Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Procalcitonin increased, Pulse absent, Pyelonephritis, Pyrexia, Renal disorder
Clinical narrative: Hospitalized 12/25/2021-still currently admitted; COVID-19 positive 12/25/2021; fully vaccinated plus booster HISTORY OF PRESENT ILLNESS:   This is a very pleasant 73-year-old woman with history of polycystic kidney disease status post renal transplant, insulin-dependent diabetes.  She she was recently hospitalized 1 week ago for E coli bacteremia secondary to pyelonephritis.  The symptoms resolved, she was discharged home on 12/21.  On 12/22 she developed upper respiratory symptoms, cough congestion.  Today she developed fever and weakness.  She had poor appetite for several days. She presented to the ER with a fever of 39.6, heart rate 113, blood pressure 110/54, 88% on room air.  She is stable on 2 L of oxygen.  Chest x-ray showed bilateral infiltrates.  Lactic acid is normal.  Urinalysis shows resolution of her prior urinary tract infection. ASSESSMENT/PLAN:  a 73 y.o. female with:  COVID 19 pneumonia Hypoxemia - discharged from hospital 12/21, developed respiratory symptoms on 12/22. - increase steroid to decadron 6mg daily - remdesivir not recommended with eGFR 18 - continuous pulse ox - check sputum culture to evaluate for possible bacterial superinfection 12/31/2021 notes: #Hemorrhagic shock #Suspected upper GI bleed Overnight, patient noted to have syncopal episode with code blue being called for loss of pulses for 7 seconds. Patient's hemoglobin 6.4 with dark red bowel movements. Concern for upper GI bleed.Our team spoke with GI who believes the patient is too unstable for the endo suite and would need to be stabilized or be in the ICU before being able to intervene. Hemorrhagic shock remained despite fluid and blood resuscitation. Reached out to MICU regarding need for vasopressor support.  -Start peripheral Levophed for pressure support -Discontinue Heparin gtt -Start protonix gtt -Patient given IVF -Given 2u PRBC -Held anti-hypertensives -CBC q6h -GI consulted -Patient will be transferred to MICU service for continued vasopressor support #Acute hypoxic respiratory failure #Pneumonia secondary to COVID-19 Currently on 4L NC, with respiratory symptoms starting 12/22. COVID+ test on 12/25.  Pulm rehab found patient to require 3L at rest and 6L with exertion.  -Increased steroids to IV Solumedrol at 40mg BID -Albuterol inhaler q4h -Repeat CXR -Continue oxygen support -Wean O2 as able, pulse ox 01/05/2022 notes: Intubated 12/31 in setting of COVID-19 pneumonia, shock due to GI bleed, requirement for EGD Current respiratory support: Device (Oxygen Therapy): ventilator GI prophylaxis: PPI infusion DVT prophylaxis: subcutaneous heparin  Plan:  SBT, assess for extubation / continue PSV as tolerated  * Pneumonia due to COVID-19 virus COVID+ test on 12/25. Assessment & Plan NO proning or paralysis Treatment No Remdesivir due to AKI on CKD Steroids (chronic prednisone 5 mg daily, held) Dexamethasone 6 mg daily 12/26 - 12/31 Methylprednisolone 40 mg IV Q12h 12/31 -  Antibiotics None Anticoagulation 12/30 doppler with left peroneal DVT Heparin gtt 12/30 - 12/31, discontinued due to hemodynamically significant GI bleed Current SCD's