Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Fibrin D dimer, Heart sounds abnormal, Hypoxia, Immunoglobulin therapy, Lung consolidation
Clinical narrative: Primary Care Physician at Discharge: DO   Hematologist/Oncologist: Dr.   Admission Date: 3/28/2023 Discharge Date: 04/07/2023 Patient's Discharge Disposition: Deceased This is a 77 y.o. year old patient who was admitted on 3/28/2023 with PMH of multiple myeloma who presented to Hospital Emergency Department with symptoms of cough and low oxygen saturations at home. She had been dealing with a productive cough for 5 days prior to arrival after going out to dinner with her friends on 3/24/23. Her friends then notified her that they were covid-19 positive. She had felt fatigued and poor appetite since. An outpatient chest xray was completed on 3/27/23 that showed patchy right greater than left interstitial and alveolar opacities. She was prescribed augmentin and azithromycin with close follow up planned. However, her daughter checked her oxygen saturations at home with a pulse oximeter and she was found to have oxygen saturations around 86-87% on room air. She did a home covid-19 test that did result positive. With the low oxygen saturations, she felt weak and dizzy when trying to walk so her daughter brought her in for evaluation.   Upon arrival to the ED, she was found to be tachycardic to 110 and hypoxic to 83% on room air. She was placed on 5L nasal cannula with improvement in her oxygen saturations. Lab work was obtained and remarkable for sodium 131, potassium 3.3, chloride 92, AST 36, and D-dimer 3650. Her left ankle has been chronically swollen for years from a prior injury, but her calf was very tender on initial evaluation so a lower extremity ultrasound was obtained. This ultrasound was negative for DVT. CTA thorax was obtained and was negative for pulmonary embolism, but did show diffuse patchy groundglass and streaky consolidative bilateral airspace opacities with somewhat peripheral distribution. Blood cultures were drawn and she was started on rocephin with azithromycin. She was weaned down to 2L nasal cannula and was admitted for further care of COVID-19 pneumonia.   The Infectious Disease team and Pulmonology teams were consulted for assistance in management of her COVID-19 pneumonia and hypoxic respiratory failure. She was treated with dexamethasone + remdesivir as well as linezolid + cefepime. She had progressively increasing oxygen requirements so PO dexamethasone was changed to IV methylprednisolone and tocilizumab. She was requiring high-flow nasal cannula with non-rebreather mask over it and putting herself into prone position to maintain oxygen saturations > 90%. Her IgG level was low so she received IVIG, however the infusion infiltrated overnight of 4/5-4/6. Her arm was initially swollen but this improved with warm compresses and elevation. On 4/7/23, she discussed her wishes with her daughter and son at the bedside. She decided she was tired and had enough so she decided to pursue comfort measures. She transitioned to comfort care with her family members at the bedside and removed her oxygen support.    Oncology provider notified of the patient appearing to have expired. Assessed patient at bedside. Patient is unresponsive to voice and nail bed pressure. Pupils are equal, dilated, and non-reactive to light. No corneal light reflex present. No visible chest rise. No heart and lung sounds via auscultation for 1 minute. No central or peripheral pulses noted.    Time of Death: 1934 on 4/7/2023