Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Haemodialysis, Hypervolaemia, Hyponatraemia, Hypotension, Hypoxia
Clinical narrative: Pfizer Dose 1 3/13/21 (EN6207) Pfizer Dose 2 4/3/21 (ER8729) COVID Positive 1/6/22 COVID Positive 1/9/22  1/9/22: Patient is a 60-year-old morbidly obese male with past medical history significant coronary artery disease status post bypass grafting x3, essential hypertension, hyperlipidemia, pre- diabetes has come to the emergency room with complaints of worsening shortness of breath for 2 days. He reports that his stepson has symptoms and is currently being tested. He apparently started having symptoms about a week ago but in the last 2 days had worsening of symptoms. He reports having sore throat for a few days but not anymore. He had intermittent fevers, shortness of breath, cough, decreased appetite, and fatigue. He denies having any diarrhea. He denies any nausea or vomiting or headache. He apparently received his vaccination for COVID-19 with Pfizer vaccine. He reports not receiving the booster yet. Patient denies any swelling in the lower extremities. He denies any chest pain or palpitation. He reports no other acute health concerns. During the emergency room evaluation, patient was noted to 80's severely hypoxemic needing to be put on 15 L and then BiPAP with FiO2 of 70%. He did have a fever of 101°F. He is noted to be in acute kidney injury with creatinine of 2.33, mild elevation of AST at 61 and mild troponin elevation. Patient did not have any leukocytosis. Chest x-ray showed diffuse bilateral pneumonia. Patient's COVID test is pending. Influenza testing is negative. Patient is being admitted for acute hypoxemic respiratory failure likely from COVID 19 infection based on current pandemic and patient's symptoms. Since patient is needing BiPAP support patient will need to be admitted to ICU. 2/6/22: 60-year-old morbidly obese male patient with history of CAD, hypertension, type 2 diabetes, can be age, dyslipidemia new was admitted to the hospital on 1/9/2022 with complaints of shortness of breath. Patient received 2 doses of the COVID-19 vaccine but was yet to receive his booster does prior to admission. He was noted to have a pulse ox of 80% on admission and was placed on 15 L and subsequently transitioned to BiPAP.  He was also noted to have a fever of 101° F on admission. He was also noted to be in acute renal failure with metabolic acidosis, hyponatremia and volume overload and hence Nephrology consultation was obtained. Patient was admitted to the ICU for close monitoring and Dr. was consulted from pulmonology. Patient had a central line placed. Patient required hemodialysis for his renal failure caused due to acute tubular necrosis from COVID-19 infection. Patient underwent intubation within the 1st 48 hours of admission. He had elevated D-dimer level and CRP. Patient was placed on heparin drip and given a dose of Actemra also. Since he was hypotensive, pressor support was given with Levophed. Patient was initiated on tube feedings. He completed his course of antibiotics since admission. He was also noted to be in paroxysmal atrial fibrillation for which anticoagulation therapy with Eliquis was initiated. Patient was taken off of propofol after 14 days of being on ventilator. Patient was awake, responsive in an un-purposeful manner and was agitated. A long discussion with the wife with regards to the prognosis and his long-term treatment plan, tracheostomy and PEG tube placement was discussed along with the tunnel catheter placement for dialysis. The wife reluctantly agreed to the placement of the tracheostomy as she wanted the patient to be enrolled in comfort care but however the patient's kids wanted the procedure to be performed. Post tracheostomy placement, the patient remained agitated and required pressor support on and off. Dr. from pulmonology did discuss with the patient's son, and all questions were answered on 02/05. They were to make a decision about not proceeding with any further surgical interventions such as tunnel catheter placement and PEG tube placement. The patient's wife, POA decided for the patient to be DNR.  In the early hours of 2/6, the patient had wide complex tachycardia. The wife was called who did not want any further prolongation of his treatment. The patient passed away at 07:36 on 02/06/22. The family was informed.