chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Blood creatinine increased, Blood lactic acid, COVID-19, Cardiac arrest
Clinical narrative: Patient is a 73 y.o. male patient with history of hypertension, now presented after a fall at home.  Patient became acutely hypoxic on 1/26/2023 morning.  Transferred to ICU where he developed asystole and passed away at 12:09 PM     Acute hypoxic respiratory failure PEA cardiac arrest COVID-19 infection became acutely hypoxic on 1/26/2023.  Stat chest x-ray, troponin, proBNP, lactic acid ordered Discussed with patient's wife on the phone and she confirmed that patient is DNR CCA/DNI, also reviewed docs in chart Patient developed PEA cardiac arrest at 12:09 PM on 1/26/2023   Fall, initial encounter Weakness and fatigue Failure to thrive CT head with no intracranial injury Scalp wound stapled in ER   Metastatic liver cancer Large liver mass at the hepatic hilum Cholangiocarcinoma Followed with Dr.   Acute kidney injury Likely prerenal from diarrhea Admission creatinine 1.7; baseline creatinine 0.85   Diarrhea on admission Rectal bleeding Acute infectious/inflammatory colitis of unclear etiology Cause unknown; suspect colitis of unclear etiology.  CT abdomen pelvis on admission showed nonspecific colonic wall thickening could reflect portal hypertensive colopathy, infectious/inflammatory colitis or incomplete distention   Diabetes  Hypertension   AAA Followed with Dr.    Anxiety and depression   Obesity BMI: 36.32.   History of tobacco abuse
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray, Cholangiocarcinoma, Computerised tomogram abdomen abnormal, Computerised tomogram head normal, Death
Clinical narrative: Patient is a 73 y.o. male patient with history of hypertension, now presented after a fall at home.  Patient became acutely hypoxic on 1/26/2023 morning.  Transferred to ICU where he developed asystole and passed away at 12:09 PM     Acute hypoxic respiratory failure PEA cardiac arrest COVID-19 infection became acutely hypoxic on 1/26/2023.  Stat chest x-ray, troponin, proBNP, lactic acid ordered Discussed with patient's wife on the phone and she confirmed that patient is DNR CCA/DNI, also reviewed docs in chart Patient developed PEA cardiac arrest at 12:09 PM on 1/26/2023   Fall, initial encounter Weakness and fatigue Failure to thrive CT head with no intracranial injury Scalp wound stapled in ER   Metastatic liver cancer Large liver mass at the hepatic hilum Cholangiocarcinoma Followed with Dr.   Acute kidney injury Likely prerenal from diarrhea Admission creatinine 1.7; baseline creatinine 0.85   Diarrhea on admission Rectal bleeding Acute infectious/inflammatory colitis of unclear etiology Cause unknown; suspect colitis of unclear etiology.  CT abdomen pelvis on admission showed nonspecific colonic wall thickening could reflect portal hypertensive colopathy, infectious/inflammatory colitis or incomplete distention   Diabetes  Hypertension   AAA Followed with Dr.    Anxiety and depression   Obesity BMI: 36.32.   History of tobacco abuse
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Depression, Diabetes mellitus, Diarrhoea, Fall, Fatigue
Clinical narrative: Patient is a 73 y.o. male patient with history of hypertension, now presented after a fall at home.  Patient became acutely hypoxic on 1/26/2023 morning.  Transferred to ICU where he developed asystole and passed away at 12:09 PM     Acute hypoxic respiratory failure PEA cardiac arrest COVID-19 infection became acutely hypoxic on 1/26/2023.  Stat chest x-ray, troponin, proBNP, lactic acid ordered Discussed with patient's wife on the phone and she confirmed that patient is DNR CCA/DNI, also reviewed docs in chart Patient developed PEA cardiac arrest at 12:09 PM on 1/26/2023   Fall, initial encounter Weakness and fatigue Failure to thrive CT head with no intracranial injury Scalp wound stapled in ER   Metastatic liver cancer Large liver mass at the hepatic hilum Cholangiocarcinoma Followed with Dr.   Acute kidney injury Likely prerenal from diarrhea Admission creatinine 1.7; baseline creatinine 0.85   Diarrhea on admission Rectal bleeding Acute infectious/inflammatory colitis of unclear etiology Cause unknown; suspect colitis of unclear etiology.  CT abdomen pelvis on admission showed nonspecific colonic wall thickening could reflect portal hypertensive colopathy, infectious/inflammatory colitis or incomplete distention   Diabetes  Hypertension   AAA Followed with Dr.    Anxiety and depression   Obesity BMI: 36.32.   History of tobacco abuse
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Gastrointestinal wall thickening, Hepatic cancer metastatic, Hepatic mass, Hypoxia, Intensive care
Clinical narrative: Patient is a 73 y.o. male patient with history of hypertension, now presented after a fall at home.  Patient became acutely hypoxic on 1/26/2023 morning.  Transferred to ICU where he developed asystole and passed away at 12:09 PM     Acute hypoxic respiratory failure PEA cardiac arrest COVID-19 infection became acutely hypoxic on 1/26/2023.  Stat chest x-ray, troponin, proBNP, lactic acid ordered Discussed with patient's wife on the phone and she confirmed that patient is DNR CCA/DNI, also reviewed docs in chart Patient developed PEA cardiac arrest at 12:09 PM on 1/26/2023   Fall, initial encounter Weakness and fatigue Failure to thrive CT head with no intracranial injury Scalp wound stapled in ER   Metastatic liver cancer Large liver mass at the hepatic hilum Cholangiocarcinoma Followed with Dr.   Acute kidney injury Likely prerenal from diarrhea Admission creatinine 1.7; baseline creatinine 0.85   Diarrhea on admission Rectal bleeding Acute infectious/inflammatory colitis of unclear etiology Cause unknown; suspect colitis of unclear etiology.  CT abdomen pelvis on admission showed nonspecific colonic wall thickening could reflect portal hypertensive colopathy, infectious/inflammatory colitis or incomplete distention   Diabetes  Hypertension   AAA Followed with Dr.    Anxiety and depression   Obesity BMI: 36.32.   History of tobacco abuse
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Large intestine infection, Obesity, Prohormone brain natriuretic peptide, Pulseless electrical activity, Rectal haemorrhage
Clinical narrative: Patient is a 73 y.o. male patient with history of hypertension, now presented after a fall at home.  Patient became acutely hypoxic on 1/26/2023 morning.  Transferred to ICU where he developed asystole and passed away at 12:09 PM     Acute hypoxic respiratory failure PEA cardiac arrest COVID-19 infection became acutely hypoxic on 1/26/2023.  Stat chest x-ray, troponin, proBNP, lactic acid ordered Discussed with patient's wife on the phone and she confirmed that patient is DNR CCA/DNI, also reviewed docs in chart Patient developed PEA cardiac arrest at 12:09 PM on 1/26/2023   Fall, initial encounter Weakness and fatigue Failure to thrive CT head with no intracranial injury Scalp wound stapled in ER   Metastatic liver cancer Large liver mass at the hepatic hilum Cholangiocarcinoma Followed with Dr.   Acute kidney injury Likely prerenal from diarrhea Admission creatinine 1.7; baseline creatinine 0.85   Diarrhea on admission Rectal bleeding Acute infectious/inflammatory colitis of unclear etiology Cause unknown; suspect colitis of unclear etiology.  CT abdomen pelvis on admission showed nonspecific colonic wall thickening could reflect portal hypertensive colopathy, infectious/inflammatory colitis or incomplete distention   Diabetes  Hypertension   AAA Followed with Dr.    Anxiety and depression   Obesity BMI: 36.32.   History of tobacco abuse
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Suture insertion, Troponin, Wound
Clinical narrative: Patient is a 73 y.o. male patient with history of hypertension, now presented after a fall at home.  Patient became acutely hypoxic on 1/26/2023 morning.  Transferred to ICU where he developed asystole and passed away at 12:09 PM     Acute hypoxic respiratory failure PEA cardiac arrest COVID-19 infection became acutely hypoxic on 1/26/2023.  Stat chest x-ray, troponin, proBNP, lactic acid ordered Discussed with patient's wife on the phone and she confirmed that patient is DNR CCA/DNI, also reviewed docs in chart Patient developed PEA cardiac arrest at 12:09 PM on 1/26/2023   Fall, initial encounter Weakness and fatigue Failure to thrive CT head with no intracranial injury Scalp wound stapled in ER   Metastatic liver cancer Large liver mass at the hepatic hilum Cholangiocarcinoma Followed with Dr.   Acute kidney injury Likely prerenal from diarrhea Admission creatinine 1.7; baseline creatinine 0.85   Diarrhea on admission Rectal bleeding Acute infectious/inflammatory colitis of unclear etiology Cause unknown; suspect colitis of unclear etiology.  CT abdomen pelvis on admission showed nonspecific colonic wall thickening could reflect portal hypertensive colopathy, infectious/inflammatory colitis or incomplete distention   Diabetes  Hypertension   AAA Followed with Dr.    Anxiety and depression   Obesity BMI: 36.32.   History of tobacco abuse
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Ammonia normal, Aortic stenosis, Atrial fibrillation
Clinical narrative: Patient is a 82 y.o. female patient of DO with history of hypertension hyperlipidemia, A. fib presented to a local Hospital with shortness of breath A. fib with RVR    Acute on chronic hypoxemic/hypercarbic respiratory failure  Community-acquired pneumonia ABG at the time presentation, PCO2 of 97, repeat ABG today, PCO2 58 with normal pH Abx dced on discharge. Patient was initially on BiPAP, as patient is DNR CC now, will hold off on BiPAP.   Acute on chronic diastolic heart failure Pulmonary hypertension moderate RVSP 57 proBNP 17,000 at time presentation Echocardiogram July 2022, EF 70%, severe aortic stenosis Monitor renal function closely given concomitant severe aortic stenosis   A-fib with RVR Continue with p.o. amiodarone, p.o. metoprolol Continue Xarelto   Encephalopathy, likely metabolic, improving CT head no acute intracranial abnormality Normal ammonia Likely secondary to respiratory acidosis   Acute kidney injury,  Monitor renal function daily Consider transition to p.o. Lasix   Moderate to severe aortic stenosis Echo in August reviewed?EF 70%.  Diastolic function indeterminate. Functionally bicuspid AV.  There is moderate to severe aortic valve stenosis, V-max 3.3 m/s, mean gradient 27 mmHg, AVA by continuity 1.0 cm2, dimensionless index 0.32, planimetry 1.0 cm2 Diuresis as above   Goals of care: Patient was listed as DNR CCA and DNI, patient has been on BiPAP for 2 days.  Patient remains in A-fib with RVR.  Goals of care discussed with patient, patient upon entering the room states that she does not want to live and wants to die and be comfortable.  Also discussed with patient's son over the phone regarding patient services and son agrees that those were her wishes and patient should be transitioned to DNR CC and hospice has been consulted. Patient is being discharged to hospice.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Blood gases abnormal, Blood pH normal, Cardiac failure acute, Computerised tomogram head abnormal, Condition aggravated
Clinical narrative: Patient is a 82 y.o. female patient of DO with history of hypertension hyperlipidemia, A. fib presented to a local Hospital with shortness of breath A. fib with RVR    Acute on chronic hypoxemic/hypercarbic respiratory failure  Community-acquired pneumonia ABG at the time presentation, PCO2 of 97, repeat ABG today, PCO2 58 with normal pH Abx dced on discharge. Patient was initially on BiPAP, as patient is DNR CC now, will hold off on BiPAP.   Acute on chronic diastolic heart failure Pulmonary hypertension moderate RVSP 57 proBNP 17,000 at time presentation Echocardiogram July 2022, EF 70%, severe aortic stenosis Monitor renal function closely given concomitant severe aortic stenosis   A-fib with RVR Continue with p.o. amiodarone, p.o. metoprolol Continue Xarelto   Encephalopathy, likely metabolic, improving CT head no acute intracranial abnormality Normal ammonia Likely secondary to respiratory acidosis   Acute kidney injury,  Monitor renal function daily Consider transition to p.o. Lasix   Moderate to severe aortic stenosis Echo in August reviewed?EF 70%.  Diastolic function indeterminate. Functionally bicuspid AV.  There is moderate to severe aortic valve stenosis, V-max 3.3 m/s, mean gradient 27 mmHg, AVA by continuity 1.0 cm2, dimensionless index 0.32, planimetry 1.0 cm2 Diuresis as above   Goals of care: Patient was listed as DNR CCA and DNI, patient has been on BiPAP for 2 days.  Patient remains in A-fib with RVR.  Goals of care discussed with patient, patient upon entering the room states that she does not want to live and wants to die and be comfortable.  Also discussed with patient's son over the phone regarding patient services and son agrees that those were her wishes and patient should be transitioned to DNR CC and hospice has been consulted. Patient is being discharged to hospice.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Echocardiogram abnormal, Ejection fraction normal, Left ventricular failure, Metabolic encephalopathy
Clinical narrative: Patient is a 82 y.o. female patient of DO with history of hypertension hyperlipidemia, A. fib presented to a local Hospital with shortness of breath A. fib with RVR    Acute on chronic hypoxemic/hypercarbic respiratory failure  Community-acquired pneumonia ABG at the time presentation, PCO2 of 97, repeat ABG today, PCO2 58 with normal pH Abx dced on discharge. Patient was initially on BiPAP, as patient is DNR CC now, will hold off on BiPAP.   Acute on chronic diastolic heart failure Pulmonary hypertension moderate RVSP 57 proBNP 17,000 at time presentation Echocardiogram July 2022, EF 70%, severe aortic stenosis Monitor renal function closely given concomitant severe aortic stenosis   A-fib with RVR Continue with p.o. amiodarone, p.o. metoprolol Continue Xarelto   Encephalopathy, likely metabolic, improving CT head no acute intracranial abnormality Normal ammonia Likely secondary to respiratory acidosis   Acute kidney injury,  Monitor renal function daily Consider transition to p.o. Lasix   Moderate to severe aortic stenosis Echo in August reviewed?EF 70%.  Diastolic function indeterminate. Functionally bicuspid AV.  There is moderate to severe aortic valve stenosis, V-max 3.3 m/s, mean gradient 27 mmHg, AVA by continuity 1.0 cm2, dimensionless index 0.32, planimetry 1.0 cm2 Diuresis as above   Goals of care: Patient was listed as DNR CCA and DNI, patient has been on BiPAP for 2 days.  Patient remains in A-fib with RVR.  Goals of care discussed with patient, patient upon entering the room states that she does not want to live and wants to die and be comfortable.  Also discussed with patient's son over the phone regarding patient services and son agrees that those were her wishes and patient should be transitioned to DNR CC and hospice has been consulted. Patient is being discharged to hospice.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: PCO2 increased, Pneumonia, Positive airway pressure therapy, Prohormone brain natriuretic peptide increased, Pulmonary hypertension
Clinical narrative: Patient is a 82 y.o. female patient of DO with history of hypertension hyperlipidemia, A. fib presented to a local Hospital with shortness of breath A. fib with RVR    Acute on chronic hypoxemic/hypercarbic respiratory failure  Community-acquired pneumonia ABG at the time presentation, PCO2 of 97, repeat ABG today, PCO2 58 with normal pH Abx dced on discharge. Patient was initially on BiPAP, as patient is DNR CC now, will hold off on BiPAP.   Acute on chronic diastolic heart failure Pulmonary hypertension moderate RVSP 57 proBNP 17,000 at time presentation Echocardiogram July 2022, EF 70%, severe aortic stenosis Monitor renal function closely given concomitant severe aortic stenosis   A-fib with RVR Continue with p.o. amiodarone, p.o. metoprolol Continue Xarelto   Encephalopathy, likely metabolic, improving CT head no acute intracranial abnormality Normal ammonia Likely secondary to respiratory acidosis   Acute kidney injury,  Monitor renal function daily Consider transition to p.o. Lasix   Moderate to severe aortic stenosis Echo in August reviewed?EF 70%.  Diastolic function indeterminate. Functionally bicuspid AV.  There is moderate to severe aortic valve stenosis, V-max 3.3 m/s, mean gradient 27 mmHg, AVA by continuity 1.0 cm2, dimensionless index 0.32, planimetry 1.0 cm2 Diuresis as above   Goals of care: Patient was listed as DNR CCA and DNI, patient has been on BiPAP for 2 days.  Patient remains in A-fib with RVR.  Goals of care discussed with patient, patient upon entering the room states that she does not want to live and wants to die and be comfortable.  Also discussed with patient's son over the phone regarding patient services and son agrees that those were her wishes and patient should be transitioned to DNR CC and hospice has been consulted. Patient is being discharged to hospice.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Respiratory acidosis, Respiratory failure
Clinical narrative: Patient is a 82 y.o. female patient of DO with history of hypertension hyperlipidemia, A. fib presented to a local Hospital with shortness of breath A. fib with RVR    Acute on chronic hypoxemic/hypercarbic respiratory failure  Community-acquired pneumonia ABG at the time presentation, PCO2 of 97, repeat ABG today, PCO2 58 with normal pH Abx dced on discharge. Patient was initially on BiPAP, as patient is DNR CC now, will hold off on BiPAP.   Acute on chronic diastolic heart failure Pulmonary hypertension moderate RVSP 57 proBNP 17,000 at time presentation Echocardiogram July 2022, EF 70%, severe aortic stenosis Monitor renal function closely given concomitant severe aortic stenosis   A-fib with RVR Continue with p.o. amiodarone, p.o. metoprolol Continue Xarelto   Encephalopathy, likely metabolic, improving CT head no acute intracranial abnormality Normal ammonia Likely secondary to respiratory acidosis   Acute kidney injury,  Monitor renal function daily Consider transition to p.o. Lasix   Moderate to severe aortic stenosis Echo in August reviewed?EF 70%.  Diastolic function indeterminate. Functionally bicuspid AV.  There is moderate to severe aortic valve stenosis, V-max 3.3 m/s, mean gradient 27 mmHg, AVA by continuity 1.0 cm2, dimensionless index 0.32, planimetry 1.0 cm2 Diuresis as above   Goals of care: Patient was listed as DNR CCA and DNI, patient has been on BiPAP for 2 days.  Patient remains in A-fib with RVR.  Goals of care discussed with patient, patient upon entering the room states that she does not want to live and wants to die and be comfortable.  Also discussed with patient's son over the phone regarding patient services and son agrees that those were her wishes and patient should be transitioned to DNR CC and hospice has been consulted. Patient is being discharged to hospice.
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood creatinine increased, Blood glucose increased, Blood potassium increased, Blood urea increased
Clinical narrative: The patient is a 72 y.o. female with history of CAD with prior PCI, CKD stage IV, uncontrolled IDDM, HTN, chronic diastolic HFpEF, HLD, peripheral artery disease, depression, overactive bladder, obesity, dementia, presented to the Medical Center with shortness of breath with exertion found to be COVID-positive on 1/24/2023.   Acute respiratory failure with hypoxia Multifocal PNA Due to COVID pneumonia, difficult to rule out secondary bacterial pneumonia but lack of leukocytosis and low PCT suggest against Small effusions on CT chest in addition to multifocal airspace disease, suggests some volume component but otherwise appears euvolemic Doubt bacterial pneumonia and UTI has been treated, no need to continue levaquin on discharge (completed 4d inpatient) See below re COVID Respiratory failure resolved, ok for discharge   Covid-19 Virus Infection CRP: 140 (1/24) Date of onset of symptoms: Circa 1/18/23 Symptoms present on admission: DOE, hypoxemia Date of covid positive test: 1/24/23 Vaccination status: vaccinated and boosted Imaging:  Cxr (1/24/23) Multifocal consolidation  CT chest same date multifocal consolidation and small-mod pleural eff b/l Baseline oxygen: None Oxygen requirements on admission: 4 liters NC Current oxygen requirements: 94% RA Medical therapy: dexamethasone, not eligible for remdesivir (CKD) Consultants following: ID Anticipated special isolation end date: 2/3/23   CAD S/P PCI HLD Troponin T: Undetected, EKG NSR without ST elevation or depression or T wave TTE 10/2020 EF 55-6% Moderate concentric LVH. Normal RV size and function.  Appeared mildly fluid overloaded on admission, now appears euvolemic Diuresis as below Resuming toprol 50 mg bid, norvasc 10 mg daily, hyralazine 100 mg TID with hold parameters Continue aspirin 81 mg daily, Atorvastatin 40 mg daily   HTN Resuming Norvasc 10 mg daily, Toprol 50 mg twice daily, hydralazine 100 mg 3 times daily   CKD Stage IV Hyperkalemia Adm K: 5.7, BUN: 68, Cr: 2.66, GFR: 19 (baseline Cr: 2.6, GFR: 21) Cr up to 3.1 after initial diuresis and resuming home torsemide Cr down to 2.7, resumed torsemide once daily (home dose twice daily) Can resume home diuretic regimen on discharge IDDMT2 Steroid induced hyperglycemia Adm Glucose: 323 A1c: 9.5 (12/29/22), EAG: 226-- on lantus 60u HS and novolog SSI Check blood sugars ac & HS; still running high Lantus to 45u BID, humalog 5/5/5 with meals and normal sensitivity SSI here Control improved Will be off steroids at discharge, resume home regimen on discharge   ESBL UTI Dx 1/20/23, w/ dysuria Discontinued cipro on 1/25, started levaquin until 1/28 for UTI  Completed course of treatment C/s ID; appreciated
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal
Clinical narrative: The patient is a 72 y.o. female with history of CAD with prior PCI, CKD stage IV, uncontrolled IDDM, HTN, chronic diastolic HFpEF, HLD, peripheral artery disease, depression, overactive bladder, obesity, dementia, presented to the Medical Center with shortness of breath with exertion found to be COVID-positive on 1/24/2023.   Acute respiratory failure with hypoxia Multifocal PNA Due to COVID pneumonia, difficult to rule out secondary bacterial pneumonia but lack of leukocytosis and low PCT suggest against Small effusions on CT chest in addition to multifocal airspace disease, suggests some volume component but otherwise appears euvolemic Doubt bacterial pneumonia and UTI has been treated, no need to continue levaquin on discharge (completed 4d inpatient) See below re COVID Respiratory failure resolved, ok for discharge   Covid-19 Virus Infection CRP: 140 (1/24) Date of onset of symptoms: Circa 1/18/23 Symptoms present on admission: DOE, hypoxemia Date of covid positive test: 1/24/23 Vaccination status: vaccinated and boosted Imaging:  Cxr (1/24/23) Multifocal consolidation  CT chest same date multifocal consolidation and small-mod pleural eff b/l Baseline oxygen: None Oxygen requirements on admission: 4 liters NC Current oxygen requirements: 94% RA Medical therapy: dexamethasone, not eligible for remdesivir (CKD) Consultants following: ID Anticipated special isolation end date: 2/3/23   CAD S/P PCI HLD Troponin T: Undetected, EKG NSR without ST elevation or depression or T wave TTE 10/2020 EF 55-6% Moderate concentric LVH. Normal RV size and function.  Appeared mildly fluid overloaded on admission, now appears euvolemic Diuresis as below Resuming toprol 50 mg bid, norvasc 10 mg daily, hyralazine 100 mg TID with hold parameters Continue aspirin 81 mg daily, Atorvastatin 40 mg daily   HTN Resuming Norvasc 10 mg daily, Toprol 50 mg twice daily, hydralazine 100 mg 3 times daily   CKD Stage IV Hyperkalemia Adm K: 5.7, BUN: 68, Cr: 2.66, GFR: 19 (baseline Cr: 2.6, GFR: 21) Cr up to 3.1 after initial diuresis and resuming home torsemide Cr down to 2.7, resumed torsemide once daily (home dose twice daily) Can resume home diuretic regimen on discharge IDDMT2 Steroid induced hyperglycemia Adm Glucose: 323 A1c: 9.5 (12/29/22), EAG: 226-- on lantus 60u HS and novolog SSI Check blood sugars ac & HS; still running high Lantus to 45u BID, humalog 5/5/5 with meals and normal sensitivity SSI here Control improved Will be off steroids at discharge, resume home regimen on discharge   ESBL UTI Dx 1/20/23, w/ dysuria Discontinued cipro on 1/25, started levaquin until 1/28 for UTI  Completed course of treatment C/s ID; appreciated
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Diuretic therapy, Dyspnoea exertional, Dysuria, Echocardiogram abnormal, Ejection fraction normal
Clinical narrative: The patient is a 72 y.o. female with history of CAD with prior PCI, CKD stage IV, uncontrolled IDDM, HTN, chronic diastolic HFpEF, HLD, peripheral artery disease, depression, overactive bladder, obesity, dementia, presented to the Medical Center with shortness of breath with exertion found to be COVID-positive on 1/24/2023.   Acute respiratory failure with hypoxia Multifocal PNA Due to COVID pneumonia, difficult to rule out secondary bacterial pneumonia but lack of leukocytosis and low PCT suggest against Small effusions on CT chest in addition to multifocal airspace disease, suggests some volume component but otherwise appears euvolemic Doubt bacterial pneumonia and UTI has been treated, no need to continue levaquin on discharge (completed 4d inpatient) See below re COVID Respiratory failure resolved, ok for discharge   Covid-19 Virus Infection CRP: 140 (1/24) Date of onset of symptoms: Circa 1/18/23 Symptoms present on admission: DOE, hypoxemia Date of covid positive test: 1/24/23 Vaccination status: vaccinated and boosted Imaging:  Cxr (1/24/23) Multifocal consolidation  CT chest same date multifocal consolidation and small-mod pleural eff b/l Baseline oxygen: None Oxygen requirements on admission: 4 liters NC Current oxygen requirements: 94% RA Medical therapy: dexamethasone, not eligible for remdesivir (CKD) Consultants following: ID Anticipated special isolation end date: 2/3/23   CAD S/P PCI HLD Troponin T: Undetected, EKG NSR without ST elevation or depression or T wave TTE 10/2020 EF 55-6% Moderate concentric LVH. Normal RV size and function.  Appeared mildly fluid overloaded on admission, now appears euvolemic Diuresis as below Resuming toprol 50 mg bid, norvasc 10 mg daily, hyralazine 100 mg TID with hold parameters Continue aspirin 81 mg daily, Atorvastatin 40 mg daily   HTN Resuming Norvasc 10 mg daily, Toprol 50 mg twice daily, hydralazine 100 mg 3 times daily   CKD Stage IV Hyperkalemia Adm K: 5.7, BUN: 68, Cr: 2.66, GFR: 19 (baseline Cr: 2.6, GFR: 21) Cr up to 3.1 after initial diuresis and resuming home torsemide Cr down to 2.7, resumed torsemide once daily (home dose twice daily) Can resume home diuretic regimen on discharge IDDMT2 Steroid induced hyperglycemia Adm Glucose: 323 A1c: 9.5 (12/29/22), EAG: 226-- on lantus 60u HS and novolog SSI Check blood sugars ac & HS; still running high Lantus to 45u BID, humalog 5/5/5 with meals and normal sensitivity SSI here Control improved Will be off steroids at discharge, resume home regimen on discharge   ESBL UTI Dx 1/20/23, w/ dysuria Discontinued cipro on 1/25, started levaquin until 1/28 for UTI  Completed course of treatment C/s ID; appreciated
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram normal, Glomerular filtration rate decreased, Glycosylated haemoglobin increased, Hyperglycaemia, Hypervolaemia
Clinical narrative: The patient is a 72 y.o. female with history of CAD with prior PCI, CKD stage IV, uncontrolled IDDM, HTN, chronic diastolic HFpEF, HLD, peripheral artery disease, depression, overactive bladder, obesity, dementia, presented to the Medical Center with shortness of breath with exertion found to be COVID-positive on 1/24/2023.   Acute respiratory failure with hypoxia Multifocal PNA Due to COVID pneumonia, difficult to rule out secondary bacterial pneumonia but lack of leukocytosis and low PCT suggest against Small effusions on CT chest in addition to multifocal airspace disease, suggests some volume component but otherwise appears euvolemic Doubt bacterial pneumonia and UTI has been treated, no need to continue levaquin on discharge (completed 4d inpatient) See below re COVID Respiratory failure resolved, ok for discharge   Covid-19 Virus Infection CRP: 140 (1/24) Date of onset of symptoms: Circa 1/18/23 Symptoms present on admission: DOE, hypoxemia Date of covid positive test: 1/24/23 Vaccination status: vaccinated and boosted Imaging:  Cxr (1/24/23) Multifocal consolidation  CT chest same date multifocal consolidation and small-mod pleural eff b/l Baseline oxygen: None Oxygen requirements on admission: 4 liters NC Current oxygen requirements: 94% RA Medical therapy: dexamethasone, not eligible for remdesivir (CKD) Consultants following: ID Anticipated special isolation end date: 2/3/23   CAD S/P PCI HLD Troponin T: Undetected, EKG NSR without ST elevation or depression or T wave TTE 10/2020 EF 55-6% Moderate concentric LVH. Normal RV size and function.  Appeared mildly fluid overloaded on admission, now appears euvolemic Diuresis as below Resuming toprol 50 mg bid, norvasc 10 mg daily, hyralazine 100 mg TID with hold parameters Continue aspirin 81 mg daily, Atorvastatin 40 mg daily   HTN Resuming Norvasc 10 mg daily, Toprol 50 mg twice daily, hydralazine 100 mg 3 times daily   CKD Stage IV Hyperkalemia Adm K: 5.7, BUN: 68, Cr: 2.66, GFR: 19 (baseline Cr: 2.6, GFR: 21) Cr up to 3.1 after initial diuresis and resuming home torsemide Cr down to 2.7, resumed torsemide once daily (home dose twice daily) Can resume home diuretic regimen on discharge IDDMT2 Steroid induced hyperglycemia Adm Glucose: 323 A1c: 9.5 (12/29/22), EAG: 226-- on lantus 60u HS and novolog SSI Check blood sugars ac & HS; still running high Lantus to 45u BID, humalog 5/5/5 with meals and normal sensitivity SSI here Control improved Will be off steroids at discharge, resume home regimen on discharge   ESBL UTI Dx 1/20/23, w/ dysuria Discontinued cipro on 1/25, started levaquin until 1/28 for UTI  Completed course of treatment C/s ID; appreciated
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Left ventricular hypertrophy, Lung consolidation, Lung disorder, Malaise, Pleural effusion
Clinical narrative: The patient is a 72 y.o. female with history of CAD with prior PCI, CKD stage IV, uncontrolled IDDM, HTN, chronic diastolic HFpEF, HLD, peripheral artery disease, depression, overactive bladder, obesity, dementia, presented to the Medical Center with shortness of breath with exertion found to be COVID-positive on 1/24/2023.   Acute respiratory failure with hypoxia Multifocal PNA Due to COVID pneumonia, difficult to rule out secondary bacterial pneumonia but lack of leukocytosis and low PCT suggest against Small effusions on CT chest in addition to multifocal airspace disease, suggests some volume component but otherwise appears euvolemic Doubt bacterial pneumonia and UTI has been treated, no need to continue levaquin on discharge (completed 4d inpatient) See below re COVID Respiratory failure resolved, ok for discharge   Covid-19 Virus Infection CRP: 140 (1/24) Date of onset of symptoms: Circa 1/18/23 Symptoms present on admission: DOE, hypoxemia Date of covid positive test: 1/24/23 Vaccination status: vaccinated and boosted Imaging:  Cxr (1/24/23) Multifocal consolidation  CT chest same date multifocal consolidation and small-mod pleural eff b/l Baseline oxygen: None Oxygen requirements on admission: 4 liters NC Current oxygen requirements: 94% RA Medical therapy: dexamethasone, not eligible for remdesivir (CKD) Consultants following: ID Anticipated special isolation end date: 2/3/23   CAD S/P PCI HLD Troponin T: Undetected, EKG NSR without ST elevation or depression or T wave TTE 10/2020 EF 55-6% Moderate concentric LVH. Normal RV size and function.  Appeared mildly fluid overloaded on admission, now appears euvolemic Diuresis as below Resuming toprol 50 mg bid, norvasc 10 mg daily, hyralazine 100 mg TID with hold parameters Continue aspirin 81 mg daily, Atorvastatin 40 mg daily   HTN Resuming Norvasc 10 mg daily, Toprol 50 mg twice daily, hydralazine 100 mg 3 times daily   CKD Stage IV Hyperkalemia Adm K: 5.7, BUN: 68, Cr: 2.66, GFR: 19 (baseline Cr: 2.6, GFR: 21) Cr up to 3.1 after initial diuresis and resuming home torsemide Cr down to 2.7, resumed torsemide once daily (home dose twice daily) Can resume home diuretic regimen on discharge IDDMT2 Steroid induced hyperglycemia Adm Glucose: 323 A1c: 9.5 (12/29/22), EAG: 226-- on lantus 60u HS and novolog SSI Check blood sugars ac & HS; still running high Lantus to 45u BID, humalog 5/5/5 with meals and normal sensitivity SSI here Control improved Will be off steroids at discharge, resume home regimen on discharge   ESBL UTI Dx 1/20/23, w/ dysuria Discontinued cipro on 1/25, started levaquin until 1/28 for UTI  Completed course of treatment C/s ID; appreciated
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Pneumonia, SARS-CoV-2 test positive, Troponin T, Urinary tract infection, Urinary tract infection enterococcal
Clinical narrative: The patient is a 72 y.o. female with history of CAD with prior PCI, CKD stage IV, uncontrolled IDDM, HTN, chronic diastolic HFpEF, HLD, peripheral artery disease, depression, overactive bladder, obesity, dementia, presented to the Medical Center with shortness of breath with exertion found to be COVID-positive on 1/24/2023.   Acute respiratory failure with hypoxia Multifocal PNA Due to COVID pneumonia, difficult to rule out secondary bacterial pneumonia but lack of leukocytosis and low PCT suggest against Small effusions on CT chest in addition to multifocal airspace disease, suggests some volume component but otherwise appears euvolemic Doubt bacterial pneumonia and UTI has been treated, no need to continue levaquin on discharge (completed 4d inpatient) See below re COVID Respiratory failure resolved, ok for discharge   Covid-19 Virus Infection CRP: 140 (1/24) Date of onset of symptoms: Circa 1/18/23 Symptoms present on admission: DOE, hypoxemia Date of covid positive test: 1/24/23 Vaccination status: vaccinated and boosted Imaging:  Cxr (1/24/23) Multifocal consolidation  CT chest same date multifocal consolidation and small-mod pleural eff b/l Baseline oxygen: None Oxygen requirements on admission: 4 liters NC Current oxygen requirements: 94% RA Medical therapy: dexamethasone, not eligible for remdesivir (CKD) Consultants following: ID Anticipated special isolation end date: 2/3/23   CAD S/P PCI HLD Troponin T: Undetected, EKG NSR without ST elevation or depression or T wave TTE 10/2020 EF 55-6% Moderate concentric LVH. Normal RV size and function.  Appeared mildly fluid overloaded on admission, now appears euvolemic Diuresis as below Resuming toprol 50 mg bid, norvasc 10 mg daily, hyralazine 100 mg TID with hold parameters Continue aspirin 81 mg daily, Atorvastatin 40 mg daily   HTN Resuming Norvasc 10 mg daily, Toprol 50 mg twice daily, hydralazine 100 mg 3 times daily   CKD Stage IV Hyperkalemia Adm K: 5.7, BUN: 68, Cr: 2.66, GFR: 19 (baseline Cr: 2.6, GFR: 21) Cr up to 3.1 after initial diuresis and resuming home torsemide Cr down to 2.7, resumed torsemide once daily (home dose twice daily) Can resume home diuretic regimen on discharge IDDMT2 Steroid induced hyperglycemia Adm Glucose: 323 A1c: 9.5 (12/29/22), EAG: 226-- on lantus 60u HS and novolog SSI Check blood sugars ac & HS; still running high Lantus to 45u BID, humalog 5/5/5 with meals and normal sensitivity SSI here Control improved Will be off steroids at discharge, resume home regimen on discharge   ESBL UTI Dx 1/20/23, w/ dysuria Discontinued cipro on 1/25, started levaquin until 1/28 for UTI  Completed course of treatment C/s ID; appreciated
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray, Death, Endotracheal intubation
Clinical narrative: given vaccine on 11/29/2022.  Tested positive for COVID with symptoms on 12/11/2022.  Respiratory decline on 12/19/2022 and intubated on 12/20/2022.  Hospitalized including ICU intubation from 12/20/2022-12/29/2022.  He released back to the nursing home with again respiratory decline on 01/16/2023 and hospitalized on 01/19/2023-01/26/2023 diagnosed with COVID pneumonia.  he did not improve during these dates and thus was discharged back to the nursing home on 01/26/2023 with hospice.  He expired 02/09/2023.
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Intensive care, Laboratory test, Malaise, Respiratory disorder, SARS-CoV-2 test positive
Clinical narrative: given vaccine on 11/29/2022.  Tested positive for COVID with symptoms on 12/11/2022.  Respiratory decline on 12/19/2022 and intubated on 12/20/2022.  Hospitalized including ICU intubation from 12/20/2022-12/29/2022.  He released back to the nursing home with again respiratory decline on 01/16/2023 and hospitalized on 01/19/2023-01/26/2023 diagnosed with COVID pneumonia.  he did not improve during these dates and thus was discharged back to the nursing home on 01/26/2023 with hospice.  He expired 02/09/2023.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Alport's syndrome, Atrioventricular block first degree, Blood creatinine increased, Blood potassium increased
Clinical narrative: Assessment and Plan:  45 year old female (pronouns he/him) with a history of ESRD secondary to Alport syndrome, HTN, HLD, chronic pain, and chronic ulcer who presents with cardiac arrest in setting of hyperkalemia.  Hospital course complicated by COVID and cdiff.  Currently on minimal vent settings but mental status precludes extubation.  Neurology following for evaluation of anoxic brain injury with poor prognosis.       Acute Respiratory Failure Secondary to cardiac arrest, now also with COVID and pulmonary infiltrates, further plan as below Continue vent support Pulm/CC consulted and continue care per critical care team Palliative care following Transitioned to DNRCC and compassionate extubation on 1/20 and patient expired   Anoxic Encephalopathy Anoxic Brain injury Refractory Status Epilepticus  Secondary to cardiac arrest as below CT head non-acute EEG consistent with global cerebral dysfunction Non-epileptiform seizures well controlled on propofol and versed gtt Elevated neuron specific enolase indicative of significant neurologic injury Neurology followed: continue Keppra, cEEG MRI 1/6: diffuse anoxic brain injury without evidence of significant mass effect, midline shift or acute intracranial hemorrhage Poor prognosis for neurological recovery.   Palliative care follows, DNR CCA DNI Transition to comfort care only   Cardiac Arrest Low suspicion for primary cardiac event Admission EKG sinus w/ 1st degree AV block, prolonged Qtc Echo: EF 53%, mild AS, mild TR Cardiology signed off, no further recommendations Telemetry Pulmonary Infiltrates Fevers Noted on imaging: chronic fibrosis vs infectious infiltrates Urine antigens negative Completed rocephin, on ancef for chronic wound infection Further recs per critical care   COVID Vent management as above S/p IV decadron for 10 day course Now out of isolation   Cdiff Completed Vanc through tube Remains on contact precautions    UTI E. Coli +1/2 Continue antibiotics  Was on ancef   ESRD  Alport Syndrome Hyperkalemia Cr 4.2, at baseline, K 6.4 on admission, now improved Secondary to Alports syndrome MWF dialysis, started on midodrine, initiate epogen with HD sessions Neph continued to follow
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Brain injury, COVID-19, Cardiac arrest, Cerebral disorder, Clostridium difficile infection
Clinical narrative: Assessment and Plan:  45 year old female (pronouns he/him) with a history of ESRD secondary to Alport syndrome, HTN, HLD, chronic pain, and chronic ulcer who presents with cardiac arrest in setting of hyperkalemia.  Hospital course complicated by COVID and cdiff.  Currently on minimal vent settings but mental status precludes extubation.  Neurology following for evaluation of anoxic brain injury with poor prognosis.       Acute Respiratory Failure Secondary to cardiac arrest, now also with COVID and pulmonary infiltrates, further plan as below Continue vent support Pulm/CC consulted and continue care per critical care team Palliative care following Transitioned to DNRCC and compassionate extubation on 1/20 and patient expired   Anoxic Encephalopathy Anoxic Brain injury Refractory Status Epilepticus  Secondary to cardiac arrest as below CT head non-acute EEG consistent with global cerebral dysfunction Non-epileptiform seizures well controlled on propofol and versed gtt Elevated neuron specific enolase indicative of significant neurologic injury Neurology followed: continue Keppra, cEEG MRI 1/6: diffuse anoxic brain injury without evidence of significant mass effect, midline shift or acute intracranial hemorrhage Poor prognosis for neurological recovery.   Palliative care follows, DNR CCA DNI Transition to comfort care only   Cardiac Arrest Low suspicion for primary cardiac event Admission EKG sinus w/ 1st degree AV block, prolonged Qtc Echo: EF 53%, mild AS, mild TR Cardiology signed off, no further recommendations Telemetry Pulmonary Infiltrates Fevers Noted on imaging: chronic fibrosis vs infectious infiltrates Urine antigens negative Completed rocephin, on ancef for chronic wound infection Further recs per critical care   COVID Vent management as above S/p IV decadron for 10 day course Now out of isolation   Cdiff Completed Vanc through tube Remains on contact precautions    UTI E. Coli +1/2 Continue antibiotics  Was on ancef   ESRD  Alport Syndrome Hyperkalemia Cr 4.2, at baseline, K 6.4 on admission, now improved Secondary to Alports syndrome MWF dialysis, started on midodrine, initiate epogen with HD sessions Neph continued to follow
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram head normal, Condition aggravated, Death, Echocardiogram abnormal, Ejection fraction decreased
Clinical narrative: Assessment and Plan:  45 year old female (pronouns he/him) with a history of ESRD secondary to Alport syndrome, HTN, HLD, chronic pain, and chronic ulcer who presents with cardiac arrest in setting of hyperkalemia.  Hospital course complicated by COVID and cdiff.  Currently on minimal vent settings but mental status precludes extubation.  Neurology following for evaluation of anoxic brain injury with poor prognosis.       Acute Respiratory Failure Secondary to cardiac arrest, now also with COVID and pulmonary infiltrates, further plan as below Continue vent support Pulm/CC consulted and continue care per critical care team Palliative care following Transitioned to DNRCC and compassionate extubation on 1/20 and patient expired   Anoxic Encephalopathy Anoxic Brain injury Refractory Status Epilepticus  Secondary to cardiac arrest as below CT head non-acute EEG consistent with global cerebral dysfunction Non-epileptiform seizures well controlled on propofol and versed gtt Elevated neuron specific enolase indicative of significant neurologic injury Neurology followed: continue Keppra, cEEG MRI 1/6: diffuse anoxic brain injury without evidence of significant mass effect, midline shift or acute intracranial hemorrhage Poor prognosis for neurological recovery.   Palliative care follows, DNR CCA DNI Transition to comfort care only   Cardiac Arrest Low suspicion for primary cardiac event Admission EKG sinus w/ 1st degree AV block, prolonged Qtc Echo: EF 53%, mild AS, mild TR Cardiology signed off, no further recommendations Telemetry Pulmonary Infiltrates Fevers Noted on imaging: chronic fibrosis vs infectious infiltrates Urine antigens negative Completed rocephin, on ancef for chronic wound infection Further recs per critical care   COVID Vent management as above S/p IV decadron for 10 day course Now out of isolation   Cdiff Completed Vanc through tube Remains on contact precautions    UTI E. Coli +1/2 Continue antibiotics  Was on ancef   ESRD  Alport Syndrome Hyperkalemia Cr 4.2, at baseline, K 6.4 on admission, now improved Secondary to Alports syndrome MWF dialysis, started on midodrine, initiate epogen with HD sessions Neph continued to follow
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram QT prolonged, Electrocardiogram abnormal, Electroencephalogram abnormal, Escherichia test positive, Fibrosis
Clinical narrative: Assessment and Plan:  45 year old female (pronouns he/him) with a history of ESRD secondary to Alport syndrome, HTN, HLD, chronic pain, and chronic ulcer who presents with cardiac arrest in setting of hyperkalemia.  Hospital course complicated by COVID and cdiff.  Currently on minimal vent settings but mental status precludes extubation.  Neurology following for evaluation of anoxic brain injury with poor prognosis.       Acute Respiratory Failure Secondary to cardiac arrest, now also with COVID and pulmonary infiltrates, further plan as below Continue vent support Pulm/CC consulted and continue care per critical care team Palliative care following Transitioned to DNRCC and compassionate extubation on 1/20 and patient expired   Anoxic Encephalopathy Anoxic Brain injury Refractory Status Epilepticus  Secondary to cardiac arrest as below CT head non-acute EEG consistent with global cerebral dysfunction Non-epileptiform seizures well controlled on propofol and versed gtt Elevated neuron specific enolase indicative of significant neurologic injury Neurology followed: continue Keppra, cEEG MRI 1/6: diffuse anoxic brain injury without evidence of significant mass effect, midline shift or acute intracranial hemorrhage Poor prognosis for neurological recovery.   Palliative care follows, DNR CCA DNI Transition to comfort care only   Cardiac Arrest Low suspicion for primary cardiac event Admission EKG sinus w/ 1st degree AV block, prolonged Qtc Echo: EF 53%, mild AS, mild TR Cardiology signed off, no further recommendations Telemetry Pulmonary Infiltrates Fevers Noted on imaging: chronic fibrosis vs infectious infiltrates Urine antigens negative Completed rocephin, on ancef for chronic wound infection Further recs per critical care   COVID Vent management as above S/p IV decadron for 10 day course Now out of isolation   Cdiff Completed Vanc through tube Remains on contact precautions    UTI E. Coli +1/2 Continue antibiotics  Was on ancef   ESRD  Alport Syndrome Hyperkalemia Cr 4.2, at baseline, K 6.4 on admission, now improved Secondary to Alports syndrome MWF dialysis, started on midodrine, initiate epogen with HD sessions Neph continued to follow