Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Lung consolidation, Mental status changes, Musculoskeletal pain, Oropharyngeal pain, Osteomyelitis
Clinical narrative: Discharge summary "HPI: Pt is a 62 YO female. Chronic health conditions include multiple ulcers HFrEF  heart block s/p BI-V AICD restrictive lung disease due to  kyphoscoliosis  asthma  HTN  HLD  GERD  . Patient presented to the ED with c/o low 02 levels, AMS, .  Patient is a poor historian and answers some questions. Pain  is  denied, but relays her "butt" hurts on occasion when she sits on it. She reports that she has had a cough and sore scratchy throat for about three days. Also she has had diarrhea. Staff report patient has had diarrhea for about a week. Patient does not walk at baseline. They also report thast today she was gray colored, her 02 level was 72% and she was not responding in conversation well. She has one more day of ATBs and is then supposed to have her PICC line removed. Her last dose of Zosyn was at 1500 today. She received all medications before 1900, including Coreg.    ED Labs/Imaging of concern: WBC 14.2  lactate 1.6  heart rate 101  blood pressure 96/41  RR 29 HGB 9.0 Glucose 153 Calcium 7.7 AST 44 Troponin 25  D-dimer 5900  CTA is shows moderate to large areas of consolidation in both lower lobes but negative for pleural effusion pulmonary embolism or pneumothorax    ED Treatments/Medications: Blood cultures drawn    HOME RX  Zosyn  albuterol Advair  simvastatin  losartan Coreg  oxybutynin  tramadol  Zanaflex  omeprazole   Assessment/Plan:   Sepsis secondary to pneumonia versus osteomyelitis (wound) versus PICC line.  Has been receiving IV antibiotic since February 2023 for osteomyelitis of ischial wound.  ID consulted was taking ceftriaxone and vancomycin changed to Zosyn for 6 weeks, tomorrow is to be the last dose.  Has infected lower back pressure wound, also has wounds to R ischium, R upper back, R heel. -continue Zosyn add Vanco PTD -consider PICC line removal and culture -received IVF, remain conservative with CHF -wound care nurse eval and treat -awaiting UA -Albuterol Q4   Anemia significant drop in hemoglobin since late February, no obvious bleeding -anemia panel -complete blood count in am -monitor for bleeding   Diarrhea has been on IV antibiotic, consider as cause.  -obtain stool for C difficile, PCR -isolation   Hypocalcemia reports having poor appetite since she had COVID and also having diarrhea -replace calcium   Elevated D-dimer etiology unclear, CTA negative for PE is in recovery from COVID over last month -U/S BLE   HFrEF does not appear to have current exacerbation, no obvious fluid overload last echo 2018 EF 45%.  Current home medications include carvedilol and losartan, continue with daily weight/strict I&O   Complete heart block s/p Bi-V AICD  last device check January 2023 battery intact, next device check scheduled for April 11 (next week).  Is followed by Dr. Awaiting interrogation report    Restrictive lung disease due to  kyphoscoliosis  continue albuterol and Advair is non-formulary with allergy to Symbicort   Asthma  continue albuterol and Advair is non-formulary with allergy to Symbicort    HTN  continue losartan and Coreg, vitals Q4   HLD  simvastatin is non formulary   GERD continue omeprazole as Protonix   DVT Prophylaxis  heparin subQ    Diet   heart healthy Activity   Q 2 turn, PT eval and treat Code Status   full code  Confirmed at bedside with A/O pt  Patient is a 62 y/o female with multiple medical comorbidities. She presented to the ED on 4/7/2023 with AMS and hypoxia. She was diagnosed with pneumonia, started on antibiotics and nebulizers and admitted to the floor. Unfortunately on 4/8/2023 Code blue was called, ROSC was achieved and patient was intubated and transferred to the ICU. Family made the decision to make the patient and DNR. She subsequently had another PEA arrest and expired on 4/8/2023 at 20:45. Family was at bedside."