CHIEF COMPLAINT: tracheobronchial malacia

PRESENT ILLNESS: 50 yr old male w/ sever tracheobronchial malacia managed by y
stnt which resulted in growth od granulation tissue and airway
occlusion. Admitted for removal of Y stent and excision of
granulation tissue on [**2102-3-8**].

MEDICAL HISTORY: tracheobronchomalacia, schizophrenia, mood d/o, anxiety,
allergies, h/o mitral valve prolapse (discovered '[**00**]), chronic
pneumonias

MEDICATION ON ADMISSION: albuterol, baclofen 5"', buspar 10"', claritin, clozapine 200
qhs, cogentin 2 [**Hospital1 **], depakote [**Telephone/Fax (1) 36883**], feosol 325", feodon
160", klonopin 0.5", mvt, protonix 40', cingulair 10', tylenol
prn

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: General: well appearing, cooperative schizophrenic male in NAD.
Reports decreased dyspnea and improved performance w/ Y stent.
resp: lungs course w/ barking cough, difficulty clearing
secretions.
COR: RRR S1, S2
ABD: soft, NT, ND, +BS
Extrem; no C/C/E
Neuro: A+OX3. approp.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: lives in own apt w/ daily supportive care.
Counselor: [**Doctor First Name **] [**Telephone/Fax (1) 66549**] (pt makes his own decisions, has no
proxy)
[**Name (NI) 66550**] (sister): H [**Telephone/Fax (1) 66551**], C [**Telephone/Fax (1) 66552**]
Pneumonia, organism unspecified,Acute kidney failure, unspecified,Unspecified schizophrenia, unspecified,Acute bronchitis,Unspecified transient mental disorder in conditions classified elsewhere
Pneumonia, organism NOS,Acute kidney failure NOS,Schizophrenia NOS-unspec,Acute bronchitis,Transient mental dis NOS
Admission Date:  [**2102-3-8**]              Discharge Date:   [**2102-4-10**]

Date of Birth:  [**2051-4-1**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides)

Attending:[**Last Name (NamePattern1) 1561**]
Chief Complaint:
tracheobronchial malacia

Major Surgical or Invasive Procedure:
rigid bronch with Y stent removal [**2102-3-8**]
[**2102-3-12**] rigid bronch w/ Y stent replacement

History of Present Illness:
50 yr old male w/ sever tracheobronchial malacia managed by y
stnt which resulted in growth od granulation tissue and airway
occlusion. Admitted for removal of Y stent and excision of
granulation tissue on [**2102-3-8**].


Past Medical History:
tracheobronchomalacia, schizophrenia, mood d/o, anxiety,
allergies, h/o mitral valve prolapse (discovered '[**00**]), chronic
pneumonias

Social History:
lives in own apt w/ daily supportive care.
Counselor: [**Doctor First Name **] [**Telephone/Fax (1) 66549**] (pt makes his own decisions, has no
proxy)
[**Name (NI) 66550**] (sister): H [**Telephone/Fax (1) 66551**], C [**Telephone/Fax (1) 66552**]


Family History:
non contributory

Physical Exam:
General: well appearing, cooperative schizophrenic male in NAD.
Reports decreased dyspnea and improved performance w/ Y stent.
resp: lungs course w/ barking cough, difficulty clearing
secretions.
COR: RRR S1, S2
ABD: soft, NT, ND, +BS
Extrem; no C/C/E
Neuro: A+OX3. approp.

Pertinent Results:
CXR [**2102-4-4**]: CHEST PA AND LATERAL: Compared to the study from
[**2102-4-1**]. There is improved aeration of the right lung.
Improvement is seen in the subcutaneous emphysema over the right
neck. There is interval removal of the right IJ line. The heart
size, mediastinal and hilar contours are unremarkable. A small
right effusion is noted.

SPECIMEN SUBMITTED:  LT MAIN STEM TUMOR.
DIAGNOSIS:
Left mainstem mass, biopsy:
Granulation tissue with respiratory mucosal lining, squamous
metaplasia, and acute and chronic inflammation

ECHO: [**2102-3-10**]
Conclusions:
1. Left ventricular wall thickness, cavity size, and systolic
function are
normal (LVEF>55%). Due to suboptimal technical quality, a focal
wall motion
abnormality cannot be fully excluded.
2. The aortic valve leaflets (3) are mildly thickened. No aortic
regurgitation
is seen.
3. The mitral valve appears structurally normal with trivial
mitral
regurgitation.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1445**], MD on [**2102-3-10**] 16:49.
[**Location (un) **] PHYSICIAN: [**Name Initial (NameIs) **]


Brief Hospital Course:
Pt was admitted for evaulation of TBM. A rigid bronch was done
which showed Y stent w/ obstructing granulation tissue of LMSB.
Y stent was removed and granulation tissue was mechanically
cleared. There was significant TBM (80-90% of proximal left and
right main stem seen after Y stent removal. Thick copious
secretions were removed and pt was started on IVAB for post
obstructive PNA. Became increasingly more hypoxic requiring
transfer to ICU for management.
Became septic w/ decreased mental status requiring transfer to
ICU for pressor support. Psych was called to eval mutliple psych
meds which were tapered to increase level of alertness and to
eval for suggestions re: post op management when unable to take
po meds. Level of alertness improved w/ management of PNA w/ ABx
and alteration of psych medications. Head CT was done d/t
decreased mental status and was unremarkable for acute event.
Baseline HCt 24-26- did rec transfusions of PRBC to maintain
baseline. Weaned of pressors w/ stable hemodynamics.
Once PNA resolved and pt afebrile he was taken to the OR for a
rigid bronch to have y stent removed on [**2102-3-21**] in preparation
for tracheobroncheoplasty on [**2102-3-24**]. Pt remained intubated after
stent removal as a precaution.
He underwent a tracheobroncheoplasty on [**2102-3-24**].
Managed in the ICU post op -intubated for airway secretion
management, bronched on POD#1 for minimal secretions and open
trachea and bronchus s/p plasty. Found to have laryngeal
edema-placed on steriods. Cont'd w/ serial bronch's for secteion
management. Extubated on POD#3 ([**2102-3-27**]). Throughout [**Hospital **]
hospital course he was followed daily by psych for pharmacologic
management. Remained in ICU post extubation until mental status
near baseline and pt could protect his airway.
transferred to surgical floor for continued psych, surgical and
rehab management.
At the time of discharge, pt was pain free, [**Last Name (un) 1815**] reg diet,
ambulatory and per his outpt psych team, at his psychiatric
baseline.
Pt was escorted home by his community mental health nurse [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 66553**].



Medications on Admission:
albuterol, baclofen 5"', buspar 10"', claritin, clozapine 200
qhs, cogentin 2 [**Hospital1 **], depakote [**Telephone/Fax (1) 36883**], feosol 325", feodon
160", klonopin 0.5", mvt, protonix 40', cingulair 10', tylenol
prn

Discharge Medications:
1. Benztropine 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*90 Tablet(s)* Refills:*2*
2. Clozapine 200 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
3. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Albuterol 90 mcg/Actuation Aerosol Sig: [**12-19**]  Inhalation qid
prn.
Disp:*1 * Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
tracheobronchial malacia
s/p Y stent removal [**2102-3-8**], replacement [**2102-3-12**], and removal
for tracheobroncheolplasty [**2102-3-24**]


Discharge Condition:
good


Discharge Instructions:
Call Dr.[**Name (NI) 1816**] office [**Telephone/Fax (1) 170**] for a follow up
appointment after you are discharged from rehab or if you have
increased cough, fever, chills, shortness of breath.

Followup Instructions:
You have a follow up appointment with Dr. [**Last Name (STitle) 952**] ([**Telephone/Fax (1) 170**])
on [**4-27**] at 3:30pm in the [**Hospital Ward Name 23**] Clinical Center [**Location (un) **].



Completed by:[**2102-4-10**]
{'Pneumonia, organism unspecified,Acute kidney failure, unspecified,Unspecified schizophrenia, unspecified,Acute bronchitis,Unspecified transient mental disorder in conditions classified elsewhere'}


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: tracheobronchial malacia

PRESENT ILLNESS: 50 yr old male w/ sever tracheobronchial malacia managed by y
stnt which resulted in growth od granulation tissue and airway
occlusion. Admitted for removal of Y stent and excision of
granulation tissue on [**2102-3-8**].

MEDICAL HISTORY: tracheobronchomalacia, schizophrenia, mood d/o, anxiety,
allergies, h/o mitral valve prolapse (discovered '[**00**]), chronic
pneumonias

MEDICATION ON ADMISSION: albuterol, baclofen 5"', buspar 10"', claritin, clozapine 200
qhs, cogentin 2 [**Hospital1 **], depakote [**Telephone/Fax (1) 36883**], feosol 325", feodon
160", klonopin 0.5", mvt, protonix 40', cingulair 10', tylenol
prn

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: General: well appearing, cooperative schizophrenic male in NAD.
Reports decreased dyspnea and improved performance w/ Y stent.
resp: lungs course w/ barking cough, difficulty clearing
secretions.
COR: RRR S1, S2
ABD: soft, NT, ND, +BS
Extrem; no C/C/E
Neuro: A+OX3. approp.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: lives in own apt w/ daily supportive care.
Counselor: [**Doctor First Name **] [**Telephone/Fax (1) 66549**] (pt makes his own decisions, has no
proxy)
[**Name (NI) 66550**] (sister): H [**Telephone/Fax (1) 66551**], C [**Telephone/Fax (1) 66552**] 

### Response:
{'Pneumonia, organism unspecified,Acute kidney failure, unspecified,Unspecified schizophrenia, unspecified,Acute bronchitis,Unspecified transient mental disorder in conditions classified elsewhere'}
