Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Adenovirus test, Ageusia, Anosmia, Anticoagulant therapy
Clinical narrative: ED to Hosp-Admission Discharged  3/26/2021 - 4/5/2021 (10 days)    Last attending ? Treatment team Sepsis  Principal problem Discharge Summary    Inpatient Discharge Summary   BRIEF OVERVIEW Admitting Provider:  Discharge Provider:     Admission Date: 3/26/2021     Discharge Date: 4/5/2021   Discharge Diagnosis Severe sepsis COVID-19 pneumonia Acute hypoxic respiratory failure Atrial fibrillation/atrial flutter with RVR   DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission patient is an 70 y.o. female with a past medical history of atrial fibrillation chronically anticoagulated with Xarelto, S/P ablation x3 at the Medical Center, and sinus bradycardia who presented to the ED for evaluation of general malaise, shortness of breath, loss of taste and smell, coughing, and shortness of breath and was found to have sepsis due to COVID-19 pneumonia in the ED.   Patient states that over the past week she has been extremely weak, with nausea, diarrhea, but denies vomiting. She also reports that her appetite has decreased and noted that the symptoms has worsened and as a result she presented to the ED for further evaluation.Patient denies abdominal pain, lightheadedness, or chest pain.   Upon further evaluation and tests in the ED, she was noted to have severe sepsis as indicated by vital signs and chest x-ray imaging indicating groundglass pneumonia typical of COVID-19 infection. She also had COVID-19 swab which returned  positive result. Additionally, patient was noted to be hypoxia with SPO2 of 88% requiring oxygen supplementation.    Hospital Course patient was admitted to a Hospital due to shortness of breath, with fatigue and weakness, and was found to have severe sepsis with endorgan damage of acute hypoxic respiratory failure due to COVID-19 pneumonia on admission.  Imaging study showed no evidence of PE, but did show evidence of bilateral pulmonary infiltrates.   Pulmonary was consulted, she was started on remdesivir with Decadron.  She had an increase in oxygen requirement to the maximum of 10 L via specialty nasal cannula during the admission.  With the treatment of remdesivir and Decadron she had improvement in her hypoxia, and was ultimately weaned to room air by the time of discharge.   She underwent a desaturation study on the day of discharge and determined that she did not need any supplemental oxygen.  She completed her entire steroid and remdesivir course during the admission.  She had no evidence of superimposed bacterial pneumonia.   Her hospitalization was complicated by atrial fibrillation/flutter with RVR, that improved with metoprolol administration.  This was thought to be precipitated by her severe hypoxia with acute illness.  She was kept on metoprolol 25 mg twice daily on discharge, and will need to follow-up with her cardiologist at  Medical Center to determine if she can come off of this again.  She will continue to take her Xarelto as previously prescribed.   She was medically stable for discharge on 4/5 in stable condition, and will need to follow-up with PCP within 7 days, with cardiology within 2 weeks at the hospital, and pulmonary within 2 weeks as well.