Age: 88.0
Sex: M
Vaccine: COVID19
Symptoms: Hyponatraemia, Influenza A virus test negative, Influenza B virus test, International normalised ratio decreased, Intervertebral disc degeneration
Clinical narrative: ED to Hosp-Admission Discharged  4/28/2021 - 5/1/2021 (3 days) Last attending ? Treatment team Acute respiratory failure with hypoxia Principal problem  Hospital Course Admission HPI:  (patient) is an 88 y.o. male come to emergency room for evaluation of cough with thick yellow sputum which is going on since past 2 days.  Which is progressively getting worse.  Associated with some shortness of breath.  On arrival of EMS patient found to have significant hypoxia with 70% at room air.  He was placed on nasal cannula.  Did bring him to the emergency room.  Patient had a dose of Covid vaccine and is due for second dose soon.  In emergency room, he was thoroughly evaluated.  He found to be septic.  He was given dose of IV Levaquin and Covid swab come back positive.  Hospitalist service requested to admit the patient. Asking patient, is feeling little better after coming to emergency room.  He is having shortness of breath with significant cough with sputum production.  He felt wheezy.  Denies any fever but had chills.  He feels nauseated.     Hospital Course:  Pt was admitted to the hospital for management of acute hypoxic respiratory failure secondary to COVID-19 virus pneumonia.  His breathing improved precipitously.  He had resistant hypertension this admission and was started on amlodipine. He did have mild hyponatremia this admission but did not appear to have any volume overload. TSH elevated at 13.8.  Will need repeat study. He did also have rising procalcitonin and received few doses of antibiotics. Lipid panel was benign.  ED Discharged  5/9/2021 (58 minutes) Hospital ER Treatment team Thrush, oral Clinical impression Sore Throat Chief complaint ED Provider Notes (Physician Assistant) Emergency Medicine Cosigned by: (Doctor) at 5/9/2021  6:45 PM Attestation signed by (Doctor) at 5/9/2021 6:45 PM The patient was seen and treated primarily by the PA-C. I did not independently evaluate the patient.    Chief Complaint Patient presents with ? Sore Throat     HPI  Patient is a very pleasant 88-year-old male with recent COVID-19 infection diagnosed on 4/28/2021 on oxygen 4L NC, who presents to the emergency department complaining of sore throat x 1 day. He states that he started yesterday with a sore throat, painful to swallow, then noticed this morning that he had twice patches on his tongue and mouth.  He states he is able to tolerate food and liquid, but that it hurts to do so.  He denies any fevers or chills.  From a Covid perspective, he states that he would not be here if it were not for the pains and sores in his mouth/throat.  He feels that his breathing is stable and he is doing well on 4 L of oxygen nasal cannula as prescribed.  He has finished a course of Decadron and states he is currently on no further treatment for COVID-19.   ED to Hosp-Admission Discharged  5/10/2021 - 5/13/2021 (3 days) Hospital  (Doctor) Last attending ? Treatment team Aspiration pneumonia  Principal problem Hospital Course Patient come to the hospital with complaining of abdominal pain and hypoxia and cough.  Patient found to have a right middle lobe pneumonia.  We are believing that it is aspiration pneumonia which is improving at this time.  He had a recent COVID-19 infection which is resolving at this time.  During course, GI, pulmonology, urology and oncology consultation obtained.  Patient continued to improve clinically.  Patient had a urinary retention because of the constipation.  He is able to void now.   Today morning, I am seeing him.  He is feeling better.  Is agreed to go home.  I discussed with the patient's wife regarding plan.  Once he fully recovered from pneumonia he need to have colonoscopy and possible biopsy of colon mass.