Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Unresponsive to stimuli, Use of accessory respiratory muscles
Clinical narrative: Reported Symptoms: 10011232:COUGHING; 10011906:DEATH; 10021097:HYPOTENSION; 10039100:RHINORRHEA; 10040604:SHORTNESS OF BREATH; 10041367:SORE THROAT; 10053459:SECRETION DISCHARGE; Narrative: On 6/9/23 he was discharged to Post Acute and Rehabilitation. His MPOA/ daughter came w/ her father and reported increased cough/ secretions/ SOB, sore throat, and recent hypotension. Bps 90/50s at ENT and pt. sent to the ER for further evaluation. Testing revealed + COVID test. BP improved w/ IVFs x 1 liter. He was given remdesivir and dexamethasone for his covid19. Prior to admission he had a trach and a peg placed and soon after admission to our hospital, the hospitalist had spoken with the MPOA daughter regarding his case and that the patient had been declining since trach placement and expressed regret for placement in the first place. He was continued on treatment for his covid-19 nand secretion burden was an issue for him. tube feeds were continued with the goal of gaining weight and resuming immunotherapy. At the beginning of july, it was appearing the patient was improving and thought brielfy that he may even go to clinic while gaining further strength, however with time and ongoing discussion with the family, it was slowly decided that less agressive interventions were going to be pursued and that the tracheostomy would be downsized and eventually removed. on 8/3 the patients trach was removed by ENT. the family was aware that this would likely cause difficulty breathing and possible demise. The family was aware, wished to be close and watch im and eventually take him home with plan to continue immunotherapy as scheduled if the patient could make it to his next scheduled dose. On early morning of 8/12, the hospitalist recieved a call that the patient appeared to be using accessory muscles of respiration, tachypnic, did not open eyes to sternal rub. ABG returned at this time, pH 7.23, pCO2 78. Patient transferred to ICU. The patient was temporized briefly with bipap in the ICU until family could come to see the patient before he passed away. Family was able to spend ample time with the patient before his bipap was removed and he was made completely comfortable with analgesia and anxiolytics. The time of death noted in the ICU was 0929 8/12/23. Other Relevant HX: Patient is a 76 year old MALE with PMhx of T4aN2M0 left supraglottic/hypopharyngeal squamous cell carcinoma with extra laryngeal extension and bilateral neck metastases s/p induction chemotherapy and radiation therapy completed in 09/2022,, BPh, CLL (dx 2013), CVA x2, COPD who presented from Post Acute and Rehabilitation for hospital follow-up w/ ENT today for hospital f/u after a recent hospitalization where he underwent trahceostomy for concern for impending airway obstruction and g-tube placement w/ IR on 6/1/23. He was treated for concern for tracheitis versus HAP/VAP that admission. On 6/9/23 he was discharged to Post Acute and Rehabilitation. His MPOA/ daughter came w/ her father and reported that he has been having worsening secretions, being unable to work w/ PT b/c his eyes roll back when sitting up, low bps in the 90s, and issues w/ g-tube. BP as 95/56 in clinic. Pt. on 2L via trach collar, daughter reports her father was walking 6/1/23. Reports now PT will only work w/ him bedside and not have him walk. Reports he is in