Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Hyperlipidaemia, Hypoxia, Immature granulocyte count, Intensive care, Lactic acidosis
Clinical narrative: Discharge Summary Date of Service Jan-27-2022 1627  Date of Admission Admit Date: Jan-23-2022  Date of Discharge Date of discharge Jan-27-2022  Allergies Penicillins - Anaphylaxis  Niacin - Not Specified  diazePAM - Not Specified  Chief Complaint Shortness of breath  Final Diagnoses Pneumonia  Acute hypoxemic respiratory failure  Procedure(s) Performed None  Lab Results Jan-27-2022 1440 Point Of Care GLUSTX  263 Jan-27-2022 1340 Chemistry GLUCOSE  280BUN  61CREAT  6.2MDRD GFR  9NA  136K  6.4CL  103CALCIUM  7.4CO2  23.6OSMO  299.3ANION GP  15.8BUN/CRE  9.8 Jan-27-2022 1326 Point Of Care GLUSTX  253 Jan-27-2022 1230 Point Of Care GLUSTX  286 Jan-27-2022 1131 Point Of Care GLUSTX  291 Jan-27-2022 1043 Point Of Care GLUSTX  310 Jan-27-2022 0927 Point Of Care GLUSTX  325 Jan-27-2022 0737 Blood Gas PH VEN  7.240PCO2 VEN  42.2PO2 VEN  176.0BICARB V  17.6BE VEN  -8.9CO2 CT V  16.7O2 SAT V  100 Jan-27-2022 0716 Point Of Care GLUSTX  277 Jan-27-2022 0542 Point Of Care GLUSTX  293 Jan-27-2022 0450 Serology PROCALC  10.91 Jan-27-2022 0450 Hematology WBC  12.2RBC  4.01HGB  11.0HCT  37.8MCV  94.3MCH  27.4MCHC  29.1RDW  17.9RDWSD  62.5PLT  201MPV  10.8AUTONEU%  83.2AUTOLYM%  8.0AUTOMON%  7.4AUTOEOS%  0.2AUTOBAS%  0.4AUTONEU#  10.2AUTOLYM#  1.0AUTOMON#  0.9AUTOBAS#  0.1AUTOEOS#  0.0NRBC%  0.2NRBC  0.0HGB/HCT  3.4IG#  0.10IG%  0.8 Jan-27-2022 0450 Chemistry GLUCOSE  431BUN  58CREAT  5.3MDRD GFR  11NA  133K  6.2CL  101CALCIUM  7.2ALK PHOS  103CO2  22.8AST  79ALT  47AST/ALT  1.7TL PROT  6.3ALBUMIN  1.8TBILI  0.9OSMO  301.0ANION GP  15.4BUN/CRE  10.9CRP  27.10MAGNESIU  3.0 Jan-27-2022 0018 Point Of Care GLUSTX  317 Jan-26-2022 1706 Point Of Care GLUSTX  256 Jan-26-2022 0510 Serology PROCALC  6.78 Jan-26-2022 0510 Hematology WBC  11.5RBC  4.61HGB  12.6HCT  43.4MCV  94.1MCH  27.3MCHC  29.0RDW  17.8RDWSD  61.8PLT  205MPV  9.9AUTONEU%  76.7AUTOLYM%  14.0AUTOMON%  8.2AUTOEOS%  0.1AUTOBAS%  0.4AUTONEU#  8.8AUTOLYM#  1.6AUTOMON#  0.9AUTOBAS#  0.1AUTOEOS#  0.0NRBC%  0.2NRBC  0.0HGB/HCT  3.4IG#  0.07IG%  0.6 Jan-26-2022 0510 Chemistry GLUCOSE  214BUN  49CREAT  2.7MDRD GFR  24NA  146K  5.5CL  112CALCIUM  7.8ALK PHOS  119CO2  29.6AST  55ALT  41AST/ALT  1.3TL PROT  6.6ALBUMIN  1.6TBILI  0.7OSMO  309.9ANION GP  9.9BUN/CRE  18.1CRP  28.30MAGNESIU  3.2 Jan-25-2022 0500 Serology PROCALC  4.14 Jan-25-2022 0500 Hematology WBC  12.5RBC  4.85HGB  13.5HCT  44.5MCV  91.8MCH  27.8MCHC  30.3RDW  17.8RDWSD  59.8PLT  217MPV  10.1AUTONEU%  77.3AUTOLYM%  11.5AUTOMON%  9.9AUTOEOS%  0.2AUTOBAS%  0.6AUTONEU#  9.6AUTOLYM#  1.4AUTOMON#  1.2AUTOBAS#  0.1AUTOEOS#  0.0NRBC%  0.0NRBC  0.0HGB/HCT  3.3IG#  0.06IG%  0.5 Jan-25-2022 0500 Chemistry GLUCOSE  175BUN  23CREAT  1.1MDRD GFR  68NA  149K  4.9CL  113CALCIUM  8.1ALK PHOS  122CO2  26.3AST  34ALT  24AST/ALT  1.4TL PROT  6.9ALBUMIN  1.8TBILI  0.7OSMO  304.1ANION GP  14.6BUN/CRE  20.9CRP  34.30MAGNESIU  2.6 Jan-24-2022 0540 Serology PROCALC  7.64 Jan-24-2022 0540 Chemistry GLUCOSE  136BUN  24CREAT  1.0MDRD GFR  76NA  143K  4.9CL  109CALCIUM  7.8CO2  22.1OSMO  291.1ANION GP  16.8BUN/CRE  24.0LDH  532CRP  29.90FERRITIN  789 Jan-23-2022 1016 Serology PROCALC  0.40 Jan-23-2022 1016 Microbiology C BLD  No growth after 2 nights of incubation. Culture is being held for 5 nights incubation. (Preliminary) Jan-23-2022 1016 Hematology WBC  18.5RBC  5.62HGB  15.8HCT  49.1MCV  87.4MCH  28.1MCHC  32.2RDW  17.7RDWSD  54.9PLT  254MPV  10.5AUTONEU%  74.5AUTOLYM%  15.4AUTOMON%  8.6AUTOEOS%  0.4AUTOBAS%  0.5AUTONEU#  13.8AUTOLYM#  2.8AUTOMON#  1.6AUTOBAS#  0.1AUTOEOS#  0.1NRBC%  0.1NRBC  0.0HGB/HCT  3.1IG#  0.12IG%  0.6 Jan-23-2022 1016 Chemistry GLUCOSE  328BUN  15CREAT  1.2MDRD GFR  62NA  134K  5.3CL  98CALCIUM  8.3ALK PHOS  121CO2  20.2AST  28ALT  20AST/ALT  1.4TL PROT  8.0ALBUMIN  2.3TBILI  1.0OSMO  281.8ANION GP  21.1BUN/CRE  12.5TROPI  <0.017CRP  23.20PROBNP  414 Jan-23-2022 1016 Blood Gas PH  7.300PC02  37.8PO2 ART  49.0BICARB  18.1BE  -7.3CO2 CT  16.3O2 SAT  74.3O2 THER  100TYPEABG  Arterial Imaging Results Chest x-ray 01/23/2022, per official report "IMPRESSION: Interval increase in severe bilateral pulmonary opacities consistent with worsening pneumonia and concerning for COVID-19. Stable cardiomegaly. Interval intubation. Endotracheal tube tip terminates approximately 2 cm above the carina. No pneumothorax identified."  Chest x-ray 01/26/2022, per official report "IMPRESSION: Mild interval decrease in severe bilateral pulmonary opacities which are most consistent with pneumonia. "  Right lower extremity venous duplex 01/27/2022, per patient report "Conclusions No evidence for right leg DVT."  Social History tobacco use Former Smoker, Smoking Cessation Not Applicable pt quit smoking 5 yrs ago  alcohol use Beer  drug use No Known Use  marital status Divorced  occupation Former forklift operator  general comment Lives in apartment by himself.  Health Concerns Pneumonia  Former Smoker  Beer  Mother Deceased Myocardial infarction @ 41  Vital Signs Jan-27-2022 1200 T     101.8 HR 90 RR     22 BP       95  /     54  O2Sat     85 Jan-27-2022 1000 T     101 HR 91 RR     23 BP       87  /     49  O2Sat 89 Hospital Course Pt. was a 60 year old male who presented to the ED on 01/23/2022 with complaints of chest pain and shortness of breath. His medical history was significant for type 2 diabetes with left above the knee amputation, hypertension, vascular disease, and recent COVID infection requiring hospitalization (Discharged 1/09/2022).  Upon arrival to the ED he was found to have vital signs as follows: blood pressure 195/101, pulse 102, respirations 37, SpO2 of 70% on 15L non-rebreather mask. Rapid sequence intubation was subsequently performed due to his persistent hypoxia despite adequate oxygenation. His SpO2 levels improved and was admitted to the CCU under the care of the internal medicine teaching service.  He was placed on linezolid and meropenem due to concern for sepsis with concern for a bacterial pneumonia. Meropenem was discontinued on day 4 due to concern for contributing to his fever. His stay was significant for increasing oxygen requirements requiring frequent adjustments to his ventilator settings and refractory hypoxia. Throughout his stay he had a persistent fever as well as intermittent bouts of atrial fibrillation. On hospital day five Pt.'s renal function had declined to the point of anuria and continued to desaturate despite close monitoring and adjustments to his ventilator settings. Late in the afternoon on 01/27/2022, he began to display signs of pulmonary edema and persistent shock despite increasing administration of levophed and phenylephrine. An echochardiogram and EKG were ordered to assess for possible cardiac dysfunction and/or signs of right heart strain suggestive of pulmonary embolism. During the bedside echocardiogram he went into asystole and there was no heart motion on echocardiogram. Time of death was 1529.  Condition at Discharge Expired  Discharge Disposition Expired  Plan Asssessment/Plan:  -Cardiac arrest (asystole) at 1525 -Severe sepsis on admission (WBC 18.5 HR 102 RR 37 Lactate 4.3) improved with resuscitation 1.2, likely secondary to bacterial pneumonia -Acute on chronic hypoxic respiratory failure secondary to community acquired pneumonia requiring 100% FiO2.  Baseline O2 since last admission is 3L via nasal cannula.  -Acute Renal Failure with Cr 6.2, likely secondary to ATN in the setting of poor renal perfusion. -Anuria, 24 urine output 0.0 cc/kg/ HR -Acute hyperkalemia, potassium 6.2 on 01/27/2022  -Diabetes mellitus type II, unknown control, with nephropathy -Paroxysmal atrial fibrillation, currently in afib   -Lactic Acidosis. resolved with fluid resuscitation.  -Chronic hypoxic respiratory failure discharged on 3 liters of oxygen 01/09/22 -Hyperlipidemia  -Chronic obstructive pulmonary disease -History of covid tested positive 01/4/22 -Essential hypertension -History of myocardial infarction x 3 with stent placement x 6, ca. 2016-2021 -History of CVA x 3, ca. 2009-2017 -History of DVT, per patient history -History of fungal infection requiring surgical intervention -History of arterial blockage of right subclavian artery. -Peripheral vascular disease -Obesity -Left above the knee leg amputation -Hx MRSA infection  Pt.'s time of death was 1529. His body will be released to the funeral home of the family's choosing.