CHIEF COMPLAINT: Diffuse severe tracheal bronchomalacia.

PRESENT ILLNESS: Ms. [**Known lastname 69234**] is a 53-year-old woman who had previously undergone a
cervical tracheal resection and reconstruction, as well as a
posterior thoracic
membranous wall tracheoplasty on [**2126-7-31**]. Ms. [**Known lastname 69234**]
had previously had multiple surgeries requiring intubation in
the past and was found have progressive dyspnea beginning in
[**2124**]. She was diagnosed with sarcoid via a right thoracoscopic
biopsy. She was also found to have tracheal stenosis in the
cervical trachea, as well as more distal tracheomalacia. The
tracheal stenosis was resected as mentioned above and a wedge
tracheoplasty of the membranous
wall down past the thoracic inlet had been performed.

MEDICAL HISTORY: Tracheal stenosis, Trachealbronchomalacia, diagnosis of
sarcoidosis and multiple endotracheal intubations (7 total)for
various surgical procedures
PMHX: sarcoidosis, OSA-CPAP at home, Asthma, hypothyroid, DJD
PSHX: bilat TKR, CCY, VATS right lung bx, hiatal
hernia/fundoplication

MEDICATION ON ADMISSION: Rosuvstatin 20mg daily, Bupropion 300mg qam, 150mg qpm, zolpidem
5mg qhs, clonazepam 0.5mg qhs/prn, furosemide 40mg [**Hospital1 **], K'cl
20mEq [**Hospital1 **], albuterol nebs, cymbalta 60mg [**Hospital1 **], vicodin 750mg prn

ALLERGIES: Erythromycin Base

PHYSICAL EXAM: General: 53 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes mosit
Neck: supple, no lymphadenopathy
Card: RRR, normal S1,S2 no murmur/gallop or rub
Resp: scattered rhonchi throughout
GI: obese, positive bowel sounds, abdomen soft
non-tender/non-distended
Extr: warm no edema
Incision: R. thoracotomy clean dry intact, no erythema
Neuro: non-focal

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives in [**State 2690**] with husband- here at hotel while pt in hospital
Occupation- paramedic
+ smoker x9 years- quit
Other diseases of trachea and bronchus,Unspecified pleural effusion,Sarcoidosis,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Osteoarthrosis, unspecified whether generalized or localized, site unspecified
Trachea & bronch dis NEC,Pleural effusion NOS,Sarcoidosis,Obstructive sleep apnea,Asthma NOS,Hypothyroidism NOS,Osteoarthros NOS-unspec
Admission Date:  [**2128-1-23**]              Discharge Date:   [**2128-1-30**]

Date of Birth:  [**2074-5-13**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Erythromycin Base

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Diffuse severe tracheal bronchomalacia.


Major Surgical or Invasive Procedure:
[**2128-1-23**]  Flexible [**Year/Month/Day **], tracheoplasty with mesh, right
and left mainstem bronchus and bronchus intermedius
bronchoplasty with mesh


History of Present Illness:
Ms. [**Known lastname 69234**] is a 53-year-old woman who had previously undergone a
cervical tracheal resection and reconstruction, as well as a
posterior thoracic
membranous wall tracheoplasty on [**2126-7-31**]. Ms. [**Known lastname 69234**]
had previously had multiple surgeries requiring intubation in
the past and was found have progressive dyspnea beginning in
[**2124**]. She was diagnosed with sarcoid via a right thoracoscopic
biopsy. She was also found to have tracheal stenosis in the
cervical trachea, as well as more distal tracheomalacia. The
tracheal stenosis was resected as mentioned above and a wedge
tracheoplasty of the membranous
wall down past the thoracic inlet had been performed.

Unfortunately Ms. [**Known lastname 69237**] dyspnea and cough returned and it was
progressive over the course of the last year. Repeat
[**Known lastname **] noted that there was no significant residual
tracheal stenosis, but there was diffuse tracheal
bronchomalacia, most notably in the proximal and distal trachea,
as well as right mainstem bronchus. She underwent
tracheobronchial Y stenting on [**2127-11-20**]. Following this,
she had marked improvement in her dyspnea.
Unfortunately, she still did have a cough which was thought to
be secondary to the foreign body. Due to the significant
improvement in her dyspnea, it was recommended to move forward
with the surgical correction of her airway. This
would involve a right thoracotomy and posterior tracheal
splinting with a Marlex mesh. We would also perform bilateral
bronchoplasty.


Past Medical History:
Tracheal stenosis, Trachealbronchomalacia, diagnosis of
sarcoidosis and multiple endotracheal intubations (7 total)for
various surgical procedures
PMHX: sarcoidosis, OSA-CPAP at home, Asthma, hypothyroid, DJD
PSHX: bilat TKR, CCY, VATS right lung bx, hiatal
hernia/fundoplication

Social History:
lives in [**State 2690**] with husband- here at hotel while pt in hospital
Occupation- paramedic
+ smoker x9 years- quit


Family History:
non-contributory

Physical Exam:
General: 53 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes mosit
Neck: supple, no lymphadenopathy
Card: RRR, normal S1,S2 no murmur/gallop or rub
Resp: scattered rhonchi throughout
GI: obese, positive bowel sounds, abdomen soft
non-tender/non-distended
Extr: warm no edema
Incision: R. thoracotomy clean dry intact, no erythema
Neuro: non-focal

Pertinent Results:
[**2128-1-22**] WBC-7.7 RBC-4.46 Hgb-12.0 Hct-36.6 Plt Ct-367
[**2128-1-29**] WBC-7.3 RBC-3.19* Hgb-8.4* Hct-25.6* Plt Ct-473*
[**2128-1-29**] Glucose-95 UreaN-7 Creat-0.7 Na-140 K-3.9 Cl-99
HCO3-33*
[**2128-1-22**] Glucose-94 UreaN-21* Creat-1.2* Na-138 K-4.1 Cl-99
HCO3-28
[**2128-1-29**] 07:20AM BLOOD Calcium-8.7 Phos-3.4 Mg-2.4

[**2128-1-26**] Source: Rectal swab. No VRE isolated.
[**2128-1-26**] MRSA SCREEN     Site: RECTAL   MRSA No MRSA isolated.

CHEST (PA & LAT)  [**2128-1-27**]
IMPRESSION: Postoperative pleural effusions persistent and
apparently unchanged when comparing frontal views. Lateral view
confirms loculated distribution along posterior pleural wall and
upper portion of major fissure on right side.


Brief Hospital Course:
Ms. [**Known lastname 69234**] is a 53 year-old female with h/o tracheal stenosis,
tracheobronchomalacia, sarcoidosis s/p VATS biopsy of the R
lung, who presented to [**Hospital1 18**] for scheduled tracheoplasty.  On
[**2128-1-22**], she underwent R thoracotomy and tracheoplasty.  She
tolerated all procedures well - for details of the operation,
please see operative note.  Her [**Hospital **] hospital course has been
relatively uncomplicated. She was admitted to the SICU post-op
for routine monitoring, Acute Pain Service placed an epidural
preoperatively, which provided good pain control until POD#2,
when the epidural was split, and a Dilaudid PCA was added for
better pain control. This was transitioned to PO pain medication
on POD#4 with good effect.  The chest-tube was removed and no
pneumothorax was seen on chest x-ray.  The foley was removed and
she voided without difficulty.  On POD #5 she was started on a
clear liquid diet which she tolerated and was advanced to a
soft-dysphagia prior discharge.  Aggressive pulmonary toileting
was continued, along with CPAP at bedtime.  On POD #7 she
underwent [**Hospital **] which revealed: The distal trachea had
very minimal residual malacia. The left mainstem had no
significant malacia. The right mainstem had very minimal
residual malacia. There were some thin, whitish secretions.
There was no purulence. All airways were otherwise patent. She
continued on her home medications and was discharged to [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 86**]
location prior to returning to [**State 2690**].  She will follow-up with
Dr. [**Last Name (STitle) **] as an outpatient.


Medications on Admission:
Rosuvstatin 20mg daily, Bupropion 300mg qam, 150mg qpm, zolpidem
5mg qhs, clonazepam 0.5mg qhs/prn, furosemide 40mg [**Hospital1 **], K'cl
20mEq [**Hospital1 **], albuterol nebs, cymbalta 60mg [**Hospital1 **], vicodin 750mg prn

Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
2. Rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Bupropion 150 mg Tablet Sustained Release Sig: Two (2) Tablet
Sustained Release PO QAM (once a day (in the morning)).
4. Bupropion 150 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO QPM (once a day (in the evening)).
5. Zolpidem 5 mg Tablet Sig: 2.5 Tablets PO HS (at bedtime).
6. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)) as needed.
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO BID (2 times a day).
9. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Cymbalta 60 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
12. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
Disp:*70 Tablet(s)* Refills:*0*
13. Albuterol Sulfate 2.5 mg/3 mL Solution for Nebulization Sig:
One (1)  Inhalation every 4-6 hours as needed.


Discharge Disposition:
Home

Discharge Diagnosis:
Tracheobronchomalacia, s/p R thoracotomy and tracheoplasty
Tracheal stenosis
Sarcoidosis s/p VATS biopsy R lung,
Hypothyroidism
Asthma.


Discharge Condition:
Good


Discharge Instructions:
Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 170**] if experience:
-Fever > 101 or chills
-Difficulty swallowing or painful swallowing
-Avoid carbonated beverages and caffine
Incision: develeops drainage, warmth or redness
No driving while taking narcotics: continue stool softeners with
narcotics.
Sleep with head elevated 30 degress
** Do not take additional Tylenol or Percogesic with your
narcotic medications, do not exceed recommended dosage  - do not
exceed 4gms of Tylenol per day.


Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**]: Date/Time:[**2128-2-5**]
3:30pm in the [**Hospital Ward Name 516**] Sharpiro Clinical Center, [**Location (un) **].
Report to the [**Location (un) 861**] Radiolgoy Department for a Chest X-Ray
45 minutes before your appointment.



Completed by:[**2128-2-3**]
{'Other diseases of trachea and bronchus,Unspecified pleural effusion,Sarcoidosis,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}


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: Diffuse severe tracheal bronchomalacia.

PRESENT ILLNESS: Ms. [**Known lastname 69234**] is a 53-year-old woman who had previously undergone a
cervical tracheal resection and reconstruction, as well as a
posterior thoracic
membranous wall tracheoplasty on [**2126-7-31**]. Ms. [**Known lastname 69234**]
had previously had multiple surgeries requiring intubation in
the past and was found have progressive dyspnea beginning in
[**2124**]. She was diagnosed with sarcoid via a right thoracoscopic
biopsy. She was also found to have tracheal stenosis in the
cervical trachea, as well as more distal tracheomalacia. The
tracheal stenosis was resected as mentioned above and a wedge
tracheoplasty of the membranous
wall down past the thoracic inlet had been performed.

MEDICAL HISTORY: Tracheal stenosis, Trachealbronchomalacia, diagnosis of
sarcoidosis and multiple endotracheal intubations (7 total)for
various surgical procedures
PMHX: sarcoidosis, OSA-CPAP at home, Asthma, hypothyroid, DJD
PSHX: bilat TKR, CCY, VATS right lung bx, hiatal
hernia/fundoplication

MEDICATION ON ADMISSION: Rosuvstatin 20mg daily, Bupropion 300mg qam, 150mg qpm, zolpidem
5mg qhs, clonazepam 0.5mg qhs/prn, furosemide 40mg [**Hospital1 **], K'cl
20mEq [**Hospital1 **], albuterol nebs, cymbalta 60mg [**Hospital1 **], vicodin 750mg prn

ALLERGIES: Erythromycin Base

PHYSICAL EXAM: General: 53 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes mosit
Neck: supple, no lymphadenopathy
Card: RRR, normal S1,S2 no murmur/gallop or rub
Resp: scattered rhonchi throughout
GI: obese, positive bowel sounds, abdomen soft
non-tender/non-distended
Extr: warm no edema
Incision: R. thoracotomy clean dry intact, no erythema
Neuro: non-focal

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives in [**State 2690**] with husband- here at hotel while pt in hospital
Occupation- paramedic
+ smoker x9 years- quit 

### Response:
{'Other diseases of trachea and bronchus,Unspecified pleural effusion,Sarcoidosis,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}
