Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Ankle fracture, Base excess decreased, Blood bicarbonate decreased, Blood gases, Blood glucose normal
Clinical narrative: DO   Last attending ? Treatment team        Cardiopulmonary arrest   Clinical impression        Cardiac Arrest   Chief complaint       ED Provider Notes DO (Physician) ?  Emergency Medicine        (F) - 60 y.o.  Note Creation:8/1/2022  Encounter Date:7/27/2022        History           Chief Complaint    Patient presents with    ?   Cardiac Arrest          The patient is a 60 y.o. female with hx of cervical CA, chronic anemia, COPD, GERD, and MRSA colonization who presents to the ED for evaluation of cardiac arrest that began around 8am. Pt was eating breakfast at 0745. She is currently staying at facility s/p surgery for right ankle open trimalleolar fracture on 7/11. She tested positive for covid-19 at that time. Staff states that they came back at 0809 and began chest compressions. She was asystole with EMS and they got ROSC for a few seconds, but she returned to asystole. EMS also reports that they had a palpable pulse en route but lost it before arriving to this department. Pt was shocked x1. She was intubated 6'0 22 at the lip per EMS. Her glucose was 145 in this department. Time of Death called 0913.     The history is provided by the EMS personnel, medical records and the nursing home. The history is limited by the condition of the patient.              Past Medical History:    Diagnosis   Date    ?   Cancer            cervical    ?   Chronic anemia   07/11/2022    ?   Chronic constipation        ?   Chronic diarrhea        ?   Colitis   12/05/2020    ?   Colon polyp        ?   COPD (chronic obstructive pulmonary disease)        ?   GERD (gastroesophageal reflux disease)   01/13/2011    ?   MRSA nasal colonization   07/01/2022                Past Surgical History:    Procedure   Laterality   Date    ?   ENDOSCOPY, COLON, DIAGNOSTIC            ?   HX CLOSED REDUCTION   N/A   7/11/2022        ANKLE, EXTERNAL FIXATOR performed by MD at MC MAIN OR    ?   HX COLONOSCOPY   N/A   12/9/2020        COLONOSCOPY /C POLYPECTOMY VIA SNARE(HOT) performed by MD     ?   HX CONE BIOPSY/CONIZATION (LASER ABLATION), CERVIX            ?   HX EGJ   N/A   12/7/2020        EGD /C BIOPSY performed by MD    ?   HX EGJ   N/A   7/14/2022        EGD /C ARGON PLASMA COAGULATION performed by MD    ?   HX KNEE ARTHROSCOPY            ?   HX TONSILLECTOMY            ?   LUMBAR PUNCTURE - FLUID TO LAB   N/A   12/18/2020        LUMBAR PUNCTURE - DIAGNOSTIC performed by MD   ?   PR UPPER GI ENDOSCOPY,EXAM                        Family History    Problem   Relation   Age of Onset    ?   Heart Disease   Mother        ?   Cancer   Mother                lung (smoker)    ?   Colon Cancer   Father        ?   Cancer   Father                colon, stomach    ?   Stomach Cancer   Father               Social History             Tobacco Use    ?   Smoking status:   Current Every Day Smoker            Packs/day:   1.00            Years:   30.00            Pack years:   30.00            Types:   Cigarettes    ?   Smokeless tobacco:   Never Used    Vaping Use    ?   Vaping Use:   Never used    Substance Use Topics    ?   Alcohol use:   No    ?   Drug use:   No          Patient is a tobacco user, and I have offered a counseling referral.     No LMP recorded. Patient is postmenopausal.           Allergies    Allergen   Reactions    ?   Doxycycline   Nausea Only    ?   Penicillins   Rash            Has tolerated rocephin in the past and during admission in 7/2022               Current Outpatient Medications on File Prior to Encounter    Medication   Sig    ?   sucralfate (CARAFATE) 1 gram tablet   Take 1 Tablet by mouth Before meals and at bedtime.    ?   tiotropium (SPIRIVA) 18 mcg inhalation cap   Take 1 Capsule by inhalation Once Daily.    ?   [EXPIRED] senna (SENOKOT) 8.6 mg tablet   Take 1 Tablet by mouth Once Daily for 3 days.    ?   pantoprazole (PROTONIX) 40 mg DR tablet   Take 1 Tablet by mouth Twice a day.    ?   gabapentin (NEURONTIN) 100 mg capsule   Take 1 Capsule by mouth Once Daily.    ?   HYDROcodone-acetaminophen (NORCO) 5-325 mg per tablet   Take 1 Tablet by mouth Every 6 hours.    ?   lactulose (CHRONULAC) 20 gram/30 mL solution   Take 30 mL by mouth Three times a day.    ?   metoprolol (LOPRESSOR) 25 mg tablet   Take 1 Tablet by mouth Twice a day for 30 days.    ?   ipratropium-albuteroL (DUO-NEB) 0.5 mg-3 mg(2.5 mg base)/3 mL nebulizer solution   Take 3 mL by nebulization Every 4 hours. Indications: bronchi muscle spasm resulting from COPD    ?   budesonide-glycopyr-formoterol (BREZTRI AEROSPHERE) 160-9-4.8 mcg/actuation HFAA   Take 160 mcg by inhalation Twice a day.    ?   roflumilast (DALIRESP) 250 mcg tablet   Take 1 Tablet by mouth Once Daily.    ?   umeclidinium-vilanteroL (ANORO ELLIPTA) 62.5-25 mcg/actuation DsDv   Take 1 Puff by inhalation Daily.    ?   albuterol (VENTOLIN HFA) 90 mcg/Actuation inhaler   Take 1 Puff by inhalation Every 4 hours as needed (shortness of breath, wheezing).    ?   sodium chloride 1 gram tablet   Take 1 Tablet by mouth Three times a day with meals for 30 days.    ?   leg brace (ANKLE BRACE) Misc   1 Device Daily as needed.    ?   RT OXYGEN PER DELIVERY DEVICE   2 L/min by Nasal Cannula route RT Continuous. Indications: COPD    ?   cetirizine (ZYRTEC) 10 mg tablet   Take 10 mg by mouth Daily.    ?   esomeprazole (NEXIUM) 40 mg capsule   Take 1 Cap by mouth Daily.    ?   metoclopramide HCl (REGLAN) 10 mg tablet   Take 1 Tab by mouth Twice a day.           Review of Systems       Review of Systems   Unable to perform ROS: Acuity of condition   Constitutional: Negative for fever.   Eyes: Negative for redness.   Cardiovascular: Negative for leg swelling.   Skin: Negative for pallor and rash.   Neurological: Negative for facial asymmetry.   Hematological: Negative for adenopathy. Does not bruise/bleed easily.          Physical Exam              ED Triage Vitals    BP   BP Manual or Automatic?   Patient Position   BP Location   Heart Rate (Monitor)    --   --   --   --   --         Pulse   Pulse Source   Resp   Temp   Temp src    --   --   --   --   --         SpO2   SPO2 Location   O2 Delivery   O2 Device   O2 Flow Rate (l/min)    --   --   --   --   --         FIO2 (%)   Pain Intensity 1   Exacerbated By   Relieved By   Quality    --   --   --   --   --         Duration                    --                          Physical Exam  Vitals and nursing note reviewed.  Constitutional:       General: She is in acute distress.     Appearance: She is well-developed. She is ill-appearing and toxic-appearing.     Comments: ACLS protocol in place, compressions going on arrival. Pupils fixed round 5+ non reactive. Pale appearance. Cool to touch.   HENT:      Head: Normocephalic and atraumatic.  Eyes:      Comments: Pupils fixed.   Neck:      Vascular: No JVD.     Trachea: No tracheal deviation.  Pulmonary:      Effort: No respiratory distress.     Breath sounds: No stridor. No wheezing, rhonchi or rales.  Abdominal:     General: Bowel sounds are normal. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness. There is no guarding or rebound.     Comments: Soft non distended. No ecchymosis.    Musculoskeletal:         General: No tenderness.   Skin:     General: Skin is warm.     Capillary Refill: Capillary refill takes less than 2 seconds.     Coloration: Skin is pale.  Neurological:      Mental Status: She is unresponsive.     Coordination: Coordination normal.     Comments: gcs 3T           MDM       Treatment:  Procedures      Medications    EPINEPHrine injection (1 mg Intravenous Given 7/27/22 0910)    magnesium sulfate injection ( Intravenous Canceled Entry 7/27/22 0911)    sodium bicarbonate injection (50 mEq Intravenous Given 7/27/22 0907)    atropine injection (1 mg Intravenous Given 7/27/22 0912)                Results for orders placed or performed during the hospital encounter of 07/27/22    SARS-CoV-2, QL, PCR (Rapid)        Specimen: Throat    Result   Value   Ref Range        SARS-CoV-2 RNA   Detected (A)        Rapid Tox Screen, Urine    Result   Value   Ref Range        CANNABINOID   NEGATIVE   Cutoff: 50 ng/mL        PHENCYCLIDINE   NEGATIVE   Cutoff: 25 ng/mL        COCAINE   NEGATIVE   Cutoff: 300 ng/mL        OPIATES   POSITIVE (A)   Cutoff: 300 ng/mL        FENTANYL   NEGATIVE   Cutoff: 200 ng/mL        BUPRENORPHINE   NEGATIVE   Cutoff:  5 ng/mL        AMPHETAMINES   NEGATIVE   Cutoff: 1000 ng/mL        BENZODIAZEPINE   NEGATIVE   Cutoff: 200 ng/mL        METHADONE   NEGATIVE   Cutoff: 300 ng/mL        BARBITURATES   NEGATIVE   Cutoff: 200 ng/mL        OXYCODONE   NEGATIVE   Cutoff: 300 ng/mL        PROPOXYPHENE   NEGATIVE   Cutoff: 300 ng/mL    D-Dimer, QT    Result   Value   Ref Range        D-DIMER   2,483 (HH)   151 - 318 ng/mL    Troponin I    Result   Value   Ref Range        TROPONIN I   0.14 (A)   0.00 - 0.02 ng/mL    Fingerstick Glucose    Result   Value   Ref Range        GLUCOSE FINGERSTICK   145 (H)   70 - 110 mg/dL    RT Blood Gas, Venous    Result   Value   Ref Range        PH,VENOUS   7.01 (LL)   7.32 - 7.42        PCO2,VENOUS   77 (HH)   41 - 51 mm[Hg]        PO2, VENOUS   18 (LL)   28 - 48 mm[Hg]        HCO3   13   mmol/L        BASE EXCESS   -13   mmol/L        O2 SATURATION   11   %        DRAW SITE   Other            O2 DEVICE 1   Ambu            FIO2   100.0   %    RT Potassium    Result   Value   Ref Range        RESP K   5.0   3.5 - 5.0 meq/L    RT Sodium    Result   Value   Ref Range        RESP NA   137.00   130.00 - 150.00 meq/L    RT Ionized Calcium    Result   Value   Ref Range        RESP IONIZED CALCIUM   1.23   1.10 - 1.35 meq/L    RT Lactic Acid    Result   Value   Ref Range        RESP LACTIC ACID   14.9 (HH)   0.5 - 2.2 mmol/L              Results                            XR Portable Chest (Final result)    Result time 07/27/22 10:03:41                     Final result                                         Narrative:        Medical Center                                              Radiology      PROCEDURE DATE:  07/27/2022                          ORDERING PHYS:         EXAM: Portable chest x-ray        CLINICAL INDICATION:Cardiac arrest        TECHNIQUE:Portable AP view of the chest        COMPARISON: 07/18/2022        FINDINGS:The endotracheal tube terminates 5 cm above the carina.  There is  enlargement cardiomediastinal silhouette.  There are patchy bilateral  airspace opacities, similar to comparison exam.  No pneumothorax or definite  pleural effusion.        IMPRESSION: No pneumothorax.  Similar appearance of patchy bilateral airspace  disease.  Endotracheal tube appropriately positioned.                    THIS IS AN ELECTRONICALLY VERIFIED REPORT              7/27/2022 10:00 AM:  MD        MD      DD:  07/27/2022  TD:  07/27/2022                                             Radiology  Page 1    of   1                                                          COPY                                               Plan:     RECHECK: Time of Death 0913     MDM  Number of Diagnoses or Management Options  Cardiopulmonary arrest  Diagnosis management comments: Family made aware. And coroner notified.         Amount and/or Complexity of Data Reviewed  Clinical lab tests: ordered and reviewed  Tests in the radiology: ordered and reviewed  Tests in the medicine section: ordered and reviewed  Discussion of test results with the performing providers: yes  Decide to obtain previous medical records or to obtain history from someone other than the patient: yes  Obtain history from someone other than the patient: yes  Review and summarize past medical records: yes  Discuss the patient with other providers: yes  Independent visualization of images, tracings, or specimens: yes     Risk of Complications, Morbidity, and/or Mortality  Presenting problems: moderate Diagnostic procedures: moderate Management options: moderate   Patient Progress  Patient progress: stable     DIFFERENTIAL DIAGNOSIS  Differential Diagnosis:  The following diagnoses were considered in the evaluation of this patient: cardiac arrest, sepsis, MI, PE, CVA, metabolic derangement, electrolyte disturbance and other acute pathologies. .     Progress Note: deceased. family made aware. Coroner made aware.             ED Prescriptions              None                 Final diagnoses:    Cardiopulmonary arrest                 ED Disposition                  ED Disposition    Deceased        Condition    Stable        Comment    --