CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 56-year-old man
with a complicated and prolonged medical course.  Briefly,
was admitted on [**2133-10-26**] after presenting with shortness of
breath and was subsequently found to have pericardial
effusion.  Had 1800 cc of fluid drained by pericardiocentesis
on [**10-28**].  Pericardial fluid grew aspergillus, with negative
cytology, and patient was started on a regimen of
Voriconazole and Augmentin.  Had echocardiogram which showed
global hypokinesis.  Had episodes of recurrent AFib with
rapid ventricular response.

MEDICAL HISTORY: 1. Lung cancer status post XRT/chemotherapy/right lower
lobectomy.
2. Chronic right lung collapse.
3. Chronic left pleural effusion.
4. Paroxysmal atrial fibrillation.
5. Radiation-induced pericarditis.
6. Internal jugular clot [**6-29**].
7. Bronchiectasis.
8. Recurrent [**Doctor First Name **].
9. Hypertension.
10. Chronic renal insufficiency with history of
membranoproliferative glomerulonephritis diagnosed by renal
biopsy summer of [**2132**].
11. ASD by echocardiogram [**5-29**].
12. Questionable remote history of TB in [**Country 651**].

MEDICATION ON ADMISSION: 

ALLERGIES: Levofloxacin, Percocet.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other acute pericarditis,Aspergillosis,Cardiac arrest,Congestive heart failure, unspecified,Constrictive pericarditis,Empyema without mention of fistula,Acute and chronic respiratory failure,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure
Acute pericarditis NEC,Aspergillosis,Cardiac arrest,CHF NOS,Constrictiv pericarditis,Empyema w/o fistula,Acute & chronc resp fail,Ac kidny fail, tubr necr,Hemorrhage complic proc
Admission Date:  [**2133-10-26**]       Discharge Date:  [**2133-12-29**]

Date of Birth:   [**2079-4-27**]       Sex:  M

Service:  [**Hospital1 139**] Medicine and transferred to MICU

HISTORY OF PRESENT ILLNESS:  Patient is a 56-year-old man
with a complicated and prolonged medical course.  Briefly,
was admitted on [**2133-10-26**] after presenting with shortness of
breath and was subsequently found to have pericardial
effusion.  Had 1800 cc of fluid drained by pericardiocentesis
on [**10-28**].  Pericardial fluid grew aspergillus, with negative
cytology, and patient was started on a regimen of
Voriconazole and Augmentin.  Had echocardiogram which showed
global hypokinesis.  Had episodes of recurrent AFib with
rapid ventricular response.

On [**11-3**], had an episode of asystole with spontaneous
recovery, and was subsequently evaluated by EP with no
interventions suggested.  On [**11-15**], had a syncopal event with
hypotension, low urine output, and anasarca that was
unresponsive to low dose dopa.  A repeat echocardiogram found
reaccumulation of pericardial effusion and evidence of
constrictive pericarditis.

On [**11-17**], underwent pericardectomy and subsequently underwent
a pericardial stripping on [**11-19**].  On [**11-20**], the patient's
antibiotics were changed to
Voriconazole/Vancomycin/Unasyn/caspofungin.  Unasyn was
subsequently changed to Zosyn on [**11-22**] for Enterobacter
cloacae.  Patient's postoperative course complicated by
anasarca with difficult diuresis and worsening renal failure.
Renal consult obtained.  Patient also with respiratory
failure and intubation with difficult wean for which
Pulmonary was consulted and for which patient was transferred
to the MICU team on [**2133-11-30**].

PAST MEDICAL HISTORY:
1. Lung cancer status post XRT/chemotherapy/right lower
lobectomy.
2. Chronic right lung collapse.
3. Chronic left pleural effusion.
4. Paroxysmal atrial fibrillation.
5. Radiation-induced pericarditis.
6. Internal jugular clot [**6-29**].
7. Bronchiectasis.
8. Recurrent [**Doctor First Name **].
9. Hypertension.
10. Chronic renal insufficiency with history of
membranoproliferative glomerulonephritis diagnosed by renal
biopsy summer of [**2132**].
11. ASD by echocardiogram [**5-29**].
12. Questionable remote history of TB in [**Country 651**].

ALLERGIES:  Levofloxacin, Percocet.

MEDICATIONS ON TRANSFER TO THE MICU TEAM:
1. Voriconazole started [**10-28**].
2. Caspofungin started [**11-22**].
3. Zosyn.
4. Amiodarone.
5. Metoprolol 12.5 p.o. b.i.d.
6. Hydralazine 10 mg IV q.4. prn.
7. Heparin drip.
8. Bumetanide drip.
9. Atrovent MDI six puffs q.4-6h. prn.
10. Albuterol six puffs q.6h. prn.
11. Epo 5,000 units subQ 3x/week Tuesdays, Thursdays,
Saturdays.
12. Protonix 40 mg IV q.24.
13. Morphine prn.
14. Ativan prn.
15. Ambien prn.
16. Lacrilube one application O.U. prn.
17. Bisacodyl 10 p.r. q.d.
18. Colace 100 mg ng b.i.d.
19. Multivitamin one cap ng q.d.
20. Thiamine 100 mg ng q.d.

PHYSICAL EXAM ON TRANSFER:  T max 99.0, blood pressure
109-160/58-79, heart rate 64-71, respiratory rate 12-26,
satting 100% on 30% FIO2.  General:  Is alert in no acute
distress.  HEENT:  Intubated.  Cardiovascular:  Regular rate
and rhythm, normal S1, S2.  Pulmonary:  Left lung clear,
decreased breath sounds on right.  Abdomen was soft, mildly
distended and nontender.  Extremities had 2+ pitting edema.

HOSPITAL COURSE:  Patient is a 56-year-old man with a history
of lung cancer status post XRT/chemotherapy/right lower
lobectomy, chronically infected nonfunctional right lung and
left lung with decreased compliance resulting in difficult
wean from the ventilator.  Hospital course complicated by
recurrent pericardial effusion and constrictive pericarditis
status post pericardial stripping, aspergillus pericarditis,
and left hemothorax, status post VATS.

1. Respiratory failure:  Patient's prolonged weaning from the
ventilator secondary to combination of nonfunctional right
lung and left lung with decreased compliance also in the
setting of likely respiratory muscle weakness.  Patient is
currently alternating between assist control (250/20/5/0.40)
and trials of pressure support (25/5/0.40).  Goal is for a
pCO2 of approximately 55 to 60, which correlates roughly with
a minute ventilation of approximately 7-8 liters/minute.
Patient has a baseline tachypnea of 30-40
respirations/minute, etiology is unclear, but anxiety appears
to be a component.  Given his baseline tachypnea, the tidal
volume must be adjusted to obtain desired minute ventilation.
Plan is for continued wean of ventilator support as
tolerated.

Additionally, patient had his right pulmonary artery ligated
during his pericardial procedure in an anticipated for a
staged right pneumonectomy, if patient is able to regain
adequate functional and nutritional status prior to
undergoing procedure.

2. Hemothorax:  Patient had hemothorax on left lung on [**12-3**]
of unclear etiology (suspect lysis of clot associated with
removal of chest tube a few days prior).  Patient developed
respiratory distress, followed by cardiac arrest (SBP
approximately 50, heart rate approximately 10).  Patient
received atropine, Epinephrine, CPR with return of heart
rate, blood pressure, and pulse.  Two chest tubes were placed
by the surgical team.  Patient was on Heparin at the time for
history of AFib (PTT 91.7), which was subsequently D/C'd.
His hematocrit dropped from 30 to 15, and he was aggressively
resuscitated with blood products.  Resuscitation efforts were
complicated by difficulty ventilating the patient, ABG
(6.92/150/97) requiring high peak pressures (65-70) and a
therapeutic paracentesis to relieve abdominal distention.

Patient was stabilized and underwent a VATS [**12-7**] for
evacuation of the hematoma.  After the procedure, patient's
ventilatory mechanics improved, and he has had no further
episodes of bleeding or reaccumulation of hematoma.

3. ID:  Patient is currently being treated with caspofungin
and Voriconazole for an aspergillus pericarditis.  Length of
treatment is currently indefinite and will likely remain such
time as patient has right lung removed.  In setting of
continued antifungal therapy, patient needs to have his LFTs
checked approximately every week.  He received a 14 day
course of Zosyn for Enterobacter ventilator associated
pneumonia.  He had an episode of hypothermia, hypotension
[**12-9**].  He was treated empirically with a seven day course of
cefepime for a sputum culture with resistant Enterobacter
(although he had no evidence of pneumonia on chest x-ray or
physical exam).

Adrenal insufficiency was also a likely contributing
component of this episode, and patient responded well to a
seven day course of stress dosed steroids.  Patient has had a
low-grade fever and leukocytosis likely secondary to
sinusitis in the setting of an indwelling nasogastric tube.
His white count has been steadily trending down since removal
of the nasogastric tube.  His last positive culture was a
sputum on [**12-13**] with moderate growth of gram-negative rods
(sputum on [**12-9**] grew Enterobacter and Klebsiella).

4. Cardiovascular:  Patient is status post pericardial
stripping secondary to effusion and constrictive
pericarditis.  Has history of paroxysmal atrial fibrillation,
is on amiodarone and metoprolol.  He has been in normal sinus
rhythm for the majority of his MICU course.  At this time, he
is not on anticoagulation secondary to his hemothorax
episode.  Patient's last echocardiogram [**11-24**] revealed an EF
of 25-30% with severe global hypokinesis and 3+ TR.

5. Renal:  Patient has a history of membranoproliferative
glomerulonephritis diagnosed by biopsy 07/[**2132**].  His baseline
creatinine ranges from 1.1-1.5.  He has intermittently had
difficult diuresis and has responded to Bumex 2 mg IV b.i.d.
to t.i.d.  He had two separate episodes of ATN during his
hospital course secondary to hypotension, which both
resolved.

6. Ascites/anasarca:  Patient with volume overload in the
setting of hypoalbuminemia.  Has been slowly resolving as
patient's diuresis.

7. Coagulopathy:  Patient with INR as high as 1.8 during his
stay.  Currently 1.4.  Etiology likely secondary to poor
nutrition and has responded to vitamin K therapy.

8. Anemia:  Patient is guaiac negative.  His hematocrit has
been slowly trending down likely secondary to phlebotomy.  He
remains on Epogen 5000 units 3x/week.

9. Nutrition:  Patient's tube feeds are currently at goal of
75 cc/hour.  He receives free water boluses prn for
hypernatremia.

10. Access:  Patient has a double lumen PICC.  He also has a
post-pyloric feeding tube.

11. Prophylaxis:  Patient has subQ Heparin, proton-pump
inhibitor, and Colace.

12. Patient is full code.

13. Patient had open tracheostomy on [**2133-12-18**].

CONDITION ON DISCHARGE:  Patient is in stable, but guarded
condition.  He is still requiring ventilator support and
remains with substantial nutritional and Physical Therapy
deficits.

DISCHARGE STATUS:  Patient is to be discharged to a
ventilator rehabilitation facility.

DISCHARGE DIAGNOSES:
1. Respiratory failure.
2. Hemothorax status post VATS.
3. Aspergillus pericarditis.
4. Ventilator-associated pneumonia.
5. Adrenal insufficiency.
6. Paroxysmal atrial fibrillation.
7. Congestive heart failure (ejection fraction 30%).
8. Chronic renal insufficiency secondary to
glomerulonephritis.
9. Anasarca.
10. Anemia.

DISCHARGE MEDICATIONS:
1. Ipratropium six puffs q.4-6h. prn.
2. Albuterol six puffs q.6h. prn.
3. Voriconazole 200 mg p.o. q.12h.
4. Artificial Tears O.U. prn.
5. Colace 100 mg p.o. b.i.d.
6. Amiodarone 400 mg p.o. q.d.
7. Heparin 5,000 units subQ q.8h.
8. Metoclopramide 10 mg p.o. q.i.d.
9. Diazepam 2 mg p.o. q.8h. prn.
10. Metoprolol 12.5 mg p.o. b.i.d.
11. Lansoprazole 30 mg p.o. q.d.
12. Epoetin 5000 units subQ 3x/week (Tuesday, Thursday, and
Saturday).
13. Nystatin 5 mL p.o. q.i.d. prn.
14. Caspofungin 50 mg IV q.d.

FOLLOWUP:  Patient is to be discharged to ventilator rehab
facility.  He is to have ongoing followup as indicated with
his PCP and Dr. [**Last Name (STitle) 217**] (his pulmonologist).

MAJOR SURGICAL OR INVASIVE PROCEDURES:
1. Pericardial centesis.
2. Median sternotomy with pericardial stripping and ligation
of right pulmonary artery.
3. Left VATS with evacuation of hematoma.
4. Open tracheotomy.



                            [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7585**]

Dictated By:[**Last Name (NamePattern1) 8478**]
MEDQUIST36

D:  [**2133-12-27**]  23:43
T:  [**2133-12-28**]  07:17
JOB#:  [**Job Number 104245**]


Name:  [**Known lastname **], [**Known firstname **] Y                          Unit No:  [**Numeric Identifier 16893**]

Admission Date:  [**2133-10-26**]     Discharge Date:  [**2134-1-21**]

Date of Birth:   [**2079-4-27**]     Sex:  M

Service:  THORACIC S

ADDENDUM:  This is an addendum to the previous discharge
summaries.

DISCHARGE DIAGNOSES:
1.  Respiratory failure.
2.  Congestive heart failure.
3.  Aspergillus pericarditis.

Since the previous discharge summary, the patient has been
able to be weaned off the AC and put on pressure support and
has tolerated going down on pressure support from 28 in the
past few days to 25 and now to 22, and further going down
further without any difficulty.  His VBGs were actually
consistently within normal limits and provided further
support that he is tolerating the pressure support
ventilation.

He also had a voice tracheostomy inserted which needs to be
worked on since the patient's vocal cords actually seem to be
too weak to be able to still talk.  Additionally, he has edema
of the supraglottic larynx c/w GERD.

Also, his feeding has gotten much better.  He is now off the
tube feeds because he is tolerating his regular diet without
any difficulty and his NG tube has also been discontinued and
removed.

The patient has remained afebrile and white blood cell counts
have resolved and have remained relatively constant and
unchanged.

Within this time period, he was changed for his left partial
thrombus in his left subclavian vein and left cephalic vein.
He was initially put on Coumadin with INR goal of 1.5 to 1.6,
at which point it was changed later on after talking to
Surgery to Lovenox since the Coumadin was interfering with
his cyclic antibiotic treatments.  He just finished his two
week course of Bactrim antibiotic for which he is going to
have two weeks off and then later on following up with a two
week course of azithromycin per his Pulmonary doctor, Dr.
[**Last Name (STitle) **].  Still he is going to go on cyclical
prophylactic antibiotic treatments of Bactrim two weeks off,
Azithromycin two weeks, and so on.

Pre-discharge, we obtained a chest CT which revealed multiple
nodules on the right, thought to represent healing aspergillosis
- the ID team suggested continuing both caspofungin and
voriconazole, and Mr. [**Known lastname **] is scheduled for a f/u visit and CT
with the ID team.

The patient is in stable condition and is now working with
Physical Therapy and will require more rehabilitation
treatments to further facilitate care.

DISCHARGE MEDICATIONS:  As written.

No surgical intervention.




                          [**First Name8 (NamePattern2) 77**] [**Name8 (MD) **], M.D.  [**MD Number(1) 3616**]

Dictated By:[**Name8 (MD) 1902**]

MEDQUIST36

D:  [**2134-1-21**]  12:42
T:  [**2134-1-21**]  15:36
JOB#:  [**Job Number 16894**]
{'Other acute pericarditis,Aspergillosis,Cardiac arrest,Congestive heart failure, unspecified,Constrictive pericarditis,Empyema without mention of fistula,Acute and chronic respiratory failure,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure'}


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: 

PRESENT ILLNESS: Patient is a 56-year-old man
with a complicated and prolonged medical course.  Briefly,
was admitted on [**2133-10-26**] after presenting with shortness of
breath and was subsequently found to have pericardial
effusion.  Had 1800 cc of fluid drained by pericardiocentesis
on [**10-28**].  Pericardial fluid grew aspergillus, with negative
cytology, and patient was started on a regimen of
Voriconazole and Augmentin.  Had echocardiogram which showed
global hypokinesis.  Had episodes of recurrent AFib with
rapid ventricular response.

MEDICAL HISTORY: 1. Lung cancer status post XRT/chemotherapy/right lower
lobectomy.
2. Chronic right lung collapse.
3. Chronic left pleural effusion.
4. Paroxysmal atrial fibrillation.
5. Radiation-induced pericarditis.
6. Internal jugular clot [**6-29**].
7. Bronchiectasis.
8. Recurrent [**Doctor First Name **].
9. Hypertension.
10. Chronic renal insufficiency with history of
membranoproliferative glomerulonephritis diagnosed by renal
biopsy summer of [**2132**].
11. ASD by echocardiogram [**5-29**].
12. Questionable remote history of TB in [**Country 651**].

MEDICATION ON ADMISSION: 

ALLERGIES: Levofloxacin, Percocet.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other acute pericarditis,Aspergillosis,Cardiac arrest,Congestive heart failure, unspecified,Constrictive pericarditis,Empyema without mention of fistula,Acute and chronic respiratory failure,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure'}
