Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Neurological examination abnormal, Perfusion brain scan abnormal, Pneumonia, Prone position, Pulmonary oedema
Clinical narrative: Deceased 12/4/2021; Hospitalized 11/26/2021; COVID-19 exposed unclear if test done; fully vaccinated  BRIEF OVERVIEW: Discharge Provider: MD Primary Care Physician at Discharge: MD  Admission Date: 11/26/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute right MCA stroke [I63.511] Ischemic stroke [I63.9]   HOSPITAL COURSE Patient is a 67 yo male, history of PVD, HTN, CAD, cardiomyopathy, DM, CKD, tobacco use, and recent COVID exposure, who was admitted to Medical ICU from ED for concern of stroke in the presence of COVID pneumonia. Neuro ICU was consulted for stroke. To review, patient was found unresponsive on 11/26. He was last known well on the evening of 11/25. Down time is unknown. Patient has multiple family members at home who are COVID positive. Per ED report, patient was having some cough and respiratory symptoms while at home. EMS reportedly found patient unresponsive with a right sided gaze and left sided weakness. Patient was hypoxic with O2 sat in the 60's and a respiratory rate in the 40's. On arrival to outside ED, patients exam was documented as non verbal but following commands. Patient was stroke coded at 1130 on 11/26; initial NIH 32. Stat HCT was negative for hemorrhage. Due to unknown down time, patient was outside the window for TPA. CTA shows a left cervical ICA occlusion and a incompletely occlusive right cervical ICA thrombus. No intracranial occlusions reported. CTP showed a 7 ml core and 5 ml penumbra. Patient was showing some ST elevation in V1, V2 and lead 3 concerning for STEMI. He was given rectal aspirin. Per outside report, ED physician contacted both BW cardiology and stroke neurology for recommendations. Per cardiology, did not feel this was a STEMI, no acute need for heparin gtt from cardiac standpoint at this time. Stroke neurology recommended STAT MRI brain. There was no documented discussion regarding whether or not patient's candidacy for mechanical thrombectomy was discussed. It was assumed that patient was not a candidate. Patient was satting 90% on NRB. It was ultimately decided to admit to Medical ICU and patient was intubated for airway protection.    On 11/27an MRI brain was obtained and showed right MCA and watershed territory strokes, Left MCA/ACA watershed strokes, and possible small left petechial ICH. Throughout his ICU course his pulmonary status continued to decline and he developed severe ARDS, pneumonia, and pulmonary edema. Despite maximum medical efforts, including high dose sedation, paralytics, and prone positioning, the patient failed to make significant improvement from a pulmonary standpoint. Given his poor neurological exam in conjunction with his multiple bihemispheric strokes seen on brain MRI, as well as failure to improve on the ventilator, multiple family meetiings were held to discuss goals of care. It was decided that the current level of care and anticipated poor recovery did not align with the patients prior wishes. As such, the family elected to transition him to comfort measures. After all family was able to say their goodbyes, the patient was terminally extubated on 12/4/21. He passed away with family at his bedside at 3:53PM.