CHIEF COMPLAINT: A-fib, SOB, CP

PRESENT ILLNESS: Lung cancer complicated with
tracheoesophageal fistula; status post Y stent placement;
esophageal stent placement.

MEDICAL HISTORY: non small cell lung cancer & obstructive L mainstem lesion
45 pk-yr smoker, Chronic Obstructive Pulmonary Disease, h/o
optic neuritis

MEDICATION ON ADMISSION: iron, vicodin, atrovent

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AAOx3, NAD, gaunt
RRR
course BS B/L
Soft NT/ND
no c/c/e

FAMILY HISTORY: 

SOCIAL HISTORY: lives in [**State 1727**].  Parents very supportive
Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of other parts of bronchus or lung,Chronic airway obstruction, not elsewhere classified,Empyema with fistula
Atrial fibrillation,Food/vomit pneumonitis,Mal neo bronch/lung NEC,Chr airway obstruct NEC,Empyema with fistula
Admission Date:  [**2104-2-19**]              Discharge Date:   [**2104-2-26**]

Date of Birth:  [**2053-5-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 281**]
Chief Complaint:
A-fib, SOB, CP

Major Surgical or Invasive Procedure:
Flexible bronchoscopy - [**2-20**]


History of Present Illness:
Lung cancer complicated with
tracheoesophageal fistula; status post Y stent placement;
esophageal stent placement.


Past Medical History:
non small cell lung cancer & obstructive L mainstem lesion
45 pk-yr smoker, Chronic Obstructive Pulmonary Disease, h/o
optic neuritis


Social History:
lives in [**State 1727**].  Parents very supportive


Physical Exam:
AAOx3, NAD, gaunt
RRR
course BS B/L
Soft NT/ND
no c/c/e


Pertinent Results:
[**2104-2-21**] 07:05AM BLOOD WBC-3.1* RBC-2.77* Hgb-9.3* Hct-28.8*
MCV-104* MCH-33.4* MCHC-32.2 RDW-15.9* Plt Ct-217
[**2104-2-20**] 12:30AM BLOOD WBC-3.3* RBC-2.53* Hgb-8.7* Hct-25.8*
MCV-102* MCH-34.3* MCHC-33.6 RDW-16.2* Plt Ct-216
[**2104-2-25**] 07:44PM BLOOD Glucose-113* UreaN-7 Creat-0.6 Na-137
K-3.7 Cl-102 HCO3-28 AnGap-11
[**2104-2-21**] 07:05AM BLOOD Glucose-99 UreaN-11 Creat-0.6 Na-140
K-3.7 Cl-106 HCO3-24 AnGap-14
[**2104-2-20**] 12:30AM BLOOD Glucose-116* UreaN-23* Creat-0.8 Na-139
K-3.9 Cl-107 HCO3-21* AnGap-15
[**2104-2-19**] 11:55AM BLOOD Glucose-106* UreaN-22* Creat-0.7 Na-138
K-3.8 Cl-104 HCO3-23 AnGap-15

CTA [**2-19**] -
IMPRESSION:
1. No evidence of pulmonary embolism or thoracic aortic
dissection.
2. Aspiration pneumonia involving the right lower lobe and the
lateral segment of the right middle lobe. There is opacification
of the airways of the right lower lobe proximally.
3. Interim placement of Y-shaped tracheal stent and esophageal
stent. The right limb of the tracheal stent extends
approximately 1.5 cm into the right mainstem bronchus; however,
the tracheal stent incompletely covers the fistulous connection.
4. Fluid level within the esophageal stent, likely predisposing
to aspiration.
5. Unchanged lymph nodes within the chest.


Brief Hospital Course:
Pt admitted with A-fib and SOB.  CTA neg for PE, but showed some
aspiration and treated with Abx x7 days.  Flexible bronch showed
worsening of right bronchial
mediastinal fistula.  HR was controlled with lopressor.  Pt
after bronch had several family meetings with IP and decided on
hospice.  His diet was advanced as tolerated and pain was well
controlled with fent, lido patches and oxycodone with occasional
morphine.  His diet was advanced without issue.  He is going
home with hospice and PCP is being informed.  He will go out on
Metoprolol and diltiazem for HR control - instructed to f/u with
PCP for [**Name9 (PRE) 35455**] [**Name9 (PRE) 16333**] of this.  Also sent out with 7 more days of
Levo/Flag/Fluc.


Medications on Admission:
iron, vicodin, atrovent

Discharge Medications:
1. Oxygen
Home oxygen as needed
2. medications
please resume your preadmission medications
3. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours)
as needed.
Disp:*80 Tablet(s)* Refills:*0*
4. Fentanyl 50 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours) as needed for pain.
Disp:*5 Patch 72HR(s)* Refills:*0*
5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical Q 12 HR PRN () as
needed for pain.
Disp:*25 Adhesive Patch, Medicated(s)* Refills:*0*
6. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*100 Tablet(s)* Refills:*0*
7. Dolasetron 100 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for nausea.
Disp:*50 Tablet(s)* Refills:*0*
8. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
Disp:*7 Tablet(s)* Refills:*0*
9. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
Disp:*21 Tablet(s)* Refills:*0*
10. Diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*80 Tablet(s)* Refills:*0*
11. Fluconazole 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours) as needed for mediastinitis.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
hospice of southern [**State **]

Discharge Diagnosis:
Lung Cancer
tracheoesophageal fistula

Discharge Condition:
Stable - hospice


Discharge Instructions:
Please call if you have anything that causes you concern.
You will be seen by hospice.

Followup Instructions:
PCP - [**Telephone/Fax (1) 69212**]


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 286**]
{'Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of other parts of bronchus or lung,Chronic airway obstruction, not elsewhere classified,Empyema with fistula'}


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: A-fib, SOB, CP

PRESENT ILLNESS: Lung cancer complicated with
tracheoesophageal fistula; status post Y stent placement;
esophageal stent placement.

MEDICAL HISTORY: non small cell lung cancer & obstructive L mainstem lesion
45 pk-yr smoker, Chronic Obstructive Pulmonary Disease, h/o
optic neuritis

MEDICATION ON ADMISSION: iron, vicodin, atrovent

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AAOx3, NAD, gaunt
RRR
course BS B/L
Soft NT/ND
no c/c/e

FAMILY HISTORY: 

SOCIAL HISTORY: lives in [**State 1727**].  Parents very supportive 

### Response:
{'Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of other parts of bronchus or lung,Chronic airway obstruction, not elsewhere classified,Empyema with fistula'}
