CHIEF COMPLAINT: dyspnea and persistent cough

PRESENT ILLNESS: The patient is a 44-
year-old gentleman who underwent tracheoesophageal fistula
repair at birth. He suffered respiratory arrest, requiring
multiple tracheostomies by his father and mother. [**Name (NI) **] had an
indwelling tracheostomy from age 8 to age 16 when he
underwent tracheal resection and reconstruction [**Last Name (STitle) 69403**]
at the [**State 69404**]. He did relatively well thereafter
but has suffered from multiple pulmonary infections which
have become more frequent and severe over the past 6 years.
He has also become quite dyspneic to the point where he can
not walk across the room without becoming extremely short of
breath. He is able to exert himself, as long as he is using
pursed lips technique for breathing. He has no significant
orthopnea or intractable coughing. Evaluation including rigid
and flexible bronchoscopy as well as dynamic airway CT scan
demonstrated a 5 cm area of mixed stenosis and malacia. There
was 3 cm of relatively normal distal trachea from the carinal
spur cephalad and 2 cm of proximal airway relatively normal.
There was 5 cm of diseased airway, however, the anterior
tracheal ring had completely flattened out and the posterior
membranous wall had widened and was bulging forward at rest.
On exhalation, there was complete collapse. On rest, there
was near complete collapse. There was severe disease which
commenced just below the old stomal site and tapered off to
left severe disease distally for a total of 5 cm. In light of
this case, we felt that he would not benefit from a posterior
membranous wall tracheoplasty for 2 reasons. The main reason
was that the anterior tracheal rings measured about 2 to 2.5
cm in length and they were completely flattened and would not
likely be amenable to reshaping into the normal ring
structure, due to either stiffness and also due to inadequate
length. The airway would be converted to a completely fixed
stenosis from dynamic collapse. The surgical resection was
not an option given his prior tracheal resection and the
length of the lesion being over half his trachea. We
therefore felt the only good option was add care
augmentation.

MEDICAL HISTORY: tracheomalacia, syncopal episode, fevers
PMH: Rheumatoid arthritis, Diabetes Mellitus 2,
tracheoesophageal fistula, tracheomalacia
PSH: tracheoesophageal fistula repair '[**87**], tracheal resection
'[**02**]

MEDICATION ON ADMISSION: levaquin
glipizide 10 mg [**Hospital1 **]
aciphex 20mg qd
pepcid 30mg qd
clarinex
guaifenisen 600mg qid
codeine

ALLERGIES: Ibuprofen / Aspirin

PHYSICAL EXAM: Physical Exam: Vital signs: Heart rate 67, respirations 16,
blood pressure 127/67, and pulse oximetry 97 on room air. HEENT:

FAMILY HISTORY: F-
M- Alzheimers, bopolar
Sibling- thyroid disease.

SOCIAL HISTORY: lives in  [**Location (un) 69402**],[**State 38104**] w/ wife. Referred to Airway
Center, [**Name8 (MD) **], MD, [**Name8 (MD) 952**], MD.
[**First Name (Titles) **] [**Last Name (Titles) **], ciggs or rec rx use
Atrial fibrillation,Other vascular complications of medical care, not elsewhere classified,Cellulitis and abscess of upper arm and forearm,Rheumatoid arthritis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other anomalies of larynx, trachea, and bronchus
Atrial fibrillation,Vasc comp med care NEC,Cellulitis of arm,Rheumatoid arthritis,DMII wo cmp nt st uncntr,Phlbts sprfc vn up extrm,Laryngotrach anomaly NEC
Admission Date:  [**2131-8-29**]              Discharge Date:   [**2131-9-12**]

Date of Birth:  [**2086-9-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ibuprofen / Aspirin

Attending:[**Last Name (NamePattern1) 1561**]
Chief Complaint:
dyspnea and persistent cough

Major Surgical or Invasive Procedure:
s/p tracheoplasty/augmentation;  cellulitis/phlebitis at
R-antecub


History of Present Illness:
The patient is a 44-
year-old gentleman who underwent tracheoesophageal fistula
repair at birth. He suffered respiratory arrest, requiring
multiple tracheostomies by his father and mother. [**Name (NI) **] had an
indwelling tracheostomy from age 8 to age 16 when he
underwent tracheal resection and reconstruction [**Last Name (STitle) 69403**]
at the [**State 69404**]. He did relatively well thereafter
but has suffered from multiple pulmonary infections which
have become more frequent and severe over the past 6 years.
He has also become quite dyspneic to the point where he can
not walk across the room without becoming extremely short of
breath. He is able to exert himself, as long as he is using
pursed lips technique for breathing. He has no significant
orthopnea or intractable coughing. Evaluation including rigid
and flexible bronchoscopy as well as dynamic airway CT scan
demonstrated a 5 cm area of mixed stenosis and malacia. There
was 3 cm of relatively normal distal trachea from the carinal
spur cephalad and 2 cm of proximal airway relatively normal.
There was 5 cm of diseased airway, however, the anterior
tracheal ring had completely flattened out and the posterior
membranous wall had widened and was bulging forward at rest.
On exhalation, there was complete collapse. On rest, there
was near complete collapse. There was severe disease which
commenced just below the old stomal site and tapered off to
left severe disease distally for a total of 5 cm. In light of
this case, we felt that he would not benefit from a posterior
membranous wall tracheoplasty for 2 reasons. The main reason
was that the anterior tracheal rings measured about 2 to 2.5
cm in length and they were completely flattened and would not
likely be amenable to reshaping into the normal ring
structure, due to either stiffness and also due to inadequate
length. The airway would be converted to a completely fixed
stenosis from dynamic collapse. The surgical resection was
not an option given his prior tracheal resection and the
length of the lesion being over half his trachea. We
therefore felt the only good option was add care
augmentation.

Past Medical History:
tracheomalacia, syncopal episode, fevers
PMH: Rheumatoid arthritis, Diabetes Mellitus 2,
tracheoesophageal fistula, tracheomalacia
PSH: tracheoesophageal fistula repair '[**87**], tracheal resection
'[**02**]


Social History:
lives in  [**Location (un) 69402**],[**State 38104**] w/ wife. Referred to Airway
Center, [**Name8 (MD) **], MD, [**Name8 (MD) 952**], MD.
[**First Name (Titles) **] [**Last Name (Titles) **], ciggs or rec rx use


Family History:
F-
M- Alzheimers, bopolar
Sibling- thyroid disease.

Physical Exam:
Physical Exam: Vital signs: Heart rate 67, respirations 16,
blood pressure 127/67, and pulse oximetry 97 on room air. HEENT:

There is a 1 cm x 2 cm tracheostomy scar in the lower part of
the neck midline. Heart: Regular rate and rhythm, S1 and S2, no
murmurs. Lungs: Clear to auscultation. Abdomen: Bowel sounds
present, nontender, nondistended, and no organomegaly.
Extremities: No cyanosis, clubbing, or edema.


Pertinent Results:
[**2131-9-11**] 04:50AM BLOOD WBC-7.4 RBC-3.54*# Hgb-10.5*# Hct-30.7*
MCV-87 MCH-29.8 MCHC-34.3 RDW-13.3 Plt Ct-589*
[**2131-9-11**] 04:50AM BLOOD PT-12.6 PTT-26.9 INR(PT)-1.1
[**2131-9-11**] 01:30PM BLOOD K-4.2
[**2131-9-9**] 11:10AM BLOOD Glucose-110* UreaN-11 Creat-0.9 Na-137
K-4.3 Cl-101 HCO3-26 AnGap-14

CHEST (PORTABLE AP)  [**2131-8-29**] 10:39 PM
[**Hospital 93**] MEDICAL CONDITION:
44 year old man with
REASON FOR THIS EXAMINATION:
r/o ptx
INDICATION: 44-year-old male status post surgery for
tracheomalacia. Rule out pneumothorax.
COMPARISONS: Comparison is made to preoperative exam from [**8-23**], [**2131**].
FINDINGS: The patient is status post median sternotomy. There
are multiple skin staples in place. There are two mediastinal
drains. Other surgical material is also seen in the mediastinum.
The mediastinum appears to be widened, which could be
postoperative, but possibility of mediastinal hematoma cannot be
excluded. There are bibasilar atelectasis. There is increased
density overlying the right lung field, which could be secondary
to aspiration versus asymmetric pulmonary edema.
There is no evidence of pneumothorax.
IMPRESSION:
1. Status post surgery for tracheomalacia.
2. No evidence of pneumothorax.
3. Bibasilar atelectasis.
4. Increased density in the right mid and upper lung fields may
relate to asymmetric pulmonary edema. Aspiration cannot be ruled
out.
5. Widening of the mediastinum, likely postoperative.
Possibility of hematoma cannot be excluded.
6. Small amount of pneumomediastinum around the trachea, likely
postoperative.


Brief Hospital Course:
The patient was admitted to thoracic surgery and brought to the
OR for median sternotomy with anterior tracheal plasty
augmentation utilizing rib graft and laparotomy with pedicle
omental flap for severe tracheal malacia and stenosis.  Patient
was transferred to the ICU for postoperative care.  On POD2,
patient went into Afib and treated with amiodarone ggt and then
PO amiodarone. Patient given vanc and levo for spiking fevers on
POD4. On POD5, patient had disproportionately swollen LUE, but
had negative ultrasound for DVT. Vascular surgery was consulted
and recommended conservative care. Both chest tubes were d/c'd
on POD5. Patient was transferred to the floor.   On POD7, vanc
d/c'd and patient begun augmentin and levaquin. On POD12,
patient had bronchoscopy which showed a widely patent T-tube in
good position.  On POD13, patient remained afebrile, ambulating,
and had good oxygen saturations.  Patient was discharged home on
POD13.



Medications on Admission:
levaquin
glipizide 10 mg [**Hospital1 **]
aciphex 20mg qd
pepcid 30mg qd
clarinex
guaifenisen 600mg qid
codeine

Discharge Medications:
1. Glipizide 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 5 days: then decrease to 200mg per day starting
[**2131-9-16**].
Disp:*10 Tablet(s)* Refills:*0*
5. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): start [**2131-9-16**].
Disp:*30 Tablet(s)* Refills:*2*
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
9. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
10. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety/agitation.
Disp:*12 Tablet(s)* Refills:*0*
11. Percocet 5-325 mg Tablet Sig: Two (2) Tablet PO every six
(6) hours as needed for pain.
Disp:*80 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
s/p tracheoplasty/augmentation c cellulitis/phlebitis at
R-antecub (16 gauge PIV [**2043-8-27**]), no DVT ([**9-2**])
PMH: RA, DM2, tracheoesophageal fistula, tracheomalacia
PSH: tracheoesophageal fistula repair '[**87**], tracheal resection
'[**02**]


Discharge Condition:
good


Discharge Instructions:
Call Dr. [**Last Name (STitle) 952**]/ Thoracic Surgery office [**Telephone/Fax (1) 170**] for;
fever, chills, shortness of breath, chest pain.

Followup Instructions:
Dr. [**Last Name (STitle) 952**]/ Thoracic Surgery office [**Telephone/Fax (1) 170**] appointment-
[**2131-9-11**] at 1pm, [**Hospital Ward Name 23**] Clinical Center, [**Hospital Ward Name 516**],
[**Location (un) **], thoracic Surgery clinic.
Please follow-up with Vascular surgery in [**State 38104**] rgarding your
eipsode of phlebitis.
{'Atrial fibrillation,Other vascular complications of medical care, not elsewhere classified,Cellulitis and abscess of upper arm and forearm,Rheumatoid arthritis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other anomalies of larynx, trachea, and bronchus'}


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: dyspnea and persistent cough

PRESENT ILLNESS: The patient is a 44-
year-old gentleman who underwent tracheoesophageal fistula
repair at birth. He suffered respiratory arrest, requiring
multiple tracheostomies by his father and mother. [**Name (NI) **] had an
indwelling tracheostomy from age 8 to age 16 when he
underwent tracheal resection and reconstruction [**Last Name (STitle) 69403**]
at the [**State 69404**]. He did relatively well thereafter
but has suffered from multiple pulmonary infections which
have become more frequent and severe over the past 6 years.
He has also become quite dyspneic to the point where he can
not walk across the room without becoming extremely short of
breath. He is able to exert himself, as long as he is using
pursed lips technique for breathing. He has no significant
orthopnea or intractable coughing. Evaluation including rigid
and flexible bronchoscopy as well as dynamic airway CT scan
demonstrated a 5 cm area of mixed stenosis and malacia. There
was 3 cm of relatively normal distal trachea from the carinal
spur cephalad and 2 cm of proximal airway relatively normal.
There was 5 cm of diseased airway, however, the anterior
tracheal ring had completely flattened out and the posterior
membranous wall had widened and was bulging forward at rest.
On exhalation, there was complete collapse. On rest, there
was near complete collapse. There was severe disease which
commenced just below the old stomal site and tapered off to
left severe disease distally for a total of 5 cm. In light of
this case, we felt that he would not benefit from a posterior
membranous wall tracheoplasty for 2 reasons. The main reason
was that the anterior tracheal rings measured about 2 to 2.5
cm in length and they were completely flattened and would not
likely be amenable to reshaping into the normal ring
structure, due to either stiffness and also due to inadequate
length. The airway would be converted to a completely fixed
stenosis from dynamic collapse. The surgical resection was
not an option given his prior tracheal resection and the
length of the lesion being over half his trachea. We
therefore felt the only good option was add care
augmentation.

MEDICAL HISTORY: tracheomalacia, syncopal episode, fevers
PMH: Rheumatoid arthritis, Diabetes Mellitus 2,
tracheoesophageal fistula, tracheomalacia
PSH: tracheoesophageal fistula repair '[**87**], tracheal resection
'[**02**]

MEDICATION ON ADMISSION: levaquin
glipizide 10 mg [**Hospital1 **]
aciphex 20mg qd
pepcid 30mg qd
clarinex
guaifenisen 600mg qid
codeine

ALLERGIES: Ibuprofen / Aspirin

PHYSICAL EXAM: Physical Exam: Vital signs: Heart rate 67, respirations 16,
blood pressure 127/67, and pulse oximetry 97 on room air. HEENT:

FAMILY HISTORY: F-
M- Alzheimers, bopolar
Sibling- thyroid disease.

SOCIAL HISTORY: lives in  [**Location (un) 69402**],[**State 38104**] w/ wife. Referred to Airway
Center, [**Name8 (MD) **], MD, [**Name8 (MD) 952**], MD.
[**First Name (Titles) **] [**Last Name (Titles) **], ciggs or rec rx use 

### Response:
{'Atrial fibrillation,Other vascular complications of medical care, not elsewhere classified,Cellulitis and abscess of upper arm and forearm,Rheumatoid arthritis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other anomalies of larynx, trachea, and bronchus'}
