Age: 59.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Pseudomonas infection, Pseudomonas test positive, Red blood cell count normal, Red blood cell nucleated morphology, Red cell distribution width
Clinical narrative: Date of Admission Admit Date: Dec-31-2021 Date of Discharge Date of discharge Jan-08-2022 Allergies No Known Allergies Chief Complaint Shortness of breath Final Diagnoses  Secondary bacterial pneumonia  COVID-19 Procedure(s) Performed None Lab Results Jan-08-2022 0439 Serology  PROCALC 0.06 Jan-08-2022 0439 Hematology  WBC 8.3 RBC 5.02 HGB 15.8 HCT 44.9 MCV 89.4 MCH 31.5 (H) MCHC 35.2 RDW 12.6 RDWSD 41.5  PLT 284 MPV 9.9 AUTONEU% 81.7 (H) AUTOLYM% 7.0 (L) AUTOMON% 6.5 AUTOEOS% 0.1  AUTOBAS% 0.5 AUTONEU# 6.8 (H) AUTOLYM# 0.6 (L) AUTOMON# 0.5 AUTOBAS# 0.0 AUTOEOS# 0.0  NRBC% 0.0 NRBC 0.0 HGB/HCT 2.8 IG# 0.35 IG% 4.2 Jan-08-2022 0439 Chemistry  GLUCOSE 117 (H) BUN 21 CREAT 0.8 MDRD GFR 99 NA 139 K 4.6 CL 102 CALCIUM 8.2 (L)  CO2 25.6 OSMO 281.5 ANION GP 16.0 BUN/CRE 26.3 (H) CRP 1.20 (H) Jan-07-2022 0428 Serology  PROCALC 0.17 Jan-07-2022 0428 Hematology  WBC 7.9 RBC 4.98 HGB 15.7 HCT 44.2 MCV 88.8 MCH 31.5 (H) MCHC 35.5 RDW 12.7 RDWSD 40.8  PLT 253 MPV 10.0 AUTONEU% 75.8 (H) AUTOLYM% 10.3 (L) AUTOMON% 8.1 AUTOEOS% 0.1  AUTOBAS% 0.4 AUTONEU# 6.0 AUTOLYM# 0.8 (L) AUTOMON# 0.6 AUTOBAS# 0.0 AUTOEOS# 0.0  SCAN DIF Y NRBC% 0.0 NRBC 0.0 HGB/HCT 2.8 IG# 0.42 IG% 5.3 Jan-07-2022 0428 Chemistry  GLUCOSE 117 (H) BUN 22 CREAT 0.8 MDRD GFR 99 NA 135 K 4.6 CL 98 CALCIUM 8.1 (L)  CO2 26.5 OSMO 274.5 (L) ANION GP 15.1 BUN/CRE 27.5 (H) CRP 2.90 (H) 1 of6 Name (M) MRN  Jan-08-2022 1001 Attending Encounter  Discharge Summary Medical Ctr Admitted Discharged Dec-31-2021 Jan-08-2022 Date of Service Primary MD Jan-06-2022 0445 Serology  PROCALC 0.36 Jan-06-2022 0445 Hematology  WBC 5.6 RBC 4.75 HGB 15.3 HCT 42.0 MCV 88.4 MCH 32.2 (H) MCHC 36.4 RDW 12.6 RDWSD 41.1  PLT 218 MPV 9.5 AUTONEU% 80.8 (H) AUTOLYM% 7.9 (L) AUTOMON% 5.9 AUTOEOS% 0.0  AUTOBAS% 0.4 AUTONEU# 4.5 AUTOLYM# 0.4 (L) AUTOMON# 0.3 AUTOBAS# 0.0 AUTOEOS# 0.0  NRBC% 0.0 NRBC 0.0 HGB/HCT 2.7 IG# 0.28 IG% 5.0 Jan-06-2022 0445 Chemistry  GLUCOSE 128 (H) BUN 22 CREAT 0.9 MDRD GFR 86 NA 134 K 4.7 CL 99 CALCIUM 8.1 (L)  ALK PHOS 85 CO2 27.1 AST 11 (L) ALT 48 AST/ALT 0.2 (L) TL PROT 5.8 (L)  ALBUMIN 2.1 (L) TBILI 0.4 DBILI 0.2 OSMO 273.2 (L) ANION GP 12.6 BUN/CRE 24.4 (H)  CRP 8.20 (H) MAGNESIU 2.4 Jan-05-2022 0455 Serology  PROCALC 0.12 Jan-05-2022 0455 Microbiology  C SPUT Pseudomonas aeruginosa GS Few gram positive rods Jan-05-2022 0455 Hematology  WBC 11.1 (H) RBC 4.76 HGB 14.9 HCT 42.4 MCV 89.1 MCH 31.3 (H) MCHC 35.1 RDW 12.5  RDWSD 41.4 PLT 270 MPV 9.7 AUTONEU% 91.0 (H) AUTOLYM% 3.3 (L) AUTOMON% 3.6  AUTOEOS% 0.2 AUTOBAS% 0.2 AUTONEU# 10.1 (H) AUTOLYM# 0.4 (L) AUTOMON# 0.4 AUTOBAS# 0.0  AUTOEOS# 0.0 NRBC% 0.0 NRBC 0.0 HGB/HCT 2.8 IG# 0.19 IG% 1.7 Jan-05-2022 0455 Chemistry  GLUCOSE 102 BUN 17 CREAT 0.8 MDRD GFR 99 NA 135 K 4.2 CL 102 CALCIUM 7.9 (L) CO2 26.7  OSMO 271.8 (L) ANION GP 10.5 BUN/CRE 21.3 (H) CRP 7.40 (H) Jan-04-2022 0530 Serology  PROCALC <0.05 Jan-04-2022 0530 Hematology  WBC 6.8 RBC 4.64 (L) HGB 14.6 HCT 41.2 (L) MCV 88.8 MCH 31.5 (H) MCHC 35.4 RDW 12.5  RDWSD 40.7 PLT 270 MPV 10.3 AUTONEU% 83.9 (H) AUTOLYM% 8.6 (L) AUTOMON% 4.5  AUTOEOS% 0.9 AUTOBAS% 0.1 AUTONEU# 5.7 AUTOLYM# 0.6 (L) AUTOMON# 0.3 AUTOBAS# 0.0  AUTOEOS# 0.1 NRBC% 0.0 NRBC 0.0 HGB/HCT 2.8 IG# 0.14 IG% 2.0 Jan-04-2022 0530 Chemistry  GLUCOSE 105 BUN 14 CREAT 0.7 MDRD GFR 115 NA 135 K 4.3 CL 103 CALCIUM 7.6 (L) CO2 23.7  OSMO 270.9 (L) ANION GP 12.6 BUN/CRE 20.0 CRP 7.10 (H) Jan-03-2022 0427 Serology  PROCALC <0.05 2 of6 Name (M) MRN   Jan-08-2022 1001 Attending Encounter  Discharge Summary Medical Ctr Admitted Discharged Dec-31-2021 Jan-08-2022 Date of Service Primary MD Jan-03-2022 0427 Hematology  WBC 8.4 RBC 4.63 (L) HGB 14.5 HCT 40.8 (L) MCV 88.1 MCH 31.3 (H) MCHC 35.5 RDW 12.7  RDWSD 40.6 PLT 276 MPV 10.0 AUTONEU% 85.9 (H) AUTOLYM% 6.9 (L) AUTOMON% 5.3  AUTOEOS% 0.1 AUTOBAS% 0.1 AUTONEU# 7.2 (H) AUTOLYM# 0.6 (L) AUTOMON# 0.4 AUTOBAS# 0.0  AUTOEOS# 0.0 NRBC% 0.0 NRBC 0.0 HGB/HCT 2.8 IG# 0.14 IG% 1.7 Jan-03-2022 0427 Chemistry  GLUCOSE 114 (H) BUN 19 CREAT 0.7 MDRD GFR 115 NA 137 K 4.6 CL 104 CALCIUM 7.8 (L)  CO2 24.1 OSMO 276.9 ANION GP 13.5 BUN/CRE 27.1 (H) CRP 1.20 (H) Jan-02-2022 0548 Hematology  WBC 7.4 RBC 4.50 (L) HGB 14.4 HCT 40.0 (L) MCV 88.9 MCH 32.0 (H) MCHC 36.0 RDW 12.5  RDWSD 41.0 PLT 266 MPV 10.2 AUTONEU% 83.7 (H) AUTOLYM% 7.7 (L) AUTOMON% 7.6  AUTOEOS% 0.0 AUTOBAS% 0.1 AUTONEU# 6.2 AUTOLYM# 0.6 (L) AUTOMON# 0.6 AUTOBAS# 0.0  AUTOEOS# 0.0 NRBC% 0.0 NRBC 0.0 HGB/HCT 2.8 IG# 0.07 IG% 0.9 Jan-02-2022 0548 Chemistry  GLUCOSE 117 (H) BUN 21 CREAT 0.8 MDRD GFR 99 NA 137 K 4.3 CL 104 CALCIUM 7.9 (L)  CO2 24.2 OSMO 277.8 ANION GP 13.1 BUN/CRE 26.3 (H) CRP 2.80 (H) Jan-01-2022 0730 Hematology  WBC 5.6 RBC 4.90 HGB 15.5 HCT 43.7 MCV 89.2 MCH 31.6 (H) MCHC 35.5 RDW 12.7 RDWSD 41.6  PLT 257 MPV 9.9 AUTONEU% 75.7 (H) AUTOLYM% 14.3 (L) AUTOMON% 8.6 AUTOEOS% 0.0  AUTOBAS% 0.2 AUTONEU# 4.3 AUTOLYM# 0.8 (L) AUTOMON# 0.5 AUTOBAS# 0.0 AUTOEOS# 0.0  NRBC% 0.0 NRBC 0.0 HGB/HCT 2.8 IG# 0.07 IG% 1.2 Jan-01-2022 0730 Chemistry  GLUCOSE 107 BUN 18 CREAT 0.8 MDRD GFR 99 NA 137 K 4.4 CL 102 CALCIUM 8.1 (L)  ALK PHOS 78 CO2 23.2 AST 24 ALT 27 AST/ALT 0.9 (L) TL PROT 6.0 (L) ALBUMIN 2.4 (L)  TBILI 0.7 DBILI 0.3 OSMO 276.2 ANION GP 16.2 BUN/CRE 22.5 (H) CRP 8.20 (H)  MAGNESIU 2.3 -Sputum cultures have grown out pansensitive Pseudomonas aeruginosa. Imaging Results Portable chest x-ray obtained December 31, 2021. Report is as follows: Impression: 1. Moderate to severe bilateral COVID-19 pneumonia, increased. Portable chest x-ray obtained January 5, 2022. Report is as follows: Impression: 1. Moderate/severe interstitial and airspace opacities bilaterally, probably multifocal pneumonia/edema. COVID-19 pneumonia possible based on of the appearance. 2. Trace bilateral pleural fluid/scar Functional Status* No Functional Impairments 3 of6 Name (M) MRN  Jan-08-2022 1001 Attending Encounter  Discharge Summary Medical Ctr Admitted Discharged Dec-31-2021 Jan-08-2022 Date of Service Primary MD Mental Status* Normal Cognition Social History tobacco use  Never Smoked, 0 yrs, Smoking Cessation Not Applicable alcohol use  Beer, Current  Reports drinking 3-4 beers every night drug use  No Known Use marital status  Married occupation  Works lumbar general comment  Lives at home with his wife Health Concerns Secondary bacterial pneumonia COVID-19 Beer, Current Father Deceased @ 83 Mother Deceased Failure to thrive @ 80 Vital Signs Jan-08-2022 0732  T 98.4 HR 53 (L) RR 23 (H) BP 100 / 63 O2Sat 95 Jan-08-2022 0600  HR 46 (L) RR 17 BP 92 (L) / 63 O2Sat 93 Jan-08-2022 0400  T 98.3 Patient is on 2 L of supplemental oxygen via nasal cannula. PHYSICAL EXAM Constitutional: patient is a pleasant 6-year-old male who appears to be of stated age.  Patient appears to be in no acute distress.   Cardiovascular: Heart sounds are of regular rate and rhythm. S1 and S2 are both present without rubs clicks or murmurs. Radial pulses are 2+ bilaterally. Dorsalis pedis pulses are 2+ bilaterally. No edema is appreciated in the bilateral lower extremities. Respiratory: There is no observed increased work of breathing or accessory muscle use. Patient does not become conversationally dyspneic.  Lungs are clear to auscultation in all fields.Patient is currently on 2 L supplemental oxygen was observed to decrease to for 87% while on room air at rest.  GI: Abdomen is soft and nondistended. Bowel sounds are normoactive on auscultation. Abdomen is nontender to both light and deep palpation. No masses organomegaly are appreciated on exam. Neuro: Patient is alert and oriented x4. Cranial nerves 2-12 appear to be grossly intact. Patient is able to move all 4 limbs independently. Psych: Patient is currently RASS score 0. Patient is attentive during the exam is able answer questions appropriately. Patient 4 of6 Name (M) MRN   Jan-08-2022 1001 Attending Encounter   Discharge Summary Medical Ctr Admitted Discharged Dec-31-2021 Jan-08-2022 Date of Service Primary MD displays appropriate mood and affect. Heme/lymph: There is no evidence of excessive bruising in exposed skin. There is no saturation of bandages over vena puncture sites or oozing around IV catheters. No cervical or supraclavicular lymphadenopathy is appreciated on exam. Hospital Course Patient is a 60-year-old male who presented to the emergency department December 31st 2021 with complaint of shortness of breath. Patient was diagnosed with the COVID-19 pneumonia with onset of symptoms approximately 1 week prior to presentation. And a positive COVID test on December 28, 2021. Patient received initial workup in the emergency department and was found to have acute hypoxic respiratory failure secondary to COVID-19 pneumonia and was admitted to the PCU under the care of the Internal Medicine team. Patient was started on daily dexamethasone and continued on supplemental oxygen for management. Patient progressed to requiring noninvasive respiratory support specifically Airvo which he tolerated well patient was saline locked on day 5 of his hospitalization is he was having adequate oral intake to maintain hydration. On day 6 the patient was found to have a superimposed bacterial pneumonia and was started on doxycycline. The doxycycline was changed to oral levofloxacin but the next day to complete the course. Hospital day 7 patient was maintaining saturation on supplemental oxygen at 4 L. patient was titrated down to 2 L supplemental oxygen and was tolerated well. Patient was determined to no longer require an inpatient level of care and was discharged home with home oxygen. Condition at Discharge Stable Discharge Medications ACETAMINOPHEN 650 MG ORALLY EVERY 6 HOURS AS NEEDED for FEVER, MILD-MODERATE (PAIN 1-5 ) BENZONATATE 100 MG ORALLY 3 TIMES A DAY AS NEEDED for COUGH (ePrescribed by ASSADI AZHAR DO on Jan-08-2022 1006) DEXAMETHASONE 6 MG ORALLY DAILY AT 1600 (ePrescribed by DO on Jan-08-2022 1006) levoFLOXacin 750 MG ORALLY ONCE A DAY (ePrescribed by DO on Jan-08-2022 1006) omeprazole 20 mg TbEC 20 MG ORALLY TWICE DAILY BEFORE MEALS Xarelto 20 mg tab 20 MG ORALLY ONCE A DAY Discharge Disposition Discharge to home Plan Assessment:  - Acute hypoxic respiratory failure secondary to COVID-19 pneumonia, requiring high flow supplemental oxygen, improving - Secondary bacterial pneumonia with Pseudomonas aeruginosa - COVID-19 pneumonia, positive test 12/26 - History of DVT, on Eliquis - Essential hypertension, on metoprolol and lisinopril - Gastroesophageal reflux disease, on omeprazole Plan:  The patient has been determined to no longer require an inpatient level of care and is discharged home with home oxygen. Patient may return to normal activity as tolerated. Patient may return to normal diet as tolerated. At the time of discharge we are holding the patient's lisinopril metoprolol to soft blood pressures they should follow-up with his primary care physician to restart these medications if necessary. Patient is discharged with an additional 3 days of Levaquin to complete a 5 day course for his superimposed bacterial pneumonia as well as additional 2 days of steroids to complete 10 day course. Patient should follow-up with 5 of6 Name (M) MRN   Jan-08-2022 1001 Attending Encounter   Discharge Summary Medical Ctr Admitted Discharged Dec-31-2021 Jan-08-2022 Date of Service Primary MD his PCP within 7-10 days of discharge. The patient should return to the hospital should he begin experiencing fevers, chills, or worsening shortness of breath which is not improve with increasing his supplemental oxygen. Primary Care Provider MD Electronically signed by DO RESIDENT on Jan-08-2022 1011