Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: Procalcitonin, Pulmonary oedema, Purulent discharge, Radiotherapy, Respiratory failure
Clinical narrative: Patient is a 52 years old female patient of MD with history of asthma, hypertension, peripheral artery disease, renal artery stenosis, non-small cell lung cancer with metastasis to the brain s/p craniotomy, atrial fibrillation presented to  Hospital with abdominal pain. Pt found to have a perforated diverticulitis of the sigmoid colon. Initially IR placed drain, f/u showed possible fistula so sigmoidectomy with colostomy done on 6/8 Hospital stay complicated with AFib with RVR, fluid overload and respiratory failure.   Acute hypoxic respiratory failure  COVID 19 pneumonia  Bronchospasm, likely d/t pulmonary edema  Metastatic NSCLC Noted increased oxygen require Noted increased oxygen requirements since yesterday, has been on diuresis CXR 6/11 with b/l pleural effusions, LL opacities, possible pulmonary edema Afebrile, HR 140s, normotensive, on 20L HHF @ 100% FiO2  CTPA negative for acute PE.   Procal not suggestive of infection.  MRSA probe negative.  Sputum culture with normal flora. Resp PCR + COVID19  Lasix decreased to daily.  Started on decadron 6mg daily x10d   Continues on supplemental oxygen, discharged on 4L NC.  Change abx to levaquin (completed prolonged course of zosyn for intraabdominal pathology).  Discharge with 7d supply   Acute sigmoid diverticulitis with perforation and Abscess s/p hemicolectomy and colostomy on 6/8 CT scan of the abdomen and pelvis 5/27 interval development of generalized small bowel wall thickening with surrounding free fluid.   Repeat CT Abdomen/pelvis 5/30/23 noted Organized abscess likely secondary to acute sigmoid diverticulitis.  CT-guided drain placed via a right transgluteal approach on 6/1. Ongoing foul smelling purulent drainage.  Culture with heavy growth Candida albicans and heavy normal enteric flora, unclear clinical significance of candida albicans.  Repeat CT abd 6/5 placement of catheter in the air fluid collection in the pelvis, now contains mostly air and some debris in its dependent portion.  This might have a fistulous connection to the sigmoid colon.  Dr performed sigmoid colectomy with colostomy, wash out of pelvic abscess with stools 6/8. Pain controlled, bowel sounds +, liquid ostomy output,   Tolerating diet, progress J drain removed (6/11)   Acute pain Ongoing issue, medication has bene changing often. Palliative team following   Insomnia  Cont Trazodone to 150 mg scheduled with melatonin 10 mg scheduled.   Doxepin added per order   Paroxysmal Atrial fibrillation/flutter, occasional RVR  Patient was initially diagnosed for anticoagulation was held at the time due to metastatic lung disease with metastasis to the brain. Cardiology following, started on PO and  IV amiodarone, now  PO only.  Echocardiogram Left ventricular systolic function is normal, EF 60 +/- 5%. Discussed with cardiology and neurology, no anticoagulation recommended until seen by neurosurgery due to brain mets.  Pulmonary edema- resolved Pt noted to be in AFib again  (6/2) with rate controlled at ~80, now NSR again.    Hyponatremia, resolved    Hypertension essential Resume norvasc at reduced dose and continue metoprolol    Cerebral metastatic tumor History of non-small cell lung cancer with metastasis to the brain, currently on chemo and radiation therapy. Outpatient follow-up with medical oncologist to discuss systemic therapy including chemotherapy immunotherapy. Postop radiation therapy with Dr S/p Right posterior fossa craniectomy for resection of tumor with neuronavigation and placement of external ventricular drain 5/10/2023. Pending initiation of palliative chemotherapy