Age: 60.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Liver function test abnormal, Multiple organ dysfunction syndrome, Pain, Pain in extremity, Peripheral swelling
Clinical narrative: 1/7/22  60 yr/o female with a history of COPD, morbidly obese, who presents to the emergency department complaining of 2-week history of leg pain and swelling.  She states she started having swelling in her left leg about 2 weeks ago she notified her PCP and they placed her on a water pill.  She states last week she was walking from the bedroom to the kitchen with her cane and she had fallen landing on her abdomen.  She denies any injury from the fall and states the fire department had to help and come pick her up.  She states she thinks she might of fallen because of her left leg.  The pain is a sharp pain located in her left thigh that radiates down to her left.  She states she feels like her left foot is swollen She states she feels like her left foot is swollen like there is a balloon in her foot she states yesterday evening she went to get ready for bed and she felt like her left leg was "locking up" and she could not get into the bed and that her significant other had to help push her into the bed.  The pain is persistent despite attempts of relief with 50 mg tramadol.  There are no associated symptoms of chest pain, worsening shortness of breath, abdominal pain, numbness/tingling or weakness to lower extremities.  She states she has been having issues with shortness of breath for a while and that is why her PCP placed her on oxygen several months ago.      2100-patient was seen walking out of the bathroom in the back hallway with a walker.  She appeared in acute respiratory distress, tachypneic, with pursed lip breathing and was not wearing her required daily oxygen.  I brought a wheelchair and had the patient sit in the wheelchair and hooked her up to the pulse oximeter, grabbed an oxygen tank and placed her on 4 L via nasal cannula, oxygen sats were 83% on room air.  After about 10 minutes oxygen saturations maintained at 87% on 6 L and was increased to 10 L.  Patient wheeled back to the bed and was placed in the room on a monitor.  After about 2-3 minutes on 10 L her oxygen increased to 92%.  RT arrived at bedside. Patient's husband states that she has been running low on her home oxygen tanks, and that she has an issue with the insurance. He states they will only allow her to have several small oxygen tanks.  He states she was placed on the oxygen about 6 months ago due to persistent dyspnea with exertion but feels as if the oxygen is not helping. She is to wear 2L of oxygen continuously. Review of Systems  Constitutional: Negative for chills, diaphoresis, fatigue and fever.  HENT: Negative for facial swelling.   Eyes: Negative for redness.  Respiratory: Negative for cough and shortness of breath.   Cardiovascular: Negative for chest pain and leg swelling.  Gastrointestinal: Negative for abdominal pain, constipation, diarrhea, nausea and vomiting.  Genitourinary: Negative for dysuria and flank pain.  Musculoskeletal: Negative for back pain and arthralgias.       Left leg pain  Skin: Negative for pallor and rash.  Neurological: Negative for speech difficulty.  Hematological: Negative for adenopathy.  Psychiatric/Behavioral: Negative for confusion. The patient is not nervous/anxious.   1/23/22 Discharge Diagnoses/Reason for Hospitalization:  Principal Problem:   Acute respiratory failure with hypoxia  Active Problems:   Obesity hypoventilation syndrome   COPD (chronic obstructive pulmonary disease)   Hypertension     Abnormal LFTs     Left leg pain   COVID-19 PNA,   Hospital Course:     61 yo F admitted with acute respiratory failure due to COVID-19 pneumonia. Despite aggressive treatment, we reached the point of being unable to successfully oxygenate and ventilate patient, with SpO2 persistently in low 80s despite high vent settings, inhaled nitric oxide, sedatives, paralytics. She began developing multiorgan system failure due to hypoxia. Patient's long time significant other stated that patient would not want prolonged mechanical ventilation if there was no hope for recovery. Unfortunately, they were not married and she has no children. Attempted to obtain emergency guardianship for S.O. with no success, so ICU care was continued. Patient ultimately suffered cardiac arrest, ACLS was performed with no return of spontaneous circulation on 1/22/22