Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Constipation, Diastolic dysfunction, Dyspnoea, Echocardiogram, Epistaxis
Clinical narrative: HPI: 83 years old male with past medical history of chronic diastolic congestive heart failure, hypertension, morbid obesity, obstructive sleep apnea on CPAP, chronic kidney disease stage III and DVT presented to local ER complaining of worsening shortness of breath and cough associated with weakness that started 5 days ago and has been progressively getting worse. Patient said that he was diagnosed with COVID 19 infection on Thursday (01/20/2022) by home test and since then his shortness of breath, productive cough associated with clear phlegm and weakness, he noticed that his oxygen saturation is low and last night the patient rolled off his bed then lay on the floor for an extended period of time until his daughter discovered him then she called EMS. Patient denies any sore throat, abdominal pain, chest pain, headache nor urinary symptoms. Patient is fully vaccinated against COVID-19. At the ER, chest x-ray as below and patient was started on Decadron 6 mg p.o. x1, his oxygen saturation was found in the 70s and he was placed on 6 L nasal cannula to maintain oxygen saturation more than 90% and ultrasound of the lower extremities was ordered. PROGRESS NOTE 1/30/2022- 83-year-old male with history of chronic diastolic heart failure presenting with acute hypoxemic respiratory failure secondary COVID-19 pneumonia with possible superimposed bacterial pneumonia. Acute hypoxic respiratory failure likely due to COVID-19 pneumonia with possible superimposed bacterial pneumonia. Optiflow now down to 12 L HFNC, Patient had been diagnosed with COVID-19 on 01/20/2022, he is fully vaccinated against COVID-19, Full barrier precautions, CRP improving, O2 requirement improved, continue Solu-Medrol to 60 mg IV every 6 hours today, Continue empiric ceftriaxone, completed azithromycin given elevated procalcitonin, albuterol as needed and Tylenol as needed for pain and fever, RT consult, Lovenox BID per D dimer, PPI for PPX, Trend CRP, which is improving, Doppler venous ultrasound of the lower extremities showed no DVT2, CT PA protocol was negative for PE, Not a candidate for Tocilizumab or Baricitinib, Lasix IV 20 mg increased to twice daily, takes 20 mg p.o. twice daily at baseline, net neg 3.2 L, Monitor epistaxis, added humidified oxygen, saline spray PRN, can consider petrolatum jelly intranasally if needed. Chronic diastolic congestive heart failure- Appears compensated at present, updated TTE as above, IVC was not dilated, Last echo in 2018 showed ejection fraction is 60% and there is a diastolic dysfunction as above, Continue PTA aspirin, Holding PTA Lasix, lisinopril/HCTZ, BP starting to rise with steroids, PTA Lisinopril restarted, Lasix IV BID as above. Essential hypertension Better controlled, IV hydralazine as needed, Lasix IV BID, Continue PTA lisinopril. History of chronic kidney disease stage III, Creatinine is 1.52, baseline creatinine is 1.4, around baseline, stable. Obstructive sleep apnea and history of asthma, PTA albuterol as needed, CPAP QHS. Leukocytosis, Suspect secondary to bacterial infection and steroids. Continue antibiotics and trend CBC. Constipation, Continue bowel regimen today. CODE STATUS: Full Code: DVT prophylaxis: Lovenox subcutaneous, therapeutic dosing GI prophylaxis: Lovenox therapeutic and High dose steroids, started PPI Daily 1/26/2022. ACCESS: IV. RESTRAINTS: None. DISPOSITION: TBD, improving slowly.