Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Complication associated with device, Computerised tomogram abnormal, Computerised tomogram thorax abnormal, Dyspnoea, Electrocardiogram abnormal
Clinical narrative: Pt is a 90 year old MALE with pmhx of HTN, HLD, chronic  kidney disease Stage III who presented to ED 11/13 for worsening shortness of  breath and recent hx of hemoptysis. Patient states that he began experiencing  shortness of breath last night while sitting watching TV. He began coughing up  bright red blood per patient and witnessed by multiple family members. Denies  sputum production. Denies headaches, chest pain, abdominal pain, N/V, dysuria.  Patient was ultimately brought in to ED 11/13 for evaluation. Of note, patient  received 2 doses Pfizer Covid-19 vaccine in March/April 2021. Per CPRS records,  patient was exposed to Covid-19 shortly after Labor Day, in a group setting with  multiple family members. He tested positive for Covid-19 9/24, and was treated  at home with Regeneron c/b PE (diagnosed on 10/6, requiring hospitalization for  2 days). During 10/12-24 hostpial stay, patient presented with hypoxemia,  dyspnea, and chest/back pain 2/2 large right pneumothorax. Ultimately, he became  s/p pigtail catheter placement by IR x2 with complication of exudative right  sided pleural effusion and persistent volume loss on right side with right sided  tracheal deviation. His previous CT Chest on 10/18 and 10/16 showed  consolidative opacity in RML and RUL likely related to inflammation/fibrosis  which is causing volume loss. Patient is currently now on Eliquis 5mg BID. His  CT scan on 10/23 showed right mediastinal shift, suggestive of  inflammmation/fibrosis and blebs on right lung possibly suggestive of right lung  volume loss, and extensive chest wall emphysema in left lung. Patient ultimately  underwent follow CT scan on 11/1, which showed resolution of apical and basilar  pneumothorax, with posterior right lung concerning for infiltrates (vs. previous  fibrosis) with consistent extensive chest wall emphysema in left lung.   At admission, BP 123/74, with tachycardia (127). It was documented in ED that he  was initially at 91% pulse ox; however, very soon after, patient was found to be  satting at 55% on pulse ox, unable to give full history. Patient was placed on  NRB 15Lm ultimately satting at 97% on pulse ox. Chest x-ray at admission showed  small bilateral pleural effusions and extensive bilateral lung opacities, right  greater than left, increased since prior comparison study. CT thorax showed  enlarging, large right pleural effusion with new small left pleural effusion;  new multifocal septal thickening with groundglass opacity of both lung, highly  concerning for multifocal pneumonia, new fat stranding about the pancreas,  incompletely visualized concerning for pancreatitis. Patient noted to have a  heart rate initially 150 range; EKG showed sinus tachycardia. Patient  subsequently improved with IV fluids. However, given recent complex hx and  tenuous nature of his oxygenation after multiple attempts to deescalate his  oxygen in ED from NRB to Oxymask (patient will sat down to high 80s), patient  was admitted to ICU for stabilization and management."