Reporte zur Charge NFF8839

Symptomtext

"Patient with 3 COVID vaccines who admitted with pulmonary embolism and positive COVID PCR. Provider d/c note: ""50 year old female with PMHx significant for active cholangiocarcinoma s/p unsuccessful chemotherapy, pulmonary embolism on Lovenox, asthma, and depression who presented to the emergency department following a positive COVID-19 test the evening prior to admission. Since she had her diagnosis of a PE she has had shortness of breath but feels that it has worsened in the past week. In addition she endorses nausea, poor appetite, worsening fever, and generalized malaise x3 days. She also had a cough that has become more productive in the last 24 hours. She has not examined her sputum. Patient has recently underwent a second opinion for her cholangiocarcinoma at Clinic, and is set to begin gemcitabine, dose attenuated cisplatin, and durvalumab for further palliation. Infusion was to begin today. She recently underwent a port exchange approximately once week prior to admission, during the procedure was found to have SVC occlusion and required angioplasty. Upon arrival the patient underwent a CTA, finding a right sided pleural effusion without signs of pulmonary embolism. In addition she was found to have a consolidation in the right lower lobe concerning for pneumonia. She again tested + for COVID-19. Hospital Course: 1. CAP: from COVID-19 URI with likely supraimposed bacterial PNA. Pt initially febrile though improved. Otherwise hemodynamically stable. Urine strep/legionella Ag negative. Blood cx also negative She was started on empiric ceftriaxone/doxycycline with improvement in symptoms. She was discharged on Levaquin to complete course of abx 2. R pleural effusion: possibly related to above vs malignant effusion. Given elevated INR and lack of hypoxia thoracentesis was deferred 3. Cholangiocarcinoma: follows with Health 4. Hyponatremia: suspectd due to dehydration. Improving 5. Thrombocytopenia: likely reactive-repeat CBC in few days 6. Normocytic anemia 7. Hx PE - Continue Lovenox 8. MDD - Lexapro Issues Requiring Follow Up: - Follow up with PCP, oncology"""