Age: 67.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Mean cell volume normal, Mean platelet volume normal, Metabolic function test, Monocyte count, Monocyte percentage increased
Clinical narrative: 1/12/22 68 yr/o  female past medical history of anemia hypertension multiple myeloma her hematologist is Dr., she is fully vaccinated and boosted against COVID  Has been feeling badly for a few days tested positive for COVID on January 10 2 days previously, woke up this morning feeling awfully weak tired short of breath and so called EMS    Her shortness of breath limits history  EMS reports finding her satting 70% on room air tachycardic but normotensive on their arrival, but time I evaluate patient she is on nasal cannula satting in low 90s but tachypneic to the 30s  She denies chest pain ROS   Gen: Negative except as in HPI Eyes: no redness and no drainage ENT: no rhinorrhea and no congestion  ROS   CV: no murmur and no chest pain Resp: Negative except as in HPI GI: no nausea , no vomiting and no diarrhea GU: good UOP MSK: no back pain, no joint swelling, no myalgias Neuro: no weakness, no numbness, no headache Hem: no bruising and no bleeding Skin: no rash  Admit date: 1/12/2022    Discharge date and time: 1/17/2022, 5:07 PM    Discharge Diagnoses: Principal Problem:   Acute respiratory failure due to COVID-19 (CMS/HCC) (1/12/2022)   Active Problems:   Multiple Myeloma of 2016 (7/25/2016)     Hyperlipidemia (9/25/2017)     Chronic pain (5/30/2020)    Followed by palliative care service (5/30/2020)     Multiple myeloma in relapse (CMS/HCC) (1/19/2021)    Cardiomyopathy (CMS/HCC) (1/14/2022)     LV dysfunction: EF=26% (1/17/2022)     Hypotension (arterial) (1/17/2022)    Discharge Condition: deceased   Consults:  INPATIENT CONSULT TO PHARMACY IP CONSULT TO HOSPITALIST IP CONSULT TO PULMONOLOGY IP CONSULT TO CARDIOLOGY IP CONSULT TO HEMATOLOGY IP CONSULT TO PALLIATIVE CARE INPATIENT CONSULT TO PHARMACY IP CONSULT TO PALLIATIVE CARE   Hospital Course:   Acute hypoxic Resp failure Covid + Vaccinated yet compromised status - Multiple Myeloma  CTA noted  Bipap-O2 support -> intubation and Vent today  pulm tx Steroids remdesivir Empiric abx's initiated  Now on baricitinib  Check procal  Ok  Tenuous status throughout  Monitored closely - inflam markers  pulm CC followed   Hypotension  Post intubation  Pressor support -IVF's- along with Amio ->ST Wean     New Onset Sys HF -CM Elevated Trop BNP + Echo EF 26% Cards eval-mgmt  Med rx  - IV diuresis    Cards initiated Isordil ,hydralaine,  note BB allergy    Lisinopril , aldactone  Hep gtt    AKI Rising Bun/Cr Setting of diuresis Concern with possible ATN - hypotension   Hyperglycemia  -sec steroids and TF's Added Basal  SS a1c -6.6 Trend    MM Followed by hematology Asked to see Cont same - add followed by Palliative care  - ask to see apprec input   HLD Was On statin    Nut - NPO DHT-TF   DVT ppx- AC   Code Status-DNR Clinical course worsened throughout the day As above - now intubated -Required multiple pressors - Pulmonary Critical Care spoke with family - now at bedside - along with Palliative service - > family opted to pursue terminal / compassionate extubation with comfort measures- with subsequent death