CHIEF COMPLAINT: trach tube fell out

PRESENT ILLNESS: This is a 65 year old female with a history of tracheomalacia,
tracheal stenosis, DM2, HTN, schizoaffective disorder, s/p
gastrostomy tube, who is here after her trach fell out.  In [**Month (only) **]
[**2104**], Ms [**Known lastname 174**] had respiratory failure and had tracheostomy tube
placed however developed significant granulation tissue around
the site.  She had a procedure for debridement and an attempt to
place a T tube failed; on [**8-19**] had T-tube reattempted but Ms
[**Known lastname 174**] became short of breath and was noted to have a stenosis
proximal to the T-tube; a trach was again placed and she was
sent to a rehab.  On the morning of this current admission, the
nursing staff noted that the tracheostomy tube was out.  She
reported feeling a "brick in her throat and some SOB" and eating
breakfast.  These symptoms lasted 1 hour and were associated
with some SOB. Dr [**Last Name (STitle) **] was notified and he requested she come
to [**Hospital1 18**] for ICU monitoring and tracheostomy replacement.  In
the past, she had respiratory failure in the setting of
tracheostomy tube displacement secondary to tight proximal
stenosis with loss of airway.  Upon arrival in the ED, Ms [**Known lastname 174**]
was taken directly to the OR where a rigid bronchoscopy was
performed.  A significant amount of granulation tissue was
noted. Percutaneous tracheostomy was performed without
difficulty.  Following the procedure, Ms [**Known lastname 174**] was admitted to
the MICU for monitoring overnight.  She was saturating normally
near 100% on humidified trach mask, with HR of 62, normotensive,
and afebrile.

MEDICAL HISTORY: --diabetes mellitus
--hypertension
--tremors
--cerebrovascular accident ~ 10 years ago
--cataracts
--schizoaffective disorder
--s/p gastrostomy tube placement

MEDICATION ON ADMISSION: 1. Risperidone 2 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
2. Risperidone 1 mg Tablet Sig: 1.5 Tablets PO QAM (once a day
(in the morning)).
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Penicillins / Keflex

PHYSICAL EXAM: Discharge Physical Exam:
Gen: Pleasant Caucasian female, trach mask in place in NAD
HEENT: Anicteric
Neck: Trach mask in place on humidified air
Cardiac: Nl s1/s2, RRR
Pulm: clear bilaterally with no wheezes or rales
Abd: soft, nontender, nondistended
Ext: No noted edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Prior to hospitalization for PNA, the patient lived alone in
[**Location (un) 1294**]. After her hospitalization, she spent one month at
[**Hospital **] rehab. The patient currently lives at [**Location 44563**], a
nursing home/rehab facility. She retired as a school teacher
over 30 years ago and supports herself with [**Social Security Number 86960**]social security. She
Mechanical complication of tracheostomy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Schizoaffective disorder, unspecified,Unspecified cataract,Other abnormal granulation tissue
Tracheostomy - mech comp,Abn react-procedure NEC,Accid in resident instit,Hypertension NOS,DMII wo cmp nt st uncntr,Schizoaffective dis NOS,Cataract NOS,Abnormal granulation NEC
Admission Date:  [**2105-9-6**]              Discharge Date:   [**2105-9-7**]

Date of Birth:  [**2039-8-31**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Keflex

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
trach tube fell out

Major Surgical or Invasive Procedure:
Rigid bronchoscopy


History of Present Illness:
This is a 65 year old female with a history of tracheomalacia,
tracheal stenosis, DM2, HTN, schizoaffective disorder, s/p
gastrostomy tube, who is here after her trach fell out.  In [**Month (only) **]
[**2104**], Ms [**Known lastname 174**] had respiratory failure and had tracheostomy tube
placed however developed significant granulation tissue around
the site.  She had a procedure for debridement and an attempt to
place a T tube failed; on [**8-19**] had T-tube reattempted but Ms
[**Known lastname 174**] became short of breath and was noted to have a stenosis
proximal to the T-tube; a trach was again placed and she was
sent to a rehab.  On the morning of this current admission, the
nursing staff noted that the tracheostomy tube was out.  She
reported feeling a "brick in her throat and some SOB" and eating
breakfast.  These symptoms lasted 1 hour and were associated
with some SOB. Dr [**Last Name (STitle) **] was notified and he requested she come
to [**Hospital1 18**] for ICU monitoring and tracheostomy replacement.  In
the past, she had respiratory failure in the setting of
tracheostomy tube displacement secondary to tight proximal
stenosis with loss of airway.  Upon arrival in the ED, Ms [**Known lastname 174**]
was taken directly to the OR where a rigid bronchoscopy was
performed.  A significant amount of granulation tissue was
noted. Percutaneous tracheostomy was performed without
difficulty.  Following the procedure, Ms [**Known lastname 174**] was admitted to
the MICU for monitoring overnight.  She was saturating normally
near 100% on humidified trach mask, with HR of 62, normotensive,
and afebrile.


Past Medical History:
--diabetes mellitus
--hypertension
--tremors
--cerebrovascular accident ~ 10 years ago
--cataracts
--schizoaffective disorder
--s/p gastrostomy tube placement

Social History:
Prior to hospitalization for PNA, the patient lived alone in
[**Location (un) 1294**]. After her hospitalization, she spent one month at
[**Hospital **] rehab. The patient currently lives at [**Location 44563**], a
nursing home/rehab facility. She retired as a school teacher
over 30 years ago and supports herself with [**Social Security Number 86960**]social security. She

smoked 2 ppd for 40 years but quit in [**Month (only) 958**]. She denied the use
of EtOH or drugs. She currently walks with a walker, but is
learning how to walk with only a cane.

Family History:
Non-contributory.

Physical Exam:
Discharge Physical Exam:
Gen: Pleasant Caucasian female, trach mask in place in NAD
HEENT: Anicteric
Neck: Trach mask in place on humidified air
Cardiac: Nl s1/s2, RRR
Pulm: clear bilaterally with no wheezes or rales
Abd: soft, nontender, nondistended
Ext: No noted edema


Pertinent Results:
[**2105-9-7**] 04:50AM BLOOD WBC-11.1* RBC-4.13* Hgb-12.9 Hct-37.1
MCV-90 MCH-31.2 MCHC-34.7 RDW-14.0 Plt Ct-261
[**2105-9-6**] 05:30PM BLOOD WBC-10.7 RBC-4.22 Hgb-13.0 Hct-38.1
MCV-90 MCH-30.7 MCHC-34.0 RDW-14.0 Plt Ct-264
[**2105-9-6**] 05:30PM BLOOD Neuts-65.3 Lymphs-25.3 Monos-5.8 Eos-2.5
Baso-1.1
[**2105-9-7**] 04:50AM BLOOD Plt Ct-261
[**2105-9-7**] 04:50AM BLOOD PT-13.0 PTT-20.9* INR(PT)-1.1
[**2105-9-6**] 05:30PM BLOOD Plt Ct-264
[**2105-9-6**] 05:30PM BLOOD PT-13.1 PTT-22.4 INR(PT)-1.1

[**2105-9-6**]: Operative report
OPERATIVE NOTE:  Once written consent was obtained the
patient was moved into OR #7 at the [**Hospital1 190**]. There a time-out was performed identifying
the patient by medical record number and date of birth as
well as the procedure to be performed. The patient was
sedated via monitored anesthesia care and the flexible
bronchoscope was introduced into the oral cavity and passed
through the cords with some difficulty passing through
granulation tissue immediately below the cords. The proximal
trachea had severe tracheobronchomalacia and large amounts of
granulation tissue and there was no identifiable tract from
previous trach. The bronchoscope was then removed as it was
decided to convert to a rigid bronchoscope for better airway
control while percutaneous tracheostomy was performed. The
patient was then anesthetized with total intravenous
anesthesia and the black [**10-16**] tracheoscope was introduced
into the oral cavity into the cords which were visualized
easily but the scope was too large to be passed through the
granulation tissue distal to the cords. The scope was then
withdrawn and the red tracheal bronchoscope was introduced
easily through the cords and into the trachea. Then, jet
ventilation was initiated.


Brief Hospital Course:
ASSESSMENT:  66 year old female with history of type 2 diabetes
mellitus, HTN, CVA history, schizoaffective disorder, and recent
history of tracheostomy s/p pneumonia, now presenting after
trach fell out at nursing home and s/p trach replacement
admitted to MICU for monitoring.
.
PLAN:
.
# Tracheal stenosis - Patient was admitted when tracheostomy
tube fell out. Patient was brought to OR where interventional
pulmonary placed a new tracheostomy tube in old tract. Patient
was admitted to the MICU for overnight observation. Prior to
discharge patient was hemodynamically stable and satting well on
tracheostomy mask.
.
# HTN: This was an inactive issue during this admission. Patient
was restarted home medications.
.
# Schizoaffective disorder: This was an inactive issue during
this admission. Patient was restarted home medications.
.
# Type 2 DM: This was an inactive issue during this admission.
Patient was restarted home medications.
.
# Hyperlipidemia: This was an inactive issue during this
admission. Patient was restarted home medications.

Medications on Admission:
1. Risperidone 2 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
2. Risperidone 1 mg Tablet Sig: 1.5 Tablets PO QAM (once a day
(in the morning)).
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).


4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

times a day).
5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
6. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).


7. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
8. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
9. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for anxiety.
10. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
11. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q2H (every 2 hours) as
needed for shortness of breath.
12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
13. Labetalol 200 mg Tablet Sig: Three (3) Tablet PO TID (3
times a day): Hold for sbp<100, hr<50.
14. Benztropine 0.5 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
15. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**12-6**]
Puffs Inhalation Q6H (every 6 hours) as needed for shortness of
breath.
16. Codeine Sulfate 30 mg Tablet Sig: One (1) Tablet PO Q4H
(every 4 hours) as needed for cough.
17. Insulin Glargine 100 unit/mL Solution Sig: Fifty (50) u
Subcutaneous at bedtime.
18. Lovastatin 40 mg Tablet Sig: One (1) Tablet PO at bedtime.
19. Vitamin D  Oral
20. Insulin Aspart  Subcutaneous
21. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.

Discharge Medications:
1. Risperidone 2 mg Tablet Sig: One (1) Tablet PO at bedtime.
2. Risperidone 1 mg Tablet Sig: 1.5 Tablets PO QAM.
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
6. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
7. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO once a day as needed for
constipation.
9. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation q2h as needed for
shortness of breath or wheezing.
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day.
11. Labetalol 200 mg Tablet Sig: One (1) Tablet PO three times a
day.
12. Benztropine 0.5 mg Tablet Sig: One (1) Tablet PO twice a
day.
13. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**12-6**]
puffs Inhalation every six (6) hours as needed for shortness of
breath or wheezing.
14. Codeine Sulfate 30 mg Tablet Sig: One (1) Tablet PO every
four (4) hours as needed for cough.
15. Insulin Glargine 100 unit/mL Solution Sig: Fifty (50) units
Subcutaneous at bedtime.
16. Lovastatin 40 mg Tablet Sig: One (1) Tablet PO at bedtime.
17. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
18. Novolog 100 unit/mL Solution Sig: See Sliding Scale
Instructions units Subcutaneous three times a day: For blood
sugars: 150-200 give 6 units; 201-250 give 8 units; >251 give 10
units.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 44563**] Nursing and Rehabilitation Center - [**Hospital1 10478**]

Discharge Diagnosis:
Tracheal stenosis
Hypertension
Diabetes Mellitus


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
On trach mask.


Discharge Instructions:
Dear Ms. [**Known lastname 174**],

You were admitted because your tracheostomy tube fell out. The
internventional pulmonary doctors were [**Name5 (PTitle) 460**] to replace the tube
without difficulty. You were monitored in the ICU after your
procedure. You were discharged back to your rehab unit.

Followup Instructions:
Please keep the following appointments:

Provider: [**Name10 (NameIs) 17853**] CLINIC INTERVENTIONAL PULMONARY (SB)
Phone:[**Telephone/Fax (1) 3020**] Date/Time:[**2105-9-22**] 9:45
Provider: [**Name10 (NameIs) 1532**] [**Last Name (NamePattern4) 8786**], MD Phone:[**Telephone/Fax (1) 3020**]
Date/Time:[**2105-9-22**] 10:30
Provider: [**Name10 (NameIs) 5073**] INTAKE,ONE [**Name10 (NameIs) 5073**] ROOMS/BAYS Date/Time:[**2105-9-22**] 12:00



Completed by:[**2105-9-7**]
{'Mechanical complication of tracheostomy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Schizoaffective disorder, unspecified,Unspecified cataract,Other abnormal granulation tissue'}


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: trach tube fell out

PRESENT ILLNESS: This is a 65 year old female with a history of tracheomalacia,
tracheal stenosis, DM2, HTN, schizoaffective disorder, s/p
gastrostomy tube, who is here after her trach fell out.  In [**Month (only) **]
[**2104**], Ms [**Known lastname 174**] had respiratory failure and had tracheostomy tube
placed however developed significant granulation tissue around
the site.  She had a procedure for debridement and an attempt to
place a T tube failed; on [**8-19**] had T-tube reattempted but Ms
[**Known lastname 174**] became short of breath and was noted to have a stenosis
proximal to the T-tube; a trach was again placed and she was
sent to a rehab.  On the morning of this current admission, the
nursing staff noted that the tracheostomy tube was out.  She
reported feeling a "brick in her throat and some SOB" and eating
breakfast.  These symptoms lasted 1 hour and were associated
with some SOB. Dr [**Last Name (STitle) **] was notified and he requested she come
to [**Hospital1 18**] for ICU monitoring and tracheostomy replacement.  In
the past, she had respiratory failure in the setting of
tracheostomy tube displacement secondary to tight proximal
stenosis with loss of airway.  Upon arrival in the ED, Ms [**Known lastname 174**]
was taken directly to the OR where a rigid bronchoscopy was
performed.  A significant amount of granulation tissue was
noted. Percutaneous tracheostomy was performed without
difficulty.  Following the procedure, Ms [**Known lastname 174**] was admitted to
the MICU for monitoring overnight.  She was saturating normally
near 100% on humidified trach mask, with HR of 62, normotensive,
and afebrile.

MEDICAL HISTORY: --diabetes mellitus
--hypertension
--tremors
--cerebrovascular accident ~ 10 years ago
--cataracts
--schizoaffective disorder
--s/p gastrostomy tube placement

MEDICATION ON ADMISSION: 1. Risperidone 2 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
2. Risperidone 1 mg Tablet Sig: 1.5 Tablets PO QAM (once a day
(in the morning)).
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Penicillins / Keflex

PHYSICAL EXAM: Discharge Physical Exam:
Gen: Pleasant Caucasian female, trach mask in place in NAD
HEENT: Anicteric
Neck: Trach mask in place on humidified air
Cardiac: Nl s1/s2, RRR
Pulm: clear bilaterally with no wheezes or rales
Abd: soft, nontender, nondistended
Ext: No noted edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Prior to hospitalization for PNA, the patient lived alone in
[**Location (un) 1294**]. After her hospitalization, she spent one month at
[**Hospital **] rehab. The patient currently lives at [**Location 44563**], a
nursing home/rehab facility. She retired as a school teacher
over 30 years ago and supports herself with [**Social Security Number 86960**]social security. She 

### Response:
{'Mechanical complication of tracheostomy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Schizoaffective disorder, unspecified,Unspecified cataract,Other abnormal granulation tissue'}
