Age: 35.0
Sex: M
Vaccine: COVID19
Symptoms: Accidental overdose, Acute respiratory failure, Agonal respiration, Angiogram pulmonary abnormal, Blood HIV RNA
Clinical narrative: Patient is a 36 y.o. male patient of Physician No with history of HIV, GERD, polysubstance abuse, tobacco abuse who presented with suspected overdose on 11/21/22   Acute respiratory failure with hypercarbia, hypoxia Multifactorial, including overdose, sepsis, COVID, underlying OSA Requiring NRB on admission, no baseline requirement Initial VBG with respiratory acidosis and hypercarbia Intolerant to BiPAP therapy CTA w/ multifocal PNA Aggressive pulmonary hygiene Wean O2 as able to maintain SPO2 88-92 Further management as below   Sepsis Present on admission: yes Etiology: PNA Criteria: Tachycardia, tachypnea, source Evidence of end organ damage:  Initial lactic acid: 1.0 WBC WNL, afebrile COVID-positive, flu negative Given Rocephin/azithromycin in the ED, held on admission Culture data: Blood cultures pending Vasopressors/steroids: none Small fluid bolus given in ED Monitor   Covid-19 Virus Infection Date of onset of symptoms: 11/21 Symptoms present on admission: Hypoxia Date of covid positive test: 11/21 Vaccination status: unvaccinated Imaging: CTA with bilateral interstitial infiltrates Oxygen requirements on admission: 15L NRB Medical therapy: steroids Consultants following: None Anticipated special isolation end date: 12/1   Acute toxic encephalopathy Unintentional overdose Polysubstance Use Disorder Found down by EMS w/agonal respirations Mental status improved following Narcan administration UDS + amphetamine, cannabis, fentanyl No focal neuro deficits on exam Initial CTH non-acute  CBC, CMP, UA unrevealing Delirium precuations Addiction med consult No AMA   Brugada Syndrome Likely triggered by amphetamine use EKG w/Brugada syndrome Monitor on tele Cardio consult   HIV Chronic, controlled VL indictable, CD4 >700 10/2022 Continue HARRT therapy CD4, VL pending   GERD Chronic, controlled Resume home PPI   Tobacco Use Disorder Smokes 1PPD >3 minutes spent counseling cessation NRT while hospitalized   Code Status: FULL Medication Reconciliation: Verified Residence prior to admission: homeless or homeless shelter Was patient transferred from outlying hospital or ED no  Patient woke up the next morning and left  Reason for patient leaving:    Patient did not feel like he was sick enough to require hospitalization. He was repeatedly asking staff to leave prior to my evaluation this morning. Patient's mentation had returned to baseline on my exam. He was alert and oriented x 4 and had decision making capacity. At time of exam, I reinforced that I did not think it was safe for him to be discharged given the amount of oxygen he was requiring. I told him it was unsafe for his oxygenation to be low and could results in serious bodily harm, including death. Patient verbalized understanding of this. When I asked patient if there I was anything I could do to get him to agree to stay, he replied no. Stressed importance of self isolation for covid, cessation of amphetamines and illegal drugs, return to ED with worsening shortness of breath. Notified by staff that patient had eloped this afternoon.   Patient with decision making capacity: yes--- patient alert and oriented x 4   Patient meets criteria for emergency hold: no   form signed: eloped without notifying staff   Risks have been explained to the patient: yes ?             Specific Risks:  informed patient that could result in serious bodily harm, including death    Patient's concerns addressed, questions answered and offered them care at any time if they choose to return: yes-- encouraged to return to ED with worsening shortness of breath   Recommended follow-up with outpatient care provider: yes   Additional efforts made to prevent the patient from leaving: when asked patient if there I was anything I could do to get him to agree to stay, he replied no   discharge management plan: self isolation for covid, cessation of amphetamines and illegal drugs, return to ED with worsening shortness of breath