Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Gastrostomy, Headache, Hypotension, Hypoxia, Increased upper airway secretion
Clinical narrative: Pfizer Dose 1 1/25/22 (33025BD) COVID Positive 2/10/2022  2/10/22: Patient is a 66-year-old male with past medical history significant for hypertension, COPD, hyperlipidemia, rheumatoid arthritis, history of pneumococcal pneumonia status post lung surgery at outside hospitals  has come to the emergency room with complaints of worsening shortness of breath for 10 days. He apparently was not vaccinated for COVID-19 till 10 days ago.  He thinks that soon after vaccination he started having symptoms which gradually progressed. He had associated cough with occasional yellow sputum. He denied any sore throat or loss of sense of smell or taste. He denies any nasal congestion. He denies any vomiting but had nausea. He denies any diarrhea. He had mild headache. He denies any fever or chills. He finally presented to the emergency room where he was needing BiPAP support to maintain the oxygenation.  He was weaned to 5 L OxyMask at my exam. Patient's COVID test was pending initially, but came back positive at the time of my exam. He had the highly elevated D-dimer for which he underwent a CT chest which was negative for PE but did show fibrotic chronic interstitial lung disease.  There was also possible pneumonitis with chronic changes.  Patient is being admitted for further management.  Patient denies any chest pain, he denies any abdominal pain or any other concerns except for shortness of breath and cough during my exam in the emergency.   He has no other acute health concerns.  3/22/22: Course during Hospitalization: 2/10:  66-year-old male patient with history of hypertension, dyslipidemia, rheumatoid arthritis, COPD was admitted to the hospital on 02/10. Patient was vaccinated on 02/01 for the SARS-CoV-2 virus. Patient was started on remdesivir and dexamethasone and given dose of Actemra. 2/13:  Pulmonology consultation was obtained for acute hypoxic respiratory failure.  Patient was maintained on BiPAP. 2/17:  Patient was transition to OptiFlow to maintain pulse ox above 90%.  Possibility of rheumatoid arthritis affecting the lungs was considered.  Antitussives and Xanax were given for relief due to cough and anxiety respectively. 2/21:  Patient was started on Solu-Medrol per pulmonology as patient also has history of COPD to see if he could get some relief.  Patient also had a brief run of SVTs. Minimal movement even in bed was causing significant hypoxia. 2/28:  Patient expresses his significant fatigue with OptiFlow and wants to be intubated.  Intubation performed per anesthesia. 3/1:  Patient started on low-dose of Levophed for hypotension.  Solu-Medrol.  Started on a Zosyn. 3/3: Patient's urine, sputum, blood cultures from 3/1 are NGTD 3/4: Sedation vacation was tried. Pt able to follow commands and coughing. 3/7:  Tube feeld held due to significant amount of copious secretions.  Dietitian consulted. 3/8: Checked  Abdominal series for constipation-normal X-ray 3/9: Slow introduction of Tube feeds. 3/11: s/p trach and PEG placement. Pt had significant arrhythmias from SVT, atrial fibrillation and V-tach overnight 3/12:  1 DES to the RCA placed, Levophed and dopamine started.  Significant oral and G-tube secretions present. 3/13:  Patient off of dopamine. Tube feeding held. 3/17: Pt not tolerating the tube feeds, unable to get the tip of the tube into the jejunum.  Currently tip present between 2nd and 3rd part of duodenum. 3/18 : LUE Cephalic vein thrombosis+, on BID dosing of Lovenox. 3/20:  Patient tolerating tube feeds better.  Tracheal secretions present. 3/21:  Patient's FiO2 increased from 80-100% today. Tracheostomy area erythematous.  Patient made DNR/DNI. 3/22:  Patient on 100% FiO2.  Started on Levophed  at 30 mcg/minute   Patient went into PEA at around 18:10 and asystole at 18:13 and passed away on 3/22/2022.