Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Inappropriate schedule of product administration, Intensive care, Lactic acidosis, Leukocytosis, Lung infiltration
Clinical narrative: Patient is a 64-year-old man with a history of non-small cell lung carcinoma status post radiation and chemotherapy, history of COPD of unknown severity, chronic atrial fibrillation, and coronary artery disease, who presented to the hospital with a cough in the setting of known COVID-19 infection with symptom onset 6 days prior to presentation.     Severe sepsis  Acute hypoxic respiratory failure Suspected community-acquired pneumonia  Covid-19 pneumonia COPD without exacerbation  Acute metabolic encephalopathy - resolved Lactic acidosis - resolved Hx of Non-small cell lung carcinoma status post radiation and chemotherapy Fully vaccinated with booster. The patient tested positive for COVID prior to arrival and presented on symptom day #6.  In the ED he was found to be tachycardic, with blood pressure in the 90 systolic and hypoxic. Started on nonrebreather mask. Labs revealed leukocytosis, lactate up to 2.4 but normalized on recheck.  Chest x-ray showed infiltrate throughout the right lung base suspicious for bacterial pneumonia. Suspect sepsis due to bacterial pneumonia and associated respiratory failure.  CT pulmonary angio without PE. Initially admitted to ICU for close monitoring but able to transfer out shortly after.  - Steroids: methylprednisolone 40mg daily; taper as able - Full barrier precautions - Continuous pulse oximetry, goal saturation >90% - As needed Tylenol, melatonin, Tessalon Perles, Robitussin - Encourage proning - Received cefepime and vancomycin on presentation, but switched to doxycycline and pip-tazo - Blood culture: H. Flu in 1/4 bottles; Beta-lactamase negative; sample also sent to health office per protocol; No additional sensitivities expected per micro lab however health office will type the HFlu; repeat BCx negative; Pip-taz should cover; switch to PO beta-lactam at discharge - Dimer: 1.86; CTA negative for PE; On Warfarin for AC as noted below - Continue PTA albuterol inhaler; Breo inhaler while in house (on advair PTA) - Procal elevated from 2.44 to 9.65 and with new leukocytosis on 1/16, despite abx with doyx and pip-tazo; Sputum culture growing Staph aureus as of 1/16; sensitivities expected to result on 1/17 per micro lab - Trend CRP: 28.6 -> 17.7   Chronic atrial fibrillation - Continue PTA warfarin for anticoagulation; Pharmacy consulted for warfarin dosing - Goal INR 2-3 - Continue PTA metoprolol succinate 50mg daily    Acute urinary retention Suspected BPH  Enlarged prostate noted on review of CT imaging from prior hospitalizations. Foley placed on 1/13, removed on 1/15 and passed voiding trial.  - Follow up with PCP as outpatient for monitoring of prostate/urinary symptoms   Mild normocytic anemia, chronic Hb ranging 11-13 on this hospital stay. Most recent prior in October was 13.1 - Daily CBC   Type 2 diabetes mellitus with acute hyperglycemia and neuropathy Steroid-induced hyperglycemia A1c 6.8% on 1/13.  - ISS qAC/HS - Carbohydrate controlled diet - Continue PTA gabapentin - Hold PTA metformin 1g BID while in house; restart at discharge   Mood disorder - Continue PTA sertraline 50mg daily     CODE STATUS: Full Code  DVT prophylaxis: Warfarin GI prophylaxis: PO intake Interpreter Type Used: None ACCESS: pIV RESTRAINTS: Not indicated FAMILY COMMUNICATION: Daughter updated via phone call at bedside on 1/16 DISPOSITION:     discharge: 1/17