Age: 57.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Hypoxia, Intensive care, Laboratory test, Legionella test, Leukocytosis
Clinical narrative: Patient admitted 7/21/2021 for presents as transfer for acute hypoxic respiratory failure and covid pneumonia. Vaccinated for COVID 3/31/2021, tested positive 7/21/2021 Patient discharged, DEATH, 7/26/2021  Date of Vaccination:3/31/2021 & 3/10/2021 Dose: 2 doses total Vaccine Manufacturer: Pfizer Lot #: EN6202/EN6207 Clinic Administering Vaccine: unknown Injection site: R deltoid both times Description of event/reaction: patient died from severe ARDS from COVID-19   Patient initially presented on 06/29 with dyspnea, productive cough and wheezing. She reported having difficulty breathing for the last month, however, her symptoms progressively worsened after 6/26/21. Patient was found to be hypoxic on her home oxygen requirement of 3L to SpO2 52% upon arrival to ER. Of note, patient was discharged from a hospitalization on 6/22/21 (unknown reason for hospitalization, duration, and location).    Patient is reportedly fully vaccinated for COVID prior to her current admission and received her last vaccine in February 2021. She tested positive for COVID on 6/29 upon admission, and stated that her daughter had been sick recently and tested negative for COVID. Patient was started on Remdesivir, Decadron, Albuterol, Thiamine, Zinc, Quercetin complex, and Vitamin D. Patient was also started on Vapotherm for supplemental oxygen which was alternated with BiPAP, as well as empiric Vancomycin (6/29-7/10 and 7/15-7/21) and Zosyn (6/29-7/8). Patient was ultimately intubated on 07/15 and her antibiotics were escalated to Vanc and Meropenem (7/13-7/21) for presumed pneumonia. She continued to require high ventilator settings (100%, PEEP 16).  Her hospitalization was complicated by shock requiring vasopressors. On 7/17, patient was increasingly acidotic with pH 6.99 and PCO2 78 and was subsequently proned and paralyzed.  Her infectious work-up was positive for VRE bacteremia on 7/17 and candida in urine culture. On 7/21 she was transferred to MICU for hypoxic respiratory failure and COVID pneumonia. On arrival, she is sedated on mechanical ventilation...Acute Hypoxic Hypercapneic Respiratory Failure requiring Mechanical Ventilation (POA) COVID PNA (POA) History of COPD (POA) - Etiology: COVID PNA - COVID positive 6/29 - Fully vaccinated with Moderna vaccine prior to admission - s/p Remdesivir, convalescent plasma, dexamethasone - 7/15 Intubated at outside hospital - 7/17 Paralyzed and proned - CXR: bilateral diffuse patchy airspace disease - ABG on arrival: 7.43/53/65/35 on 80%, PEEP 10, PF 81 PLAN: - PAL, comp resp panel, Strep and Legionella urine Ag pending - Continue mechanical ventilation to optimize ventilation and oxygenation, maintain SpO2 >/= 92% - DuoNebs q4hr - Empiric broad spectrum antibiotics as outlined below: Linezolid and cefepime - Propofol and Dilaudid drips to facilitate tolerance of mechanical ventilation - Start DEXARDS protocol - Repeat ABG at 2000; prone if PF ratio not improved - Consider CT chest when clinically stable   VRE Bacteremia (POA) Sepsis (POA) Leukocytosis (POA) - Has received dexamethasone - Received the following courses abx: Vanc 6/29-7/10, 7/15- 7/21 Zosyn 6/29 - 7/8 Merrem 7/13-7/21 - BCx from 7/17 resulted for +VRE; transitioned to Linezolid prior to transfer - On vasopressors on 7/18 - WBC 26k, lactate here 1.2 - CXR: bilateral diffuse patchy airspace disease Plan: - PAN cultures: Bcx, UA, PAL, strep/legionella urinary Ag pending - Follow cultures; determine insertion date of PICC line - Empiric antibiotics with : Linezolid (start 7/21) and cefepime - ECHO pending   AKI (POA) - Scr on admission 0.96, up to 1.96 on 7/17  - Multifactorial AKI is likely related to sepsis PLAN:  - BMP here pending - Renal lytes pending - Renally dose medications, avoid contrast medications - Consult the renal team when appropriate      T2DM (POA) - HgbA1C pending - FSBG with correction SSI q6hr per ICU protocol