Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Decubitus ulcer, Dysphagia, Dyspnoea, Feeding tube user, Gastrostomy
Clinical narrative: Patient is a 72 y.o. male with a history of Parkinson's disease, nonischemic cardiomyopathy, orthostatic hypotension, factor 5 Leiden with DVT on Pradaxa, and hospitalization from 12/2-12/9/22 for PNA complicated by dysphagia and eventually discharged to SNF who presented to RMH 3/10/2023 from home with fever, cough and dyspnea and found to have COVID-19. Clinical decline 3/11/23 requiring HHFNC and broadening of abx. Course c/b dysphagia requiring tube feeds. Prolonged stay for PEG placement. Course further complicated by aspiration event 3/21/23 requiring HHFNC and delaying PEG. PEG ultimately placed 3/24/23.   1. Acute hypoxic respiratory failure: required 3L on admit secondary to COVID 19. CT Chest on admit with b/l patchy infiltrates and improved LLL consolidation. Worsening hypoxia on ABG 3/11/23, required HHFNC. CXR 3/11/23 w/ b/l stable airspace disease. Resolved until sudden onset hypoxia on 3/21/23, suspect aspiration given thick secretions. Placed back on HHFNC. Antibiotics completed for aspiration pneumonia. On room air since 3/23/23. Resolved. 2. Sepsis: Febrile and tachycardic on admit likely due to COVID 19 but could not rule out underlying bacterial process. Initially treated with rocephin/azithro, broadened to vanc/cefepime 3/11/23 with recurrent fever, hypotension, tachycardia. Discontinued antibiotics 3/12/23. Recurrence of sepsis 3/21/23 as below. Resolved. 3. Aspiration pneumonia: Episode of sudden onset hypoxia while in endo for PEG 3/21/23. CXR with LLL infiltrate. Febrile, tachycardic, tachypnic. MRSA negative. Sputum culture, blood cultures negative. Unasyn transitioned to PO Augmentin, completed 3/25/23. 4. COVID-19 Pneumonia: positive on admit. Hypoxic, IV decardon initiated for 10 days. Started Remdesivir 3/11/23 for worsening clinical conditions. Recommend repeat CT chest in 3 months to ensure resolution of pneumonia.  5. Dysphagia: Chronic issue, recent on modified diet at SNF. SLP followed for witnessed aspiration. FEES 3/11/23 with profound aspiration. NPO, corflo and TF. SLP followed. Pt pulled out corflo 3/13/23 and replaced 3/14/23. Failed MBS 3/17/23 with recs for NPO. Aspiration event while patient down for PEG. PEG placed 3/24/23. Tube feeds through PEG initiated 3/25/23. 6. Parkinson's disease: follows with Dr (neuro). Continued home primidone.  7. Factor 5 Leiden with DVT: per history. Held pradaxa as pt NPO and unable to give via tube, started lovenox bid 3/11/23. Eliquis not option due to interaction with home primidone. Coumadin initiated 3/24/23, plan for lovenox bridge. 8. Orthostatic Hypotension: per history. Held home florinef while on dexamethasone, resumed with midodrine at dsicharge. 9. NICM: follows with Dr (cardiology). TTE 2018 EF 55-60%%. Euvolemic on admit. 10. Chronic pain: follows with Dr (pain medicine). Previously had IT pain pump but has been off due to recent MRSA infection from wound. 11. Wounds: sacral wound s/p wound vac. Stage IV sacral pressure ulcer and unstageable left lower back pressure ulcer, both POA. ET followed. 12. Severe malnutrition: secondary to chronic illness with dysphagia and poor intake with chronic weight loss. RD followed.