Age: 77.0
Sex: M
Vaccine: COVID19-2, FLU4
Symptoms: Scan, Syncope, Vomiting
Clinical narrative: 1/20/23  0840 Patient said did not feel well and told me about  severe congestion the nights of 1/18 and 19 but was able to clear it. Nite of 1/18 accompanied by right arm pain. AM of 1/20 his breathing was gurgling and raspy. 0910 While I researched ERs he went to bathroom. 0925 When he was gone too long I checked to find him collapsed against bath door. 0930 called 911 and forced way into bathrm. He was lying on left side, had vomited, was conscious, moaning, not talking, kept reaching up with right arm. 0935 Ambulance arrived and 0940 took him to Hospital Emergency Room arriving approximately 0950.  Admitted to ER and ICU. He was conscious, able to talk with slight slur, intubated.  He asked for a Kleenex but could not wipe his nose so I did and told him it was difficult bek he had a device in his nose to which he responded "canula." They were his last words to me since 2 Dr's (one Emergency Dept, other Dr from Neuroscience ICU) pulled me out to get consent for TPA and interventional radiology (thrombectomy) because they thought he had an ischemic stroke with large thrombus on right side in middle cerebral artery. They asked history questions and I told them of  Covid booster, prostate aqua ablation, hernia surgery and Covid episode dated in item 19. While I was out they sedated patient and gave him TPA about 1030. 11:30 Dr  began interventional radiology. I was told it got the highest possible score for clot removal. 1:30 Moved to Neuroscience ICU 2:30 BP low. Maybe internal bleeding from groin insertion aggravated by TPA. Angioseal not work so used pressure disk which did. Heart beating weakly. Started lots of meds for bleeding and/or heart? Dr said maybe Covid, maybe TPA. Do formal echo and scan to make sure not bleeding. Central X trial lines and then ECG. Dr asked me re BP meds  told him well-controlled with Enalpril. They sent me away about 3:30 4:45  aortic line to precisely monitor BP. BP better but have to keep jacking up meds. Dr brought in cardiac team. 5:20  catheter to get rid of fluid, but could not get in bek of aqua ablation but later a guy from Urology was able to. 5:45  taken to scan 6:15  brought back up with scan incomplete bek went unstable. Gave lots meds for BP. Dr -  Heart not functioning, not pumping. Can do some kind of shock. Need to: 1. Id cause and reverse; 2.do what can to allow heart to rest.  3. Talked to cardio specialists  transcardiogenic shock. Do cardiac catheterization to examine vessels. If blocked, link heart to attachment and maybe insert mechanical device. Myocarditis  maybe covid. Need to act or won't survive. 7:04  Interventional cardiologists , Dr and colleague. TPA makes catheterization risky. Will only do right bek left too risky for bleeding. Dr wanted both sides. Max RX  more too much. Is unstable bek of stroke Dr thinks long-standing heart disease.( Nonsense) They asked me about CPR and I said yes. The other cardiologist recommended against bek he didn't think it would help and it is very painful for the family to watch. He was right. After the O on the monitor did not change for much too long, I stopped it.