CHIEF COMPLAINT: Respiratory distress and stridor.

PRESENT ILLNESS: Ms. [**Known lastname 62065**] is a 60 y/o, F, who has a very complicated past
medical history including tracheostomy followed by
decannulation,
status post stent placement for tracheobronchomalacia followed
by
removal, St. [**Known lastname 923**] valve placement for mitral valve prolapse,
hypertension, and aortic stent with dissection. She S/P tracheal
silicone stent with external fixation 2 days ago on [**2152-7-17**] for
her cervical tracheal stenosis and did well post-op and was
discharged home that same day. Earlier this morning, she started
experiencing progressive dyspnea in addition to stridor with
minimal productive cough. She was seen at [**Hospital 1562**] hospital ED
then sent here for further eval. She denies any chest pain,
fevers, chills, or hemoptysis.

MEDICAL HISTORY: Severe Bronchomalacia with extreinic compression of distal right
main stem bronchus s/p Y stent removal [**2151-1-5**]
Tracheostomy & G-tube
HTN
HLD
CHF
GERD
Pulmonary AVM emboli [**1-28**]
Cushings Disease s/p left adrenalectomy & incidental splenetomy\
[**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 923**] [**Last Name (NamePattern1) **] Placment [**2143**] on coumadin
AAA repair [**2143**]
Cardiac Arrest x 2

MEDICATION ON ADMISSION: Hypertension, coronary artery disease, gastroesophageal reflux
disease, she has a history of [**Location (un) **] disease status post left
adrenoidectomy and splenectomy,
she has a St. [**Male First Name (un) 1525**] aortic valve, and is anticoagulated, TBM,
cervical tracheal stenosis.

ALLERGIES: Codeine / Talwin / Nafcillin / Ace Inhibitors

PHYSICAL EXAM: 

FAMILY HISTORY: NC

SOCIAL HISTORY: unknown.
Acute respiratory failure,Foreign body in trachea,Other diseases of trachea and bronchus,Congestive heart failure, unspecified,Unspecified essential hypertension,Esophageal reflux,Other acquired absence of organ,Long-term (current) use of steroids,Heart valve replaced by other means,Foreign body accidentally entering other orifice,Chronic obstructive asthma, unspecified,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms without mention of resistance to multiple drugs
Acute respiratry failure,Foreign body in trachea,Trachea & bronch dis NEC,CHF NOS,Hypertension NOS,Esophageal reflux,Acq absence of organ NEC,Long-term use steroids,Heart valve replac NEC,FB entering oth orifice,Chronic obst asthma NOS,Bacteria dis carrier NEC,Inf mcr rst ot drg nt ml
Admission Date:  [**2152-7-19**]              Discharge Date:   [**2152-7-22**]

Date of Birth:  [**2092-3-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Talwin / Nafcillin / Ace Inhibitors

Attending:[**First Name3 (LF) 492**]
Chief Complaint:
Respiratory distress and stridor.


Major Surgical or Invasive Procedure:
[**2152-7-19**] Flexible bronchoscopy with therapeutic aspiration
and excision of endotracheal tumor.
[**2152-7-20**]
1. Rigid bronchoscopy
2. Flexible bronchoscopy.
3. Tracheal silicone stent replacement.
4. External fixation with the silicone tracheal stent.


History of Present Illness:
Ms. [**Known lastname 62065**] is a 60 y/o, F, who has a very complicated past
medical history including tracheostomy followed by
decannulation,
status post stent placement for tracheobronchomalacia followed
by
removal, St. [**Known lastname 923**] valve placement for mitral valve prolapse,
hypertension, and aortic stent with dissection. She S/P tracheal
silicone stent with external fixation 2 days ago on [**2152-7-17**] for
her cervical tracheal stenosis and did well post-op and was
discharged home that same day. Earlier this morning, she started
experiencing progressive dyspnea in addition to stridor with
minimal productive cough. She was seen at [**Hospital 1562**] hospital ED
then sent here for further eval. She denies any chest pain,
fevers, chills, or hemoptysis.



Past Medical History:
Severe Bronchomalacia with extreinic compression of distal right
main stem bronchus s/p Y stent removal [**2151-1-5**]
Tracheostomy & G-tube
HTN
HLD
CHF
GERD
Pulmonary AVM emboli [**1-28**]
Cushings Disease s/p left adrenalectomy & incidental splenetomy\
[**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 923**] [**Last Name (NamePattern1) **] Placment [**2143**] on coumadin
AAA repair [**2143**]
Cardiac Arrest x 2


Social History:
unknown.


Family History:
NC

Pertinent Results:
[**2152-7-19**] 02:39PM BLOOD WBC-10.5 RBC-4.00* Hgb-12.3 Hct-40.0
MCV-100* MCH-30.7 MCHC-30.7* RDW-15.2 Plt Ct-117*#
[**2152-7-19**] 02:39PM BLOOD Glucose-174* UreaN-13 Creat-0.9 Na-143
K-4.4 Cl-109* HCO3-23 AnGap-15

Brief Hospital Course:
Mrs. [**Known lastname 62065**] was admitted on [**2152-7-19**] Respiratory distress
and stridor with tracheal stenosis status post recent silicone
tracheal stent placement with external fixation and [**2152-7-17**].
Overnight she was transferred to the SICU for respiratory
distress.  She was placed on heliox.  She underwent Flexible
bronchoscopy with therapeutic aspiration and excision of
endotracheal tumor.  Her respiratory status improved.  She
weaned off heliox.  On [**2144-7-20**] she went to the operating room
for Rigid and Flexible bronchoscopy. Tracheal silicone stent
replacement. External fixation with the silicone tracheal stent.
 She did well was monitored in the PACU prior to transfer to the
floor.  She continued on Lovenox and her coumadin was restarted.
 Her respiratory status was monitored closely for the next 24-48
hours. Aggressive pulmonary toilet and nebs were continued.  She
tolerated a regular diet and was discharged on [**2152-7-22**].  She
will follow-up as an outpatient.


Medications on Admission:
Hypertension, coronary artery disease, gastroesophageal reflux
disease, she has a history of [**Location (un) **] disease status post left
adrenoidectomy and splenectomy,
she has a St. [**Male First Name (un) 1525**] aortic valve, and is anticoagulated, TBM,
cervical tracheal stenosis.


Discharge Medications:
1. Prednisone 5 mg Tablet [**Male First Name (un) **]: One (1) Tablet PO DAILY (Daily).

2. Enoxaparin 80 mg/0.8 mL Syringe [**Male First Name (un) **]: One (1) dose
Subcutaneous [**Hospital1 **] (2 times a day): stop when INR > 2.0.
Disp:*15 * Refills:*2*
3. Nexium 40 mg Capsule, Delayed Release(E.C.) [**Hospital1 **]: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Lexapro 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day.
5. Ativan 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO every six (6) hours
as needed.
6. Wellbutrin SR 100 mg Tablet Sustained Release [**Hospital1 **]: One (1)
Tablet Sustained Release PO once a day.
7. Aspirin 325 mg Tablet, Delayed Release (E.C.) [**Hospital1 **]: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
8. Multivitamin     Tablet [**Hospital1 **]: One (1) Tablet PO once a day.
9. Metoprolol Tartrate 50 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID
(2 times a day).
10. Warfarin 5 mg Tablet [**Hospital1 **]: One (1) Tablet PO Once Daily at 4
PM: take as directed to maintain INR 2.0-3.0.
11. Mucinex 1,200 mg Tab, Multiphasic Release 12 hr [**Hospital1 **]: One (1)
Tab, Multiphasic Release 12 hr PO twice a day.
12. Calcium 600 600 mg (1,500 mg) Tablet [**Hospital1 **]: One (1) Tablet PO
once a day.
13. Ergocalciferol (Vitamin D2) 400 unit Capsule [**Hospital1 **]: One (1)
Capsule PO once a day.
14. Provigil 100 mg Tablet [**Hospital1 **]: 0.5 Tablet PO once a day.
15. Simvastatin 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day.

16. Clindamycin HCl 150 mg Capsule [**Hospital1 **]: Three (3) Capsule PO Q8H
(every 8 hours) for 7 days.
Disp:*21 Capsule(s)* Refills:*0*
17. Docusate Sodium 50 mg/5 mL Liquid [**Hospital1 **]: Two (2)  PO BID (2
times a day) for 10 days.
Disp:*20 * Refills:*1*


Discharge Disposition:
Home With Service

Facility:
VNA Assoc. of [**Hospital3 **]

Discharge Diagnosis:
Respiratory distress and stridor
tracheal stenosis status post recent silicone tracheal stent
placement with external fixation


Discharge Condition:
stable


Discharge Instructions:
Call Dr.[**Name (NI) 5070**] office [**Telephone/Fax (1) 7769**] if experience:
-Fevers > 101 or chills, increased shortness of breath, cough or
sputum production.
-Difficulty with T-tube
Lovenox: 80 mg twice daily until INR > 2.0
Coumadin 5 mg daily.  Blood Draw Monday
Follow-up with Dr. [**Last Name (STitle) **] for coumadin managment

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] as directed
Follow-up with Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 62067**] for further coumadin
dosing


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

Completed by:[**2152-7-25**]
{'Acute respiratory failure,Foreign body in trachea,Other diseases of trachea and bronchus,Congestive heart failure, unspecified,Unspecified essential hypertension,Esophageal reflux,Other acquired absence of organ,Long-term (current) use of steroids,Heart valve replaced by other means,Foreign body accidentally entering other orifice,Chronic obstructive asthma, unspecified,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms without mention of resistance to multiple drugs'}


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: Respiratory distress and stridor.

PRESENT ILLNESS: Ms. [**Known lastname 62065**] is a 60 y/o, F, who has a very complicated past
medical history including tracheostomy followed by
decannulation,
status post stent placement for tracheobronchomalacia followed
by
removal, St. [**Known lastname 923**] valve placement for mitral valve prolapse,
hypertension, and aortic stent with dissection. She S/P tracheal
silicone stent with external fixation 2 days ago on [**2152-7-17**] for
her cervical tracheal stenosis and did well post-op and was
discharged home that same day. Earlier this morning, she started
experiencing progressive dyspnea in addition to stridor with
minimal productive cough. She was seen at [**Hospital 1562**] hospital ED
then sent here for further eval. She denies any chest pain,
fevers, chills, or hemoptysis.

MEDICAL HISTORY: Severe Bronchomalacia with extreinic compression of distal right
main stem bronchus s/p Y stent removal [**2151-1-5**]
Tracheostomy & G-tube
HTN
HLD
CHF
GERD
Pulmonary AVM emboli [**1-28**]
Cushings Disease s/p left adrenalectomy & incidental splenetomy\
[**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 923**] [**Last Name (NamePattern1) **] Placment [**2143**] on coumadin
AAA repair [**2143**]
Cardiac Arrest x 2

MEDICATION ON ADMISSION: Hypertension, coronary artery disease, gastroesophageal reflux
disease, she has a history of [**Location (un) **] disease status post left
adrenoidectomy and splenectomy,
she has a St. [**Male First Name (un) 1525**] aortic valve, and is anticoagulated, TBM,
cervical tracheal stenosis.

ALLERGIES: Codeine / Talwin / Nafcillin / Ace Inhibitors

PHYSICAL EXAM: 

FAMILY HISTORY: NC

SOCIAL HISTORY: unknown. 

### Response:
{'Acute respiratory failure,Foreign body in trachea,Other diseases of trachea and bronchus,Congestive heart failure, unspecified,Unspecified essential hypertension,Esophageal reflux,Other acquired absence of organ,Long-term (current) use of steroids,Heart valve replaced by other means,Foreign body accidentally entering other orifice,Chronic obstructive asthma, unspecified,Carrier or suspected carrier of other specified bacterial diseases,Infection with microorganisms without mention of resistance to multiple drugs'}
