CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: This is a 43-year-old female with a
history of relapsing polychondritis and complex airway
involvement.  Her initial presentation dates back to [**2186**] where
she initially presented with worsening shortness of breath and
cough.  At that time, she was misdiagnosed as asthma and she was
resistant to all inhaled medication.  Her symptoms progressed to
the point that further workup was initiated in [**2189**]/[**2190**]
including PFTs and CT scan of the chest.  Meanwhile, the patient
was also experiencing classical symptoms of relapsing
polychondritis, including recurrent ear pain and transformation
in the shape of her nose to a saddle nose and hoarseness of her
voice.  In [**2190**], based on those symptoms and appearance for CAT
scan, bronchoscopy was performed, which revealed severe
tracheobronchomalacia and follow up airways and two Polyflex
stents were placed in the trachea for central airway
stabilization.  Since that time, the patient's breathing
improved; however, she has been having a problem with recurrent
bronchitis and recurrent pseudomonas pulmonary infection
requiring multiple antibiotic courses.  Most recently, the
patient was admitted to hospital in [**Location (un) 36413**] for respiratory
distress, stridor.  She was given antibiotics and sent home with
PO Cipro for recurrent Pseudomonas infection.  In addition, the
patient has been on a very high-dose of systemic steroids,
prednisone 80 mg daily.  Currently, her main complaint include
history of recurrent bronchitis, shortness of breath and cough.
She continues to have stridor and reports fatigue while walking
due to tachycardia, and SOB.

MEDICAL HISTORY: Relapsing polychondritis
C-section
Knee injury
Gastroesophageal reflux disease
Hypertension after initiation of steroids
NIDDM

MEDICATION ON ADMISSION: CIPRO 500MG [**Hospital1 **]
ACETYLCYSTEINE - 20 % (200mg/mL) Solution - 2ml for inhalation
prn
ALBUTEROL SULFATE - 2.5 mg/3 mL(0.083 %)Nebulization - 1 neb
q4-6 hours
DIPHENHYDRAMINE HCL -  25 mgCapsule - 1 Capsule(s) by mouth
daily as needed
INSULIN GLARGINE [LANTUS] -  (Prescribed by Other Provider) -
100
unit/mL Solution - 15 units subcutaneous qam
MOM[**Name (NI) **] [NASONEX] - 50 mcg Spray, - 2 sprays in each nostril
daily
PREDNISONE - 20 mg Tablet - 2 Tablet(s) by mouth twice a day
TELMISARTAN [MICARDIS] 80 mg Tablet - 1 Tablet(s) by mouth daily
TOLTERODINE [DETROL LA] 4 mg Capsule, Sust. Release 24 hr - 1
Capsule(s) by mouth daily
TRIMETHOPRIM-SULFAMETHOXAZOLE -800 mg-160 mg Tablet - 1
Tablet(s) by mouth q
monday/wenesday/friday
VERAPAMIL - 240 mg Tablet Sustained Release - 1 Tablet(s) by
mouth twice a day

ALLERGIES: Codeine / Biaxin / Toothpaste

PHYSICAL EXAM: VS: 97.9 96 115/62 22 100% TM
Gen: alert and oriented x 3, NAD
Cardiac: distant heart sounds, RRR, no MRGC
Pulm: Upper airway transmitted sounds/rhonchi
Abdomen: Soft, non-tender, non-distended
Wounds: Tracheostomy site--purulent discharge on either side of
Bovona. [**Hospital1 **] 2x2 dry dressing change. NOTE: THERE IS ONE 2X2
GAUZE ON EITHER SIDE OF THE TRACH FOR A TOTAL OF 2 2X2
Groin site--serosang discharge. QID 4x4 dry dressing change.
NOTE: THERE IS ONE 4X4 GAUZE PACKED IN THE WOUND

FAMILY HISTORY: Significant for relapsing similar airway problem
in her aunts and a brother with Crohn disease.

SOCIAL HISTORY: Denies ETOH, cigarettes.  Lives with husband in [**Name (NI) 36413**].
Cellulitis and perichondritis of larynx,Infection of tracheostomy,Acute bronchiolitis due to other infectious organisms,Seroma complicating a procedure,Esophageal reflux,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Morbid obesity,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants
Laryngeal cellulitis,Tracheostomy infection,Acu brnchlts d/t oth org,Seroma complicting proc,Esophageal reflux,Hypertension NOS,DMII wo cmp nt st uncntr,Morbid obesity,Pseudomonas infect NOS,Abn react-surg proc NEC,Long-term use anticoagul
Admission Date:  [**2193-11-7**]              Discharge Date:   [**2193-11-29**]

Date of Birth:  [**2150-4-21**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Biaxin / Toothpaste

Attending:[**First Name3 (LF) 281**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
[**2193-11-12**] 7.0 [**Last Name (un) 295**] trache and foreign body (stent) removal from
the trachea with femoral arterial and venous ECMO
intraoperatively.


History of Present Illness:
This is a 43-year-old female with a
history of relapsing polychondritis and complex airway
involvement.  Her initial presentation dates back to [**2186**] where
she initially presented with worsening shortness of breath and
cough.  At that time, she was misdiagnosed as asthma and she was
resistant to all inhaled medication.  Her symptoms progressed to
the point that further workup was initiated in [**2189**]/[**2190**]
including PFTs and CT scan of the chest.  Meanwhile, the patient
was also experiencing classical symptoms of relapsing
polychondritis, including recurrent ear pain and transformation
in the shape of her nose to a saddle nose and hoarseness of her
voice.  In [**2190**], based on those symptoms and appearance for CAT
scan, bronchoscopy was performed, which revealed severe
tracheobronchomalacia and follow up airways and two Polyflex
stents were placed in the trachea for central airway
stabilization.  Since that time, the patient's breathing
improved; however, she has been having a problem with recurrent
bronchitis and recurrent pseudomonas pulmonary infection
requiring multiple antibiotic courses.  Most recently, the
patient was admitted to hospital in [**Location (un) 36413**] for respiratory
distress, stridor.  She was given antibiotics and sent home with
PO Cipro for recurrent Pseudomonas infection.  In addition, the
patient has been on a very high-dose of systemic steroids,
prednisone 80 mg daily.  Currently, her main complaint include
history of recurrent bronchitis, shortness of breath and cough.
She continues to have stridor and reports fatigue while walking
due to tachycardia, and SOB.


Past Medical History:
Relapsing polychondritis
C-section
Knee injury
Gastroesophageal reflux disease
Hypertension after initiation of steroids
NIDDM


Social History:
Denies ETOH, cigarettes.  Lives with husband in [**Name (NI) 36413**].


Family History:
Significant for relapsing similar airway problem
in her aunts and a brother with Crohn disease.


Physical Exam:
VS: 97.9 96 115/62 22 100% TM
Gen: alert and oriented x 3, NAD
Cardiac: distant heart sounds, RRR, no MRGC
Pulm: Upper airway transmitted sounds/rhonchi
Abdomen: Soft, non-tender, non-distended
Wounds: Tracheostomy site--purulent discharge on either side of
Bovona. [**Hospital1 **] 2x2 dry dressing change. NOTE: THERE IS ONE 2X2
GAUZE ON EITHER SIDE OF THE TRACH FOR A TOTAL OF 2 2X2
Groin site--serosang discharge. QID 4x4 dry dressing change.
NOTE: THERE IS ONE 4X4 GAUZE PACKED IN THE WOUND

Pertinent Results:
[**2193-11-19**] 06:20AM BLOOD WBC-12.3* RBC-3.28* Hgb-8.1* Hct-27.1*
MCV-83 MCH-24.8* MCHC-30.1* RDW-19.8* Plt Ct-220#
[**2193-11-19**] 06:20AM BLOOD Glucose-121* UreaN-18 Creat-0.5 Na-138
K-4.6 Cl-96 HCO3-34* AnGap-13
[**2193-11-19**] 06:20AM BLOOD WBC-12.3* RBC-3.28* Hgb-8.1* Hct-27.1*
MCV-83 MCH-24.8* MCHC-30.1* RDW-19.8* Plt Ct-220#
[**2193-11-27**] 06:30AM BLOOD Glucose-122* UreaN-17 Creat-0.7 Na-130*
K-4.3 Cl-91* HCO3-29 AnGap-14

Brief Hospital Course:
Mrs. [**Known firstname **] [**Known lastname **] was admitted on [**2193-11-7**] with relapsing
polychondritis,
tracheobronchomalacia and status post two Polyflex stents with
recurrent pseudomonal respiratory infection.  She presented with
increasing shortness of breath, tachycardia, and stridor. She
underwent CT of the trachea the following day revealing patent
stents however severe tracheobronchoomalacia with focal stenosis
in the subglottic
region, right mainstem bronchus with obstruction of the origin
of the bronchus
intermedius on the expiratory phase. There was also multifocal
bronchiolitis with peribronchial wall thickening, secretions,
plugging and centrilobular nodules involving all lobes with the
exception of the left upper lobe is most likely due to repeated
aspiration causing infection or inflammation. The patient
underwent flexible bronchoscopy by Dr. [**First Name (STitle) **] [**Name (STitle) **] on [**2193-11-11**]
revealing airway inflammation and granulation tissue. It was
then determined that the patient would need to go to the
Operating Room for rigid bronchoscopy for debridement,  however
during this procedure the patient airway edema and difficulties
with oxygen saturations, even becoming pulseless. The patient
was on ECMO and then had open trachestomy due to diffuse airway
edema. The patient also had stent removal during such time. She
stabilized and was taken to the ICU for recovery. She was stable
and transfered to the floor, where she underwent PT/OT
evaluations and swallow evaluation. She had penetration with
nectar thick liquids but was cleared for thin liquids and solids
and pills whole with puree. She was afebrile, and had a modest
WBC elevation to 12.1 on [**2193-11-20**] however the patient had foul
smelling secretions from her trach. It turns out there was a
retained gauze that her skin healed over. The wound was opened
and we started [**Hospital1 **] gauze chages. The wound grew out
pseudomonsas, which she is colonized with in the past.
Infectious disease recommended no further antibiotic treatment.
The patient also complained of decreased motor on the right,
however this is improving and there are no color, temperature or
sensory deficits compared to the left lower extremity. Of note a
doppler US revealed no pseudoaneurysm at the groin site. The
right fem ECMO site was covered by staples and a seroma
developed so the wound was partially opened and packed with a
dry gauze QID. Rheumotology was consulted and they did not want
to change her current high dose prednisone, however to watch the
patient and follow up in one month. They also did not recommend
restarting anti-TNF therapy.  She continued to do well, with
stable vital signs, stable respiratory status, ambulating with
the help of PT, and tolerating a regular diet. She was
discharged on [**11-29**] to [**Location (un) 36413**] where she will be admitted back
to her referring physician.


Medications on Admission:
CIPRO 500MG [**Hospital1 **]
ACETYLCYSTEINE - 20 % (200mg/mL) Solution - 2ml for inhalation
prn
ALBUTEROL SULFATE - 2.5 mg/3 mL(0.083 %)Nebulization - 1 neb
q4-6 hours
DIPHENHYDRAMINE HCL -  25 mgCapsule - 1 Capsule(s) by mouth
daily as needed
INSULIN GLARGINE [LANTUS] -  (Prescribed by Other Provider) -
100
unit/mL Solution - 15 units subcutaneous qam
MOM[**Name (NI) **] [NASONEX] - 50 mcg Spray, - 2 sprays in each nostril
daily
PREDNISONE - 20 mg Tablet - 2 Tablet(s) by mouth twice a day
TELMISARTAN [MICARDIS] 80 mg Tablet - 1 Tablet(s) by mouth daily
TOLTERODINE [DETROL LA] 4 mg Capsule, Sust. Release 24 hr - 1
Capsule(s) by mouth daily
TRIMETHOPRIM-SULFAMETHOXAZOLE -800 mg-160 mg Tablet - 1
Tablet(s) by mouth q
monday/wenesday/friday
VERAPAMIL - 240 mg Tablet Sustained Release - 1 Tablet(s) by
mouth twice a day


Discharge Disposition:
Home with Service

Discharge Diagnosis:
Tracheobronchomalacia s/p tracheostomy and stent removal.


Discharge Condition:
stable


Discharge Instructions:
Call your local pulmonologist if you experience any worsening
shortness of breath, chest pains, fevers, chills or questions.
Follow up with your local rheumatologist.
Follow up with Dr. [**Last Name (STitle) **] in one month.

Twice daily 2x2 dry dressing change of the tracheostomy site:
put one 2x2 gauze on either side of the tracheostomy for a total
of two gauze sponges.

Four times daily 4x4 dry dressing change of the Right groin
site: put one 4x4 gauze into the groin wound and cover with 4x4
sponges.

Followup Instructions:
Follow up with your local pulmonologist and rheumatologist.
Follow up with Dr. [**Last Name (STitle) **] in one month. Call Dr. [**Last Name (STitle) **] at
[**Telephone/Fax (1) 10084**] for follow up appointment.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 286**]

Completed by:[**2193-12-3**]
{'Cellulitis and perichondritis of larynx,Infection of tracheostomy,Acute bronchiolitis due to other infectious organisms,Seroma complicating a procedure,Esophageal reflux,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Morbid obesity,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants'}


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: shortness of breath

PRESENT ILLNESS: This is a 43-year-old female with a
history of relapsing polychondritis and complex airway
involvement.  Her initial presentation dates back to [**2186**] where
she initially presented with worsening shortness of breath and
cough.  At that time, she was misdiagnosed as asthma and she was
resistant to all inhaled medication.  Her symptoms progressed to
the point that further workup was initiated in [**2189**]/[**2190**]
including PFTs and CT scan of the chest.  Meanwhile, the patient
was also experiencing classical symptoms of relapsing
polychondritis, including recurrent ear pain and transformation
in the shape of her nose to a saddle nose and hoarseness of her
voice.  In [**2190**], based on those symptoms and appearance for CAT
scan, bronchoscopy was performed, which revealed severe
tracheobronchomalacia and follow up airways and two Polyflex
stents were placed in the trachea for central airway
stabilization.  Since that time, the patient's breathing
improved; however, she has been having a problem with recurrent
bronchitis and recurrent pseudomonas pulmonary infection
requiring multiple antibiotic courses.  Most recently, the
patient was admitted to hospital in [**Location (un) 36413**] for respiratory
distress, stridor.  She was given antibiotics and sent home with
PO Cipro for recurrent Pseudomonas infection.  In addition, the
patient has been on a very high-dose of systemic steroids,
prednisone 80 mg daily.  Currently, her main complaint include
history of recurrent bronchitis, shortness of breath and cough.
She continues to have stridor and reports fatigue while walking
due to tachycardia, and SOB.

MEDICAL HISTORY: Relapsing polychondritis
C-section
Knee injury
Gastroesophageal reflux disease
Hypertension after initiation of steroids
NIDDM

MEDICATION ON ADMISSION: CIPRO 500MG [**Hospital1 **]
ACETYLCYSTEINE - 20 % (200mg/mL) Solution - 2ml for inhalation
prn
ALBUTEROL SULFATE - 2.5 mg/3 mL(0.083 %)Nebulization - 1 neb
q4-6 hours
DIPHENHYDRAMINE HCL -  25 mgCapsule - 1 Capsule(s) by mouth
daily as needed
INSULIN GLARGINE [LANTUS] -  (Prescribed by Other Provider) -
100
unit/mL Solution - 15 units subcutaneous qam
MOM[**Name (NI) **] [NASONEX] - 50 mcg Spray, - 2 sprays in each nostril
daily
PREDNISONE - 20 mg Tablet - 2 Tablet(s) by mouth twice a day
TELMISARTAN [MICARDIS] 80 mg Tablet - 1 Tablet(s) by mouth daily
TOLTERODINE [DETROL LA] 4 mg Capsule, Sust. Release 24 hr - 1
Capsule(s) by mouth daily
TRIMETHOPRIM-SULFAMETHOXAZOLE -800 mg-160 mg Tablet - 1
Tablet(s) by mouth q
monday/wenesday/friday
VERAPAMIL - 240 mg Tablet Sustained Release - 1 Tablet(s) by
mouth twice a day

ALLERGIES: Codeine / Biaxin / Toothpaste

PHYSICAL EXAM: VS: 97.9 96 115/62 22 100% TM
Gen: alert and oriented x 3, NAD
Cardiac: distant heart sounds, RRR, no MRGC
Pulm: Upper airway transmitted sounds/rhonchi
Abdomen: Soft, non-tender, non-distended
Wounds: Tracheostomy site--purulent discharge on either side of
Bovona. [**Hospital1 **] 2x2 dry dressing change. NOTE: THERE IS ONE 2X2
GAUZE ON EITHER SIDE OF THE TRACH FOR A TOTAL OF 2 2X2
Groin site--serosang discharge. QID 4x4 dry dressing change.
NOTE: THERE IS ONE 4X4 GAUZE PACKED IN THE WOUND

FAMILY HISTORY: Significant for relapsing similar airway problem
in her aunts and a brother with Crohn disease.

SOCIAL HISTORY: Denies ETOH, cigarettes.  Lives with husband in [**Name (NI) 36413**]. 

### Response:
{'Cellulitis and perichondritis of larynx,Infection of tracheostomy,Acute bronchiolitis due to other infectious organisms,Seroma complicating a procedure,Esophageal reflux,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Morbid obesity,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants'}
