CHIEF COMPLAINT: Malignant airway obstruction.

PRESENT ILLNESS: Pt is a 71 yo F admitted to OSH on [**7-17**] w/ acute onset wheezing
she attributed to asthma as well as epigastric pain. Endoscopy
revealed a large esophageal mass & TE fistula w/ path of esoph
SCCa. L M bronchus stent was placed on [**7-26**]. Also w/ Jtube,
protocath this admission. Intubated for resp distress on [**2177-8-5**],
and transferred to [**Hospital1 **] [**2177-8-6**] for further care.

MEDICAL HISTORY: Breast cancer T2N0M0 s/p mastectomy left and 4 cycles of
chemotherapy w/ Adriamycin/Cytoxan limited due to GI-toxicity
and
Tamoxifen 20mg for 5 years till [**2170**]
Esophagitis, gastritis, Pyloroplastic
CAD
Hysterectomy
Appendectomy, Cholecystectomy

MEDICATION ON ADMISSION: fentanyl 125mc patch, metadone 40 mg tid, albuterol IH,
Omeprazole 20 mg daily

ALLERGIES: Codeine / Bactrim / Erythromycin Base / Penicillins /
Prochlorperazine / Nalbuphine / Iodine / Phenothiazines /
Aspirin

PHYSICAL EXAM: VS: T: 99.1   HR: 104 ST   BP: 152/89  Sats : 96% RA
General: sitting up in bed no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR
Resp: decreased breath sounds otherwise clear
GI: benign.  J-tube in place.
Wound: mid-abdominal with staples
Extr: warm no edema
Neuro: non-focal

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married lives with husband.  [**Name (NI) 1139**] quit [**2148**]
Acute respiratory failure,Secondary malignant neoplasm of lung,Tracheoesophageal fistula,Malignant neoplasm of retroperitoneum,Pneumonitis due to inhalation of food or vomitus,Status of other artificial opening of gastrointestinal tract,Personal history of malignant neoplasm of breast
Acute respiratry failure,Secondary malig neo lung,Tracheoesophageal fstula,Mal neo retroperitoneum,Food/vomit pneumonitis,Enterostomy status NEC,Hx of breast malignancy
Admission Date:  [**2177-8-6**]              Discharge Date:   [**2177-8-11**]

Date of Birth:  [**2106-3-12**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Bactrim / Erythromycin Base / Penicillins /
Prochlorperazine / Nalbuphine / Iodine / Phenothiazines /
Aspirin

Attending:[**First Name3 (LF) 492**]
Chief Complaint:
Malignant airway obstruction.


Major Surgical or Invasive Procedure:
[**2177-8-7**] Rigid bronchoscopy, flexible bronchoscopy, tumor
destruction with mechanical forceps, tumor destruction with
cryotherapy, Y-stent placement and therapeutic aspiration of
secretions.


History of Present Illness:
Pt is a 71 yo F admitted to OSH on [**7-17**] w/ acute onset wheezing
she attributed to asthma as well as epigastric pain. Endoscopy
revealed a large esophageal mass & TE fistula w/ path of esoph
SCCa. L M bronchus stent was placed on [**7-26**]. Also w/ Jtube,
protocath this admission. Intubated for resp distress on [**2177-8-5**],
and transferred to [**Hospital1 **] [**2177-8-6**] for further care.


Past Medical History:
Breast cancer T2N0M0 s/p mastectomy left and 4 cycles of
chemotherapy w/ Adriamycin/Cytoxan limited due to GI-toxicity
and
Tamoxifen 20mg for 5 years till [**2170**]
Esophagitis, gastritis, Pyloroplastic
CAD
Hysterectomy
Appendectomy, Cholecystectomy


Social History:
Married lives with husband.  [**Name (NI) 1139**] quit [**2148**]


Family History:
non-contributory

Physical Exam:
VS: T: 99.1   HR: 104 ST   BP: 152/89  Sats : 96% RA
General: sitting up in bed no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR
Resp: decreased breath sounds otherwise clear
GI: benign.  J-tube in place.
Wound: mid-abdominal with staples
Extr: warm no edema
Neuro: non-focal

Pertinent Results:
[**2177-8-7**] WBC-11.0 RBC-3.60* Hgb-10.4* Hct-30.5* Plt Ct-610*
[**2177-8-6**] WBC-11.6* RBC-3.64* Hgb-10.1* Hct-31.2 Plt Ct-616*
[**2177-8-10**] Glucose-117* UreaN-9 Creat-0.5 Na-137 K-3.9 Cl-99
HCO3-29
[**2177-8-6**] Glucose-92 UreaN-15 Creat-0.4 Na-140 K-3.8 Cl-103
HCO3-31
[**2177-8-10**] Calcium-9.1 Phos-2.4* Mg-2.0

Esophageal: [**2177-8-8**] No evidence of esophageal fistulization
with the airways.

Chest CT IMPRESSION:
Intended esophageal stent displaced to the right by large, gas
containing
retrotracheal mediastinal abscess and subcarinal mass. No
tracheoesophageal fistula is defined by a tract, but cannot be
excluded, and there are small gas collections adjacent to the
stent that suggest transmural esophageal erosion. The precise
location of the esophageal stent and the integrity of the
esophagus are best examined by a contrast swallow, followed by
mediastinal CT, if necessary.
Left main bronchus stent is compromised by extrinsic compression
by mass
and abscess as well as soft tissue or secretions at its origin.
The distal
left main bronchus and right bronchial tree are patent.
Probable aspiration pneumonia, right lower lobe.
Left lower lobe atelectasisi adjacent to a loculated pleural
fluid.




Brief Hospital Course:
Mrs. [**Known lastname 3012**] was transferred from N.E. [**Hospital1 **] intubated for
respiratory distress and left main stem obstruction.  On
[**2177-8-7**] she underwent Rigid bronchoscopy, flexible
bronchoscopy, tumor destruction with mechanical forceps,tumor
destruction with cryotherapy, Y-stent placement and therapeutic
aspiration of secretions.  She was successfully extubated.
Aggressive pulmonary toilet and nebs continued.  A barium
swallow no evidence of esophageal fistulization with the
airways.  She was seen by speech and swallow for a
video-swallow. With penetration of thin liquids during the
swallow resulting in aspiration immediately after the swallow.
There was a long conversation with patient and husband regarding
risk for aspiration.  She wishes to continue to eat a regular
diet with thin liquids and will follow the aspirations
precautions.  Hem/Onc was consulted and she will follow-up with
Dr. [**Last Name (STitle) **] at [**Hospital6 **] for her oncology treatments.  She
was seen by physical therapy who deemed her safe for home.


Medications on Admission:
fentanyl 125mc patch, metadone 40 mg tid, albuterol IH,
Omeprazole 20 mg daily

Discharge Medications:
1. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for agitation or anxiety.
Disp:*30 Tablet(s)* Refills:*0*
2. Mucinex 1,200 mg Tab, Multiphasic Release 12 hr Sig: One (1)
Tab, Multiphasic Release 12 hr PO twice a day for 2 weeks.
Disp:*28 Tab, Multiphasic Release 12 hr(s)* Refills:*0*
3. Tessalon Perles 100 mg Capsule Sig: One (1) Capsule PO three
times a day as needed for cough for 2 weeks.
Disp:*60 Capsule(s)* Refills:*0*
4. Fentanyl 100 mcg/hr Patch 72 hr Sig: One (1)  Transdermal
Q72H (every 72 hours).
5. Fentanyl 25 mcg/hr Patch 72 hr Sig: One (1)  Transdermal once
a day: total 125 mcg/hr .
6. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for
wheezes or SOB.
7. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble
PO TID (3 times a day).
8. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Moxifloxacin 400 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) as needed for Esophageal fistula for 2 weeks.
Disp:*12 Tablet(s)* Refills:*0*
10. Senna 8.8 mg/5 mL Syrup Sig: 1-2 Tablets PO BID (2 times a
day).
11. Docusate Sodium 50 mg/5 mL Liquid Sig: Ten (10) mL PO BID (2
times a day).
12. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
13. Acetylcysteine 10 % (100 mg/mL) Solution Sig: Three (3) mL
Miscellaneous twice a day: for Y stent patency
Mix w/albuterol to prevent bronchospasm.
Disp:*180 mL* Refills:*2*
14. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: Three (3) mL Inhalation twice a day: mix
w/mucomyst.
Disp:*180 mL* Refills:*2*
15. Nebulizer


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Malignant airway obstruction.


Discharge Condition:
stable


Discharge Instructions:
Call Dr.[**Name (NI) 5070**] office [**Telephone/Fax (1) 10651**] if develops Fevers > 101
increased shortness of breath, cough or shortness of breath

Followup Instructions:
Follow-up with Medical Oncology Dr. [**Last Name (STitle) **] as directed
Follow-up with Dr. [**Last Name (STitle) **] in 2 weeks.  Please call for an
appointment
[**Telephone/Fax (1) 7769**]


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**Doctor First Name 494**]

Completed by:[**2177-8-13**]
{'Acute respiratory failure,Secondary malignant neoplasm of lung,Tracheoesophageal fistula,Malignant neoplasm of retroperitoneum,Pneumonitis due to inhalation of food or vomitus,Status of other artificial opening of gastrointestinal tract,Personal history of malignant neoplasm of breast'}


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: Malignant airway obstruction.

PRESENT ILLNESS: Pt is a 71 yo F admitted to OSH on [**7-17**] w/ acute onset wheezing
she attributed to asthma as well as epigastric pain. Endoscopy
revealed a large esophageal mass & TE fistula w/ path of esoph
SCCa. L M bronchus stent was placed on [**7-26**]. Also w/ Jtube,
protocath this admission. Intubated for resp distress on [**2177-8-5**],
and transferred to [**Hospital1 **] [**2177-8-6**] for further care.

MEDICAL HISTORY: Breast cancer T2N0M0 s/p mastectomy left and 4 cycles of
chemotherapy w/ Adriamycin/Cytoxan limited due to GI-toxicity
and
Tamoxifen 20mg for 5 years till [**2170**]
Esophagitis, gastritis, Pyloroplastic
CAD
Hysterectomy
Appendectomy, Cholecystectomy

MEDICATION ON ADMISSION: fentanyl 125mc patch, metadone 40 mg tid, albuterol IH,
Omeprazole 20 mg daily

ALLERGIES: Codeine / Bactrim / Erythromycin Base / Penicillins /
Prochlorperazine / Nalbuphine / Iodine / Phenothiazines /
Aspirin

PHYSICAL EXAM: VS: T: 99.1   HR: 104 ST   BP: 152/89  Sats : 96% RA
General: sitting up in bed no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR
Resp: decreased breath sounds otherwise clear
GI: benign.  J-tube in place.
Wound: mid-abdominal with staples
Extr: warm no edema
Neuro: non-focal

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married lives with husband.  [**Name (NI) 1139**] quit [**2148**] 

### Response:
{'Acute respiratory failure,Secondary malignant neoplasm of lung,Tracheoesophageal fistula,Malignant neoplasm of retroperitoneum,Pneumonitis due to inhalation of food or vomitus,Status of other artificial opening of gastrointestinal tract,Personal history of malignant neoplasm of breast'}
