tokens: Admission Date: 2011-02-08 Discharge Date : 2011-02-14 Date of Birth : 1953-05-15 Sex : M Service : CMED HISTORY OF THE PRESENT ILLNESS : Briefly , this is a 57-year-old gentleman with a history of COPD , status post intubation six years ago but not on home 02 with recent FEV1 27% of predicted value , and FEV1/FVC ratio 56% of hypercholesterolemia , who was admitted for COPD exacerbation and worsening of upper respiratory tract infection symptoms for a week prior to admission . He was afebrile with stable vital signs on presentation to HOSPITAL COURSE : He was started on p.o. steroids and to CMED for management of COPD exacerbation but he appeared in more respiratory distress overnight and was started on IV Solu-Medrol and more frequent nebulizers for COPD . He was also started on antibiotics for possible bronchitis or community-acquired pneumonia . Given his tenuous respiratory status , he was transferred to the FICU with closer observation . He did not require intubation and improved with q. two hour nebulizers and chest PT . He was again transferred to the CMED Service for further management of his COPD exacerbation . He was continued on p.o. prednisone and frequent nebulizers for COPD . He was evaluated by the physical therapist in the hospital and was found to desaturate to 84% with ambulating on room air . Therefore , home 02 was recommended on discharge . DISCHARGE CONDITION : Stable . DISCHARGE STATUS : To home . DISCHARGE DIAGNOSIS : 1. Chronic obstructive pulmonary disease exacerbation . 2. Bronchitis . 3. Community-acquired pneumonia . 4. Rule out myocardial infarction . DISCHARGE MEDICATIONS : 1. Flovent two puffs b.i.d. 2. Levofloxacin 500 mg p.o. q.d. for another 11 days for a total of a 14 day course . 3. Albuterol inhaler one to two puffs q. four to six hours p.r.n. 4. Aspirin 81 mg p.o. q.d. 5. Salmeterol one to two puffs b.i.d. 6. Oxygen 2 liters nasal cannula with ambulating as needed . 7. Prednisone taper with 40 mg p.o. q.d. for two days , 30 mg p.o. q.d. for two days , 20 mg p.o. q.d. for two days , 10 mg p.o. q.d. for two days . DISCHARGE FOLLOW-UP : The patient will see his PCP in one to two weeks . The patient will also see his pulmonologist , Dr. Daniel Bell , appointment was made on discharge . John C Stalnaker , M.D. 35-693 Dictated By : Margaret BT Mahaffey , M.D. MEDQUIST36 D : 2011-02-19 10:21 T : 2011-02-21 18:42 JOB #: 74873 Signed electronically by : DR. Kate Gentry on : MON 2011-03-07 4:08 PM ( End of Report )