CHIEF COMPLAINT: transferred for IP procedure

PRESENT ILLNESS: Mr [**Known lastname 84248**] is a 70 year old man with a history of non-small cell
lung CA s/p R thoractomy with en bloc wedge resection in [**2184**],
LUL resection [**2187**], and LUL lobectomy followed tracheostomy/PEG
placement in [**2188**]. He presents today for removal of a LUL
endobronchial stent.
.
Mr. [**Known lastname 84250**] recent history began in [**9-/2189**] when he was found to
have a broncopleural fisutla in the RUL. A stent was placed at
[**Hospital1 18**] broncoscopically to block the fistula. Since that time, he
has been living at [**Hospital **] rehab and has been intermittently
ventilator dependent. He has had recurrent air leaks and
numerous procedures to attempt to repair his fistulas. He is s/p
2 muscle flaps to attempt to repair the fisulta ([**2189-12-2**] and
early [**2189-12-29**]). These have been complicated by local infections
requiring drainage. He is now transferred to [**Hospital1 18**] for removal
of LUL stent to attempt improve the healing and improve
infectious complications of his most recent muscle flap.
:

MEDICAL HISTORY: - NSCLC as above:
- R thoracotomy, en bloc resection portions of
RUL/RLM/RLL [**2184**]
- [**Doctor Last Name **] lobectomy, LL lobe wedge resection via L thoractomy
[**2189-7-28**],
- hx ETOH abuse
- GERD
- Depression
- L knee OA
- h/o PE

MEDICATION ON ADMISSION: metoprolol 25 mg [**Hospital1 **]
ferrous sulfate 300 mg [**Hospital1 **]
acetaminophen 650 mg q4h prn
pantoprazole 40 mg daily
MVI 15 mL daily
zinc sulfate 220 mg daily
ascorbic acid 500 mg daily
protein supplement 1 scoop q8h
water 200 ml q6h
chlorhexidine .5 oz [**Hospital1 **]
heparin 5000 U sc tid
trazodone 50 mg daily
docusate 100 mg [**Hospital1 **]
magnesium 400 mg [**Hospital1 **]
haloperidol 1 mg IV q8h prn
morphine 2-4 mg IV q2h prn
loraepam .5-1 mg q4h prn
glucerna full strength 65 cc/h
Social History:
Lived in [**State 1727**], currently at [**Hospital3 **] Ex-smoker and
drinker.

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: VS: T 96.7, HR 104, RR 19, BP 109/62 on PCV with FiO2 50% / PIP
18 / RR 10 / PEEP 5
GEN: sppears comfortable
SKIN: L upper chest wall bandage clean and dry
HEENT: JVP not elevated
CHEST: Lungs are diffusely rhonchorus with expiratory wheezes
and decreased sounds in both upper lobes
CARDIAC: Regular rhythm; no murmurs, rubs, or gallops.
ABDOMEN: G-tube clean, dry, and intact
EXTREMITIES: L arm PICC no peripheral edema, warm without
cyanosis
NEUROLOGIC: Alert, appropriately responds to questions by
mouthing words, declines to write for further communication

FAMILY HISTORY: unknown

SOCIAL HISTORY: Lives in [**State 1727**]. Ex-smoker. + EtOH
Malignant neoplasm of other parts of bronchus or lung,Chronic respiratory failure,Dependence on respirator, status,Unspecified protein-calorie malnutrition,Esophageal reflux,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Personal history of venous thrombosis and embolism,Other specified cardiac dysrhythmias,Leukocytosis, unspecified,Dysthymic disorder,Insomnia, unspecified,Tracheostomy status
Mal neo bronch/lung NEC,Chronic respiratory fail,Respirator depend status,Protein-cal malnutr NOS,Esophageal reflux,Loc osteoarth NOS-l/leg,Hx-ven thrombosis/embols,Cardiac dysrhythmias NEC,Leukocytosis NOS,Dysthymic disorder,Insomnia NOS,Tracheostomy status
Admission Date:  [**2190-1-18**]              Discharge Date:   [**2190-1-21**]

Date of Birth:  [**2119-2-27**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
transferred for IP procedure

Major Surgical or Invasive Procedure:
broncoscopy

History of Present Illness:
Mr [**Known lastname 84248**] is a 70 year old man with a history of non-small cell
lung CA s/p R thoractomy with en bloc wedge resection in [**2184**],
LUL resection [**2187**], and LUL lobectomy followed tracheostomy/PEG
placement in [**2188**]. He presents today for removal of a LUL
endobronchial stent.
.
Mr. [**Known lastname 84250**] recent history began in [**9-/2189**] when he was found to
have a broncopleural fisutla in the RUL. A stent was placed at
[**Hospital1 18**] broncoscopically to block the fistula. Since that time, he
has been living at [**Hospital **] rehab and has been intermittently
ventilator dependent. He has had recurrent air leaks and
numerous procedures to attempt to repair his fistulas. He is s/p
2 muscle flaps to attempt to repair the fisulta ([**2189-12-2**] and
early [**2189-12-29**]). These have been complicated by local infections
requiring drainage. He is now transferred to [**Hospital1 18**] for removal
of LUL stent to attempt improve the healing and improve
infectious complications of his most recent muscle flap.
:


Past Medical History:
- NSCLC as above:
- R thoracotomy, en bloc resection portions of
RUL/RLM/RLL [**2184**]
- [**Doctor Last Name **] lobectomy, LL lobe wedge resection via L thoractomy
[**2189-7-28**],
- hx ETOH abuse
- GERD
- Depression
- L knee OA
- h/o PE

Social History:
Lives in [**State 1727**]. Ex-smoker. + EtOH



Family History:
unknown

Physical Exam:
VS: T 96.7, HR 104, RR 19, BP 109/62 on PCV with FiO2 50% / PIP
18 / RR 10 / PEEP 5
GEN: sppears comfortable
SKIN: L upper chest wall bandage clean and dry
HEENT: JVP not elevated
CHEST: Lungs are diffusely rhonchorus with expiratory wheezes
and decreased sounds in both upper lobes
CARDIAC: Regular rhythm; no murmurs, rubs, or gallops.
ABDOMEN: G-tube clean, dry, and intact
EXTREMITIES: L arm PICC no peripheral edema, warm without
cyanosis
NEUROLOGIC: Alert, appropriately responds to questions by
mouthing words, declines to write for further communication


Pertinent Results:
Admission labs:

[**2190-1-18**] 11:59AM   ALBUMIN-3.0* CALCIUM-9.1 PHOSPHATE-5.4*#
MAGNESIUM-2.2
[**2190-1-18**] 11:59AM   GLUCOSE-114* UREA N-43* CREAT-0.9 SODIUM-143
POTASSIUM-4.3 CHLORIDE-101 TOTAL CO2-32 ANION GAP-14
[**2190-1-18**] 11:59AM   WBC-14.0*# RBC-3.61* HGB-10.3*# HCT-32.0*
MCV-89# MCH-28.6# MCHC-32.3 RDW-17.8*
[**2190-1-18**] 11:59AM   NEUTS-81.2* LYMPHS-12.6* MONOS-5.5 EOS-0.6
BASOS-0.1

Brief Hospital Course:
A 70 year-old man with a history of NSCLC s/p multiple
resections complicated by broncopleural fistulas and
endobronchial stent placement presents now for stent removal.
.
# NSCLC s/p stent: OSH physician feels that recurrent infections
may be reduced by removal of stent. He is now s/p multiple
muscle flaps with the intention of fixing the fistulas.  Bedside
bronchoscopy demonstrated the previously placed coverd stent in
place leading to LLL, appropriately blocking off L lingula and L
upper lobe.  LLL bronchus was widely patent and looked clean.
IP recommend not to extract the stent, because  L lingula/LUL
are nonfunctioning and the area may start to bleed if stent is
removed. This was explained to the referring physician.  [**Name10 (NameIs) **]
chest revealed that stent was in place.
.
# SVT:  On the morning after admission, pateint flipped into SVT
at a rate of 150-160.  BP fell from baseline 120s to 100, and he
remained completely asymptomatic.  He was given 5 mg IV
metoprolol with improvement in rate to 90s, sinus with frequent
APC.  An hour later he flipped into SVT again and again
responded to metoprolol 5 mg IV.  PO metoprolol at home dose was
considered.  Given no history of documented arrhthmia or cardiac
workup at [**Hospital1 18**], he may warrant further evaluation by a
cardiologist and/or echocardiogram going forward, depending on
overall goals of care.
.
# Chronic respiratory failure: Patient remained on his
ventilator via tracheostomy on PCV and appeared comfortable at
current settings from [**Hospital1 **] (FiO2 50% / PIP 18 / RR 10 / PEEP
5)
.
# Leukocytosis: WBC 14, up from 9 at the time of discharge.
Likely secondary to chronic fistula infections. He was afebrile.

.
# Malnutrition:  Tube feeds were held for procedure.
.
# history of PE: Not currently anticoagulated for unclear
reasons.
.
# GERD:  Pantoprazole was continued.
.
# Anxiety and pain:  Lorazepam, morphine, and haloperidol PRN
were continued.
.
# Depression/insomnia:  Trazodone was continued but did not help
him sleep. Zolpidem, lorazepam were tried without much success.
Finally quetiapine seemed to help him sleep.
.
Patient confirmed full code status
.
CONTACT: [**First Name8 (NamePattern2) 6303**] [**Known lastname 84248**], daughter, HCP
home: [**Telephone/Fax (1) 84251**]
cell: [**Telephone/Fax (1) 84252**]


Medications on Admission:
metoprolol 25 mg [**Hospital1 **]
ferrous sulfate 300 mg [**Hospital1 **]
acetaminophen 650 mg q4h prn
pantoprazole 40 mg daily
MVI 15 mL daily
zinc sulfate 220 mg daily
ascorbic acid 500 mg daily
protein supplement 1 scoop q8h
water 200 ml q6h
chlorhexidine .5 oz [**Hospital1 **]
heparin 5000 U sc tid
trazodone 50 mg daily
docusate 100 mg [**Hospital1 **]
magnesium 400 mg [**Hospital1 **]
haloperidol 1 mg IV q8h prn
morphine 2-4 mg IV q2h prn
loraepam .5-1 mg q4h prn
glucerna full strength 65 cc/h
Social History:
Lived in [**State 1727**], currently at [**Hospital3 **] Ex-smoker and
drinker.


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Ferrous Sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
5. Therapeutic Multivitamin     Liquid Sig: Five (5) ML PO DAILY
(Daily).
6. Ascorbic Acid 90 mg/mL Drops Sig: One (1)  PO DAILY (Daily).

7. Zinc Sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
8. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: One (1) ML
Mucous membrane [**Hospital1 **] (2 times a day).
9. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
10. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
11. Morphine 250 mg/10 mL Solution Sig: 2-4 mg Intravenous every
four (4) hours as needed for pain.
12. Haloperidol Lactate 5 mg/mL Solution Sig: One (1)  Injection
TID (3 times a day) as needed for anxiety.
13. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
14. Protein     Powder Sig: One (1) Scoop PO every eight (8)
hours.
15. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
16. Lorazepam 0.5-1 mg IV Q8H:PRN anxiety
17. PICC Care
Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
18. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] - [**Location (un) 86**]

Discharge Diagnosis:
NSCLC
- history of Right thoracotomy, en bloc resection portions of
RUL/RLM/RLL  [**2184**]
- Supraventricular tachycardia
- [**Doctor Last Name **] lobectomy, LL lobe wedge resection via L thoractomy
[**2189-7-28**],
- hx ETOH abuse
- GERD
- Depression


Discharge Condition:
Clear sensorium, vent dependent via trach, VS otherwise stable


Discharge Instructions:
You were admitted to the [**Hospital1 18**] Intensive care unit for
evaluation of your stent for possible removal. Our
Interventional Pulmonary team performed a bronchoscopy and
determined that the stent should be left in place, and a CT scan
was done to confirm placement.  You were maintained on your home
ventilatory settings.

While you were here you developed an episode of fast heart rate
called a Superventricular Tachycardia which was controlled with
an extra dose of your home metoprolol.  It is recommended that
you and your doctor's consider an echocardiogram and consider
anticoagulation for this rhythm.

Followup Instructions:
Please follow up with your regular doctors [**First Name (Titles) **] [**Last Name (Titles) 84253**] as
scheduled
{'Malignant neoplasm of other parts of bronchus or lung,Chronic respiratory failure,Dependence on respirator, status,Unspecified protein-calorie malnutrition,Esophageal reflux,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Personal history of venous thrombosis and embolism,Other specified cardiac dysrhythmias,Leukocytosis, unspecified,Dysthymic disorder,Insomnia, unspecified,Tracheostomy status'}


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: transferred for IP procedure

PRESENT ILLNESS: Mr [**Known lastname 84248**] is a 70 year old man with a history of non-small cell
lung CA s/p R thoractomy with en bloc wedge resection in [**2184**],
LUL resection [**2187**], and LUL lobectomy followed tracheostomy/PEG
placement in [**2188**]. He presents today for removal of a LUL
endobronchial stent.
.
Mr. [**Known lastname 84250**] recent history began in [**9-/2189**] when he was found to
have a broncopleural fisutla in the RUL. A stent was placed at
[**Hospital1 18**] broncoscopically to block the fistula. Since that time, he
has been living at [**Hospital **] rehab and has been intermittently
ventilator dependent. He has had recurrent air leaks and
numerous procedures to attempt to repair his fistulas. He is s/p
2 muscle flaps to attempt to repair the fisulta ([**2189-12-2**] and
early [**2189-12-29**]). These have been complicated by local infections
requiring drainage. He is now transferred to [**Hospital1 18**] for removal
of LUL stent to attempt improve the healing and improve
infectious complications of his most recent muscle flap.
:

MEDICAL HISTORY: - NSCLC as above:
- R thoracotomy, en bloc resection portions of
RUL/RLM/RLL [**2184**]
- [**Doctor Last Name **] lobectomy, LL lobe wedge resection via L thoractomy
[**2189-7-28**],
- hx ETOH abuse
- GERD
- Depression
- L knee OA
- h/o PE

MEDICATION ON ADMISSION: metoprolol 25 mg [**Hospital1 **]
ferrous sulfate 300 mg [**Hospital1 **]
acetaminophen 650 mg q4h prn
pantoprazole 40 mg daily
MVI 15 mL daily
zinc sulfate 220 mg daily
ascorbic acid 500 mg daily
protein supplement 1 scoop q8h
water 200 ml q6h
chlorhexidine .5 oz [**Hospital1 **]
heparin 5000 U sc tid
trazodone 50 mg daily
docusate 100 mg [**Hospital1 **]
magnesium 400 mg [**Hospital1 **]
haloperidol 1 mg IV q8h prn
morphine 2-4 mg IV q2h prn
loraepam .5-1 mg q4h prn
glucerna full strength 65 cc/h
Social History:
Lived in [**State 1727**], currently at [**Hospital3 **] Ex-smoker and
drinker.

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: VS: T 96.7, HR 104, RR 19, BP 109/62 on PCV with FiO2 50% / PIP
18 / RR 10 / PEEP 5
GEN: sppears comfortable
SKIN: L upper chest wall bandage clean and dry
HEENT: JVP not elevated
CHEST: Lungs are diffusely rhonchorus with expiratory wheezes
and decreased sounds in both upper lobes
CARDIAC: Regular rhythm; no murmurs, rubs, or gallops.
ABDOMEN: G-tube clean, dry, and intact
EXTREMITIES: L arm PICC no peripheral edema, warm without
cyanosis
NEUROLOGIC: Alert, appropriately responds to questions by
mouthing words, declines to write for further communication

FAMILY HISTORY: unknown

SOCIAL HISTORY: Lives in [**State 1727**]. Ex-smoker. + EtOH 

### Response:
{'Malignant neoplasm of other parts of bronchus or lung,Chronic respiratory failure,Dependence on respirator, status,Unspecified protein-calorie malnutrition,Esophageal reflux,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Personal history of venous thrombosis and embolism,Other specified cardiac dysrhythmias,Leukocytosis, unspecified,Dysthymic disorder,Insomnia, unspecified,Tracheostomy status'}
