Age: 51.0
Sex: M
Vaccine: COVID19
Symptoms: Hypertension, Hypokalaemia, Hypotension, Hypoxia, Pericardial excision
Clinical narrative: Patient is a 54 y.o. male patient of CNP with history of Recurrent pericardial effusion with recent pericardial window 09/28/23, HFrEF with 45% EF, COPD, HTN, HLD presented to Medical Center with dyspnea and found to have acute hypoxic respiratory failure, L pleural effusion, COVID-19 and hypotension.  Hospital course complicated by AKI.   Acute Hypoxic Respiratory Failure Secondary to L pleural effusion, atelectasis and COVID-19 85% on room air on admission and required BIPAP on admission Weaned to 4L NC (10/12), back on 5L O2 NC (10/14) CTPA (10/8) without PE Lasix 20mg IV BID started (10/10), increased to 40mg IV BID (10/11) Continue to wean O2 as able Has been on and off nasal cannula O2 1015/1016 Pulm following Patient qualified for Home oxygen. Appreciate CM assistance with arrangements   Covid-19 Virus Infection Date of onset of symptoms: 10/8 Symptoms present on admission: Hypoxia, cough Date of covid positive test: 10/7/23 Vaccination status: vaccinated Imaging: CXR and CTPA with atelectasis, L pleural effusion Oxygen requirements on admission: BIPAP Current oxygen requirements: 3L Medical therapy: remdesivir and steroids, Vanco, Cefepime Consultants following: Pulm Anticipated special isolation end date: 10/19/23   Severe Sepsis, resolved Presented with fever, Hypoxia, hypotension, no leukocytosis, lactic acid 1.8 CTPA (10/8) with atelectasis, L pleural effusion S/P Rocephin/azithromycin in ER, changed to Vanco/Cefepime due to recent hospitalization, completed 7 day course (10/14) Blood cx (10/8) NGTD MRSA probe postiive Urine antigens negative   AKI, resolved Cr normal at baseline and normal on admission, Cr 1.40 (10/9), normalized (10/10) Avoid nephrotoxins Monitor with diuresis   Large Pleural Effusion Recent Pericardial Effusion Hx of recurrent pericardial effusion 2015, 2022 S/P Pericardial Window with CT placement (9/28/23) Discharged (10/7) and presented to ER (10/8)  CTPA (10/8) with Large left pleural effusion CTS consulted, recommend aggressive diuresis to see if pt can clear the fluid without need for CT placement, repeat CT (10/13) stable, no need for drainage per CT Surgery Acute on chronic HFrEF NICM Recent echo (10/2) with LVEF 45%  LHC (10/6) without obstructive CAD Presented with hypoxia, dyspnea, lower extremity swelling CT (10/8) with large L sided pleural effusion and RLL with trace effusion Unable to diurese with IV lasix on admission due to hypotension, IV lasix started (10/10), increased (10/11) Home carvedilol, entresto restarted, aldactone increased Continue to hold home farxiga  Strict I/Os, daily weights Cardiology consulted, do not feel that effusion is due to HF Net IO Since Admission: -8,663.38 mL [10/16/23 2218]   Hypokalemia, resolved K 3.1 (10/15), likely due to diuresis, Mg 1.9 Replaced Continue to monitor and replace as needed   HTN Home amlodipine, carvedilol, aldactone held on admission due to hypotension/sepsis Home meds resumed, amlodipine and aldactone increased due to uncontrolled HTN   COPD No exacerbation Duonebs Scheduled and PRN, Dulera   Tobacco Use Smokes >10 cigs per day Declined NRT   PreDM Recent A1c 5.9 Hyperglycemia due to steroids SSI started   Adrenal mass Recently Noted on CT; L mass at 3.2cm, likely benign adenoma Outpt adrenal washout CT vs chemical shift MRI