Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Fall, Hypercapnia, Lethargy, Lung consolidation, Lymphadenopathy mediastinal
Clinical narrative: Patient is a 77-year-old man with history of COPD (severe; 6 L NC at baseline), CAD, non-small cell lung cancer (preivously underwent round of chemotherapy in 2019, but not actively undergoing treatment), AFib, and diastolic heart failure who presented to the ED with hypoxia and shortness of breath.     Patient was on BiPAP at the time my assessment and was difficult to obtain full history.  History is supplemented by review of EMR and discussion with patient's daughter via telephone.   Patient has required multiple admissions related to hypoxic respiratory failure and pneumonia over the last year.  He was last hospitalized in 11/2021 with hypoxic respiratory failure.  He was noted to have Pseudomonas pneumonia with associated bacteremia that admission.  He responded appropriately to antibiotics and was able to be transition to his baseline oxygen requirements.  Palliative Care has evaluated patient on multiple admissions.  Patient is thought to be hospice appropriate, but patient and famly have continued to request full medical support and usual medical care.   Patient was last seen in the ED on 1/15 after he experienced a fall at home.  CT head and C-spine did not show any acute findings.  He had a forehead laceration that was repaired  He was able to be discharged back to his home in stable condition.   On 1/21,  he worked with home health PT and started to have worsening shortness of breath. His family reported that he was starting to become more hypoxic during this time.  His family believed that his home oxygen concentrator was malfunctioning and that this was contributing to his ongoing hypoxia.  Patient developed an episode of dizziness and weakness one day prior to admission.  On the day of admission, patient was noted to be much more ill according to family. He was noted to be more lethargic and struggling to breathe.  EMS was then summoned.  Patient was noted to have significant hypoxia with O2 sats in the 70's was placed on BiPAP.  He was then brought to the ED for further evaluation.     Upon arrival to ED, patient was noted to be hypoxic and required BiPAP support.  He was noted to be tachycardic in the low 100's and normotensive.  Admission lab work was notable for WBC 24.  ABG showed hypoxia and mild hypercarbia on BiPAP.  Patient tested positive for COVID-19.  CXR showed diffuse airspace disease bilaterally, stable from prior studies.  CTA chest showed no PE, but shows stable dense consolidation in LLL, and partial consolidations in RLL and RML.  It also showed persistent mediastinal lymphadenopathy.  Patient was started on broad-spectrum antibiotics in the ED. Hospitalist was then contacted for admission.     Of note, patient was vaccinated against COVID-19 and completed an mRNA vaccine series in 2/2021.  He had not received COVID-19 vaccine booster.  I spoke with patient's daughter and expressed concerns regarding his severity of illness and his prognosis. She affirms that patient wishes to be full medical support at this time.  She was upset that she was not able to visit patient while he is in the COVID unit.   PT IS INPATIENT AT THIS TIME.