CHIEF COMPLAINT: Stridor and fever.

PRESENT ILLNESS: This 40-year-old female has a long history of esophageal webs
and strictures. She was evaluated for this in the past and was
admitted in [**Month (only) **] with worsening dysphasia. She had an EGD on
[**2130-6-1**] that was successful on the third attempt and tissue
biopsy at that time revealed an invasive squamous cell
carcinoma. CT showed no evidence of metastases or local
invasion. She was started on Cetuximab with concurrent radiation
on [**2130-7-13**]. She completed her radiation therapy on [**2130-8-24**]
for a total of 6600 Gy. She also completed her Erbitux therapy
at that time. She was admitted on [**2130-12-4**] due to nausea and
vomiting. On that admission, she was found to have evidence of
tracheal obstruction. In addition, she had a CT of her neck,
which was concerning for perforation. Thoracic was consulted and
felt that she would benefit from a tracheostomy for airway
protection, which was placed on [**2130-12-8**]. She tolerated this
well. She was noted to have a left upper lobe cavitary lesion on
the CT scan. She underwent a wedge resection on [**2130-1-11**], which
revealed carcinomatous plaques on the pleural wall. This was
confirmed to be a metastatic disease on frozen section. In terms
of her tracheostomy, she was decannulated on [**2131-1-17**]. During
the hospitalization she was treated for pharyngeal abscess and
had issues with tachycardia as well as hypotension. She was
discharged home on [**2131-1-19**]. She began a palliative chemotherapy
regimen of 5-FU and carboplatin on [**2131-3-13**].

MEDICAL HISTORY: PAST ONCOLOGIC HISTORY (as previously documented on last
discharge summary dated [**3-18**]):
======================
This 40-year-old female has a long history of esophageal webs
and strictures. She was evaluated for this in the past and was
admitted in [**Month (only) **] with worsening dysphasia. She had an EGD on
[**2130-6-1**] that was successful on the third attempt and tissue
biopsy at that time revealed an invasive squamous cell
carcinoma. CT showed no evidence of metastases or local
invasion. She was started on Cetuximab with concurrent radiation
on [**2130-7-13**]. She completed her radiation therapy on [**2130-8-24**]
for a total of 6600 Gy. She also completed her Erbitux therapy
at that time. She was admitted on [**2130-12-4**] due to nausea and
vomiting. On that admission, she was found to have evidence of
tracheal obstruction. In addition, she had a CT of her neck,
which was concerning for perforation. Thoracic was consulted and

MEDICATION ON ADMISSION: 1. Lactulose 10 gram/15 mL Syrup [**Month/Day (4) **]: Thirty (30) ML PO Q8H
(every 8 hours) as needed for constipation: through j tube.
2. Lorazepam 0.5 mg Tablet [**Month/Day (4) **]: 1-2 Tablets PO Q6H (every 6
hours) as needed for anxiety/nausea: through j tube.
3. Methadone 5 mg Tablet [**Month/Day (4) **]: 1-2 Tablets PO BID (2 times a
day).
4. Nortriptyline 10 mg Capsule [**Month/Day (4) **]: One (1) Capsule PO HS (at
bedtime).
5. Omeprazole-Sodium Bicarbonate 40-1,680 mg Packet [**Month/Day (4) **]: One (1)

ALLERGIES: Roxicet

PHYSICAL EXAM: VITAL SIGNS - Temp 95.6 F, BP 101/35 mmHg, HR 122 BPM, RR 18 X',
O2-sat 96% RA
.
GENERAL - well-appearing woman in NAD, comfortable, appropriate
HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, no JVD, no carotid bruits
LUNGS - mild ronchi bilateraly, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2, tachycardic
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**5-1**] throughout, sensation grossly intact throughout, DTRs 2+ and
symmetric, cerebellar exam intact, steady gait

FAMILY HISTORY: She has a maternal aunt with breast cancer. Her mother and
father are alive and healthy and siblings are all alive and
healthy.

SOCIAL HISTORY: Originally from [**Country 3587**] and portugesse creole speaking only.
Drug induced neutropenia,Malignant neoplasm of other specified part of esophagus,Other specified septicemias,Sepsis,Acute respiratory failure,Fever presenting with conditions classified elsewhere,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Stricture and stenosis of esophagus,Anemia in neoplastic disease,Dehydration,Stridor,Backache, unspecified
Drug induced neutropenia,Mal neo esophagus NEC,Septicemia NEC,Sepsis,Acute respiratry failure,Fever in other diseases,Adv eff antineoplastic,Esophageal stricture,Anemia in neoplastic dis,Dehydration,Stridor,Backache NOS
Admission Date:  [**2131-3-26**]              Discharge Date:   [**2131-4-11**]

Date of Birth:  [**2090-5-18**]             Sex:   F

Service: MEDICINE

Allergies:
Roxicet

Attending:[**First Name3 (LF) 477**]
Chief Complaint:
Stridor and fever.

Major Surgical or Invasive Procedure:
Tracheostomy placemnt on [**2131-3-26**].
Right subclavian line placement [**2131-3-28**].
Right subvlacian line removal.


History of Present Illness:
This 40-year-old female has a long history of esophageal webs
and strictures. She was evaluated for this in the past and was
admitted in [**Month (only) **] with worsening dysphasia. She had an EGD on
[**2130-6-1**] that was successful on the third attempt and tissue
biopsy at that time revealed an invasive squamous cell
carcinoma. CT showed no evidence of metastases or local
invasion. She was started on Cetuximab with concurrent radiation
on [**2130-7-13**]. She completed her radiation therapy on [**2130-8-24**]
for a total of 6600 Gy. She also completed her Erbitux therapy
at that time. She was admitted on [**2130-12-4**] due to nausea and
vomiting. On that admission, she was found to have evidence of
tracheal obstruction. In addition, she had a CT of her neck,
which was concerning for perforation. Thoracic was consulted and
felt that she would benefit from a tracheostomy for airway
protection, which was placed on [**2130-12-8**]. She tolerated this
well. She was noted to have a left upper lobe cavitary lesion on
the CT scan. She underwent a wedge resection on [**2130-1-11**], which
revealed carcinomatous plaques on the pleural wall. This was
confirmed to be a metastatic disease on frozen section. In terms
of her tracheostomy, she was decannulated on [**2131-1-17**]. During
the hospitalization she was treated for pharyngeal abscess and
had issues with tachycardia as well as hypotension. She was
discharged home on [**2131-1-19**]. She began a palliative chemotherapy
regimen of 5-FU and carboplatin on [**2131-3-13**].

Past Medical History:
PAST ONCOLOGIC HISTORY (as previously documented on last
discharge summary dated [**3-18**]):
======================
This 40-year-old female has a long history of esophageal webs
and strictures. She was evaluated for this in the past and was
admitted in [**Month (only) **] with worsening dysphasia. She had an EGD on
[**2130-6-1**] that was successful on the third attempt and tissue
biopsy at that time revealed an invasive squamous cell
carcinoma. CT showed no evidence of metastases or local
invasion. She was started on Cetuximab with concurrent radiation
on [**2130-7-13**]. She completed her radiation therapy on [**2130-8-24**]
for a total of 6600 Gy. She also completed her Erbitux therapy
at that time. She was admitted on [**2130-12-4**] due to nausea and
vomiting. On that admission, she was found to have evidence of
tracheal obstruction. In addition, she had a CT of her neck,
which was concerning for perforation. Thoracic was consulted and

felt that she would benefit from a tracheostomy for airway
protection, which was placed on [**2130-12-8**]. She tolerated this
well. She was noted to have a left upper lobe cavitary lesion on

the CT scan. She underwent a wedge resection on [**2130-1-11**], which
revealed carcinomatous plaques on the pleural wall. This was
confirmed to be a metastatic disease on frozen section. In terms

of her tracheostomy, she was decannulated on [**2131-1-17**]. During
the hospitalization she was treated for pharyngeal abscess and
had issues with tachycardia as well as hypotension. She was
discharged home on [**2131-1-19**]. She began a palliative chemotherapy
regimen of 5-FU and carboplatin on [**2131-3-13**].

PAST MEDICAL HISTORY:
====================
1. Esophageal strictures and webs.
2. Anemia.
3. G tube placed on 06/[**2129**].
4. History of prior constipation.
5. Tracheostomy placed on [**2130-12-8**], removed on [**2131-1-17**]
6. Hypercalcemia

Social History:
Originally from [**Country 3587**] and portugesse creole speaking only.

EtOH: one
Tobacco: none
Lives at home with her cousin who cares for her.


Family History:
She has a maternal aunt with breast cancer. Her mother and
father are alive and healthy and siblings are all alive and
healthy.

Physical Exam:
VITAL SIGNS - Temp 95.6 F, BP 101/35 mmHg, HR 122 BPM, RR 18 X',
O2-sat 96% RA
.
GENERAL - well-appearing woman in NAD, comfortable, appropriate
HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, no JVD, no carotid bruits
LUNGS - mild ronchi bilateraly, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2, tachycardic
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**5-1**] throughout, sensation grossly intact throughout, DTRs 2+ and
symmetric, cerebellar exam intact, steady gait

Pertinent Results:
On Admission:
[**2131-3-26**] 12:00PM   WBC-1.0* RBC-3.68* HGB-10.6* HCT-30.2* MCV-82
MCH-28.9 MCHC-35.2* RDW-14.1
[**2131-3-26**] 12:00PM   PLT COUNT-209
[**2131-3-26**] 12:00PM   GRAN CT-140*
[**2131-3-26**] 12:00PM   ALT(SGPT)-22 AST(SGOT)-28 LD(LDH)-181 ALK
PHOS-85 TOT BILI-0.4
[**2131-3-26**] 12:00PM   ALBUMIN-3.8 CALCIUM-10.1 PHOSPHATE-2.7
MAGNESIUM-2.0
[**2131-3-26**] 12:00PM   UREA N-15 CREAT-0.5 SODIUM-136 POTASSIUM-3.9
CHLORIDE-96 TOTAL CO2-31 ANION GAP-13
[**2131-3-27**] 12:00AM   PT-15.1* PTT-29.0 INR(PT)-1.3*
[**2131-3-27**] 12:00AM   PLT SMR-NORMAL PLT COUNT-156
.
Echocardiogram [**2131-3-28**]:
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
diameters of aorta at the sinus, ascending and arch levels are
normal. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic regurgitation. No
masses or vegetations are seen on the aortic valve. The mitral
valve appears structurally normal with trivial mitral
regurgitation. No mass or vegetation is seen on the mitral
valve. The estimated pulmonary artery systolic pressure is
normal. There is no pericardial effusion.
.
CXR [**2131-4-26**]:
Portable AP chest radiograph was compared to [**2131-3-22**].

There is no significant change in the left basal consolidation
and at least partially loculated left pleural effusion including
the apical component. The right lung is essentially clear. The
mediastinal contours are unchanged. The postsurgical sutures in
the left upper lung are unchanged. There is a lucency projecting
over the left apical fluid collection that may represent small
loculated pneumothorax. The Port-A-Cath catheter tip is at the
cavoatrial junction.
The cavities in the right lung seen on the PET/CT from [**2131-3-8**] is difficult to see on both prior radiographs from [**3-22**]
and the current radiograph from [**2131-3-26**] that can be
either resolved or being below the limitations of the radiograph
resolution . If clinically warranted, further evaluation with
chest CT might be considered.
.
CT Abdomen/Pelvis [**2131-3-28**]:
1. Soft tissue density mass posterior to the tracheostomy
catheter was seen on prior CT scan and is consistent with
patient's metastatic esophageal cancer.
2. Multiple right-sided right lung as well as right pleural
nodules concerning for progression of metastatic disease on that
side.
3. Overall stable appearance to extensive pleural as well as
parenchymal metastatic disease in the left lung. Nodular foci in
the right and left lungs, however, could also represent foci of
infectious process and would recommend followup to assess for
change or resolution.
.
CT Neck:
Ill-defined soft tissue associated with the esophagus in the
post-cricoid region and hypopharynx in the area of prior FDG
avidity. Lack of soft tissue delineation limits ability to fully
evaluate.

Brief Hospital Course:
40 yo F with metastatic esophageal carcinoma s/p recent
initiation of carboplatin and 5fu, s/p trach in past, admitted
to oncology with febrile neutropenia and transferred for
concerning increased stridor and narrowed airway.
.
## Stridor: Patient with history of stridor in past, leading to
trach in [**10-25**] for esophageal perforation possibly in
setting of nausea/vomiting and laryngeal edema. Recent PET scan
with increased uptake in this area. Based on ENT evaluation,
patient's airway narrowed to 1-2 mm. Area of concern from prior
imaging was in cervical esophagus, so would be above area of
possible trach. Pt received IV decadron without improvement. Her
respiratory rate increased, there was use of accesory muscles so
she was tranferred to the ICU.  She was evaluated by thoracic
surgeons who took her emergently to the OR for trach placement
with heliox given prior. After the procedure she continued to
spike fever, was tachycardic, was acutely dropping her oxygen
sats. She had an emergent bronch which showed patent airways.
She initally had difficulty weaning from the vent.  She was
weaned to trach collar on [**3-31**]. Since then she has been stable in
the floor breathing in 35% humidified air via a tracheal mask.
She was trainned in multiple days to use her tracheostoy and how
to release the inner canula. She was able to do it by herself
every single day afterwards.
.
# Neutropenic fever/sepsis: Patient spiking fevers to 101 on
cefepime on the floor.  She also spiked fever subsequently after
coming back from the OR. Overnight her first night in the ICU
her antibiotics were broadended to clinda, cefepime, flagyl,
vanco, and ceftriaxone.  She also dropped her pressures and was
started on levo (weaned off on [**3-29**]) and boluses IVF to maintain
a MAP> 65 and a CVP>10.  On the morning of [**3-28**] these were
changed to clinda/vanc/cefepime. Her fevers resolved and her
clindamycin was d/c after 6 doses.   She was continued on
filgrastim and was no longer neutropenic as of [**2131-3-31**]. The plan
was to continue a 10 day course of vanc/cefepime with day 1
being [**3-31**] and her last dose being [**2131-4-9**].  However, cefepime
will not be covered by her insurance so we started ciprofloxacin
instead on [**4-4**] and we recommend two days of treatment on cipro
and then discontinuing the cipro. She compleated the antibiotic
course in house and was afebrile afterwards.
.
# Sinus tachy: has been ongoing issue per last discharge
summary, has been ranging in 120s in past, is of unknown
etiology. Has been persistent despite fluid resuscitation,
transfusion, and correction of hypercalcemia in past. EKGs sinus
tachycardia.  Her sinus tachycardia did not respond to fluid
resuscitation in the ICU.  It is possible that this could be
secondary to vagus nerve infiltration of her tumor, leading to
unopposed sympathetic stimulation.
.
# Metastatic esophageal cancer: with mets to lungs, recent PET
scan showed increased disease in lung, upper esophagus, and
paratracheal region. Has been recently reinitiated on
carboplatin and 5FU about 1 week prior to being in the ICU.  As
per family meetings while in the ICU, the plan is to give her 2
week holiday and then assess and consider palliative
chemotherapy.
.
# HCT: Pt received 2 units of packed RBCs for HCT of 23 and
bumped appropriately.  She has not required blood transfusion
since [**3-29**].
.
# Left flank/back pain: Likely secondary to mets. At home on
lidocaine, methadone, tylenol.  Methadone was restarted on [**3-29**].
.
# FEN/GI: Pt getting tube feeds started on [**3-30**].  S & S saw pt
and is ok  to get ice chips, but pt was unable to tolerate
liquids. She will need to be strict NPO.
.
# PROPHY: sc heparin, bowel regimen , PPI.
.
# ACCESS: right portacath, left PIV, CVL.  An a-line was put in
while in the ICU and d/c while in the ICU.
.
# Dispo: Home with free hospice.

Medications on Admission:
1. Lactulose 10 gram/15 mL Syrup [**Month/Day (4) **]: Thirty (30) ML PO Q8H
(every 8 hours) as needed for constipation: through j tube.
2. Lorazepam 0.5 mg Tablet [**Month/Day (4) **]: 1-2 Tablets PO Q6H (every 6
hours) as needed for anxiety/nausea: through j tube.
3. Methadone 5 mg Tablet [**Month/Day (4) **]: 1-2 Tablets PO BID (2 times a
day).
4. Nortriptyline 10 mg Capsule [**Month/Day (4) **]: One (1) Capsule PO HS (at
bedtime).
5. Omeprazole-Sodium Bicarbonate 40-1,680 mg Packet [**Month/Day (4) **]: One (1)

PO once a day: through j tube.
6. Prochlorperazine 25 mg Suppository [**Month/Day (4) **]: One (1) Rectal every

six (6) hours as needed for nausea.
7. Acetaminophen 160 mg/5 mL Solution [**Month/Day (4) **]: [**12-29**] PO every six (6)

hours as needed for pain.
8. Bisacodyl 10 mg Suppository [**Month/Day (2) **]: One (1) Suppository Rectal 1

to 2 times per day as needed for constipation.
9. Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (2) **]: 10mL PO BID (2 times
a day).
10. Senna 8.8 mg/5 mL Syrup [**Month/Day (2) **]: One (1) PO twice a day.
11. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Month/Day (2) **]:
Three (3) Adhesive Patch, Medicated Topical DAILY (Daily): apply

to left side for no more than 12 hours at a time.
12. Guaifenesin 100 mg/5 mL Syrup [**Month/Day (2) **]: Fifteen (15) ML PO Q6H
(every 6 hours) as needed.


Discharge Medications:
1. Oxygen
35% continuous via tracheal mask with cool mist via [**Last Name (un) **]
compressor.
2. Suction Machine
Please provide with portable suction machine with trach suction
catheter size 14 fr.
3. Trach
Please provide with 6mm portex for tracheostomy.
4. Oxygen
Please provide with oxygen tanks at home for tracheostomy
humidifier at 35%. Respiratory diangosisL Esophageal cancer with
laringeal involvement. Lowest SpO2 90% on RA. [**Medical Record Number 71505**].
5. Methadone 10 mg/5 mL Solution [**Medical Record Number **]: Five (5) mililiters PO PM
().
6. Methadone 10 mg/5 mL Solution [**Medical Record Number **]: 2.5 mililiters PO AM ().
7. Lorazepam 0.5 mg Tablet [**Medical Record Number **]: 1-2 Tablets PO Q4H (every 4
hours) as needed for anxiety.
8. Lactulose 10 gram/15 mL Syrup [**Medical Record Number **]: Thirty (30) ML PO BID (2
times a day).
9. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
Disp:*30 Tablet,Rapid Dissolve, DR(s)* Refills:*2*
10. Nortriptyline 10 mg/5 mL Solution [**Last Name (STitle) **]: Five (5) mililiters
PO at bedtime as needed for insomnia.
Disp:*1 Liter* Refills:*0*
11. Compazine 25 mg Suppository [**Last Name (STitle) **]: One (1) Suppository Rectal
every six (6) hours as needed for nausea.
Disp:*30 Suppository* Refills:*0*
12. Acetaminophen 167 mg/5 mL Liquid [**Last Name (STitle) **]: [**5-6**] Mililiters PO
every six (6) hours as needed for Pain.
Disp:*500 mililiters* Refills:*0*
13. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Month/Year (2) **]:
One (1) Adhesive Patch, Medicated Topical Q12H (every 12 hours):
12 hours on, 12 hours off.
Disp:*30 Adhesive Patch, Medicated(s)* Refills:*2*
14. Guaifenesin 100 mg/5 mL Syrup [**Month/Year (2) **]: 5-10 MLs PO Q6H (every 6
hours) as needed for cough, throat pain.
Disp:*250 ML(s)* Refills:*0*
15. Morphine 10 mg/5 mL Solution [**Month/Year (2) **]: Five (5) Mililiters PO Q4H
(every 4 hours) as needed for pain.
Disp:*250 Mililiters* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 269**] Hospice Care

Discharge Diagnosis:
Primary Diagnosis:
Respiratory Distress/Failure secondary to either chemical
irritation of the airway or esophageal cancer infiltration to
the esophagus.
.
Secondary Diagnosis:
Esophageal strictures and webs.
Anemia.
G tube placed on [**5-/2130**]


Discharge Condition:
Stable, cleaning her tracheostomy herslef, walking miles in the
corridor.


Discharge Instructions:
You were seen at the [**Hospital1 18**] for neutropenic fever after your
chemotherapy. Upon arrival you mentioned that you had been
having difficulty breathing during the last days. It started to
get worse during the course of the first hospital day. You were
seen by the ENT, who saw a very narrow arway. Since your
breathing started getting worse and we were unable to help you
breathe a tracheostomy was put in place. You required ICU stay.
Then, you were transfered to the medical floor where you were
observed. Your tube feedings were re-started. You were evaluated
by speech and swallow, but everytime you had any liquids you
started coughing and there is risk of aspiration and
food/liquids going down the wrong pipe. Therefore we recommend
you do not drink or eat anything by mouth, but everything
through your J tube.
.
Dr. [**Last Name (STitle) **] saw you and recommended 2 weeks at home and then meet
with him so you all can talk regarding how to keep helping you
with your cancer.
.
We were able to set up free hospice at home, where you will have
a tem that will help you with your feeding tubes, tracheostomy,
pain and transition for better control of your symptoms.
.
If you have fever, chills, cough, difficulty breathing,
worsening of your pain or anything else that concerns you please
come back to our ER.

Followup Instructions:
Please make an appointment with Dr. [**Last Name (STitle) **] within 2 weeks. You can
call ([**Telephone/Fax (1) 694**].
.
[**2131-4-17**]  02:30p  Dr [**Last Name (STitle) 1533**] in the THORACIC CLINIC to
remove the stitches of your tracheostomy.


                             [**Name6 (MD) **] [**Name8 (MD) 490**] MD, [**MD Number(3) 491**]
{'Drug induced neutropenia,Malignant neoplasm of other specified part of esophagus,Other specified septicemias,Sepsis,Acute respiratory failure,Fever presenting with conditions classified elsewhere,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Stricture and stenosis of esophagus,Anemia in neoplastic disease,Dehydration,Stridor,Backache, 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: Stridor and fever.

PRESENT ILLNESS: This 40-year-old female has a long history of esophageal webs
and strictures. She was evaluated for this in the past and was
admitted in [**Month (only) **] with worsening dysphasia. She had an EGD on
[**2130-6-1**] that was successful on the third attempt and tissue
biopsy at that time revealed an invasive squamous cell
carcinoma. CT showed no evidence of metastases or local
invasion. She was started on Cetuximab with concurrent radiation
on [**2130-7-13**]. She completed her radiation therapy on [**2130-8-24**]
for a total of 6600 Gy. She also completed her Erbitux therapy
at that time. She was admitted on [**2130-12-4**] due to nausea and
vomiting. On that admission, she was found to have evidence of
tracheal obstruction. In addition, she had a CT of her neck,
which was concerning for perforation. Thoracic was consulted and
felt that she would benefit from a tracheostomy for airway
protection, which was placed on [**2130-12-8**]. She tolerated this
well. She was noted to have a left upper lobe cavitary lesion on
the CT scan. She underwent a wedge resection on [**2130-1-11**], which
revealed carcinomatous plaques on the pleural wall. This was
confirmed to be a metastatic disease on frozen section. In terms
of her tracheostomy, she was decannulated on [**2131-1-17**]. During
the hospitalization she was treated for pharyngeal abscess and
had issues with tachycardia as well as hypotension. She was
discharged home on [**2131-1-19**]. She began a palliative chemotherapy
regimen of 5-FU and carboplatin on [**2131-3-13**].

MEDICAL HISTORY: PAST ONCOLOGIC HISTORY (as previously documented on last
discharge summary dated [**3-18**]):
======================
This 40-year-old female has a long history of esophageal webs
and strictures. She was evaluated for this in the past and was
admitted in [**Month (only) **] with worsening dysphasia. She had an EGD on
[**2130-6-1**] that was successful on the third attempt and tissue
biopsy at that time revealed an invasive squamous cell
carcinoma. CT showed no evidence of metastases or local
invasion. She was started on Cetuximab with concurrent radiation
on [**2130-7-13**]. She completed her radiation therapy on [**2130-8-24**]
for a total of 6600 Gy. She also completed her Erbitux therapy
at that time. She was admitted on [**2130-12-4**] due to nausea and
vomiting. On that admission, she was found to have evidence of
tracheal obstruction. In addition, she had a CT of her neck,
which was concerning for perforation. Thoracic was consulted and

MEDICATION ON ADMISSION: 1. Lactulose 10 gram/15 mL Syrup [**Month/Day (4) **]: Thirty (30) ML PO Q8H
(every 8 hours) as needed for constipation: through j tube.
2. Lorazepam 0.5 mg Tablet [**Month/Day (4) **]: 1-2 Tablets PO Q6H (every 6
hours) as needed for anxiety/nausea: through j tube.
3. Methadone 5 mg Tablet [**Month/Day (4) **]: 1-2 Tablets PO BID (2 times a
day).
4. Nortriptyline 10 mg Capsule [**Month/Day (4) **]: One (1) Capsule PO HS (at
bedtime).
5. Omeprazole-Sodium Bicarbonate 40-1,680 mg Packet [**Month/Day (4) **]: One (1)

ALLERGIES: Roxicet

PHYSICAL EXAM: VITAL SIGNS - Temp 95.6 F, BP 101/35 mmHg, HR 122 BPM, RR 18 X',
O2-sat 96% RA
.
GENERAL - well-appearing woman in NAD, comfortable, appropriate
HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, no JVD, no carotid bruits
LUNGS - mild ronchi bilateraly, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2, tachycardic
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**5-1**] throughout, sensation grossly intact throughout, DTRs 2+ and
symmetric, cerebellar exam intact, steady gait

FAMILY HISTORY: She has a maternal aunt with breast cancer. Her mother and
father are alive and healthy and siblings are all alive and
healthy.

SOCIAL HISTORY: Originally from [**Country 3587**] and portugesse creole speaking only. 

### Response:
{'Drug induced neutropenia,Malignant neoplasm of other specified part of esophagus,Other specified septicemias,Sepsis,Acute respiratory failure,Fever presenting with conditions classified elsewhere,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Stricture and stenosis of esophagus,Anemia in neoplastic disease,Dehydration,Stridor,Backache, unspecified'}
