Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Bacterial test positive, Biopsy lung abnormal, Blood pH decreased, Bronchoalveolar lavage, Bronchoscopy
Clinical narrative: Discharge Provider: DO Primary Care Physician at Discharge: MD   Admission Date: 9/14/2022  PRESENTING PROBLEM: Cardiac arrest [I46.9]   HOSPITAL COURSE: Patient was a 60-year-old female significant for tobacco use, complex cancer history including invasive squamous cell carcinoma of the trachea, status post tracheal resection, cricoid dissection, left thyroidectomy, neck dissection, tracheal reconstruction in March 2018, status post radiation.  She was then found to have lung Mets and was treated with Keytruda 5 cycles from March to June 2019. She then was noted to have worsening lower lobe nodules and underwent carboplatin and Taxol for 6 cycles from August to November of 2019. On August 8, 2022 patient had a CT scan showing new left upper lobe mass.  Underwent CT-guided biopsy on 08/17/2022, which showed small cell cancer.  She had an IR port placement for chemotherapy on 09/08/2022.  She received 1 cycle of chemotherapy of cisplatin and etoposide.   Patient was last known well at 10:00 p.m. on 09/13/2022.  She was found unresponsive by her daughter the next morning 09/14/2022 at approximately 10:00 a.m. Daughter called EMS who arrived shortly thereafter and found the patient to be without a pulse and began chest compressions.  Patient received 6 rounds of chest compressions in total and was intubated in the field.  Noted to have pulseless electrical activity.  Patient was brought to the ER and was found to be having severe respiratory acidosis with pH of 6.9.  CT chest showed bilateral lung infiltrates and right lower lobe consolidation which was worsened from CT scan compared to 08/27/2022.  CT head was obtained and was negative for any acute intracranial process.  Patient was then transferred to the intensive care unit for PEA cardiac arrest and shock.  Upon arrival to the intensive care unit she was found to be having generalized tonic clonic seizures for which she was loaded with Keppra and started on Versed.  Neuro Intensive Care Unit was consulted.  Cardiology was consulted.  EKG was obtained showing Q-waves in the inferior leads.  Echo was obtained showing RV volume overload. RV wall motion abnormalities.  Patient was managed with post cardiac arrest care.  Differential Etiology for cardiac arrest included respiratory failure, seizures, infection, cardiac cause.   Discussion was had with patient's family at that point and her code status was made do not resuscitate. EEG was started and patient was noted to have continued seizure activity.  Neuro intensive care unit then added Dilantin and changed Versed to weight based dosing. Bronchoscopy with BAL was performed and cultures were obtained. Patient was placed on empiric antibiotic coverage.    Overnight patient's pressor requirements increased.  Patient was requiring 3 pressors.  Patient was found to be COVID positive, with BAL culture notable for many WBCs, many Gram-negative rods, few Gram-positive cocci.     Given patient's poor prognosis this morning patient's family decided to make her comfort care, with care to be withdrawn once other family members were able to come to the hospital.  Supportive measures were withdrawn at family's direction this afternoon.  Patient passed shortly thereafter.  Date of Death: 9/15/22 Time of Death:  5:51 PM Preliminary Cause of Death: Cardiac arrest