Age: 58.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Arterial stenosis, COVID-19 pneumonia, Cardiac arrest
Clinical narrative: Discharged. Per ICU Course: " Patient is a 59-year-old female with a history of chronic obstructive pulmonary disease, coronary artery disease who presented to the emergency department on 01/14 with approximately 2 weeks of chest pain and shortness of breath.  She was found to have increasing oxygen requirements, likely secondary to chronic obstructive pulmonary disease exacerbation with overlying COVID pneumonia.  During workup in the emergency department patient had abrupt decompensation during which she desaturated and required intubation and 1 round of CPR before obtaining ROSC.  At that point patient was placed on pressors for persistent hypotension post cardiac arrest and admitted to the medical intensive care unit intubated and sedated for further care of acute hypoxic respiratory failure.  Patient was treated for COVID pneumonia and chronic obstructive pulmonary disease exacerbation, pressors and sedation or slowly weaned.  Patient was able to be extubated on 01/16 and has been stable on 6 L nasal cannula since that time, she is on 2.5 L at baseline.  She was initially found to have elevated troponins in the 200s, however there were stable and thought to be likely secondary to cardiac arrest.  She had an abrupt elevation of her troponins on 1/16 with continued ST depressions in the lateral leads most notably V4 through V6, cardiology was consulted at this time for further evaluation.  Patient remained hemodynamically stable off pressors and sedation, continued to maintain oxygen saturation above 95% on 6 L nasal cannula, and was improving from symptomatic standpoint.  Cardiology has requested left heart catheterization some point during hospitalization although this is not urgent at this time.  She is no longer requiring intensive care unit level of care secondary to no need for further pressors or respiratory support."  Post ICU Care:   - she continued to do well post extubation. She was able to wean off of her oxygen and she was placed on oral steroid taper. Cardiology did left heart cath with successful PCI with DES to proximal right posterior lateral branch. She was started on brillinta and eliquis after cath. She was started on metoprolol and lisinopril at lower dose than at home.  Her oxygen saturation improved and she was at her baseline 2-3 liters of oxygen and 4 liters with exertion.   She was also given prescription for norco as she was having rib pain following chest compression.   Report from controlled medication registry has been reviewed.  This patient will be prescribed an opioid analgesic at discharge. I have discussed the risks of taking this type of medication. This includes the risk of substance use disorder, addiction, overdose, and mixing with other sedating medications. For female patients of child bearing age I reviewed the risks of taking these medications while pregnant. I also reviewed the safe disposal of opioids and the fact that it is a felony to distribute these medications without a prescription. A "Start Talking" form will be signed by the patient at discharge.