Age: 57.0
Sex: M
Vaccine: COVID19
Symptoms: Blood creatinine increased, Bordetella test negative, COVID-19, COVID-19 pneumonia, Cardiomegaly
Clinical narrative: ED to Hosp-Admission  Discharged  9/14/2021 - 9/16/2021 (2 days) Last attending ? Treatment team Shortness of breath   Principal problem   Admission Diagnosis     Medical Problems     Hospital Problems        POA   Hiatal hernia Yes       Essential hypertension Yes       Mild intermittent asthma Yes       Obesity Yes       Obstructive sleep apnea syndrome Yes       COVID-19 Yes        Hospital Course     HPI: Patient is an 58 y.o. male patient of the Dr. with past medical history of mild intermittent asthma and kidney stones. He presents today to the ED with complaints of increasing shortness of breath, nonproductive cough, and recent exposure to COVID-19. It has been over 3 days duration, but last night it became significantly worse for him. He is unable to ambulate around his home without significant shortness of breath and feeling as though he will "pass out." No chest pain, no palpitations, no fever noted. He was vaccinated with Pfizer in the past. His wife was not. He has no issues with his perception of smell and taste, he has nausea, but no vomiting or diarrhea. No dysuria, hematuria, constipation, myalgias. He notes + headache and persistent cough. Temps in 99 range. ED workup reveals a slightly elevated creatinine, but otherwise appropriate lab panel outside of COVID-19 +. XR demonstrates hypoinflation, negative for PNA.  Albuterol has not helped him at this time.      Hospital Course:      Please send details from H&P and follow-up note lab work and imaging   In briefly this is a morbidly obese 58-year-old male history of multiple comorbid condition including asthma obesity he was completed his COVID-19 vaccination admitted here with shortness of breath cough fever chills for 3 days and he was found COVID-19 pneumonia.  In addition of that he is having mild hypoxia so initially started some oxygen and remdesivir and Decadron.  Fortunately patient improving totally oxygenation is 9495% in room air still having some cough but clinically she is much improving completed 3 days of remdesivir.  We will continue Decadron for total of 10 days.  He is clinically stable and RPM is provided he will benefit to follow-up with PCP in 7 days.  Because of his obesity debility deconditioning I will put him Xarelto 10 mg p.o. daily for 4 weeks to prevent thromboembolism secondary from COVID-19   Medical Problems     Hospital Problems        POA   * (Principal) Shortness of breath Yes       Hypersomnia, unspecified Yes       Hiatal hernia Yes       Essential hypertension Yes       Mild intermittent asthma Yes       Obesity Yes       Obstructive sleep apnea syndrome Yes       COVID-19 Yes            Medical Problems        Plan:  58 year old male patient with acute shortness of breath likely secondary to COVID-19 infection, but noted history of asthma. Pt will be observed on Med Surg floor for the above. I will start patient on Dexamethasone only at this time, continue his home asthma medications, using Albuterol inhaler as well. If his oxygen sats decline and stay below 94% persistently, would recommend starting Remdesivir. He will be started on Benzonatate for cough at this time. I anticipate a 2-3 day admission. If he does not desaturate, then he should be able to go home sooner.    I personally spent over half of a total 75 minutes in counseling and discussion with the patient and coordination of care as described above.      VTE prophylaxis: Lovenox and SCD's Full Code     History of Present Illness      Patient is an 58 y.o. male patient of the Dr. with past medical history of mild intermittent asthma and kidney stones. He presents today to the ED with complaints of increasing shortness of breath, nonproductive cough, and recent exposure to COVID-19. It has been over 3 days duration, but last night it became significantly worse for him. He is unable to ambulate around his home without significant shortness of breath and feeling as though he will "pass out." No chest pain, no palpitations, no fever noted. He was vaccinated with Pfizer in the past. His wife was not. He has no issues with his perception of smell and taste, he has nausea, but no vomiting or diarrhea. No dysuria, hematuria, constipation, myalgias. He notes + headache and persistent cough. Temps in 99 range. ED workup reveals a slightly elevated creatinine, but otherwise appropriate lab panel outside of COVID-19 +. XR demonstrates hypoinflation, negative for PNA.  Albuterol has not helped him at this time.        Review of Systems  Constitutional: Positive for activity change and fatigue. Negative for fever.  HENT: Negative for sinus pressure and sinus pain.   Respiratory: Positive for cough and shortness of breath. Negative for apnea and wheezing.   Cardiovascular: Negative for chest pain.  Gastrointestinal: Positive for nausea. Negative for abdominal pain, diarrhea and vomiting.  Genitourinary: Negative for difficulty urinating, dysuria, flank pain and frequency.  Musculoskeletal: Negative for arthralgias and myalgias.  Skin: Negative for color change, pallor, rash and wound.  Neurological: Positive for weakness and headaches.  Psychiatric/Behavioral: The patient is nervous/anxious.