Age: 75.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Large intestinal obstruction, Nausea, Pain, SARS-CoV-2 test positive, Sepsis
Clinical narrative: Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support.