Age: 86.0
Sex: M
Vaccine: COVID19-2
Symptoms: Intensive care, Klebsiella test positive, Nausea, Oesophagogastroduodenoscopy abnormal, Oxygen saturation decreased
Clinical narrative: Admit Date: 11/2/2022  5:13 PM Discharge Date: 11/20/2022 COVID positive Date 11/2/2022   Admitting Physician: DO Attending Physician: MD,  Discharge Clinician:  MD,  Primary Care Provider at Discharge: MD  Hospital Course:  Patient is a 86 y.o. male HTN, HLD, adult acne on intermittent doxycyline therapy presented to emergency room complaining of worsening shortness of breath and dyspnea on exertion for 2 days.  Patient also had nausea, and poor oral intake besides moderate sharp substernal chest pain noted while walking in hardware store 2 days ago. Denies active chest pain.  Patient found to be hypoxic desaturating to the 80s while ambulating.    Patient tested positive for COVID.  Patient was continued on respiratory isolation.  Patient was started on dexamethasone and remdesivir.  Infectious diseases recommended discontinuing dexamethasone and remdesivir due to low cycle threshold (of 36).  Patient had persistent positive blood cultures with Enterococcus and Klebsiella bacteremia.  Patient was initially placed on IV vancomycin and IV Zosyn.  After sensitivities were available patient was transitioned to IV Zosyn.  Repeat blood cultures remained negative.  CT scan of the abdomen showed cholecystitis with possible perforation and abscess.  IR was consulted and placed image guided cholecystostomy drain.   Patient was taking aspirin 650 mg daily along with naproxen for back pain.  Patient developed multiple bloody bowel movements overnight.  CT angiogram was positive for active extravasation of contrast into the gastric body.  Gastroenterology performed EGD which found gastric and duodenal ulcers which were treated.  Gastroenterology team recommended IV Protonix for 72 hours.     Patient also had thrombocytopenia for which she received 2 units of platelets.   Developed acute drop in hemoglobin down to 5.4.  Patient was transferred to intensive care unit. He was given 6 units of PRBC, 1 unit of FFP and 1 unit of platelets. He was intubated and EGD was performed. EGD showed actively bleeding gastric ulcer and ulcer was treated with clips and epinephrine. After intubation, the patient was hypotensive and started on pressors. He was extubated after EGD. The patient has been off pressors since 11/13/22. His course was complicated by anxiety and HTN. His home blood pressure medications have been resumed. The patient was transferred out of the ICU to the hospitalist service on 11/15/2022.    Patient's hemoglobin remained stable after transfer out of intensive care unit.  Patient was continued on IV Zosyn.  Patient had elevated QTC interval.  Repeat EKG with improvement in QTC.  Infectious diseases recommended transitioning patient to oral Cipro and Augmentin to finish total 6 weeks of antibiotics until December 17th, 2022. Patient will need Infectious diseases follow-up in 2-4 weeks.  Patient complained of mild diarrhea on antibiotics which resolved by itself.   Patient had elevated blood pressures and continued to have high blood pressure despite increasing losartan.  Patient was continued on metoprolol.  Hydralazine was added for better blood pressure control.   Patient was discharged to Subacute rehab in stable condition as recommended by therapy.