Age: 66.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Pericardial effusion, Postictal state, Pulse absent, Pulseless electrical activity, Respiratory symptom
Clinical narrative: Deceased 01/10/2022; Hospitalized 01/09/2022; COVID-19 positive 01/09/2022; fully vaccinated  Discharge Provider:  MD Primary Care Physician at Discharge:  MD Admission Date: 1/9/2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Dizziness [R42] AKI (acute kidney injury) (HCC) [N17.9] Elevated brain natriuretic peptide (BNP) level [R79.89] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 67 year old female with a past medical history of NICM (EF 30%), HTN, T2DM, who presents following a syncopal episode while at home. Patient reports URI symptoms that have been ongoing for for the last week and half with an associated cough. She had decreased oral intake as well as increasing dizziness prior to presentation. She would get a room spinning sensation upon standing and noted having a witnessed LOC while at home. After falling, she was noted to have a postictal state for approximately 2-3 minutes as well as losing bladder control. Based off of this history, orthostatic hypotension in the setting of COVID-19 and seizure disorder were high in the differential. In the ED, she was noted to be hemodynamically stable and appeared well on room air. Her dizziness occurs primarily with positional changes. Orthostatic blood pressures were noted to be positive in the emergency department. Due to her fall, CT head was performed which showed no acute intracranial abnormality. CXR was obtained with no sings of vascular congestion noted. She was found to have an AKI which is likely secondary to poor oral intake in the setting of her COVID-19 infection. BNP and Troponin were noted to be elevated and cardiology was contacted to discuss the patient further. Without any chest pain, ACS was thought to be unlikely and her second troponin was found to be downtrending. Her BNP and troponin were also thought to be elevated in the setting of her acute kidney injury.   For further work up of her syncopal episode, Echocardiogram was ordered to investigate further for possible structural changes. CT chest without contrast and bilateral lower extremity ultrasound was ordered to rule out DVT and possible PE. Neurology was consulted to work up possible seizure as her cause of her LOC. EEG was ordered as well as MRI brain and MRA head and neck. Echocardiogram resulted showing poor visualization with mild left ventricular hypertrophy and moderate right ventricular systolic dysfunction.   In the evening of 1/10/2022, patient was noted to have an unwitnessed fall while attempting to go to the bathroom. Upon evaluation, the patient was noted to having diarrhea, diaphoresis with vomiting in relation to getting up from bed. Work up was beginning to occur after her fall until there was a noted significant event with a code blue being called secondary to a PEA arrest. Chest compressions were started immediately and attempts were made to obtain ROSC. The patient was intubated with her airway being secured. Echocardiogram was attempted bedside with poor visualization but there were signs of a moderate pericardial effusion noted. Cardiology was contacted who attempted a bedside pericardiocentesis without success. CPR was performed for 50mins and she continued to remain pulseless with echocardiogram showing no cardiac activity. Ultimately, Dr. called the code. Patient had a death exam performed by Dr. with time of death called at 6:08pm on 1/10/2022. Family was contacted throughout the code blue and was updated as events developed. ME was contacted who declined the case for autopsy.