Age: 55.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood pH decreased, Blood urea normal, Bundle branch block right, Carbon dioxide decreased, Catheter placement
Clinical narrative: Johnson & Johnson COVID Vaccine EUA J&J Dose 4/9/21 NOT COVID POSITIVE  5/25/21: The patient is a 55-year-old male presents to the emergency department via EMS today after calling 911 with acute shortness of breath and being found unresponsive and pulseless at home, subsequently requiring cardiopulmonary resuscitation on route to the ED.  the patient has a past medical history significant for gout, which he takes indomethacin as needed, and recently went to another state in March.  His significant other reports that COVID-19 infection went throughout the house in December, although he did test negative, they believe he had it due to his symptoms.  He did have that Johnson and Johnson COVID-19 vaccination at the beginning of April of this year. Apparently the patient was speaking with the 1st responder right up until for minutes prior to EMS arrival and when fire department arrived on the scene the patient was found unresponsive, pulseless, and apneic, and subsequently they performed 1 round of CPR administering epinephrine and Narcan, when the patient regained a pulse.  The patient lost a pulse again, requiring subsequent CPR and airway tube was placed.   The patient arrived in the ED at 10:02 a.m., epinephrine was administered x7 rounds, patient was intubated with a 7.5 ET tube, Lucas device on patient, at 1053 the patient was awake, opening his eyes, squeezing nursing staff hand. At 10:59 a.m., nursing staff reported patient trying to pull his ET tube out.  The patient received at least 1 hour 15 minutes CPR including time on scene, on route to ED, and in ED.  At 11:10 a.m. patient's O2 saturation decreased to 79%, patient became diaphoretic with decreased responsiveness.  At 11:13 a.m., cardiology was at the bedside.  The patient's laboratory studies were significant for platelets 44, INR 1.2, CO2 16, AGAP 24, glucose 475, BUN 17, CR 1.55, ALT 248, AST 274, ALP 123, mg 2.9, lactate 15, troponin negative, 1st ABG:  PH 7.11, pCO2 39.4, base excess -17, PO2 46, HC03 12.6, O2 saturation 100%.  EKG showed right bundle-branch block with ST elevation in lead 3, V1, V2, V3, and V4 leads with ST depression in 1, aVL, and lead II.  Limited stat bedside echo showed akinetic septum and hypokinetic right ventricle.  The patient was taken to the cath lab.  Dr.  completed a pulmonary arteriogram and found bilateral massive emboli subsequently undergoing thrombectomy.  Patient was on epinephrine, norepinephrine, IV fluids, heparin, and propofol.   The patient was seen postprocedure in the intensive care unit while mechanically ventilated and sedated.  The patient's sedation was stopped and the patient woke up, moved all extremities, and followed some commands.  The patient's significant other was at the bedside.  He is currently on norepinephrine at 20mcg/min, epinephrine 20mcg/min, heparin per PE protocol after receiving bolus in CCL, propofol 25mcg/kg/min, and IV NS fluids.  The patient's wife reports that he has a history of chewing tobacco, but quit over 20 years ago.  She believes that he has a family history of blood clots in his sister's and maybe his dad, but she is not completely sure about that.  6/8/21: 56-year-old man who called EMS with complaints of acute onset shortness breath, was found unresponsive, apneic and without a pulse on arrival of EMS. ACLS protocol was initiated, he was brought to the emergency department where CPR was continued with Lucas device. He was intubated, required administration of 7 rounds of epinephrine, a total of 1 arm 15 minutes of resuscitation was required prior to return of spontaneous CT circulation. Cardiology was emergently consulted, he was taken to the cath had last cath lab with only mild nonobstructive CAD noted. He then underwent pulmonary angiography with the finding of saddle pulmonary embolism as well as bilateral main pulmonary artery thrombosis. He underwent mechanical thrombectomy of the right and left main pulmonary trunk, right upper middle old and lower lobe pulmonary artery, left lower lobe pulmonary artery.  Therapeutic anticoagulation was initiated with IV heparin then transition to oral Eliquis.    He was treated with empiric antibiotic therapy for presumed aspiration pneumonia. Tunneled hemodialysis catheter was placed secondary to legal Rhea and acute kidney injury, renal replacement therapy was initiated with CRRT. Clinical response was favorable, he was subsequently extubated and transitioned to intermittent hemodialysis. He was assessed by Physical and Occupational therapy and recommended for acute rehabilitation placement. His been discharged today in stable medical condition to continue hemodialysis as scheduled per Nephrology at the acute rehabilitation unit.