Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Anticoagulation drug level above therapeutic, Arterial catheterisation, Blood lactic acid, Blood lactic acid increased, COVID-19
Clinical narrative: COVID+ 11/8/2022 - Vaccination status J&J x1 BRIEF OVERVIEW: Discharge Provider: DO Primary Care Physician at Discharge: DO   Admission Date: 11/8/2022   Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 11/09/2022 Unknown ? Acute hypoxic respriatory failure due to COVID-19   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: AKI (acute kidney injury)  [N17.9] Supratherapeutic INR [R79.1] Hematoma of rectus sheath, initial encounter [S30.1XXA] COVID [U07.1] COVID-19 [U07.1] Respiratory arrest [R09.2]   HOSPITAL COURSE: Patient is a 69 y.o. male with a past medical history of metastatic prostate cancer, hypertension, hyperlipidemia, GERD, rheumatoid arthritis who presents today with symptoms of severe abdominal pain, cough and shortness of breath.  Patient states that he has been congested for approximately the last month with his significant other testing positive for COVID-19 1 week ago. He has continued coughing with sudden development of abdominal pain from coughing so much.   Upon arrival to facilitY, imaging was performed showing large right rectus sheath hematoma without evidence of active bleeding.  Patient does take Coumadin at home and was noted to be supratherapeutic on coagulation studies.  Patient was also found to be COVID-19 positive with no evidence of pneumonia on chest x-ray.  Patient did receive 1 dose of vitamin K in the emergency department for supratherapeutic INR of 8. Patient was initially admitted today oncology service for further treatment. While on the floor he had significant desaturation and ultimately a code blue is called. He receives one round of compressions and epinephrine and ROSC is achieved. He is intubated and requires multiple pressors for circulatory support.    Upon admission to the ICU the patient has a central and arterial line placed. He is found to have a 3g Hbg drop and has increasing pressor requirements. During his stay in the ICU he eventually required CRRT for worsening kidney function. He required 4 pressors and stress dose steroids with poor prognosis.  On 11/11/2022, resident team called significant other and 1st degree sister to discuss ongoing need for dialysis and raising pressor requirements despite adequate volume resuscitation.  Both of them agreed in his current state he would not want repeat resuscitation with chest compressions and code status was changed to do not resuscitate.  Around 8:00 p.m. on the same day, patient's pressor requirements increasing and lactate continues to up trend. Patient's significant other as well as only first degree sister were contacted regarding worsening clinical status. Both expressed that patient would have not wanted to pursue aggressive medical care in this clinical sitting as things don't seem to be improving. Goals of cares were discussed and both parties expressed their wishes totransition to comfort care.  At around 3:15 a.m., resident team called to bedside to pronounce patient death.  Patient was seen and examined, time of death was 3:25 a.m. on 11/12/2022.