CHIEF COMPLAINT: thick secretions

PRESENT ILLNESS: Ms. [**Known lastname **] is a 88 YO Spanish speaking female w/PMHx HTN, who
was recently admitted [**11-18**] to [**12-15**] to [**Hospital1 18**] with HA and found
to have diffuse SAH, s/p coiling of right PCA aneurysm with VP
shunt placement. She was intubated for the procedure, but failed
extubation requiring re-intubation due to previously unknown
large thoracic mass, c/w goiter. The mass was biopsied and
results showed benign thyroid nodule. She eventually underwent
t-tube placement ([**12-7**]) by IP. She also had a PEG placed and
was evaluated by EGD for a few episodes of dark/tarry occult
blood positive stools and slow Hct drop requiring 2 units of
blood at the same time which showed no ulcers or varices. Her
hospital course was also notable for right LE DVT, s/p IVC
filter placement.

MEDICAL HISTORY: Subarachnoid hemorrhage
R PCOMM aneurysm
Respiratory failure requiring intubation and trach
Hydrocephalus s/p VP shunt
Left sided hygroma
Thyroid mass
GI bleed with no source found from EGD ([**Last Name (un) **] not performed)
anemia
Deep vein thrombosis s/p IVC filter
Hypertension

MEDICATION ON ADMISSION: Medications on transfer:
tylenol PRN fever
Mucomyst nebulizer [**Hospital1 **] and Q 4 hr PRN
albuterol neb Q 4 PRN
Amiodarone 200 mg via G tube daily
Colace daily
Ferrous sulfate 300 mg [**Hospital1 **]
Prevacid 30 mg [**Hospital1 **]
Levofloxacin 250 mg Q day
Protonix 40 mg IV Q day
Zosyn 3.375 mg Q 6hr
Senna Q day

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission exam
Vitals: T: 98.2 BP: 161/69 P: 84 R: 13 O2: 98%
General: tired, but regarding examiner
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Audible rhonchi in right middle lung field, no audible
breath sounds in right lower field, audible crackles @ Left base

FAMILY HISTORY: CAD

SOCIAL HISTORY: Lives with her daughter and two grandchildren. Originally from
the [**Country 13622**] Republic. Daughter works at hospice.
Other diseases of trachea and bronchus,Pneumonitis due to inhalation of food or vomitus,Obstructive hydrocephalus,Foreign body in larynx,Foreign body accidentally entering other orifice,Attention to tracheostomy,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Goiter, unspecified,Atrial fibrillation,Headache,Dysphagia, unspecified,Unspecified essential hypertension,Anemia, unspecified,Osteoporosis, unspecified,Gastrostomy status,Presence of cerebrospinal fluid drainage device,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Trachea & bronch dis NEC,Food/vomit pneumonitis,Obstructiv hydrocephalus,Foreign body in larynx,FB entering oth orifice,Atten to tracheostomy,Thyrotox NOS no crisis,Goiter NOS,Atrial fibrillation,Headache,Dysphagia NOS,Hypertension NOS,Anemia NOS,Osteoporosis NOS,Gastrostomy status,Ventricular shunt status,Hx TIA/stroke w/o resid
Admission Date:  [**2180-12-26**]              Discharge Date:   [**2180-12-30**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Doctor First Name 3298**]
Chief Complaint:
thick secretions

Major Surgical or Invasive Procedure:
T-tube exchange for trachestomy by interventional pulmonology


History of Present Illness:
Ms. [**Known lastname **] is a 88 YO Spanish speaking female w/PMHx HTN, who
was recently admitted [**11-18**] to [**12-15**] to [**Hospital1 18**] with HA and found
to have diffuse SAH, s/p coiling of right PCA aneurysm with VP
shunt placement. She was intubated for the procedure, but failed
extubation requiring re-intubation due to previously unknown
large thoracic mass, c/w goiter. The mass was biopsied and
results showed benign thyroid nodule. She eventually underwent
t-tube placement ([**12-7**]) by IP. She also had a PEG placed and
was evaluated by EGD for a few episodes of dark/tarry occult
blood positive stools and slow Hct drop requiring 2 units of
blood at the same time which showed no ulcers or varices. Her
hospital course was also notable for right LE DVT, s/p IVC
filter placement.

The patient was discharged to rehab on [**12-5**], and was seen in IP
for f/u bronch on [**12-20**]. They recommended mucinex and flushes to
keep her T-tube patent, however per her daughter, the rehab was
not doing this. While at the rehab facility, she developed
thick, copious secretions, and was started on IV Zosyn and
Levaquin for presumed aspiration pneumonia.

On [**12-23**] she went to [**Hospital3 **] for routine Hct check and was
found to have Hct 22.7 with Guiac + stools. She was admitted for
blood transfusion and received two units. Subsequent guiac tests
were negative, and the patient was started on a PPI. During her
stay, her T-tube was noted to be obstructed when capped, and she
was progressively unable to speak. She desaturated from a mucus
plug and required frequent suctioning. IP requested transfer
back to [**Hospital1 18**] for rigid bronch in OR to evaluate. The patient's
last Hct prior to transfer was 25.6. At the time of transfer,
her respiratory status was stable on 35% trach collar.

Vital signs on transfer were BP: 120/95 HR: 68 RR: O2 Sat: 99%
on 35% trach collar.  On the floor the patient remained unable
to speak. Her daughter was present who translated for her. She
currently complains of SOB and pleuritic chest pain, however
none at rest. Per her daughter, she spiked a fever with chills 3
days ago and had diarrhea yesterday with no blood.  Per the
daughter she has continued to require frequent suctionings to
keep her comfortable and prevent her from desaturating. Shortly
after presentation to the medical floor, she continued to
require frequent suctioning in order to remain comfortable, and
was transfered to the MICU due to her need for frequent nursing
care.


Past Medical History:
Subarachnoid hemorrhage
R PCOMM aneurysm
Respiratory failure requiring intubation and trach
Hydrocephalus s/p VP shunt
Left sided hygroma
Thyroid mass
GI bleed with no source found from EGD ([**Last Name (un) **] not performed)
anemia
Deep vein thrombosis s/p IVC filter
Hypertension


Social History:
Lives with her daughter and two grandchildren. Originally from
the [**Country 13622**] Republic. Daughter works at hospice.

Family History:
CAD

Physical Exam:
Admission exam
Vitals: T: 98.2 BP: 161/69 P: 84 R: 13 O2: 98%
General: tired, but regarding examiner
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Audible rhonchi in right middle lung field, no audible
breath sounds in right lower field, audible crackles @ Left base

CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Discharge exam:
Vitals: T: 98.5 BP: 109/41 P: 74 R: 20 O2: 98% on 40% trach mask

General: Sleeping, but arousable to voice, attentive to examiner

HEENT: Sclera anicteric, MMM, several white spots on tongue,
right sided facial droop
Neck: supple, JVP not elevated
Lungs: few crackles at bases
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Pulmo: tracheal sounds
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Pneumoboots on, no clubbing, cyansosis, edema


Pertinent Results:
Admission labs:
[**2180-12-26**] 11:15PM BLOOD WBC-5.1 RBC-3.41* Hgb-10.0* Hct-31.2*
MCV-91 MCH-29.2 MCHC-32.0 RDW-16.2* Plt Ct-516*
[**2180-12-26**] 11:15PM BLOOD Glucose-92 UreaN-11 Creat-0.8 Na-140
K-3.8 Cl-105 HCO3-25 AnGap-14
[**2180-12-26**] 11:15PM BLOOD Calcium-9.4 Phos-3.2 Mg-1.8

TSH:<0.02
T4: 14.1
calcTBG: 0.62
TUptake: 1.61
T4Index: 22.7

BAL Culture:
BRONCHOALVEOLAR LAVAGE      BAL RIGHT.
   GRAM STAIN (Final [**2180-12-27**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.
   RESPIRATORY CULTURE (Final [**2180-12-29**]):    NO GROWTH, <1000
CFU/ml.
   ACID FAST SMEAR (Final [**2180-12-28**]):
      NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.
   ACID FAST CULTURE (Preliminary):    NO MYCOBACTERIA ISOLATED.

   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.

Images:
Chest PA/Lateral:
IMPRESSION: AP chest compared to [**12-7**] through 26:
The right hemidiaphragm became elevated between [**12-8**] and
26, even more pronounced today. Some of this could be due to
subpulmonic pleural effusion but I would investigate either
phrenic nerve palsy or complete right lower lobe and perhaps
middle lobe collapse. Moderate cardiomegaly is stable with the
mediastinum midline. A large cervicothoracic mass presumably a
goiter displaces the trachea to the left. Left lung is clear. A
left PIC line ends roughly at the origin of the SVC.
The study and the report were reviewed by the staff radiologist.


Supra stomal tissue pathology - pending

Ct of the head:
FINDINGS: Previously seen subarachnoid hemorrhage has resolved.
Again seen
is an extra-axial left subdural fluid collection consistent with
hygroma.
However, on this examination there is area of hyperdensity
(2:[**10-29**])
consistent with an acute component. No acute intraparenchymal
hemorrhage is identified. The ventricles are normal in caliber
and configuration. A
ventriculostomy catheter via right frontal approach is
unchanged. There is
approximately 4 mm rightward shift of midline structures,
unchanged. Right
posterior communicating artery coil is unchanged in position.
No concerning osseous lesion is seen. The visualized paranasal
sinuses are
grossly clear. There is patchy opacification of the right
mastoid air cells.  Previously seen subcutaneous emphysema has
resolved.
IMPRESSION: New foci of hyperdensity in left extra-axial
subdural collection concerning for acute subdural hemorrhage. No
significant change in shift of midline structures, approximately
4 mm to the right. The ventricles have slightly decreased in
size compared to [**2180-12-4**].

Discharge labs:
[**2180-12-30**] 05:45AM BLOOD WBC-4.3 RBC-3.07* Hgb-9.3* Hct-28.5*
MCV-93 MCH-30.3 MCHC-32.7 RDW-16.4* Plt Ct-477*
[**2180-12-30**] 05:45AM BLOOD Glucose-139* UreaN-22* Creat-1.0 Na-144
K-4.0 Cl-104 HCO3-33* AnGap-11
[**2180-12-30**] 05:45AM BLOOD Calcium-8.4 Phos-3.1 Mg-1.9

Brief Hospital Course:
88F w/PMH SAH s/p PCOM aneurysm clipping, thoracic nodule goiter
with airway compression s/p t-tube placement.  Presented to OSH
from rehab with dyspnea secondary to mucus plugging and possible
aspiration PNA.  Transferred to [**Hospital1 18**] for interventional
pulmonology eval.

# Dyspnea:  Pt??????s history of copious secretions and significant
respiratory distress improved by suctioning is suggestive of
mucus plugging. Given the precipitous increase in the quantity
and the thick quality of her secretions, it was thought that she
may also be suffering from a concomitant aspiration pneumonia
even though there is no readily visible consolidation visible on
chest x-ray, no fever and no leukocytosis. She was initially in
the MICU and started on abx for HAP. She was evaluated by IP and
taken to the OR  where she underwent exchange of the t-tube for
trach and BAL of RLL, RML and biopsy and examination of
granulation tissue in upper
airway.  Bronchioalveolar lavage showed - gram stain negative
for PMN and microorganisms, respiratory culture negative, fungal
culture negative and acid fast culture pending, pathology report
is still pending. Secretions improved.  She was breathing
comfortably at time of discharge.

# Anemia: The patient??????s anemia had been an active issue during
her prior hospitalization.  Her prior negative colonoscopy and
EGD suggest against a significant ulcer or varices as the
source. As noted in her OSH documentation, her initial positive
guaiac tests may be due to manipulation of her PEG tube,
angiodysplasia that was not visible between colonoscopy and
endoscopy, or possibly gastritis (although this is less likely
in the face of her PPI use).  Other possible causes of her
anemia include her poor nutritional status and thyroid status
(TSH 0.02 @ OSH). Her hematocrit remained stable at 28 during
this hospitalization.  Repeat HCT after treatment of
hyperthyroidism to evaluate for improvement.  Further workup as
needed.

# Abnormal thyroid levels: TSH 0.02, T4 low. Endocrine was
consulted and recommended to start Methimazole 10mg [**Hospital1 **],  check
anti-thyroid antibodies: TSI (thyroid stimulating
immunoglobulin) - results still pending, anti-Tg (less than 1)
and anti-TPO antibodies (14) - anti-Tg and anti-TP both
negative. (+TSI would be indicative of [**Doctor Last Name 933**], whereas anti-Tg
and anti-TPO would be + in underlying Hashimoto's/autoimmune
disease).  Pt has follow up with endocrine scheduled for follow
up of TSI results.

# Goiter/low TSH: Patient with known goiter and low TSH, high
T4. Differential diagnosis includes [**Doctor Last Name **] disease, amiodarone
induced toxicity, toxic goiter. No history of thyroid tests at
PCP's office. Based on antibodies, likely not [**Doctor Last Name **].  Endocrine
recommended:
- TSI studies pending at time of discharge.  Pt will need follow
up with endocrine upon discharge for adjustment of medications
including possible initiation of steroids.
- Labs to be checked include CBC with diff, Chem 10, liver
function tests, and TSH, T3, T4 and should be checked in [**2-19**]
days given new medication methimazole. They should be faxed to
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Hospital1 18**].  Phone Phone:
([**Telephone/Fax (1) 9072**].

# Subarachnoid hemorrhage from a posterior communicating artery
aneurysm: Patient with hydrocephalus s/p VP shunt placement.
Notified neurosurgery of admission. She was restarted on aspirin
per neurosurgical approval.  On day of discharge she developed a
headache unresponsive to tyelnol. A CT of the head was obtained
which revealed is slightly larger extra axial fluid  collection
and a small acute/chronic SDH. Neurosurgery was consulted and
adjusted her shunt rate of CSF drainage.  Her VP shunt settings
were checked and noted to be .5 and increased to 1.5.
Neurosurgery reviewed her head CT and recommended follow-up
(already planned) with repeat head imaging.

# h/o DVT: Patient's last hospitalization complicated by DVT,
s/p IVC filter placement. She remained off anticoagulation at
this time given recent GI bleed.  IVC filter remains in place.


# Atrial fibrillation: Recently started on amiodarone on [**2180-11-22**]
for a. fib noted while in the hospital.  Amiodarone was held
given thyrotoxicity. Anticoagulation held given GIB/SAH.  At
time of discharge patient in sinus rhythm.

# Speech:   Patient failed Passy-Muir trial while here.  This is
likely because the goiter is compressing the trach.  She will
need further follow-up with speech and swallow for repeat trial
of Passy-Muir valve.

# Aspiration: She was initiated on tube feeds due to concern for
aspiration.   Tubefeeding:  Fibersource HN Full strength;
Starting rate:20 ml/hr; Advance rate by  10 ml q4h Goal rate:70
ml/hr, Residual Check:q4h Hold feeding for residual >= :200 ml,
Flush w/  50 ml  water q4h.  Other instructions: Goal cycle at
70 mL/hour.  She will need to be evaluated by nutrition at
rehab.

Transitional Issues:
Passy Muir Valve
Nutrition
Thyroid labs
Follow up with Endocrine
F/u Neurosurgery

Medications on Admission:
Medications on transfer:
tylenol PRN fever
Mucomyst nebulizer [**Hospital1 **] and Q 4 hr PRN
albuterol neb Q 4 PRN
Amiodarone 200 mg via G tube daily
Colace daily
Ferrous sulfate 300 mg [**Hospital1 **]
Prevacid 30 mg [**Hospital1 **]
Levofloxacin 250 mg Q day
Protonix 40 mg IV Q day
Zosyn 3.375 mg Q 6hr
Senna Q day


Discharge Medications:
1. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital1 **]: One (1) neb Inhalation Q6H (every 6 hours) as
needed for shortness of breath or wheezing.
2. methimazole 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times
a day).
3. aspirin 325 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).
4. heparin (porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1)
injection Injection TID (3 times a day).
5. docusate sodium 50 mg/5 mL Liquid [**Hospital1 **]: One Hundred (100) mg
PO BID (2 times a day).
6. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
7. acetaminophen 500 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
8. senna 8.6 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO twice a day as
needed for constipation.
9. Fibersource HN     Liquid [**Last Name (STitle) **]: One (1)  PO once a day:
Starting rate:20 ml/hr; Advance rate by  10 ml q4h Goal rate:70
ml/hr
 Residual Check:q4h Hold feeding for residual >= :200 ml
.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 1293**] - [**Location (un) 8957**]

Discharge Diagnosis:
PRIMARY: Aspiration pneumonia, respiratory distress secondary to
mucus plugging, hyperthyroidism


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Lethargic but arousable.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
It was a pleasure to participate in your care Ms. [**Known lastname **].  You
were admitted to the hospital with difficulty breathing.  The
interventional pulmonologists changed  your trach tube and your
breathing improved.

During your hospitalization we also found that you were
hyperthyroid.  The endocrinologists saw you and made some
recommendations for treating the hyperthyroidism. Please follow
up with them as scheduled.

You also had headaches and neurosurgeons would like to follow up
with you, but please make sure that you do the imaging (as
recommended in follow up appointments) before seeing them.

Please make the following changes to your medications:
1. START methimazole 10 mg [**Hospital1 **]
2. STOP levaquin (you have completed the course of this
antibiotic)
3. STOP zosyn (you have completed the course of this antibiotic)
4. STOP amiodarone
5. START Lansoprazole 30 mg daily

Please see below for you follow-up appointments.

Followup Instructions:
Department: MRI
When: THURSDAY [**2181-1-11**] at 12:40 PM
With: MRI [**Telephone/Fax (1) 327**]
Building: CC [**Location (un) 591**] [**Hospital 1422**]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage

Department: NEUROSURGERY
When: THURSDAY [**2181-1-11**] at 2:00 PM
With: [**Name6 (MD) **] [**Last Name (NamePattern4) 7746**], MD [**Telephone/Fax (1) 3666**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: MEDICAL SPECIALTIES
When: TUESDAY [**2181-1-16**] at 10:20 AM
With: [**First Name11 (Name Pattern1) 1409**] [**Last Name (NamePattern4) 91212**], MD [**Telephone/Fax (1) 1803**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: RADIOLOGY
When: TUESDAY [**2181-1-16**] at 11:45 AM
With: CAT SCAN [**Telephone/Fax (1) 327**]
Building: CC CLINICAL CENTER [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage

Department: Chest Disease Center
When: TUESDAY [**2181-1-16**] at 2:30 PM
With: [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD [**0-0-**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Other diseases of trachea and bronchus,Pneumonitis due to inhalation of food or vomitus,Obstructive hydrocephalus,Foreign body in larynx,Foreign body accidentally entering other orifice,Attention to tracheostomy,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Goiter, unspecified,Atrial fibrillation,Headache,Dysphagia, unspecified,Unspecified essential hypertension,Anemia, unspecified,Osteoporosis, unspecified,Gastrostomy status,Presence of cerebrospinal fluid drainage device,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}


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: thick secretions

PRESENT ILLNESS: Ms. [**Known lastname **] is a 88 YO Spanish speaking female w/PMHx HTN, who
was recently admitted [**11-18**] to [**12-15**] to [**Hospital1 18**] with HA and found
to have diffuse SAH, s/p coiling of right PCA aneurysm with VP
shunt placement. She was intubated for the procedure, but failed
extubation requiring re-intubation due to previously unknown
large thoracic mass, c/w goiter. The mass was biopsied and
results showed benign thyroid nodule. She eventually underwent
t-tube placement ([**12-7**]) by IP. She also had a PEG placed and
was evaluated by EGD for a few episodes of dark/tarry occult
blood positive stools and slow Hct drop requiring 2 units of
blood at the same time which showed no ulcers or varices. Her
hospital course was also notable for right LE DVT, s/p IVC
filter placement.

MEDICAL HISTORY: Subarachnoid hemorrhage
R PCOMM aneurysm
Respiratory failure requiring intubation and trach
Hydrocephalus s/p VP shunt
Left sided hygroma
Thyroid mass
GI bleed with no source found from EGD ([**Last Name (un) **] not performed)
anemia
Deep vein thrombosis s/p IVC filter
Hypertension

MEDICATION ON ADMISSION: Medications on transfer:
tylenol PRN fever
Mucomyst nebulizer [**Hospital1 **] and Q 4 hr PRN
albuterol neb Q 4 PRN
Amiodarone 200 mg via G tube daily
Colace daily
Ferrous sulfate 300 mg [**Hospital1 **]
Prevacid 30 mg [**Hospital1 **]
Levofloxacin 250 mg Q day
Protonix 40 mg IV Q day
Zosyn 3.375 mg Q 6hr
Senna Q day

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission exam
Vitals: T: 98.2 BP: 161/69 P: 84 R: 13 O2: 98%
General: tired, but regarding examiner
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Audible rhonchi in right middle lung field, no audible
breath sounds in right lower field, audible crackles @ Left base

FAMILY HISTORY: CAD

SOCIAL HISTORY: Lives with her daughter and two grandchildren. Originally from
the [**Country 13622**] Republic. Daughter works at hospice. 

### Response:
{'Other diseases of trachea and bronchus,Pneumonitis due to inhalation of food or vomitus,Obstructive hydrocephalus,Foreign body in larynx,Foreign body accidentally entering other orifice,Attention to tracheostomy,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Goiter, unspecified,Atrial fibrillation,Headache,Dysphagia, unspecified,Unspecified essential hypertension,Anemia, unspecified,Osteoporosis, unspecified,Gastrostomy status,Presence of cerebrospinal fluid drainage device,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}
