Sex: M
Vaccine: UNK
Symptoms: Peripheral ischaemia, Respiratory acidosis, Respiratory failure, SARS-CoV-2 test positive, Sepsis
Clinical narrative: Date of Admission: 11/11/2023   Date of Discharge: 11/14/2023   Pending Study Results at Discharge:  Unresulted Lab Orders    Date and Time Order Name Status Specimen Source   11/11/2023  2:59 AM BLOOD CULTURE 2 Preliminary BLOOD   11/11/2023  2:30 AM BLOOD CULTURE Preliminary BLOOD       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) COVID-19 PNEUMONIA   ? LONG TERM NON WARFARIN ORAL ANTICOAGULANT THERAPY       Dabigatran (Pradaxa) 150mg BID Indications:  atrial fibrillation Expected length of therapy: Lifelong (Provider to assess risk vs benefits periodically)   Considerations:    HC pool: PHARMACY SERVICE    Periop Guideline Reference:   Go to Clinical Library ==>  Search: Anticoagulation Management - Perioperative- Anticoagulation Services Guideline         ? AORTIC VALVE STENOSIS        Trileaflet aortic valve with thickened and restricted leaflets.  Moderate aortic stenosis ( Vmax 3 m/sec, VA 1.4 cm 2) Need follow up 1/2018 Had echocardiogram 2018 ordered echocardiogram 10/2021 followed by cardiology  10/21 echocardiogram normal EF, moderate AS recommended by to repeat in one year needs new echocardiogram 10/2022    ? DM 2 W PERIPHERAL VASCULAR DISEASE       Has atherosclerosis of left femoral artery noted on femur xray August 2013.  On peripheral vascular study showed at least moderate ischemia of the left lower extremity caused primarily by disease in the aortoiliac segment. There may be additional disease in the distal portion of the superficial femoral artery.  November 2013 Left leg angiogram and atherectomy, PTA May 2016:  Left SFA and popliteal artery diffuse moderate and high grade plaques responded satisfactorily to 6mm drug eluting angioplasty. 2. Right CFA and SFA moderate and high grade disease. 3. 3 vessel runoff bilaterally, with right Anterior tibial artery plaques July 2016 had left femoral endarterctomy secondary to arterial occlusive disease May 2017 had atherectomy of left proximal SFA and angioplasty of entire left SFA   ? HTN (HYPERTENSION)       8/11/2023 MD - DOV  Patient will continue current medications     ? DM 2 W HYPERLIPIDEMIA   ? SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION   ? ACUTE HYPOXEMIC RESPIRATORY FAILURE   ? TYPE 2 MI   ? CHF (CONGESTIVE HEART FAILURE), UNSPECIFIED   ? ACUTE HYPERCAPNIC RESPIRATORY FAILURE   ? MELANOMA IN SITU, SCALP   ? BLADDER CANCER, TRIGONE       Added automatically from request for surgery 705777 2019 resection of bladder tumor: NONINVASIVE LOW GRADE PAPILLARY UROTHELIAL CARCINOMA WITH  ENDOPHYTIC PATTERN  - MUSCULARIS PROPRIA PRESENT     ? ATRIAL FIBRILLATION, UNSPECIFIED       ? TIA due to embolic source 4/2018     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  Home   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: 78-year-old male with a history of hypertension, AS (mild to mod on echo), atrial fibrillation, diabetes, bladder cancer, and melanoma presented to the ER with severe shortness of breath, progressivelymphedema over four days. In the ER, he was diagnosed with sepsis, hypoxia, and respiratory acidosis, showing cardiomegaly and bilateral infiltrates on imaging. He tested positive for COVID-19. Initially admitted to ICU, patient was treated with Remdesivir, Dexamethasone and empiric IV antibiotics with significant improvement, was also diuresed with IV lasix. Echocardiogram showed normal LV size, with normal function, mild to moderate AS.    Patient's respiratory status has significantly improved, now on 2L O2 and doing well, will discharge on Dexamethasone to complete course and course of PO antibiotics     Primary Procedures:  None   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  Covid-19   Complications: none   Consults:  None Smoker: Yes - An outpatient referral was made for smoking cessation counseling.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code       Note Details  Author (M.D.) File Time 11/14/2023  9:58 AM Author Type Physician Status Addendum Last Editor  (M.D.) Specialty Hospital Medicine  Admit Date 11/11/2023  Hospital Problem List   ATRIAL FIBRILLATION, UNSPECIFIED  BLADDER CANCER, TRIGONE  CHF (CONGESTIVE HEART FAILURE), UNSPECIFIED  COVID-19 PNEUMONIA  MELANOMA IN SITU, SCALP  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION  ACUTE HYPOXEMIC RESPIRATORY FAILURE  TYPE 2 MI  ACUTE HYPERCAPNIC RESPIRATORY FAILURE  LONG TERM NON WARFARIN ORAL ANTICOAGULANT THERAPY  HTN (HYPERTENSION)  DM 2 W HYPERLIPIDEMIA  DM 2 W PERIPHERAL VASCULAR DISEASE  AORTIC VALVE STENOSIS Care Timeline  11/11   Admitted to ICU from ED 0730    Transferred out of ICU 1635 11/14   Discharged 1120   showing pt is NOT vaccinated on immunization record