Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: Metabolic encephalopathy, Myopathy, Pain, Physical deconditioning, Pleural effusion
Clinical narrative: Patient is a 56 y.o. female patient of MD with history of SCD, HTN, CKD 4, presented to Medical Center with sickle cell pain, admitted for pain crisis and hypoxia. Course prolonged by sepsis due to PNA requiring chest tubes; AKI. Now improved and awaiting further improvement in Hb.   Severe anemia  Acute sickle cell crisis  2/2 sickle crisis 2/2 COVID; severe pain, refractory to multiple interventions Hgb 2-3 on admission (no blood products)  LDH>2500, low Haptoglobin, consistent w/ hemolysis Was following OSU Hematology, baseline Hg ~6 s/p Procrit, IV iron (x >2wk course) PO B12, folic acid  Dc'd oral Fe as causes pt constipation, pt adamantly refusing Heme/onc consulted, restarted EPO on 9/22 Family states that pt is usually discharged when Hb is 5. Currently 5 and patient requesting discharge home.  Patient accepted by Dr, Heme Onc, will follow outpatient on discharge 10/21 Heme recs suggested for EPO Monday Wednesday Friday for 1 week with repeat CBC and then further EPO based on blood counts   Acute on chronic pain  Generalized weakness  2/2 critical care myopathy, deconditioning, protracted inpatient hospitalization, B/L chest tube insertion s/p removal, intermittent hypoxia from severe anemia with in setting of SCD   Was prev on Oxy 10mg q4h scheduled and PRN since end of 09/25 -> weaned inpatient Oxycodone to 5mg q4h prn, Will discharge on Oxycodone with further doses to be arranged outpatient via PCP and/or Heme       Cardiac arrest- resolved Acute hypoxic respiratory failure - stable B/L exudative pleural effusion Acute chest syndrome - resolved COVID-19 - resolved Brief loss of pulse 8/21, ROSC after 1 round ACLS Arrest 2/2 hyperkalemia, severe anemia Resp failure 2/2 COVID, cardiac arrest, CAP COVID-19+ (8/12) on admission, completed isolation 8/24, completed steroids, Remdesevir held d/t AKI ETT 8/21-9/4, in setting of cardiac arrest TTE 8/13 with EF 61%,  Initial CT w/ RUL infiltrate, worsened on f/u CT,  completed Rocephin/Doxy, steroids course     ARF, prerenal - resolved Cr 0.8-0.9 at baseline, peak 2.5, now 1.01 on discharge Multifocal PNA - resolved 9/24: fevers -> WBC 17K CT 9/25 showed significant worsening of B/L effusions and MF PNA BCx 9/25 -ve; Ur Ag, sputum Cx and Resp PCR panel -ve Pleural fluid cx 9/27 -ve Completed Cefepime 10/2 S/p B/L chest tubes 9/2: exudative; -ve for malignancy  Repeat CT 10/1: significant improvement in effusions R chest tube dced 10/3 L chest tube dced 10/6 CM consulted to arrange for home o2 on discharge     Acute VTE USG duplex 9/26: acute L gastrocnemius DVT, chronic R DVT  Heme with recs for no AC and also risk of bleed with IVCF D/t AKI, V/Q scan 09/25 - intermed prob of PE suspected PE -> troponin leak, no RV strain.  On RA since 10/6 with periodic need for nc   CM consulted to arrange for home o2 on discharge     Thrombocytopenia - resolved 2/2 sepsis   Sacral pressure ulcer, stage 3 Wound care was consulted, recs appreciated. Outpatient monitoring and ongoing wound care follow up with referral if needed    AS TTE: mild AS, recommended TEE to better assess AV structure given patient's age Cards recs for outpatient follow up    Essential HTN Continue Norvasc    Anxiety Continue Lexapro   Goals of Care Palliative consulted Full code with goals rehabilitative (husband - estranged) LNOK, mother visiting frequently Family aware of limitations given her wishes.    Hyperkalemia - Resolved Shock-POA - Resolved  Acute Metabolic Encephalopathy - resolved