Age: 84.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Mental status changes, Pituitary tumour benign, Pleural effusion, Pneumonia, Pneumonia aspiration
Clinical narrative: Hospitalized 10/9/2021; COVID-19 positive 10/9/2021; fully vaccinated  HISTORY OF PRESENT ILLNESS: Pt is a 84 y.o. male with a history of chronic systolic CHF with EF 35%, hypertension, severe AS s/p TAVR, atrial flutter s/p cardioversion on Eliquis, type 2 DM, hyperlipidemia, CKD stage 3, hypothyroidism, and gout who presents with fever, altered mental status, and generalized weakness.  The patient is oriented to self, current month, and location at the time of admission but is unable to provide history.  He does admit to cough with green sputum production on ROS questioning otherwise denies complaints.  History obtained from his daughter, via phone conversation at the time of admission.  He and his wife live with their daughter.  The patient was in his usual state of health on Thursday 10/7 and drove himself to his PCP for a checkup.  Later that evening, he was more weak and family began to notice that he was confused.  Symptoms continued to progress, to the point where he was barely able to stand and required extensive assistance from family.  He has not been eating much due to decreased appetite.  He was feeling cold but no documented fevers.  He was fully vaccinated against COVID with Pfizer vaccination April 2021 and everyone in their house is also vaccinated.  He was brought to the emergency department for evaluation. COVID positive.  Urinalysis consistent with infection.  Chest x-ray showing left lower lobe and right upper lobe opacities concerning for pneumonia.  He was given Tylenol and Zosyn.  Hospitalists were asked to admit to medical facility for further care.  Unfortunately, CT head had not yet resulted at the time of admission call.  CT head revealing a large pituitary mass, recommending MRI and MRA for further evaluation.  Diffuse cortical atrophy with chronic small-vessel ischemic disease. CHIEF COMPLAINT:  Sepsis (HCC),  ASSESSMENT/PLAN: Sepsis due to UTI, CAP Acute respiratory failure with hypoxia - presenting with fever, generalized weakness, altered mental status - UA consistent with infection - CXR- right upper and left lower lobe opacities concerning for pneumonia - s/p Zosyn in ED - will start ceftriaxone, doxycycline (avoid azithro due to digoxin) - follow-up blood and urine cultures - wean supplemental oxygen as able - PT/OT COVID 19 - fully vaccinated with Pfizer April 2021 - CXR as above - given lobar infiltrates, presentation felt more related to bacterial pneumonia at this time - check procal - hold off on decadron for now; could add if fails to improve - start remdesivir 10/14/2021 note: CHIEF COMPLAINT: Sepsis (HCC) ASSESSMENT / PLAN: Sepsis 2/2 aspiration pneumonia Ecoli UTI -continue rocephin (day 5/7), will d/c flagyl given no empyema or loculated pl effusion to suggest anaerobic source -dysphagia diet ordered, Mechanical soft, Nectar thick liquids  Pituitary mass -likely pituitary macroadenoma -no signs/sx of increase ICP -if develops worsening HA/Visual changse, reach out to Neurosurgery -NSx referral placed for outpt follow-up -Endocrine labs overall reassuring  COVID-19 infection -not felt to be cause of his septic picture given procalcitonin and active aspiration -fully vaccinated with Pfizer April 2021 -no decadron or remdesivir indicated 10/15/2021 note: PT/OT recommending SAR, referrals placed to Covid accepting SAR's, no beds available at this time and likely through the week. Plan: Anticipating d/c to SAR when Covid SAR bed is available. 10/19/2021 note: CHIEF COMPLAINT: Sepsis (HCC) ASSESSMENT / PLAN: Colonic pseudo-obstruction, Ileus  ? Cirrhosis  Aspiration PNA, COVID-19 (positive on 10/9/21) Sepsis on admission Ecoli UTI CHF, EF of 35% Severe AS s/p TAVR A flutter - on eliquis Pituitary mass -likely pituitary macroadenoma DM, CKD - CT AP w/ IVC 10/17 with findings suspicious for ileus. No obstructing mass or SBO. Marked gaseous and fluid-filled distention of the colon notably involving the cecum and transverse colon. - KUB today with continued gaseous distention of colon, slightly decreased today (12 > 10.4 cm) - Pt's abdomen remains soft, distended, non-tender. Covid-19 infection Not felt to be cause of septic process given normal procalcitonin and active aspiration Fully vaccinated by April 2021 (Pfizer) No decadron or remdesivir indicated Dispo: Prolonged stay noted, unclear timing of discharge given persistent encephalopathy / delirium