CHIEF COMPLAINT: Bronchopleural Fistula

PRESENT ILLNESS: Mr [**Known lastname 84248**] is a 70 year old man with a history of non-small cell
lung CA s/p R thoractomy with en bloc wedge resection in [**2184**],
who, on [**2189-7-28**] at [**Hospital6 8432**] Center, underwent left
thoracotomy, left upper lobectomy with wedge resection of left
lower lobe for two new lung lesions identified on surveillence
CT
chest in [**5-28**].  Post-operatively, the patient remained intubated
and had a mild elevation in his troponins which later trended
down.  He underwent tracheostomy on [**2189-8-11**] and G-tube
placement.
He subsequently developed ventilator associated PNA (MSSA and
enterobacter) and has been treated with Zosyn and remained
ventilaor dependant. He eventualy recovered well but had a had a
persistant air leak  and on his discharge to a [**Hospital 5442**] rehab
([**Hospital1 **]) his chest tube remained in place. The chest tube then
fell out at rehab and he was then transferred to [**Hospital3 **]
Medical Center for replacement and managament of the chest tube.
He underwent bronchoscopy and it was thought he had a
bronchopleural fistula.  He was planned to undergo a Eloesser
procedure, but was felt to be too high risk and was transferred
to [**Hospital1 18**] for bronchoscopy and possible endobronchial glue to
treat likely bronchopleural fistula. Has been afebrile at [**Hospital3 84249**], WBC normalized. last BM today. Was complaining of
LLQ pain during admission, underwent Abd CT [**9-19**] that was
normal.

MEDICAL HISTORY: LULobectomy/LLlobe wedge for lung CA via L thoractomy [**2189-7-28**]
NSCL Ca [**2184**] s/p R thoracotomy, en bloc resection portions of
RUL/RLM/RLL
ETOH
GERD
Depression
L knee OA
h/o PE

MEDICATION ON ADMISSION: Lopressor 25mg PO BID
Nexium 40 mg PO DAILY
Lorazepam 0.25mg PO q 8
Trazadone 50mg PO Daily
Colace 100mg PO BID
Fentanyl patch 50mcg topical q72hrs
Nicotine Patch 21mg topical DAILY
Zosyn 2.2.5mg IV q 6 Day #11 or 14
Tylenol 650 q 4 prn fever
albuterol nebs q 4 prn SOB
Dulcolax 10mg PO/PR prn Daily
Haldol 2mg PO q 4 prn agitation
Ativan 1 mg IV q 12 prn agitation
Morphine 2mg IV q12 prn pain
Morphine 1 mg IV q 2 prn severe pain
Zofran 4mg IV q 8 prn nausea
Oxycodone 10mg PO q 4 prn pain
Lovenox 40mg SC DAILY
ProMod w Fiber at 75cc/hr + 200cc free H20 down g-tube [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
T 97.5  HR 99  BP 131/69  RR 26  02 94% CMV 450x14 peep 5
GENERAL
[x] NAD  [x] AAO to person

FAMILY HISTORY: unknown

SOCIAL HISTORY: Lives in [**State 1727**]. Ex-smoker. + EtOH
Empyema with fistula,Malignant neoplasm of other parts of bronchus or lung,Acidosis,Esophageal reflux,Chronic airway obstruction, not elsewhere classified,Tracheostomy status,Gastrostomy status,Depressive disorder, not elsewhere classified
Empyema with fistula,Mal neo bronch/lung NEC,Acidosis,Esophageal reflux,Chr airway obstruct NEC,Tracheostomy status,Gastrostomy status,Depressive disorder NEC
Admission Date:  [**2189-9-24**]              Discharge Date:   [**2189-9-30**]

Date of Birth:  [**2119-2-27**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Bronchopleural Fistula

Major Surgical or Invasive Procedure:
[**2189-9-25**] Rigid bronchoscopy using Dumon black bronchoscope.
Flexible bronchoscopy, Placement of covered metal stent [**95**] x 40
mm in the left main stem covering the left upper lobe bronchus,
Balloon dilation of the metal stent.


History of Present Illness:
Mr [**Known lastname 84248**] is a 70 year old man with a history of non-small cell
lung CA s/p R thoractomy with en bloc wedge resection in [**2184**],
who, on [**2189-7-28**] at [**Hospital6 8432**] Center, underwent left
thoracotomy, left upper lobectomy with wedge resection of left
lower lobe for two new lung lesions identified on surveillence
CT
chest in [**5-28**].  Post-operatively, the patient remained intubated
and had a mild elevation in his troponins which later trended
down.  He underwent tracheostomy on [**2189-8-11**] and G-tube
placement.
He subsequently developed ventilator associated PNA (MSSA and
enterobacter) and has been treated with Zosyn and remained
ventilaor dependant. He eventualy recovered well but had a had a
persistant air leak  and on his discharge to a [**Hospital 5442**] rehab
([**Hospital1 **]) his chest tube remained in place. The chest tube then
fell out at rehab and he was then transferred to [**Hospital3 **]
Medical Center for replacement and managament of the chest tube.
He underwent bronchoscopy and it was thought he had a
bronchopleural fistula.  He was planned to undergo a Eloesser
procedure, but was felt to be too high risk and was transferred
to [**Hospital1 18**] for bronchoscopy and possible endobronchial glue to
treat likely bronchopleural fistula. Has been afebrile at [**Hospital3 84249**], WBC normalized. last BM today. Was complaining of
LLQ pain during admission, underwent Abd CT [**9-19**] that was
normal.


Past Medical History:
LULobectomy/LLlobe wedge for lung CA via L thoractomy [**2189-7-28**]
NSCL Ca [**2184**] s/p R thoracotomy, en bloc resection portions of
RUL/RLM/RLL
ETOH
GERD
Depression
L knee OA
h/o PE


Social History:
Lives in [**State 1727**]. Ex-smoker. + EtOH


Family History:
unknown

Physical Exam:
PHYSICAL EXAM:
T 97.5  HR 99  BP 131/69  RR 26  02 94% CMV 450x14 peep 5
GENERAL
[x] NAD  [x] AAO to person

HEENT
[x] EOMI   [x] PERRL/A   [x] Anicteric
[x] OP/NP mucosa normal     [x] Tongue midline
[x] Palate symmetric  [x] Neck supple/NT/without mass
[x] Trachea midline [x] Thyroid nl size/contour
[ ] Abnormal findings: tracheostomy tube in place, no drainage

RESPIRATORY   hyperesonent left chest, decreased BS right base,
no crackles
Left chest tube in place to WS, +airleak

CARDIOVASCULAR
[x] RRR    [x] No m/r/g    [x] No JVD

GI
 Soft, ND, No mass/HSM, tender per patient w deep palpation, no
rebound or guarding. Peg in place, capped.

GU- foley in place, deep yellow urine in bag

EXT: warm, well-perfused, 2+ edema, RUE PICC line in place. no
erythema.


Pertinent Results:
[**2189-9-30**] 02:33AM BLOOD WBC-9.3 RBC-2.91* Hgb-7.4* Hct-23.8*
MCV-82 MCH-25.6* MCHC-31.3 RDW-19.1* Plt Ct-282
[**2189-9-30**] 02:33AM BLOOD Glucose-115* UreaN-16 Creat-0.5 Na-140
K-4.0 Cl-96 HCO3-39* AnGap-9
[**2189-9-30**] 03:45AM BLOOD Hct-24.1*
[**2189-9-30**] 09:17AM BLOOD Hct-26.0*

Brief Hospital Course:
Pt was admitted to SICU on [**2189-9-24**] and had CT Chest done which
demonstrated the following.

CT Chest with Contrast ([**2189-9-24**]):
1. Likely bronchopleural fistula from the left upper lobe stump.

2. Ground-glass opacification, peribronchial consolidation and
pleural
effusion, most consistent with multifocal pneumonia and mild
pulmonary edema.
3. Enlarged hyperdense paratracheal nodes that may relate to
patient's
diagnosis of NSCLC or be reactive.
4. Severe emphysema.
5. Pattern of interstitial disease suggestive of usual
interstitial pneumonia
which may be secondary to idiopathic pulmonary fibrosis,
collagen vascular
disease, or drug reaction.
6. Lung loculated effusion on the left with apparenelty
thickened consistent
with intection/inflammation.
7. Aortic and mild coronary artery calcification.
8. Defects the ribs on the right may be due to respiratory
motion or
fractures. Correlate clinically.

Patient underwent rigid bronchoscopy with stent placement on
[**2189-9-25**].  Plans were made to transfer him back to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1727**]
Medical Center for further surgical treatment ([**Last Name (un) 72968**]
procedure) with his thoracic surgeon there.  After communication
with his thoracic surgeon it was determined that they were
unable to provide him with [**Location (un) **] transportation to his
facility.  Plans were then made to transfer to him back to
[**Hospital **] Rehab with follow-up with his thoracic surgeon in [**State 1727**].


Medications on Admission:
Lopressor 25mg PO BID
Nexium 40 mg PO DAILY
Lorazepam 0.25mg PO q 8
Trazadone 50mg PO Daily
Colace 100mg PO BID
Fentanyl patch 50mcg topical q72hrs
Nicotine Patch 21mg topical DAILY
Zosyn 2.2.5mg IV q 6 Day #11 or 14
Tylenol 650 q 4 prn fever
albuterol nebs q 4 prn SOB
Dulcolax 10mg PO/PR prn Daily
Haldol 2mg PO q 4 prn agitation
Ativan 1 mg IV q 12 prn agitation
Morphine 2mg IV q12 prn pain
Morphine 1 mg IV q 2 prn severe pain
Zofran 4mg IV q 8 prn nausea
Oxycodone 10mg PO q 4 prn pain
Lovenox 40mg SC DAILY
ProMod w Fiber at 75cc/hr + 200cc free H20 down g-tube [**Hospital1 **]


Discharge Medications:
1. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for anxiety.
2. Therapeutic Multivitamin     Liquid Sig: Five (5) ML PO DAILY
(Daily).
3. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: Fifteen (15) ML
Mucous Membrane [**Hospital1 **] (2 times a day).
4. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: Ten (10) ML
Intravenous PRN (as needed) as needed for line flush.
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
8. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Methadone 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] - [**Location (un) 86**]

Discharge Diagnosis:
Lung cancer with respiratory failure and bronchopleural fistula.


Discharge Condition:
Fair


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.

Followup Instructions:
Please follow up with your thoracic surgeon at [**State 48444**] Center in [**12-24**] weeks


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Empyema with fistula,Malignant neoplasm of other parts of bronchus or lung,Acidosis,Esophageal reflux,Chronic airway obstruction, not elsewhere classified,Tracheostomy status,Gastrostomy status,Depressive disorder, not elsewhere classified'}


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: Bronchopleural Fistula

PRESENT ILLNESS: Mr [**Known lastname 84248**] is a 70 year old man with a history of non-small cell
lung CA s/p R thoractomy with en bloc wedge resection in [**2184**],
who, on [**2189-7-28**] at [**Hospital6 8432**] Center, underwent left
thoracotomy, left upper lobectomy with wedge resection of left
lower lobe for two new lung lesions identified on surveillence
CT
chest in [**5-28**].  Post-operatively, the patient remained intubated
and had a mild elevation in his troponins which later trended
down.  He underwent tracheostomy on [**2189-8-11**] and G-tube
placement.
He subsequently developed ventilator associated PNA (MSSA and
enterobacter) and has been treated with Zosyn and remained
ventilaor dependant. He eventualy recovered well but had a had a
persistant air leak  and on his discharge to a [**Hospital 5442**] rehab
([**Hospital1 **]) his chest tube remained in place. The chest tube then
fell out at rehab and he was then transferred to [**Hospital3 **]
Medical Center for replacement and managament of the chest tube.
He underwent bronchoscopy and it was thought he had a
bronchopleural fistula.  He was planned to undergo a Eloesser
procedure, but was felt to be too high risk and was transferred
to [**Hospital1 18**] for bronchoscopy and possible endobronchial glue to
treat likely bronchopleural fistula. Has been afebrile at [**Hospital3 84249**], WBC normalized. last BM today. Was complaining of
LLQ pain during admission, underwent Abd CT [**9-19**] that was
normal.

MEDICAL HISTORY: LULobectomy/LLlobe wedge for lung CA via L thoractomy [**2189-7-28**]
NSCL Ca [**2184**] s/p R thoracotomy, en bloc resection portions of
RUL/RLM/RLL
ETOH
GERD
Depression
L knee OA
h/o PE

MEDICATION ON ADMISSION: Lopressor 25mg PO BID
Nexium 40 mg PO DAILY
Lorazepam 0.25mg PO q 8
Trazadone 50mg PO Daily
Colace 100mg PO BID
Fentanyl patch 50mcg topical q72hrs
Nicotine Patch 21mg topical DAILY
Zosyn 2.2.5mg IV q 6 Day #11 or 14
Tylenol 650 q 4 prn fever
albuterol nebs q 4 prn SOB
Dulcolax 10mg PO/PR prn Daily
Haldol 2mg PO q 4 prn agitation
Ativan 1 mg IV q 12 prn agitation
Morphine 2mg IV q12 prn pain
Morphine 1 mg IV q 2 prn severe pain
Zofran 4mg IV q 8 prn nausea
Oxycodone 10mg PO q 4 prn pain
Lovenox 40mg SC DAILY
ProMod w Fiber at 75cc/hr + 200cc free H20 down g-tube [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
T 97.5  HR 99  BP 131/69  RR 26  02 94% CMV 450x14 peep 5
GENERAL
[x] NAD  [x] AAO to person

FAMILY HISTORY: unknown

SOCIAL HISTORY: Lives in [**State 1727**]. Ex-smoker. + EtOH 

### Response:
{'Empyema with fistula,Malignant neoplasm of other parts of bronchus or lung,Acidosis,Esophageal reflux,Chronic airway obstruction, not elsewhere classified,Tracheostomy status,Gastrostomy status,Depressive disorder, not elsewhere classified'}
