100%NRB
GENERAL: awake, in mild resp distress on NRB mask, cooperative
HEENT: atraumatic, anicteric sclerae, dry mucosa, clear OP
NECK: Supple, no JVD, Ant Cerv LAD
LUNGS: Diffuse end exp wheeze b/l, no accessory muscle use, no
ronchi or crackles
BACK: no spinal or CVAT
HEART: Regular, tachy, no M/R/G
ABDOMEN: soft, Mild midepigastric tenderness, normal BS, no
guarding, no rebound, no masses appreciated
EXTREMITIES: trace b/l le edema. Warm, full DP pulses B/L
NEURO: CN II-XII intact, no focal deficits

FAMILY HISTORY: Father and aunt -pancreatic cancer
Uncle - liver cancer
Grandfather -liver cancer

SOCIAL HISTORY: 2 packs of cigarette per day for the last few years, 1 ppd
before that since age 20. He denies any
alcohol use. He owns his loan business detail in [**Location (un) **]; however,
Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of adrenal gland,Pneumonitis due to inhalation of food or vomitus,Other pulmonary insufficiency, not elsewhere classified,Bacteremia,Acute kidney failure, unspecified,Esophageal reflux,Unspecified essential hypertension,Anemia, unspecified,Encounter for palliative care
Mal neo esophagus NEC,Secondary malig neo lung,Second malig neo adrenal,Food/vomit pneumonitis,Other pulmonary insuff,Bacteremia,Acute kidney failure NOS,Esophageal reflux,Hypertension NOS,Anemia NOS,Encountr palliative care
Admission Date:  [**2142-2-14**]              Discharge Date:   [**2142-3-1**]

Date of Birth:  [**2086-12-24**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
CC:[**CC Contact Info 62774**]
Major Surgical or Invasive Procedure:
Bronchoalveolar Lavage

History of Present Illness:
55 yo man with Hx of extensive tobacco use, metastatic
esophageal cancer s/p stent placement x 2, course complicated by
pain from acid reflux, unable to control at home with Tagamet,
Protonix, and Carafate. He was admitted to the hospital for pain
mgmnt, and poor po intake leading to acute renal failure. He
complains of pain, burning and severe gas after placement of his
esophageal stent on [**2142-2-15**].He denies any vomiting or hematemesis
and complains of occassional nausea. He was evaluated by ICU
team for progressive SOB x 3 days and increased work of
breathing. His pulse oximetry dropped to as low as 85% on 6L NC
and recovered to low 90's on 100% NRB. At that time he had a
resp rate of 24, ABG was  7.43/ 36/82 on 100%NRB. in addition he
was found to have tachycardia to 130's a lactate of 4.6 and WBC
increase to 16.2. Received IV lasix 40 mg x 2, Nebs x 1.

Past Medical History:
1)Hypertension
2)Metastatic Esophageal cancer s/p 6 cycles of cisplatin and
Irinotecan. Mets to mediastinal and Abd lymph nodes, Liver,
Adrenal
3)Severe GERD


Social History:
 2 packs of cigarette per day for the last few years, 1 ppd
before that since age 20. He denies any
alcohol use. He owns his loan business detail in [**Location (un) **]; however,

he has been unable to work since the end of [**Month (only) 205**]. He is
divorced. He has 1 child. The child does not live locally.
.


Family History:
Father and aunt -pancreatic cancer
Uncle - liver cancer
Grandfather -liver cancer


Physical Exam:
vitals: 99.1 130 140/83 26 87-90% on 100%NRB
GENERAL: awake, in mild resp distress on NRB mask, cooperative
HEENT: atraumatic, anicteric sclerae, dry mucosa, clear OP
NECK: Supple, no JVD, Ant Cerv LAD
LUNGS: Diffuse end exp wheeze b/l, no accessory muscle use, no
ronchi or crackles
BACK: no spinal or CVAT
HEART: Regular, tachy, no M/R/G
ABDOMEN: soft, Mild midepigastric tenderness, normal BS, no
guarding, no rebound, no masses appreciated
EXTREMITIES: trace b/l le edema. Warm, full DP pulses B/L
NEURO: CN II-XII intact, no focal deficits


Pertinent Results:
[**2142-2-14**] 02:15PM   WBC-12.0* RBC-3.81* HGB-12.2* HCT-35.7*
MCV-94 MCH-32.0 MCHC-34.2 RDW-14.7
[**2142-2-14**] 02:15PM   PLT COUNT-407
[**2142-2-14**] 02:15PM   GRAN CT-[**Numeric Identifier 60243**]*
[**2142-2-14**] 02:15PM   ALBUMIN-3.5 CALCIUM-8.7 PHOSPHATE-2.5*
MAGNESIUM-2.1 CHOLEST-168
[**2142-2-14**] 02:15PM   LIPASE-14 GGT-87*
[**2142-2-14**] 02:15PM   ALT(SGPT)-21 AST(SGOT)-28 ALK PHOS-117
AMYLASE-13 TOT BILI-0.3 DIR BILI-0.1 INDIR BIL-0.2
[**2142-2-14**] 02:15PM   GLUCOSE-119* UREA N-30* CREAT-1.6* SODIUM-133
POTASSIUM-4.1 CHLORIDE-97 TOTAL CO2-23 ANION GAP-17
[**2142-2-14**] 07:50PM   CK-MB-2 cTropnT-0.02*
[**2142-2-14**] 07:50PM   CK(CPK)-32*

ABDOMEN (SUPINE & ERECT)  [**2142-2-14**] 4:38 PM

ABDOMEN (SUPINE & ERECT)

Reason: perforation, obstruction, stent placement

[**Hospital 93**] MEDICAL CONDITION:
55 year old man with esophageal carcinoma, s/p stent placement
REASON FOR THIS EXAMINATION:
perforation, obstruction, stent placement
INDICATION: 55-year-old man with esophageal carcinoma, status
post stent placement.

TECHNIQUE: Supine and upright abdominal radiographs.

No comparison.

FINDINGS: The patient is status post esophageal stent placement
at lower esophagus and GE junction. Note is made of unremarkable
bowel gas pattern with few air-fluid levels, without evidence of
significant dilatation or obstruction. No evidence of ascites is
seen on this radiograph. The osseous structures are
unremarkable.
.
CTA CHEST W&W/O C &RECONS; CT 100CC NON IONIC CONTRAST

Reason: please eval pulmonary embolism with CTA, but please also
inc
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
55 year old man with esophageal cancer, pleural effusions,
worsening hypoxia
REASON FOR THIS EXAMINATION:
please eval pulmonary embolism with CTA, but please also include
cuts to eval for worsening lung injury from chronic aspirations
vs pneumonia, also eval size of pleural effusions
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Hypoxia, history of esophageal cancer.

COMPARISON: Non-contrast CT from a PET study of [**2142-1-25**], chest x-ray from [**2142-2-19**].

TECHNIQUE: Multidetector CT scanning was performed of the chest
before and after the administration of 100 cc of Optiray
intravenous contrast. Multiplanar reformations were obtained.

CT OF THE CHEST: Bilateral hilar as well as mediastinal
adenopathy is seen. The heart and pericardium appear
unremarkable. There is a dilated esophagus with a stent
extending to the gastroesophageal junction. A central venous
catheter seen with its tip terminating in the superior vena
cava. The great vessels appear unremarkable. The pulmonary
arteries do not demonstrate any central or segmental filling
defects to suggest pulmonary embolism. Bilateral moderate
pleural effusions are identified of simple fluid attenuation,
which were not present on the [**1-25**] study. There has been
new development of extensive ground glass and consolidative
opacities involving the majority of the upper lobes bilaterally,
as well as the lingula, right middle lobe, and lower lobes to a
lesser extent. The airways are patent to the level of the
segmental bronchi bilaterally.

In the visualized abdomen again seen are multiple
low-attenuation masses within the liver, which appear to be
increased in size and extent since the prior study of [**1-25**]. The osseous structures demonstrate no concerning lytic or
sclerotic lesions.

IMPRESSION:
1. Bilateral ground-glass and consolidative opacities involving
multiple lobes, but most notably the upper lobes. This has
developed since the prior CT of [**1-25**] and is worsened since
the recent chest x-ray. These findings are most consistent with
aspiration pneumonia, though there may be an element of
superimposed pulmonary edema. Bilateral moderate-sized pleural
effusions have also developed in the interim.
2. Dilated esophagus with a stent extending to the
gastroesophageal junction. Extensive hilar and mediastinal
lymphadenopathy. Multiple liver hypodensities consistent with
metastatic disease.
3. No evidence of central or segmental pulmonary embolism.

These findings were discussed with Dr. [**Last Name (STitle) **] at 4:30 p.m. on
[**2142-2-21**].

IMPRESSION: Esophageal stent in lower esophagus and GE junction.
Unremarkable bowel gas pattern. Please also refer to the
official report of chest radiograph obtained on the same day.
.
BRONCHIAL WASHINGS Procedure Date of [**2142-2-21**]


REPORT APPROVED DATE: [**2142-2-23**]
SPECIMEN RECEIVED: [**2142-2-22**]    06-[**Numeric Identifier 62775**]    BRONCHIAL WASHINGS

SPECIMEN DESCRIPTION: Received 7.5 ml of bloody fluid and 1
hematology
  slide for referal. Total 2 slides.

CLINICAL DATA: Known esophageal cancer, acute hypoxemic
respiratory
  failure.
PREVIOUS BIOPSIES:
 [**2141-8-25**]   [**-4/3463**]   MEDIASTINAL LYMPH NODE


REPORT TO: DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**]

DIAGNOSIS: Bronchial lavage:

  POSITIVE FOR MALIGNANT CELLS consistent with
  adenocarcinoma


Brief Hospital Course:
A/P: 55 yo male with metastatic esophagel cancer, recent ARF [**1-18**]
dehydration who was transferred to ICU for increased oxygen
demand, Lactic Acidosis, and Elevated WBC Count:
.
1. Increased oxygen demand/ARDS: Unclear etiology, initially
thought to be secondary to pneumonitis/PNA 2x2 aspiration. There
was no evidence of PE. BAL did not show an infectious etiology.
Bacteremia was revealed by blood cultures.
Patient was initially treated with IV antibiotics and ARDS low
volume ventilation strategy. Despite this measures, patient
continue to be febrile, with elevated lactic acidosis and high
WBC. Even an steroid trial was given but patient still required
high FIO2.
.
Fevers and elevated WBC: Initially treated as a pulmonary
source. Patient initially responded to antibiotics, but later on
developed high grade fevers. Last blood cultured showed Gram
positive cocci.
.
Elevated Lactate. Persistent elevated lactate despite adequated
CVP and Mix venous saturations. It was thought to be secondary
to sepsis, with contribution of tumor burden and liver
metaastasis.
.
Acute renal failure: thought to be secondary to prerenal
azotemia in setting of sepsis. Creatinine remained at 1.4-1.6.
.
On [**2142-3-1**] a family meeting was held. The clinical situation was
explained to the family worsening ARDS, severe dead space
ventilation, worsening leukocytosis and fevers, associated with
metastatic esophageal cancer gave him very low possibilities of
recovery. Family felt that the medical team should direct goals
of care towards confort at thats time. Patient passed away
quietly in the presence of his family.


Medications on Admission:
Levaquin 500 mg po qd
Flagyl 500 po tid
Maalox QID
Anzemet PRN
Colace 100 mg po bid
Fentanyl patch 75 mcg q72
Heparin 5000 sq tid
Reglan 5 mg qid
Metoprolol 50 [**Hospital1 **]
Morphine PCA
Morphine SE 30 mg [**Hospital1 **]
Nexium 40 [**Hospital1 **]
Zantac 300 mg qhs
Sucralfate 1 qid
Simethicone 40 qid


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
Acute Respiratory Distress Syndrome
Metastatic esophageal cancer
Multiorgan failure

Discharge Condition:
expired

Discharge Instructions:
n/a

Followup Instructions:
n/a

                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]

Completed by:[**2142-9-24**]
{'Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of adrenal gland,Pneumonitis due to inhalation of food or vomitus,Other pulmonary insufficiency, not elsewhere classified,Bacteremia,Acute kidney failure, unspecified,Esophageal reflux,Unspecified essential hypertension,Anemia, unspecified,Encounter for palliative care'}


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: CC:[**CC Contact Info 62774**]
Major Surgical or Invasive Procedure:
Bronchoalveolar Lavage

PRESENT ILLNESS: 55 yo man with Hx of extensive tobacco use, metastatic
esophageal cancer s/p stent placement x 2, course complicated by
pain from acid reflux, unable to control at home with Tagamet,
Protonix, and Carafate. He was admitted to the hospital for pain
mgmnt, and poor po intake leading to acute renal failure. He
complains of pain, burning and severe gas after placement of his
esophageal stent on [**2142-2-15**].He denies any vomiting or hematemesis
and complains of occassional nausea. He was evaluated by ICU
team for progressive SOB x 3 days and increased work of
breathing. His pulse oximetry dropped to as low as 85% on 6L NC
and recovered to low 90's on 100% NRB. At that time he had a
resp rate of 24, ABG was  7.43/ 36/82 on 100%NRB. in addition he
was found to have tachycardia to 130's a lactate of 4.6 and WBC
increase to 16.2. Received IV lasix 40 mg x 2, Nebs x 1.

MEDICAL HISTORY: 1)Hypertension
2)Metastatic Esophageal cancer s/p 6 cycles of cisplatin and
Irinotecan. Mets to mediastinal and Abd lymph nodes, Liver,
Adrenal
3)Severe GERD

MEDICATION ON ADMISSION: Levaquin 500 mg po qd
Flagyl 500 po tid
Maalox QID
Anzemet PRN
Colace 100 mg po bid
Fentanyl patch 75 mcg q72
Heparin 5000 sq tid
Reglan 5 mg qid
Metoprolol 50 [**Hospital1 **]
Morphine PCA
Morphine SE 30 mg [**Hospital1 **]
Nexium 40 [**Hospital1 **]
Zantac 300 mg qhs
Sucralfate 1 qid
Simethicone 40 qid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals: 99.1 130 140/83 26 87-90% on 100%NRB
GENERAL: awake, in mild resp distress on NRB mask, cooperative
HEENT: atraumatic, anicteric sclerae, dry mucosa, clear OP
NECK: Supple, no JVD, Ant Cerv LAD
LUNGS: Diffuse end exp wheeze b/l, no accessory muscle use, no
ronchi or crackles
BACK: no spinal or CVAT
HEART: Regular, tachy, no M/R/G
ABDOMEN: soft, Mild midepigastric tenderness, normal BS, no
guarding, no rebound, no masses appreciated
EXTREMITIES: trace b/l le edema. Warm, full DP pulses B/L
NEURO: CN II-XII intact, no focal deficits

FAMILY HISTORY: Father and aunt -pancreatic cancer
Uncle - liver cancer
Grandfather -liver cancer

SOCIAL HISTORY: 2 packs of cigarette per day for the last few years, 1 ppd
before that since age 20. He denies any
alcohol use. He owns his loan business detail in [**Location (un) **]; however, 

### Response:
{'Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of adrenal gland,Pneumonitis due to inhalation of food or vomitus,Other pulmonary insufficiency, not elsewhere classified,Bacteremia,Acute kidney failure, unspecified,Esophageal reflux,Unspecified essential hypertension,Anemia, unspecified,Encounter for palliative care'}
