text:  Cardiac arrest  His arrest was of unknown etiology at the time of admission . No further history was ever gained about his cardiac arrest throughout his hospitalization . CT angiogram had been negative for pulmonary embolism . The patient had an echocardiogram on 2013-04-26   which showed a normal ejection fraction and trivial mitral regurgitation  otherwise no obvious abnormalities were seen . Given the patient had an out of hospital arrest   remained unresponsive despite hemodynamic stability   he was treated with induced hypothermia and with cold packs and a cooling blanket were placed with goals of reducing his core body temperature to 32 degrees Celsius for a period of twelve hours at which point he would be rewarmed over the subsequent six hours . This was done   however   as in problem number two below   we were not successful in any neurologic recovery . Neurology  The patient remained unresponsive after the induced hypothermia   the patient was noticed to develop myoclonic jerks and occasional fluttering of his eyelids . Electroencephalogram revealed the patient was experiencing persistent seizure activity . Neurology was consulted and the patient was treated very aggressively   loaded with multiple drugs   including Ativan and Propofol drips . The patient continued to demonstrate seizure activity despite this . He was loaded with Dilantin and ultimately was treated with a Pentobarb coma . After multiple attempts of weaning the Pentobarb   the patient was continually reverting to status epilepticus which was never able to be suppressed . Infectious disease  Over the course of his hospital stay   the patient s white blood cell count rose to a peak of 17 . Multiple cultures were done and the patient was ultimately found to have methicillin resistant Staphylococcus aureus bacteremia   pneumonia   and urinary tract infection . For all these infections   the patient was treated with Vancomycin and he was also on Levofloxacin and Flagyl for presumed aspiration pneumonia at the time of his admission . Blood cultures cleared by 2013-05-03 . Sputum culture as late as 2013-05-10   however was still positive for coagulase positive Staphylococcus which was methicillin resistant Staphylococcus aureus . The patient remained gravely ill throughout his hospital stay and had multiple meetings were held with his family with his son being his next of kin . Ultimately it was decided that the patient s wishes would be to not be maintained in a vegetative state and given his poor prognosis ultimately the decision was made to pursue comfort measures only . With these goals of care   the patient expired on 2013-05-11 . The family did consent to a postmortem examination . DISCHARGE DIAGNOSES  Cardiac arrest . Anoxic brain injury Status epilepticus Methicillin resistant Staphylococcus aureus pneumonia . MRSA urinary tract infection . MRSA Bacteremia . Steven Welch   Montana 61528 Dictated By  Julie DD George   M.D. MEDQUIST36 D  2013-12-24 135505 T  2013-12-24 204707 Job  52892 Signed electronically by  DR. Patricia Henley on  Maxine 2014-01-02 1045 AM