Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Asthenia
Clinical narrative: Document Type: History and Physical   Document Subject: History & Physical Note   Performed By: DO on February 13, 2023 07:40   Verified By: DO on February 13, 2023 07:40   Encounter Info: Hospital, Inpatient, 02/12/23 -     * Final Report *        Chief Complaint   syncope/loc  History of Present Illness/Subjective     This is a 71-year-old female with a history of diabetes, COPD, chronic arthritis, hypertension, obesity, breast cancer who presents after syncopal episode.  Husband states that she has been generally weak, has had a cough, and has been feeling short of breath for about 2 days.  Home COVID test prior to arrival was positive.  This evening, the patient was using her lift chair going from a lying to an upright position when she had a syncopal episode.  She endorses dizziness prior to passing out.  She denies any symptoms currently including abdominal pain, increased back pain above baseline, chest pain, or headache.  She did not fall to the floor or hit head.   In the ED workup revealed hypercapnia, cxr suggest possible aspiration pneumonia vs pneumonitis, ua shows likely UTI, covid test was +, lactate was elevated, and she had an AKI. With fluid administration lactate normalized, and aki improved overnight.  This patient is critically ill due to metabolic, hemodynamic and/or respiratory instability. They require high complexity evaluation, decision making, and care. They require ICU level of care and monitoring due to high risk of clinical decompensation with high risk of morbidity and mortality. Critical care time includes, but is not limited to, bedside assessment, review of medical record, radiographic and laboratory results, ventilator and/or respiratory management, review of ekg and/or cardiac monitoring, critical decision making, coordination of care with consultants and/or care team, and documentation of critical intervention/plans, and consultation with patient and/or family. Time excludes any procedural time.  I spent greater than 60 minutes in the evaluation and management of this patient with more than 50% of the time spent counseling and/or coordinating care.  I counseled the patient and/or family about the findings, differential diagnoses, my assessment, recommendations, and plan.  I coordinated care with the multidisciplinary healthcare team.  Review of Systems     A complete, 13-system review was performed and was negative except for as noted in the HPI.  Physical Exam/Objective  Vital Signs (most recent and range for last 24 hours)  Temp (CEL) 36.5 (36.5-36.5)  Temp (FAHR) 97.7 (97.7-97.7), BP 129/55 (104-152)/(44-93), HR 51 (51-77), RR 20 (13-20), O2Sat 95 (92-95) Neurologic (most recent and range for last 24 hours)  GCS 14(14-15)     Patient Weight  Current Daily Weight:    119.6 kg    02/13/23  Previous Daily Weight:    119.6 kg    02/13/23  BMI:    43.9    02/13/23    Morbid Obesity (BMI > = 40) Patient Height        Constitutional: Alert. _no acute distress, well-nourished.  Chronically ill-appearing, obese  Eye: PERRLA, EOMI, normal conjunctiva, visually fixates and follows  HENT: Normocephalic and atraumatic. External ears normal bilaterally, oral mucosa moist, no pharyngeal erythema. Normal nose.  Neck: Supple, no lymphadenopathy. Normal ROM. No meningismus.  Respiratory: Coarse bilaterally with bibasilar crackles.  Mild respiratory distress.  Ventimask in place.  Breath sounds are equal, symmetrical chest wall expansion.  Cardiovascular: Sinus bradycardia, no murmur, no gallop, good pulses equal in all extremities, normal peripheral perfusion, no edema  Genitourinary: Deferred  Gastrointestinal: Soft, non-tender, non-distended, normal bowel sounds, no organomegaly, no masses  Lymphatics: No lymphadenopathy  Musculoskeletal: Normal range of motion, normal strength, no tenderness, no swelling, no deformity, normal gait, spine straight. No TTP to TL spine.  Integumentary: Warm, dry, intact, no rashes. Capillary refill < 3 seconds  Neurologic: Alert. Oriented to person, place, and time. Moves all 4 extremities and follows commands. Gross motor function and sensation intact in all 4 extremitis. No gross focal deficits  Psychiatric: Cooperative, appropriate mood and affect    Assessment/Plan       1. Sepsis   A41.9     2. Hypercapnic respiratory failure   J96.92     3. COVID   U07.1     4. Pneumonia   J18.9     5. Syncope   R55     6. UTI (urinary tract infection)   N39.0  -admit to ICU for new bipap therapy  -likely 2/2 uti and or pneumonia as well as covid.  -follow cx, adjust abx prn, will cover for both uti and cap with rocephin doxy  -begin dexamethasone  -resp assessment, svns  -obtain inflammatory markers  -trend lactate until it normalizes  -trend wbc and procal to monitor response  -will not start remdesivir in view of aki  -supplemental O2  -bipap prn  -serial vbg  -syncope most likely 2/2 orthostatic hypotension given the severity of her dehydration when she arrived  -obtain echo to rule out alternative causes of syncope  -maintain telemetry     Gastro-esophageal reflux disease without esophagitis   K21.9  cont home meds   Ordered:   pantoprazole, 40 mg, Orally, Tab, Delayed Rel, Daily, 02/13/23 9:00:00      Generalized osteoarthritis of multiple sites   M15.9  cont home meds   Ordered:   gabapentin, 300 mg, Orally, Capsule, 4 Times Daily, 02/13/23 9:00:00      Orders:   acetaminophen, 650 mg, Orally, Tablet, Q4H, PRN, Pain, Mild PO (1-3 out of 10)/Fever, 02/12/23 23:49:00   albuterol, 2 Puff, Inhalation, Aerosol, MDI/DPI Inhaler Treatment, Q4H, PRN, Dyspnea, 02/13/23 2:05:00   albuterol, 2.5 mg, Neb Inhal, Inhalation SOLN, Aerosol Treatment, Q6H, PRN, Wheezing, 02/13/23 0:36:00, RT Care Assessment and Protocol per Policy  albuterol, 2.5 mg, Neb Inhal, Inhalation SOLN, Aerosol Treatment, Q4H, PRN, Dyspnea, 02/13/23 2:04:00, RT Care Assessment and Protocol per Policy  allopurinol, 100 mg, Orally, Tablet, Daily, 02/13/23 9:00:00   aspirin, 81 mg, Orally, Tab, Chewable, Daily, 02/13/23 9:00:00   atorvastatin, 40 mg, Orally, Tablet, At Bedtime, 02/13/23 21:00:00   carvedilol, 6.25 mg, Orally, Tablet, BID, 02/13/23 9:00:00   ceftRIAXone, 1 GM, IVPB, Injection, Q24H, Indication: UTI, 02/13/23 0:00:00, 100 mL/hr, Infuse Over 30 minutes, Total Volume (mL) = 50  dexamethasone, 6 mg, IV Push, Injection, Q24H, NOW, 02/12/23 23:49:00, for 10 Days, 02/21/23 23:49:00  Dextrose 10% in Water 500 mL, Total Volume (mL) = 500, IV, 02/12/23 23:49:00, PRN - See Comments, Clinical Weight  docusate, 100 mg, Orally, Capsule, BID, 02/13/23 9:00:00   doxycycline, 100 mg, Orally, Capsule, Q12, Indication: Pneumonia - CAP, 02/13/23 10:00:00   fentaNYL, 1 Patch, Topical, Patch, Q72H, 02/13/23 1:00:00  fluticasone-vilanterol, 1 Puff, Inhalation, Aerosol Powder, MDI/DPI Inhaler Treatment, Daily, 02/13/23 9:00:00  glucagon, 1 mg, IM, Injection, Unscheduled, PRN, Hypoglycemia, 02/12/23 23:49:00  glucose, Per Glucose Level, IV Push, Injection, Unscheduled, PRN, Low Blood Sugar, 02/12/23 23:49:00   heparin, 5,000 Units, Subcutaneous, Injection, Q8H, Routine, 02/13/23 0:00:00   insulin lispro, Sliding Scale, Subcutaneous, Injection, With Glucose Testing, PRN, Serum Glucose, 02/12/23 23:49:00   Lactated Ringers 1,000 mL, Total Volume (mL) = 1,000, IV, 02/12/23 23:49:00, 60 mL/hr, Clinical Weight  leveTIRACetam, 250 mg, Orally, Tablet, BID, 02/13/23 9:00:00  ondansetron, 4 mg, IV Push, Injection, Q6H, PRN, Nausea/Vomiting IV - Use First, 02/12/23 23:49:00   OXYcodone-acetaminophen, 1 Tablet, Orally, Tablet, Q4H, PRN, Pain, Moderate to Severe, 02/13/23 1:30:00   rOPINIRole, 0.25 mg, Orally, Tablet, TID, 02/13/23 9:00:00   sacubitril-valsartan, 4 Tablet, Orally, Tablet, BID, 02/13/23 9:00:00   Sodium Chloride 0.9% 500 mL, Total Volume (mL) = 500, IV, 02/12/23 23:50:00, Other - See Comments, Clinical Weight  spironolactone, 25 mg, Orally, Tablet, Daily, 02/13/23 9:00:00  tiZANidine, 4 mg, Orally, Tablet, At Bedtime, 02/13/23 21:00:00  torsemide, 20 mg, Orally, Tablet, Daily, 02/13/23 9:00:00   umeclidinium, 1 Puff, Inhalation, Aerosol Powder, MDI/DPI Inhaler Treatment, Daily, 02/13/23 9:00:00   180 gm Carb per day Diet  Admit to Inpatient CAH  Auto Diff  Basic Metabolic Panel  BIPAP Intermittent  Bladder Scan  Call (Specify)  Call Blood Glucose  Call Diastolic Blood Pressure  Call Heart Rate  Call Mental Status Changes  Call O2 Saturation  Call Oxygen Need Greater Than  Call Respiratory Distress  Call Respiratory Rate  Call Systolic Blood Pressure  Call Temperature  Call Urine Output  CBC w/Differential  CBC w/Differential  CK SerPl QN  CRP SerPl QN  D-Dimer Pl QN  Fall Precautions  Ferritin SerPl QN  Fluid Intake Requirement  Gluc-Strip POC  Initiate IV Care Protocols As Appropriate  Initiate Mobility Protocol  Initiate Oxygen Protocol  Initiate Respiratory Protocol  Initiate Skin and Wound Care Protocol  Intake + Output Strict  Interleukin 6 QN  L pneumophila Ag Ur QL  LDH SerPl QN  Level of Care  Lipid Panel SerPl QN  Magnesium SerPl QN  Medical Service  Medication Message to Nursing  Message to Nursing  Message to Nursing  No NSAIDS (includes COX-2 Inhibitors)  Notify Provider  Notify Provider  Notify Provider  Peripheral IV Insertion  Reason for Not Ordering Long-acting Insulin  Resp CX + Stn  Resp Evaluation or Assessment  Resuscitation Status  Sequential Compression Device  Single Oxygen Saturation  Strep pneumoniae Ag Urine  Telemetry Class III 24hr Recommendation  Vital Signs  Weight   Code Status   Resuscitation Status - Ordered    -- 02/12/23 23:49:00, Full Code   Chronic Problem List    Allergic asthma  Arthralgia  Diabetes mellitus with neurological manifestation  Family history of breast cancer  Foot callus  History of cardiomyopathy in adulthood  Hyperlipidemia  Hypertension  Low back pain  Lymphedema  Morbid obesity  NASH (nonalcoholic steatohepatitis)  Onychomycosis  Osteoarthritis  Personal history of breast cancer  Spondylosis of cervical spine  Tongue lesion  Use of opiates for therapeutic purposes  Procedure/Surgical History  ?Diabetic retinal eye exam (06/20/2022) ?Bone density scan (09/18/2017) ?Cholecystectomy (11/27/2008) ?Carpal tunnel decompression ?Colonoscopy ?Heel spur ?Hip ?Hysterectomy ?Knee replacement ?Mastectomy ?Right shoulder ?Umbilical hernia     Medications   Home Medications (27) Active  acetaminophen 650 mg, PRN, Orally, BID  albuterol 2.5 mg/3 mL (0.083%) inhalation solution 2.5 mg = 3 mL, PRN, Neb Inhal, Q6H  allopurinol 100 mg oral tablet 100 mg = 1 Tablet, Orally, Daily  aspirin 81 mg oral tablet, chewable 81 mg = 1 Tablet, Orally, Daily  atorvastatin 40 mg oral tablet 40 mg = 1 Tablet, Orally, At Bedtime  Blood Glucose Meter Not Applicable, Other, Unscheduled, DX E11.9One Touch Meter  Blood Glucose Test Strips Check one time daily, Other, Unscheduled, One Touch strips  E11.65, not on insulin, testing one a day, fax   carvedilol 6.25 mg oral tablet 6.25 mg = 1 Tablet, Orally, BID, stop metoprolol and change to coreg 6.25mg.  DME Nebulizer Machine w/ Supplies Not Applicable, Other, Unscheduled  Entresto 97 mg-103 mg oral tablet 1 Tablet, Orally, BID  fentaNYL 50 mCg/hr transdermal film, extended release 1 Patch, Topical, Q72H  Lancets Check one time daily, Other, Unscheduled, Sunmark True Metrix lancets E11.65, fax, not on insulin, testing once a day  leveTIRACetam 250 mg oral tablet 250 mg = 1 Tablet, Orally, BID  metFORMIN 1000 mg oral tablet 1,000 mg = 1 Tablet, Orally, BID, E11.9  Neurontin 300 mg oral capsule 300 mg = 1 Capsule, Orally, 4 Times Daily  omeprazole 40 mg oral delayed release capsule 40 mg = 1 Capsule, Orally, Daily  Percocet 10 mg-325 mg oral tablet 1 Tablet, Orally, Q6H  Potassium Chloride (Eqv-Klor-Con M20) 20 mEq oral tablet, extended release See Instructions, 1 Tablet  every other day  predniSONE 5 mg oral tablet 10 mg = 2 Tablet, Orally, Daily, patient has a regimen of tapering every 2 weeks  rOPINIRole 0.25 mg oral tablet 0.25 mg = 1 Tablet, Orally, TID, G89.4  spironolactone 25 mg oral tablet 25 mg = 1 Tablet, Orally, Daily  tiZANidine 2 mg oral tablet 4 mg = 2 Tablet, Orally, At Bedtime  torsemide 20 mg oral tablet 20 mg = 1 Tablet, Orally, Daily  Trelegy Ellipta , Inhalation, Daily  Trelegy Ellipta 200 mCg-62.5 mCg-25 mCg inhalation powder 1 Puff, Inhalation, Daily  Ventolin HFA 90 mCg/inh inhalation aerosol 180 mCg = 2 Puff, Inhalation, 4 Times Daily, Every 4 - 6 hours as needed for shortness of breath and/or wheezing.  Voltaren Topical 1% topical gel 2 GM, Topical, 4 Times Daily, Use dosing card to measure dose  Active Scheduled Inpatient Medications  allopurinol, Tablet, 100 mg, Orally, Daily, Start: 02/13/23 09:00:00  aspirin, Tab, Chewable, 81 mg, Orally, Daily, Start: 02/13/23 09:00:00  atorvastatin, Tablet, 40 mg, Orally, At Bedtime, Start: 02/13/23 21:00:00  ceftRIAXone, Injection, 1 GM, IVPB, Q24H, Indication: UTI, Start: 02/13/23 00:00:00  dexamethasone, Injection, 6 mg, IV Push, Q24H, Start: 02/12/23 23:49:00  docusate (docusate sodium), Capsule, 100 mg, Orally, BID, Start: 02/13/23 09:00:00  doxycycline, Capsule, 100 mg, Orally, Q12, Indication: Pneumonia - CAP, Start: 02/13/23 10:00:00  fentaNYL (fentaNYL 50 mCg/hr transdermal film, extended release), Patch, 1 Patch, Topical, Q72H, Start: 02/13/23 01:00:00  fluticasone-vilanterol (Breo Ellipta 100 mCg-25 mCg inhalation powder), Aerosol Powder, 1 Puff, Inhalation, Daily, Start: 02/13/23 09:00:00  gabapentin (Neurontin), Capsule, 300 mg, Orally, 4 Times Daily, Start: 02/13/23 09:00:00  heparin (heparin 5,000 units/0.5 mL injectable solution), Injection, 5,000 Units, Subcutaneous, Q8H, Start: 02/13/23 00:00:00  leveTIRACetam, Tablet, 250 mg, Orally, BID, Start: 02/13/23 09:00:00  pantoprazole, Tab, Delayed Rel, 40 mg, Orally, Daily, Start: 02/13/23 09:00:00  rOPINIRole, Tablet, 0.25 mg, Orally, TID, Start: 02/13/23 09:00:00  sacubitril-valsartan (Entresto 97 mg-103 mg oral tablet), Tablet, 4 Tablet, Orally, BID, Start: 02/13/23 09:00:00  spironolactone, Tablet, 25 mg, Orally, Daily, Start: 02/13/23 09:00:00  tiZANidine, Tablet, 4 mg, Orally, At Bedtime, Start: 02/13/23 21:00:00  torsemide, Tablet, 20 mg, Orally, Daily, Start: 02/13/23 09:00:00  umeclidinium (Incruse Ellipta 62.5 mCg inhalation powder), Aerosol Powder, 1 Puff, Inhalation, Daily, Start: 02/13/23 09:00:00  Lactated Ringers  1,000 mL IV  60 mL/hr 0  02/13/23  Dextrose 10% in Water  500 mL IV  PRN - See Comments     Sodium Chloride 0.9%  500 mL IV  Other - See Comments 0  02/13/23    One-Time Medications Given 02/12/23 00:00:00 TO 02/13/23 07:40:26  atorvastatin, Tablet, 40 mg, Orally, ONCE, (1 DOSE 02/13/23 01:26:00)  carvedilol, Tablet, 6.25 mg, Orally, ONCE, (1 DOSE 02/13/23 01:26:00)  fentaNYL patch DISPOSAL, Dispose , Misc, ONCE, (1 DOSE 02/13/23 01:21:00)  gabapentin, Capsule, 300 mg, Orally, ONCE, (1 DOSE 02/13/23 01:26:00)  leveTIRACetam, Tablet, 250 mg, Orally, ONCE, (1 DOSE 02/13/23 01:26:00)  rOPINIRole, Tablet, 0.25 mg, Orally, ONCE, (1 DOSE 02/13/23 01:26:00)  sacubitril-valsartan (sacubitril-valsartan 97 mg-103 mg oral tablet), Tablet, 4 Tablet, Orally, ONCE, (1 DOSE 02/13/23 01:26:00)  tiZANidine, Tablet, 4 mg, Orally, ONCE, (1 DOSE 02/13/23 01:26:00)  PRN Medications (0600 - 0559) from 02/12 - 02/13  OXYcodone-acetaminophen, 1 Tablet, Orally, Q4H, 1  Dose(s)   acetaminophen, 650 mg, Orally, Q4H, 0  Dose(s)   albuterol, 2 Puff, Inhalation, Q4H, 0  Dose(s)   albuterol, 2.5 mg, Neb Inhal, Q4H, 0  Dose(s)   albuterol, 2.5 mg, Neb Inhal, Q6H, 0  Dose(s)   glucagon, 1 mg, IM, Unscheduled, 0  Dose(s)   glucose, Per Glucose Level , IV Push, Unscheduled, 0  Dose(s)   insulin lispro, Sliding Scale , Subcutaneous, With Glucose Testing, 0  Dose(s)   ondansetron, 4 mg, IV Push, Q6H, 0  Dose(s)   Allergies   Altace (Angioedema, allergic reaction)  Vicks VapoRub (turns skin red)  sulfa drugs (allergic reaction)  Social History    Alcohol   Denies   Electronic Cigarette/Vaping   E-Cigarette Use Never.   Employment/School   disability due to RA   Home/Environment   Lives with Spouse.   Substance Abuse   Denies   Tobacco   Tobacco Use: Never (less than 100 in lifetime).  Family History   Arthritis: Mother and Father.  Asthma: Mother and Father.  Diabetes mellitus type 2: Mother.  Diabetes..: Mother.  Gout..: Mother.  Heart disease: Mother.  Heart disease..: Mother.  Hyperlipidemia: Mother and Father.  Hypertension: Mother and Father.  Hypothyroid: Father.  Osteoporosis: Mother and Father.  Osteoporosis..: Mother and Father.  Shortness of breath: Mother.  Sleep apnea...: Mother and Father.  Stroke: Mother and Father.  Lab Results    All Labs Last 24 hours (No Micro or Pathology)  Hematology:  WBC: 15.7 k/cumm High (02/13/23 04:28:00)  RBC: 3.62 million/cumm Low (02/13/23 04:28:00)  Hgb: 11.2 GM/dL Low (02/13/23 04:28:00)  Hct: 35.1 % (02/13/23 04:28:00)  MCV: 97 fL (02/13/23 04:28:00)  MCH: 30.9 pg (02/13/23 04:28:00)  MCHC: 31.9 GM/dL Low (02/13/23 04:28:00)  RDW: 16.2 % High (02/13/23 04:28:00)  Platelet: 165 k/cumm (02/13/23 04:28:00)  MPV: 8.3 fL (02/13/23 04:28:00)  Neutrophils %: 96 % (02/13/23 04:28:00)  Lymphocytes %: 3 % (02/13/23 04:28:00)  Monocytes %: 1 % (02/13/23 04:28:00)  Eosinophils %: 0 % (02/13/23 04:28:00)  Basophils %: 0 % (02/13/23 04:28:00)  Absolute Neutrophil: 15.1 k/cumm High (02/13/23 04:28:00)  Absolute Lymphocyte: 0.5 k/cumm Low (02/13/23 04:28:00)  Absolute Monocyte: 0.1 k/cumm (02/13/23 04:28:00)  Absolute Eosinophil: 0 k/cumm (02/13/23 04:28:00)  Absolute Basophil: 0 k/cumm (02/13/23 04:28:00)  Chemistry:  Sodium SerPl QN: 140 mmol/L (02/13/23 06:20:49)  Potassium SerPl QN: 3.7 mmol/L (02/13/23 06:20:49)  Chloride SerPl QN: 101 mmol/L (02/13/23 06:20:49)  Carbon Dioxide SerPl QN: 30 mmol/L High (02/13/23 06:20:49)  Anion Gap: 9 mmol/L (02/13/23 06:20:49)  BUN SerPl QN: 46 mg/dL High (02/13/23 06:20:49)  Creatinine SerPl QN: 1.48 mg/dL High (02/13/23 06:20:49)  Estimated GFR (CKD-EPI, no race): 38 mL/min/1.73m2 Low (02/13/23 06:20:49)  Estimated CRCL (CG): 45 mL/min Low (02/13/23 06:20:49)  Glucose SerPl QN: 227 mg/dL High (02/13/23 06:20:49)  Calcium Total SerPl QN: 8.2 mg/dL Low (02/13/23 06:20:49)  Alkaline Phos SerPl QN: 46 Units/L (02/12/23 18:21:00)  ALT SerPl QN: 18 Units/L (02/12/23 18:21:00)  AST SerPl QN: 14 Units/L (02/12/23 18:21:00)  Bilirubin Total SerPl QN: 1.2 mg/dL High (02/12/23 18:21:00)  Total Protein SerPl QN: 6.2 GM/dL Low (02/12/23 18:21:00)  Albumin SerPl QN: 3.6 GM/dL (02/12/23 18:21:00)  Magnesium SerPl QN: 2.1 mg/dL (02/13/23 04:26:00)  CK SerPl QN: 388 Units/L High (02/13/23 04:26:00)  Troponin-I High Sensitivity: 32 ng/L High (02/12/23 19:23:00)  BNP Pl QN: 82 pg/mL (02/12/23 18:21:00)  Lactate Venous Pl QN: 1.6 mmol/L (02/12/23 20:51:00)  pH Bld Venous QN: 7.35 (02/12/23 20:15:00)  PCO2 Bld Venous QN: 58 mmHg (02/12/23 20:15:00)  PO2 Bld Venous QN: 34 mmHg Low (02/12/23 20:15:00)  Base Excess Bld Venous: 5 mmol/L High (02/12/23 20:15:00)  Bicarb Bld Venous Calc: 32 mmol/L High (02/12/23 20:15:00)  O2 Sat Bld Venous Calc: 62 % (02/12/23 20:15:00)  Patient Temperature: 37 DegC (02/12/23 20:15:00)  C-Reactive Prot SerPl QN: 31.6 mg/dL High (02/13/23 04:26:00)  Coagulation:  PT: 13.5 seconds (02/12/23 18:21:00)  INR: 1.18 (02/12/23 18:21:00)  D-Dimer Pl QN: 533 ng/mL DDU High (02/13/23 04:26:00)  Urine Studies:  Color: Yellow (02/12/23 19:38:00)  Clarity: Clear (02/12/23 19:38:00)  Specific Gravity: 1.020 (02/12/23 19:38:00)  pH: 5.0 (02/12/23 19:38:00)  Protein: 30 Abnormal (02/12/23 19:38:00)  Glucose: NEGATIVE (02/12/23 19:38:00)  Ketones: NEGATIVE (02/12/23 19:38:00)  Bilirubin: SC Small Abnormal (02/12/23 19:38:00)  Hgb Ur: MODERATE. Abnormal (02/12/23 19:38:00)  Nitrite: NEGATIVE (02/12/23 19:38:00)  Urobilinogen: NormalUro (02/12/23 19:38:00)  Leukocyte Esterase Ur: SMALL. Abnormal (02/12/23 19:38:00)  WBC: 11-20 Abnormal (02/12/23 19:38:00)  RBC: 6-10 Abnormal (02/12/23 19:38:00)  Bacteria: Moderate Abnormal (02/12/23 19:38:00)  Squamous Epithelial: Few (02/12/23 19:38:00)  All Other Labs:  COVID 19 Specimen Source: Nasal (02/12/23 18:32:00)  Coronavirus SARS-CoV2 Rapid: Detected Abnormal (02/12/23 18:32:00)    Diagnostics  Radiology Results - Last 24 hours Across Visits 02/12/2023 18:53 - XR Chest PA or AP Portable  IMPRESSION: New opacity opacity and interstitial thickening in the right mid tolower lung since 2/1/2023 compatible with atelectasis and/orpneumonitis. The possibility of aspiration pneumonitis should beconsidered.Thank you for consulting our team of subspecialty emergencyradiologists at radiology. Healthcare providers wishing to discuss this case further can contactthe Health Emergency Radiology reading room.                Signature Line Electronically Signed on 02/13/23 07:40 ________________________________________________________ DO