Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Pulse absent, Pupil fixed, Renal impairment, Rheumatoid arthritis, Tobacco user
Clinical narrative: Date of Admission  01/24/2022   Date of Discharge  02/03/2022   Reason for Hospitalization   dyspnea  Hospital Course   Patient is a 76M who was initially admitted to ICU on 1/24 for acute hypoxic requiring Bipap and hypertensive urgency. Transferred back to ICU on 1/27 for acute hypoxic respiratory failure, likely secondary to aspiration.  Patient was progressively hypoxic overnight even with BiPAP noninvasive support.  He required intubation with mechanical ventilation.  Patient is currently on the ventilator setting and 99% with an FiO2 of 40% with 14 of pressure and 8 of PEEP on pressure control.  He was started on cefepime and azithromycin.  Chest x-ray showed severe diffuse bilateral opacities consistent with Covid pneumonia.  Patient's creatinine was 3.43 with a BUN of 72 on 1/28.  1/29 patient had few episodes of yellow vomitus most likely secondary to to overfeeding.  Unknown whether this was associated with aspiration.  1/28?1/30 patient's oxygen requirement has remained stable.  He output approximately 3 L from his nasogastric tube last night which resolved his abdominal distention.  Patient was taken off sedation 1/30 and we await his return of neurological status. D/t persistent AMS after being off sedation, CT head ordered 1/30 and revealed acute likely embolic infarcts. Neuro consulted. Pt's renal function is still poor despite diuresis, Cr 5 and BUN 97 1/31.  MRI brain 1/31 redemonstrated MCA infarcts at the watershed area.  MRA neck was unremarkable, MRA brain showed severe occlusion/stenosis of temporal branch of MCA artery, likely chronic.  Patient had approximately approximately 1.5 L of urine output 1/31?2/1.  Lasix drip was stopped 2/1 and patient still had approximately 1.7 L of urine output overnight.  Palliative care spoke to patient's wife and she informed them that they did not want to pursue any further invasive measures and would not want dialysis for Patient.  They expressed her desire to come to the hospital Friday to see him before they put him on comfort care. Comfort care commenced 2/3 with peaceful passing of patient.  Discharge Diagnoses      1. Contact with and (suspected) exposure to COVID-19     Other Diagnoses   Ongoing  Alcohol abuse  Benign Essential Hypertension  Chronic kidney disease (CKD), stage III (moderate)  History of anemia due to CKD  Hyperlipidemia  Metabolic acidosis  Renal osteodystrophy  Rheumatoid arthritis  Tobacco use  Historical  Alcoholism  Anemia  Arthritis  CKD stage 3  COPD (Chronic Obstructive Pulmonary Disease) Assessment Test scale  Dyslipidemia  Hypertension  Renal artery stenosis  Tobacco abuse  Consultants  Medicine Nephrology    Neurology    Supportive/Palliative Care   Discharge Disposition  Patient expired  Physical Exam at Discharge       Called to bedside to assess patient. No response to verbal, tactile, or painful stimuli.  No spontaneous breath sounds, pulses, or movements.  Pupils were fixed.  Patient was pronounced deceased on 02/03/2022 at 17:15.  Family at bedside. Autopsy offered, family declined.   Cause of death: acute hypoxic respiratory failure  Time Spent  >35 mins     Addendum by MD, on February 25, 2022 19:21:59 CST (Verified)    I personally saw and evaluated the patient on 02/03/2022?  . I reviewed the resident's documentation and agree with the resident's assessment and plan of care. I spent more than 35 minutes of critical care time in the care of this patient (excluding procedures). My personal observations are as follows:   Discharge diagnosis: Acute hypoxic respiratory failure secondary to aspiration episode  Decompensated heart failure with preserved ejection fraction  Oliguric Acute on chronic renal failure  COVID 19 infection  Ischemic stroke   MD  Clinical Assistant