Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Mechanical ventilation, Mobility decreased, Nothing by mouth order, Oxygen saturation decreased, Pain
Clinical narrative: Discharge Provider:  Primary Care Physician at Discharge: MD  Date of Death: 12/6/2022 COVID positive Date 11/29/2022 PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Pt is a 66 y.o. female who initially presented to hospital with worsening dyspnea and cough. She was found to be positive for COVID-19. She was treated with Redemsivir and steroids as well as treated with ceftriaxone and azithromycin. Then was transitioned to Levaquin when cultures were positive for Pseudomonas. Her oxygen needs were initially improving, however this morning patient had a PEA arrest. She also required multple transfusions (13). ROSC was achieved and she was transferred to heart center. On arrival patient was unstable and she went into PEA arrest twice.  When back board was placed, it was noted she had a possible retroperitoneal bleed. Due to the acuity of her condition, family decided that she would be DNR/DNI and that they would pursue comfort care once their family would all be able to gather.    Once family arrived a consensus decision was made amongst first degree relatives to pursue comfort care. These orders were initiated and patient was extubated. She passed away at 0048 on 12/6/22.  Notes from Hospital before transferred to Heart Center Discharge Provider: MD Primary Care Provider at Discharge: MD  Admission Date: 11/28/2022 Discharge Date: 12/5/2022 PRESENTING PROBLEM: Hypokalemia [E87.6] Acute on chronic respiratory failure with hypoxia (HCC) [J96.21] COVID-19 [U07.1] Pneumonia due to organism [J18.9]   HOSPITAL COURSE:    Pt is a 66 y.o. female with PMH of COPD, hypertension, chronic respiratory failure, hypertension, hyperlipidemia, OSA and morbid obesity who presented to hospital on 11/28/2022. The patient states that she has been having shortness of breath x 3 days. + coughing and subjective fevers. + chills. No nausea or diarrhea. No rhinorrhea or sore throat.    Last vaccination for COVID 19 was 4/27/2022.    Has been taking her home inhalers with no improvement in her breahting. She does not have significant shortness of breath during the interview but quickly gets short of breath even if she moves from the ER stretcher to the medsurg bed.    11/30/2022 She is feeling markedly better today.  She is still requiring high-flow oxygen.  She is coughing up some phlegm.  She has not been febrile.  She denies nausea, vomiting, diarrhea, weakness.  We did discuss that leaving early would likely require her to return.   12/01/2022 Patient did well overnight, with reduced oxygen requirements. I initially reduced Solu-medrol to prednisone, but she sat up at bedside and desaturated.  She was put back on Solu-Medrol.  CT scan was performed due to the worsening and an essentially normal chest x-ray.   12/02/2022  Breathing better today after starting percussion and up in chair. Extensive thick sputum production. Oxygen demand improved.  CT yesterday revealed: 1.  Near complete consolidation of the bilateral lower lobes with associated volume loss, likely a combination of atelectasis and airspace disease. Additional nodular consolidation in the posterior right upper lobe is likely infectious or inflammatory. Given significant risk factors for lung cancer, a follow-up chest CT after appropriate therapy is recommended to ensure resolution.  2.  Advanced emphysema.  3.  No pulmonary embolism.    12/03/2022 Coughing up excessive sputum, but breathing markedly better. Sputum positive for a few Pseudomonas. Considering the severity of her illness, will switch ceftriaxone and doxycycline to Levaquin PO.   12/04/2022 She is having sinus tachycardia. She is having abdominal pain. She refused CT abdomen/pelvis. She is breathing well. Her oxygen demand is improving. Down to 4 liters. She has not been very motivated to get out of bed.  She declined PT today as well. Likely will need SAR at discharge.     12/05/2022 Concern over continued sinus tachycardia and leukocytosis. Will decrease steroids and stop furosemide. Breathing is improving clinically. Patient's complaints are left shoulder pain and abdominal pain. She refused a CT abdomen/pelvis yesterday bc she does not feel well laying down. Also refused PT yesterday. This morning says she is in severe pain, but refuses "the donut" again. I asked if we sedated her, if she would be willing to have a CT scan and she said "absolutely not" I explained that for the second day her WBC is up and so is her heart rate, but she still refuses. When x-ray came to do KUB she said "I am not going in the donut!" Have had to treat her empirically for all options, Pantoprazole bolus 80 mg given and 40 mg IV BID. DC pepcid. Start metronidazole 500 mg IV TID. Make NPO.   A few minutes after discussing with the patient and left the ICU, a code blue was called. She was found in PEA and CPR was started. She was qqickly intubated. She received 8-9 mgs of epinephrine, 3 ampules of bicarbonate, magnesium, calcium. Her hemoglobin returned< 7 and 3 units of emergency blood was given. She received IV fluids and started on bicarbonate dripp, norepinephrine, epinephrine, and vasopressin.  She had ROSC after 20-25 minutes. She was breathing over the ventilator. CXR finally performed for ET placement. Aeromed contacted for transfer.