Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Blood lactic acid normal, Bronchial secretion retention, Bronchial wall thickening, COVID-19, Chronic obstructive pulmonary disease
Clinical narrative: COVID+ 11/4/22 - Vaccination status - moderna x4 Discharge Physician: MD,  Primary Care Physician: DO  Date of Admission: 11/4/2022 Discharge Date: 11/10/2022 Room Number:    BRIEF OVERVIEW:   Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 11/04/2022 Yes ? Pneumonia LUL 11/04/2022 Yes ? Toxic metabolic encephalopathy 11/04/2022 Yes ? PAD (peripheral artery disease) (HCC) 05/20/2022 Yes ? Chronic obstructive pulmonary disease with acute exacerbation (HCC) 05/14/2021 Yes ? Paroxysmal atrial fibrillation  with RVR 05/14/2021 Yes ? Essential hypertension    DETAILS OF HOSPITAL STAY:   PRESENTING PROBLEM: COPD exacerbation (HCC) [J44.1] Pneumonia of left lung due to infectious organism, unspecified part of lung [J18.9]   HOSPITAL COURSE: 82 y.o. caucasian male patient with past medical history chronic obstructive pulmonary disease, dementia, dysphagia, paroxysmal atrial fibrillation, hypertension, PAD. presents from his care facility via EMS with increased dyspnea, severe wheezing, shortness of breath   Laboratory data reviewed showing WBC 12K initial lactate normal via point of care in ER, patient's heart rate 110's to 130s, without significant tachypnea but noted some lethargy and ineffective cough with upper airway wheezing.  He received duo nebulized bronchodilators as well as 125 mg IV Solu-Medrol in the ER.  CT angiogram thorax obtained for further evaluation to rule out PE.  Noted negative for pulmonary embolism, left upper lobe pneumonia, small left pleural effusion, bronchial thickening and mucous plugging which may be indicative bronchitis. Patient tested positive for COVID-19, patient was noted to be in acute respiratory distress, acute hypoxic hypercapnic respiratory failure secondary to viral pneumonia.  Patient was treated with IV dexamethasone and started on IV remdesivir completed 5 day course.  Patient was gradually weaned off oxygen transition to hear.  Patient was initially started on Rocephin and azithromycin however after a procalcitonin was negative antibiotic was discontinued. Patient was noted to have E coli urinary tract infection for which he was treated with IV Rocephin and transition to oral Ceftin and completed course of antibiotic during the hospitalization. Patient does have history of dementia with progressive deterioration of his mentation.  Home medications were continued acute encephalopathy was noted at the time of admission which progressively improved and patient was back to baseline. He was also noted to have dysphagia for which speech therapy was consulted and video fluoroscopic study was completed speech adjusted as dysphagia diet PT/OT recommended return to SNF. MSW/CM consulted for discharge planning. Patient able to return to mission point which was arranged. Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. Patient voiced understanding was agreeable with plan of care discharge. CONSULTANTS: SLP PT/OT MSW/CM INPATIENT PROCEDURES: VFSS