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This 42 year old gentleman was admitted on January 7 and expired on January 15. He was admitted with progressive tachycardia, hemoptysis, and dyspnea. Please see his admission history and physical exam for details.
Hospital course: the patient’s hospital course was characterized by a progressively downhill course. He was initially hospitalized and found to be mildly hypoxic, which rapidly corrected to his supplemental low- flow oxygen therapy however, he gradually became more oxygen dependent on high flow oxygen, eventually requiring intubation with mechanical ventilation in order to maintain his oxygenation. He underwent an open lung biopsy in an attempt to delineate etiology of his pulmonary situation, and this was recorded as idiopathic pulmonary fibrosis and alveolitis. This specimen was sent to the Forest General Pathology Department for further evaluation and they were able to give no further help concerning the ideology of his pulmonary status. An echocardiogram showed left ventricular wall motion hypokinesia and an injection fraction of approx. 35%.
Dr. J.K. Mc Clain and other members of the cardiology department consulted on the patient. They felt that his hypoxia and breathlessness were not secondary to his cardiac status. He had supraventricular cardiac arrhythmias, including atrial fibrillation and atrial flutter. The cardiology staff utilized intravenous medications that controlled the cardiac rate, adequately resolving these cardiac issues. I managed the patient’s ventilator in intensive care status along with my respiratory therapy team. Unfortunately the patient developed multiple infections, hospital acquired, including Klebsiella pneumonia infection and probable fungemia.