Age: 42.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood glucose normal, Breath sounds abnormal, COVID-19, COVID-19 pneumonia
Clinical narrative: Chief Complaint   pt seen in ER today for SOA, fever, sore throat, HA, N/D. Given fluids and d/c, pt has had no relief, took tylenol pta  History of Present Illness      Patient is a 43 year old Female with pmh DM, HTN, HLD, bipolar and schizoaffective disorder presenting for fevers, shortness of breath. In ED patient was put on 2L O2 via NC to maintain saturations. Found to be covid positive, despite being vaccinated. Patient was tachycardic so CT PE was obtained, negative for PE but showed findings consistent with COVID pneumonia. Labwork otherwise unremarkable with exception of elevated glucose at 199. Patient was admitted for new oxygen requirements.   Upon interview, patient reports that 2-3 days ago she started to feel feverish/chills, reports headache, sore throat, myalgias.  Also reporting cough and increasing shortness of breath over the last day, for which she presented to the ER today. She is nauseous and has been having diarrhea, but denies emesis. States she has not eaten much of anything in the last 2-3 days. Denies any She has taken her home medications as prescribed. She is vaccinated against covid, completed the series months ago. Denies any known sick contacts/exposure.   Review of Systems     All systems reviewed, and is negative except as noted in the HPI.  Physical Exam  Vitals & Measurements  T: 36.8 °C  TMIN: 36.0 °C  TMAX: 36.8 °C  HR: 96  RR: 30  BP: 128/92  SpO2: 92%  WT: 121.8 kg      General: NAD Head: Normocephalic, Atraumatic Eyes: EOM intact, sclera clear Mouth: mucous membranes moist Respiratory: Dimished breath sounds throughout, no wheezes, rhonchi or rales, unlabored, symmetric chest rise Cardiovascular: RRR, no murmurs, normal S1/S2, +2/4 peripheral pulses bilaterally Abdomen: obese abdomen, soft, nontender, nondistended MSK: no gross deformities. No calf tenderness on palpation. No LE edema or redness. Neuro: alert and oriented, CN intact grossly, Psych: normal affect and mood, cooperative  Assessment/Plan       Patient is a 43-year-old female with DM, HTN, HLD, bipolar/schizoaffective admitted for acute hypoxic respiratory failure in setting newly diagnosed COVID-19 pneumonia. CT PE done negative for pulmonary embolism, findings consistent with Covid pneumonia. Labwork otherwise unremarkable, mildly hyperglycemic at 199. Inflammatory markers ordered and pending.  Pt requiring 2-4 L oxygen via nasal cannula, may have component of underlying undiagnosed sleep apnea as desaturated while sleeping.  Will start on dexamethasone, and titrate oxygen to maintain saturations greater than 92%.    Acute Hypoxemic Respiratory Failure  COVID 19  Pneumonia  - sx onset 10/5; date positive 10/8.  Is vaccinated against covid-19  - CT PE negative for PE but showing few bilateral patchy groundglass airspace opacities consistent with covid-19 pneumonia.  - doppler US bilateral LE ordered  - WBC wnl, Inflammatory markers ordered and pending  - Requiring 2L via NC, initially requirement increased to 4L while sleeping (may have component of undiagnosed sleep apnea)  - titrate supplemental oxygen to maintain sPO2 > 92%  - Continue home inhalers - albuterol, Fluticasone-salmetereol  - Bronchodilator protocol  - Start Dexamethasone 6mg daily  - could consider initiating Remdesivir  DM2:  - on home regimen metformin 500mg once daily  - Glucose elevated 199 on arrival, no evidence of AG or metabolic acidosis  - will start SSI  - hgb A1C ordered  HTN:  - continue home lisinopril 10mg daily  Asthma:  - continue home inhalers albuterol and fluticasone-salmeterol  Bipolar/Schizoaffective Disorder:  - continue home risperidone, Lamotrigine, Diazepam   Code Status: Full Code Diet: Diabetic DVT ppx: Lovenox Disposition: Floor   Patient to be staffed with attending physician.