CHIEF COMPLAINT: elective admission for tracheal stent

PRESENT ILLNESS: Mr. [**Known lastname 88214**] is a 65 yom with h/o hyperlipidemia, s/p pacemaker,
Hep C ([**1-11**] to IVDU 30 yrs prior and untreated), h/o PTX, alcohol
abuse, and smoking p/w SCLCA s/p 6 cycles etop/cisplatin, large
mediastinal masses with critical obstruction to the LUL who was
admitted for elective stent placement and is being transferred
to the CCU for pericardial effusion with early tamponade
physiology.  Per the outside report, he had progressive cough
and voice changes over the past few months and reports trouble
with both solids and liquids.  He has had weight loss of
approximately 15-20 lbs during this time as well.  Biopsy of his
left upper lung mass was consistent with small cell lung cancer
in [**11-16**].  CT brain with contrast was negative for mets.  PET
scan showed b/l subcarinal nodes but no more distant disease.
He was recently noted to have very bulky [**Location (un) 21851**] with LUL
collapse and partial occlusion of the left pulmonary artery.
Patient presented for direct admit for stent placement but CT
scan showed pericardial effusion and pulsus was reportedly
measured on the floor to be 15-20. Cardiology fellow was called
for evaluation. Bedside echo showed RV collapse with signs of
tamponade.  Transfer to CCU for monitoring with plan for
pericardiocentesis in AM.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: -SCLC:
[**11-16**] - SCLCA diagnosed, had etoposide/carboplatin with 6th
cycle given [**4-17**] (good tolerance).
[**2-16**] and [**3-18**]: RT done
[**2-16**]: showed regression in most areas.
[**5-18**]: reduction in mass, persistent subtotal central occlusion
of LUL bronchus, reduction in constriction of pulmonary artery
to the LUL and reduction in central adenopathy, reexpansion of
LUL.
[**4-17**]: last chemo
[**2180-6-1**]: PET showed reduction in all areas, no new areas.
[**2180-6-14**]: hemoptysis of teaspoon 5cc BRB. CT scan noted for new
infiltrate showing encasement of artery to LUL and subtotal
occlusion of the bronchus to the LUL. Smoking was continued at
this point 2ppd. Bronchoscopy by Dr [**First Name (STitle) **] was suspiciuous for
tumor.
[**8-18**]: continued worsening of hoarseness, paroxysmal cough, left
anterior chest dsicomfort, increased dyspnea, no other pain or
headache, no addtional bleed.
CT: increasing central adenopathy, narrowing of left mainstem
bronchus to [**12-11**] of the right bronchus, complete obliteration of
the LUL bronchus with collapse of LUL with compromise of left
pulmonary artery. Bronchus to LLL, lingular were compromised.
Started on: Etoposide and carboplatin - 2 cycles, progressive
disease noted, has a pericardial effusion.
- continued to be symptomatic dyspnea, no dysphagia, continued
anorexia. presented for paliative treatment.
Hyperlipidemia
Pacemaker [**2169**]
H/O Hep C untreated [**1-11**] IVDU 30 yrs ago
spontaneous PTX
cigarette addiction
significant alcohol intake
tendon repair 4th finger on the right hand

MEDICATION ON ADMISSION: Megace ES 625mg prn
Atenolol 25mg QD
aspirin 325 prn
mucinex 600mg prn
guaiatussin AC 20-200 prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T=99 BP=128/80 HR=102 RR=20 O2 sat=93% RA  Pulsus=6
GENERAL: NAD. Oriented x3. Depressed mood.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Father: died in 50's, emphysema
Mother: dies in 100's, Natural causes
Sister 1: 68 yrs
Sister 2: 66 yrs
Has two grown children

SOCIAL HISTORY: 2 Drinks daily, smoke [**12-11**] ppd or more till [**2-/2180**], started a
nicotine patch. married to [**Doctor First Name **]. working 12-14 hr days.
Malignant neoplasm of upper lobe, bronchus or lung,Bronchopneumonia, organism unspecified,Unspecified disease of pericardium,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Chronic hepatitis C without mention of hepatic coma,Do not resuscitate status
Mal neo upper lobe lung,Bronchopneumonia org NOS,Pericardial disease NOS,Hyperlipidemia NEC/NOS,Status cardiac pacemaker,Chrnc hpt C wo hpat coma,Do not resusctate status
Admission Date:  [**2180-11-29**]              Discharge Date:   [**2180-12-2**]

Date of Birth:  [**2115-3-19**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
elective admission for tracheal stent


Major Surgical or Invasive Procedure:
Pericardiocentesis
Pulmonary Stenting


History of Present Illness:
Mr. [**Known lastname 88214**] is a 65 yom with h/o hyperlipidemia, s/p pacemaker,
Hep C ([**1-11**] to IVDU 30 yrs prior and untreated), h/o PTX, alcohol
abuse, and smoking p/w SCLCA s/p 6 cycles etop/cisplatin, large
mediastinal masses with critical obstruction to the LUL who was
admitted for elective stent placement and is being transferred
to the CCU for pericardial effusion with early tamponade
physiology.  Per the outside report, he had progressive cough
and voice changes over the past few months and reports trouble
with both solids and liquids.  He has had weight loss of
approximately 15-20 lbs during this time as well.  Biopsy of his
left upper lung mass was consistent with small cell lung cancer
in [**11-16**].  CT brain with contrast was negative for mets.  PET
scan showed b/l subcarinal nodes but no more distant disease.
He was recently noted to have very bulky [**Location (un) 21851**] with LUL
collapse and partial occlusion of the left pulmonary artery.
Patient presented for direct admit for stent placement but CT
scan showed pericardial effusion and pulsus was reportedly
measured on the floor to be 15-20. Cardiology fellow was called
for evaluation. Bedside echo showed RV collapse with signs of
tamponade.  Transfer to CCU for monitoring with plan for
pericardiocentesis in AM.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

Past Medical History:
-SCLC:
[**11-16**] - SCLCA diagnosed, had etoposide/carboplatin with 6th
cycle given [**4-17**] (good tolerance).
[**2-16**] and [**3-18**]: RT done
[**2-16**]: showed regression in most areas.
[**5-18**]: reduction in mass, persistent subtotal central occlusion
of LUL bronchus, reduction in constriction of pulmonary artery
to the LUL and reduction in central adenopathy, reexpansion of
LUL.
[**4-17**]: last chemo
[**2180-6-1**]: PET showed reduction in all areas, no new areas.
[**2180-6-14**]: hemoptysis of teaspoon 5cc BRB. CT scan noted for new
infiltrate showing encasement of artery to LUL and subtotal
occlusion of the bronchus to the LUL. Smoking was continued at
this point 2ppd. Bronchoscopy by Dr [**First Name (STitle) **] was suspiciuous for
tumor.
[**8-18**]: continued worsening of hoarseness, paroxysmal cough, left
anterior chest dsicomfort, increased dyspnea, no other pain or
headache, no addtional bleed.
CT: increasing central adenopathy, narrowing of left mainstem
bronchus to [**12-11**] of the right bronchus, complete obliteration of
the LUL bronchus with collapse of LUL with compromise of left
pulmonary artery. Bronchus to LLL, lingular were compromised.
Started on: Etoposide and carboplatin - 2 cycles, progressive
disease noted, has a pericardial effusion.
- continued to be symptomatic dyspnea, no dysphagia, continued
anorexia. presented for paliative treatment.
Hyperlipidemia
Pacemaker [**2169**]
H/O Hep C untreated [**1-11**] IVDU 30 yrs ago
spontaneous PTX
cigarette addiction
significant alcohol intake
tendon repair 4th finger on the right hand

Social History:
2 Drinks daily, smoke [**12-11**] ppd or more till [**2-/2180**], started a
nicotine patch. married to [**Doctor First Name **]. working 12-14 hr days.

Family History:
Father: died in 50's, emphysema
Mother: dies in 100's, Natural causes
Sister 1: 68 yrs
Sister 2: 66 yrs
Has two grown children

Physical Exam:
VS: T=99 BP=128/80 HR=102 RR=20 O2 sat=93% RA  Pulsus=6
GENERAL: NAD. Oriented x3. Depressed mood.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 10cm.
CHEST: Device in place in L upper chest
CARDIAC: Muffled heart sounds. RR, normal S1, S2. No m/r/g. No
thrills, lifts. No S3 or S4.
LUNGS: Diffuse expiratory rhonchi with decreased BS at L apex
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: Trace pitting edema b/l.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

Pertinent Results:
Admission Labs:
[**2180-11-29**] 07:45PM BLOOD WBC-13.5* RBC-2.99* Hgb-10.3* Hct-29.4*
MCV-99* MCH-34.4* MCHC-35.0 RDW-16.0* Plt Ct-229
[**2180-11-29**] 07:45PM BLOOD Neuts-83* Bands-2 Lymphs-5* Monos-7 Eos-0
Baso-0 Atyps-0 Metas-2* Myelos-1*
[**2180-11-29**] 07:45PM BLOOD PT-15.0* PTT-29.1 INR(PT)-1.3*
[**2180-11-29**] 07:45PM BLOOD Glucose-128* UreaN-13 Creat-0.7 Na-134
K-3.9 Cl-95* HCO3-30 AnGap-13
[**2180-11-29**] 07:45PM BLOOD ALT-80* AST-94* LD(LDH)-271* AlkPhos-69
TotBili-0.5
[**2180-11-29**] 07:45PM BLOOD Albumin-2.7* Calcium-8.4 Phos-3.4 Mg-1.4*

Discharge labs:
[**2180-12-2**] 06:27AM BLOOD WBC-13.9* RBC-2.65* Hgb-8.8* Hct-26.1*
MCV-99* MCH-33.1* MCHC-33.6 RDW-16.0* Plt Ct-209
[**2180-12-2**] 06:27AM BLOOD Glucose-119* UreaN-14 Creat-0.5 Na-135
K-3.5 Cl-101 HCO3-29 AnGap-9
[**2180-12-2**] 06:27AM BLOOD ALT-70* AST-105* AlkPhos-55 TotBili-0.4
[**2180-12-2**] 06:27AM BLOOD Calcium-7.7* Phos-2.5* Mg-1.9

Studies:
Portable TTE (Focused views) Done [**2180-11-29**] at 9:10:48 PM
Conclusions
Overall left ventricular systolic function is normal (LVEF>55%).
The right ventricular cavity is unusually small. with normal
free wall contractility. The mitral valve leaflets are mildly
thickened. There is a moderate to large sized pericardial
effusion. No right ventricular diastolic collapse is seen. There
is brief right atrial diastolic collapse.

IMPRESSION: Moderate to large pericardial effusion located
mostly at the LV apex and LV inferolateral wall. There is
relatively little fluid overlying the right ventricular free
wall. Apical approach to pericardiocentesis likely better. No
frank echo evidence of tamponade although both ventricles are
small and patient is tachycardic.

Cardiac Cath	Study Date of [**2180-11-30**]
FINAL DIAGNOSIS:
1. Successful pericardiocentesis with 240 cc of serosanguinous
fluid
removed with access obtained under echocardiographic guidance
and
pericardial drainage bag secured and sutured into position.
(refer to
comments section)
2. Monitor drainage with plan for removal of drain in 24-36
hours

CHEST (PORTABLE AP)	Study Date of [**2180-11-30**] 5:22 PM
FINDINGS: The patient is intubated, the tip of the endotracheal
tube projects 4.5 cm above the carina. Massive volume loss in
the left lung due to fibrosis and consolidations. Subsequent
elevation of the left hemidiaphragm. A central airway stent is
visible.

No pathological changes in the right lung.

Portable TTE (Focused views) Done [**2180-11-30**] at 12:00:00 PM
Conclusions
Overall left ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There is no pericardial effusion. There are no echocardiographic
signs of tamponade.

IMPRESSION: Prior to tap, moderate to large circumferential
pericardial effusion is seen. Post-tap, there is minimal fluid
with normal biventricular function.

Brief Hospital Course:
65yo M with metastatic SCLC admitted for tracheal stent
placement, found to have pericardial effusion with concern for
early tamponade physiology on TTE, hemodynamically stable now.

# Pericardial effusion: He presented with reported shortness of
breath. He had a pulsus paradoxus of 15-20. He had questionable
tamponade physiology on echo. He was hemodynamically stable,
however, needed to drain the effusion prior to bronchial
stenting. In the CCU his pulsus was less than ten. He was taken
to the cath lab on [**2180-11-30**] and had 260cc's. A drain was kept
overnight, with drainage overnight. After multiple hours of no
output, the drain was pulled. A post procedure echo showed
minimal effusion, and echo the following day ([**12-1**]) showed
minimal increase from post procedure, after minimal output from
the drain. His pulsus remained less than ten after the
procedure.

# Small Cell Lung CA: He is undergoing palliative measures as an
outpatient. He was admitted for elective tracheal stenting.
After pericardiocentesis, he was taken for bronchial stenting.
They did not observe there to be any purulence posterior to the
obstruction, however there was extensive invasion and necrosis
from tumor, including into the [**Female First Name (un) 5309**]. He was very sedated after
the procedure, and required intubation overnight, for airway
protection post procedurally. There were minimal secretions
suctioned the morning after the procedure. He was extubated
successfully. He was well oxygenated (sats in the high 90s)
throughout his stay.

# Transaminitis: [**Month (only) 116**] be [**1-11**] chronic untreated HCV infection
given concomitant elevated INR and low albumin. Also possibly a
component of alcoholic cirrhosis/hepatitis, though AST not
significantly more elevated than ALT. Metastatic disease also on
the differential. Unclear etiology while an inpatient, and could
be worked up as an outpatient.

# Leukocytosis: WBC elevated with left shift. His WBCs increased
post procedurally to 22.6. Treatment was started with Levaquin
for postobstructive pneumonia. His WBCs trended down to 13 at
discharge.

# Follow-up: Mr. [**Known lastname 88214**] has a few pending labs that will need
to be followed-up by his primary care physician or [**Name9 (PRE) 269**] service
and faxed to his PCP [**Last Name (NamePattern4) **] [**Telephone/Fax (1) 64198**]:

Blood cultures - no growth to date
Respiratory culture - no growth to date
Broncoalveolar lavage fluid cultures - no growth to date

Medications on Admission:
Megace ES 625mg prn
Atenolol 25mg QD
aspirin 325 prn
mucinex 600mg prn
guaiatussin AC 20-200 prn

Discharge Disposition:
Home With Service

Facility:
angels visiting nurse

Discharge Diagnosis:
Primary:
Left main bronchus obstruction
Small cell lung cancer
Pericardial effusion

Secondary:
HLD
Alcoholism
Hepatitis C


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


Discharge Instructions:
Mr. [**Known lastname 88214**], it was a pleasure taking part in your care. You
were admitted to have a procedure called a pulmonary stenting.
This was to open the airway to your left lung.

On admission you were found to have fluid surrounding your
heart, which was causing mild shortness of breath. You had a
procedure called a pericardiocentesis.  The cardiologists
drained the fluid from around your heart and the pulmonologists
took you for the stenting. You tolerated the procedure well. You
required intubation (a breathing tube) overnight to help you
rest and breath. You were extubated the following day and did
very well.

On discharge you were doing well, and your breathing was
improved.  However, you may need oxygen at home to help you
breathe better.  A visiting nursing service will evaluate you
for this at home. You should continue to take antibiotics for a
total 10-day course, for what we believe may be a pneumonia.

We have made the following changes to your medications:
1) START Levofloxacin 750mg daily until [**2180-12-10**]
2) STOP atenolol and aspirin, until advised to restart by your
physicians
3) START Percocet at night as needed for pain. IT IS IMPORTANT
THAT YOU DO NOT DRIVE WHILE TAKING A SEDATING MEDICATION LIKE
THIS.  PLEASE USE A DIFFERENT OVER-THE-COUNTER PAIN RELIEVER IF
[**Street Address(1) 88215**].


Followup Instructions:
Please call [**Telephone/Fax (1) 32949**] to schedule follow-up with your primary
care doctor.

You will be contact[**Name (NI) **] by Interventional Pulmonology for
outpatient follow-up in the next 2 weeks.

Please call your oncologist for follow-up.



Completed by:[**2180-12-3**]
{'Malignant neoplasm of upper lobe, bronchus or lung,Bronchopneumonia, organism unspecified,Unspecified disease of pericardium,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Chronic hepatitis C without mention of hepatic coma,Do not resuscitate status'}


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: elective admission for tracheal stent

PRESENT ILLNESS: Mr. [**Known lastname 88214**] is a 65 yom with h/o hyperlipidemia, s/p pacemaker,
Hep C ([**1-11**] to IVDU 30 yrs prior and untreated), h/o PTX, alcohol
abuse, and smoking p/w SCLCA s/p 6 cycles etop/cisplatin, large
mediastinal masses with critical obstruction to the LUL who was
admitted for elective stent placement and is being transferred
to the CCU for pericardial effusion with early tamponade
physiology.  Per the outside report, he had progressive cough
and voice changes over the past few months and reports trouble
with both solids and liquids.  He has had weight loss of
approximately 15-20 lbs during this time as well.  Biopsy of his
left upper lung mass was consistent with small cell lung cancer
in [**11-16**].  CT brain with contrast was negative for mets.  PET
scan showed b/l subcarinal nodes but no more distant disease.
He was recently noted to have very bulky [**Location (un) 21851**] with LUL
collapse and partial occlusion of the left pulmonary artery.
Patient presented for direct admit for stent placement but CT
scan showed pericardial effusion and pulsus was reportedly
measured on the floor to be 15-20. Cardiology fellow was called
for evaluation. Bedside echo showed RV collapse with signs of
tamponade.  Transfer to CCU for monitoring with plan for
pericardiocentesis in AM.
.
On review of systems, s/he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: -SCLC:
[**11-16**] - SCLCA diagnosed, had etoposide/carboplatin with 6th
cycle given [**4-17**] (good tolerance).
[**2-16**] and [**3-18**]: RT done
[**2-16**]: showed regression in most areas.
[**5-18**]: reduction in mass, persistent subtotal central occlusion
of LUL bronchus, reduction in constriction of pulmonary artery
to the LUL and reduction in central adenopathy, reexpansion of
LUL.
[**4-17**]: last chemo
[**2180-6-1**]: PET showed reduction in all areas, no new areas.
[**2180-6-14**]: hemoptysis of teaspoon 5cc BRB. CT scan noted for new
infiltrate showing encasement of artery to LUL and subtotal
occlusion of the bronchus to the LUL. Smoking was continued at
this point 2ppd. Bronchoscopy by Dr [**First Name (STitle) **] was suspiciuous for
tumor.
[**8-18**]: continued worsening of hoarseness, paroxysmal cough, left
anterior chest dsicomfort, increased dyspnea, no other pain or
headache, no addtional bleed.
CT: increasing central adenopathy, narrowing of left mainstem
bronchus to [**12-11**] of the right bronchus, complete obliteration of
the LUL bronchus with collapse of LUL with compromise of left
pulmonary artery. Bronchus to LLL, lingular were compromised.
Started on: Etoposide and carboplatin - 2 cycles, progressive
disease noted, has a pericardial effusion.
- continued to be symptomatic dyspnea, no dysphagia, continued
anorexia. presented for paliative treatment.
Hyperlipidemia
Pacemaker [**2169**]
H/O Hep C untreated [**1-11**] IVDU 30 yrs ago
spontaneous PTX
cigarette addiction
significant alcohol intake
tendon repair 4th finger on the right hand

MEDICATION ON ADMISSION: Megace ES 625mg prn
Atenolol 25mg QD
aspirin 325 prn
mucinex 600mg prn
guaiatussin AC 20-200 prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T=99 BP=128/80 HR=102 RR=20 O2 sat=93% RA  Pulsus=6
GENERAL: NAD. Oriented x3. Depressed mood.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Father: died in 50's, emphysema
Mother: dies in 100's, Natural causes
Sister 1: 68 yrs
Sister 2: 66 yrs
Has two grown children

SOCIAL HISTORY: 2 Drinks daily, smoke [**12-11**] ppd or more till [**2-/2180**], started a
nicotine patch. married to [**Doctor First Name **]. working 12-14 hr days. 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Bronchopneumonia, organism unspecified,Unspecified disease of pericardium,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Chronic hepatitis C without mention of hepatic coma,Do not resuscitate status'}
