CHIEF COMPLAINT: voice changes, shortness of breath and
swallowing difficulty

PRESENT ILLNESS: 72yo M presents with 1 month h/o voice change, mild dyspnea and
dysphagia.  Pt had been evaluated by outside ORL for past 1-2
weeks and was scheduled to undergo possible tracheostomy and
biopsy of a known laryngeal lesion on [**2134-11-3**].  However, the
outside ORL fell sick and accordingly we are asked to evaluate
the patient for consideration of airway security.

MEDICAL HISTORY: DM
HTN

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AVSS
NAD at rest; stridor with deep rapid inspiration.
Ears clear
OC/OP clear
Nose clear
FOE: 1-2cm obstructive right supraglottic and glottic exophytic
lesion extending towards midline.  Right TVC immobility.  Left
TVC with mobility.  No other pharyngeal lesions noted.

FAMILY HISTORY: NC

SOCIAL HISTORY: 150 pack-year h/o smoking (quit 3y ago) and social
drinking
Malignant neoplasm of other specified sites of larynx,Unilateral paralysis of vocal cords or larynx, partial,Other diseases of respiratory system, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Malignant neo larynx NEC,Vocal paral unilat part,Resp system disease NEC,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2134-11-3**]              Discharge Date:   [**2134-11-10**]

Date of Birth:  [**2062-5-27**]             Sex:   M

Service: OTOLARYNGOLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7729**]
Chief Complaint:
voice changes, shortness of breath and
swallowing difficulty

Major Surgical or Invasive Procedure:
trachestomy tube placement and DL/biopsy of laryngeal lesion


History of Present Illness:
72yo M presents with 1 month h/o voice change, mild dyspnea and
dysphagia.  Pt had been evaluated by outside ORL for past 1-2
weeks and was scheduled to undergo possible tracheostomy and
biopsy of a known laryngeal lesion on [**2134-11-3**].  However, the
outside ORL fell sick and accordingly we are asked to evaluate
the patient for consideration of airway security.


Past Medical History:
DM
HTN


Social History:
150 pack-year h/o smoking (quit 3y ago) and social
drinking

Family History:
NC

Physical Exam:
AVSS
NAD at rest; stridor with deep rapid inspiration.
Ears clear
OC/OP clear
Nose clear
FOE: 1-2cm obstructive right supraglottic and glottic exophytic
lesion extending towards midline.  Right TVC immobility.  Left
TVC with mobility.  No other pharyngeal lesions noted.


Pertinent Results:
[**2134-11-3**] 12:30PM   GLUCOSE-99 UREA N-24* CREAT-0.8 SODIUM-140
POTASSIUM-3.8 CHLORIDE-104 TOTAL CO2-27 ANION GAP-13
[**2134-11-3**] 12:30PM   estGFR-Using this
[**2134-11-3**] 12:30PM   WBC-13.8* RBC-4.19* HGB-13.0* HCT-37.7*
MCV-90 MCH-30.9 MCHC-34.4 RDW-12.7
[**2134-11-3**] 12:30PM   NEUTS-74.2* LYMPHS-19.5 MONOS-4.8 EOS-1.0
BASOS-0.6
[**2134-11-3**] 12:30PM   PLT COUNT-383
[**2134-11-3**] 12:30PM   PT-13.6* PTT-24.4 INR(PT)-1.2*

Vocal Cord Lesion, Right, Biopsy:

Invasive squamous cell carcinoma, moderately differentiated.

[**11-5**] CT: No evidence of pulmonary metastasis. Right upper lobe
calcified
granuloma, areas of dorsal atelectasis, small lung cysts.

Suspicion of mucous and aspirated oral contrast in the main
right bronchus.
Short-term followup CT could confirm this suspicion.

No evidence of mediastinal lymphadenopathy. Calcified
gallstones.



Brief Hospital Course:
[**2134-11-3**] POD 0 Pt had T3 right laryngeal mass biopsied and trach
placed. Pt placed in SICU. Weaned to trach collar.

[**2134-11-4**] POD 1 DEFERRED PASSY MUIR VALVE EVALUATION due to less
than 48 hrs post op.

[**2134-11-5**] POD 2 PMV was not tolerated and trials were c/b
increased manometer
readings, aphonia, and breath-stacking.  Intolerance of PMV
could
be due to trach size, or more likely due to laryngeal mass
obstructing airway and impeding vocalization. PMV was removed
from the room and will be stored in our office for further
trials
in the future.  Regarding PO status, given increased risk for
aspiration w/o PMV would recommended video swallow study this
afternoon, prior to initiating diet. Aspiration and penetration
with thin and nectar consistencies. Pt was transferred from ICU
to floor. PT seen by med onc who agree with RT plan and will see
pt as outpt who, and discussion between rad onc, med onc and ent
[**Doctor First Name **] will be performed.

[**2134-11-6**] POD 3 PT consult cleared patient as having no issues,
able to ambulate without assistance.

[**2134-11-7**] POD 4 Pt written for IV Zofran for nausea, no other
events.

[**2134-11-8**] POD 5 #7 Portex cuffed was changed to #7 uncuffed
Portex trach

[**2134-11-9**] POD 6 Vocal Cord Lesion, Right, Biopsy:

Invasive squamous cell carcinoma, moderately differentiated,
result came back from biopsy taken during surgry.

[**2134-11-10**] POD 7
Speech and Swallow recs
1.  Monitor O2 Sats / respiration while valve is in place.

2.  Do not allow the patient to sleep with the valve in place.

3.  PMV wear schedule is up to the discretion of the
    nurse and/or respiratory therapist.

4.  PO diet of regular solids and nectar thick liquids with chin
tuck to swallow liquids

5.  Meds whole with nectar thick liquids

6.  TID oral care

7.  Please consult Nutrition to monitor caloric intake

8.  Recommend video swallow study at rehab to gain objective
data
of tolerance for thin liquids

9.  Please page to schedule video swallow study if pt is not
d/c'd as scheduled.

This swallowing pattern correlates to a Functional Oral Intake
Scale (FOIS) rating of 5 out of 7.

These recommendations were shared with the patient, nurse and
medical team.

Going to [**Hospital Ward Name **] for radiation mapping. Discharged from
hospital to rehab at [**Hospital1 41724**].

Medications on Admission:
none

Discharge Medications:
1. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
2. Famotidine(PF) in [**Doctor First Name **] (Iso-os) 20 mg/50 mL Piggyback Sig: One
(1)  Intravenous Q12H (every 12 hours): 20 mg IV q 12.
Disp:*600 mg* Refills:*2*
3. Morphine 2 mg/mL Syringe Sig: One (1)  Injection Q2H (every 2
hours) as needed for pain.
Disp:*50 mg* Refills:*0*
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day): 5000 U TID.
Disp:*[**Numeric Identifier 1871**] units* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Vocal Cord Lesion, Right, Biopsy:

Invasive squamous cell carcinoma, moderately differentiated


Discharge Condition:
Stable


Discharge Instructions:
You are being discharged on medications that may alter your
judgement, including but not limited to narcotics and
benzodiazepines.  While under the influence of such substances,
do NOT operate a motor vehicle or other heavy machinery.  Use
caution when combining narcotics and benzodiazepines as well as
other substances as they make have adverse effect such as
respiratory depression. If a narcotic/acetominophen combination
is prescribed, do NOT exceed more than 4 grams of acetominophen
in a given 24 hour period or 2 grams if impaired liver damage.
If being sent home on antibiotics, be sure to take the doses on
time and to finish all of the medication.

Please keep the neck incision site covered for 24 hours after
leaving the hospital, after which time you may shower. Normal
soap/shampoo is okay, but avoid any scrubbing on the area.  You
do not need any dressings on your incision sites as discussed
with plastics, but avoid showering longer than ~10 minutes (No
'pruning'). You may apply bacitracin to the wounds

Please call the clinic or return to the ED if you have any
worsening nausea or vomiting, new fevers, worsening pain or
other new concerns.

Please call your doctor or return to the emergency room if you
have any of the following:

 * You experience new chest pain, pressure, squeezing or
 tightness.

* New or worsening cough or wheezing.

* If you are vomiting and cannot keep in fluids or your
 medications.

* You are getting dehydrated due to continued vomiting,
 diarrhea or other reasons. Signs of dehydration include dry
 mouth, rapid heartbeat or feeling dizzy or faint when standing.

* You see blood or dark/black material when you vomit or have a
 bowel movement.


* You have shaking chills, or a fever greater than 101.5 (F)
 degrees or 38(C) degrees.

* Any serious change in your symptoms, or any new symptoms that
 concern you.

* Please resume all regular home medications and take any new
meds
 as ordered.




Followup Instructions:
Provider: [**First Name4 (NamePattern1) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 41**] Please
call to make an appointment within 1-2 weeks

Follow up with radiation oncologist



Completed by:[**2134-11-10**]
{'Malignant neoplasm of other specified sites of larynx,Unilateral paralysis of vocal cords or larynx, partial,Other diseases of respiratory system, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}


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: voice changes, shortness of breath and
swallowing difficulty

PRESENT ILLNESS: 72yo M presents with 1 month h/o voice change, mild dyspnea and
dysphagia.  Pt had been evaluated by outside ORL for past 1-2
weeks and was scheduled to undergo possible tracheostomy and
biopsy of a known laryngeal lesion on [**2134-11-3**].  However, the
outside ORL fell sick and accordingly we are asked to evaluate
the patient for consideration of airway security.

MEDICAL HISTORY: DM
HTN

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AVSS
NAD at rest; stridor with deep rapid inspiration.
Ears clear
OC/OP clear
Nose clear
FOE: 1-2cm obstructive right supraglottic and glottic exophytic
lesion extending towards midline.  Right TVC immobility.  Left
TVC with mobility.  No other pharyngeal lesions noted.

FAMILY HISTORY: NC

SOCIAL HISTORY: 150 pack-year h/o smoking (quit 3y ago) and social
drinking 

### Response:
{'Malignant neoplasm of other specified sites of larynx,Unilateral paralysis of vocal cords or larynx, partial,Other diseases of respiratory system, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
