Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Ankle brachial index, Atrial pressure increased, Brain natriuretic peptide increased
Clinical narrative: Patient is a 64 y.o. male with PMH of COPD on 3-4L home O2, HFpEF, DM2, lung adenocarcinoma s/p chemoradiation 2018, rheumatoid arthritis who presented on 1/28/2023 with worsening LE edema, pain, numbness with worsening SOB.  COVID positive. Patient started on BiPAP and was admitted to ICU, transferred out on 1/30/2023     Acute on chronic hypoxic hypercapnic respiratory failure -On 3-4L O2 at home with h/o COPD and CHF.  -Acute exacerbation in setting of COVID, CAP, Hx of lung adenocarcinoma.  -CTA negative for PE and doppler US negative for DVT. -Required BiPAP on admission and weaned to O2 of 3-4L which is his baseline   COVID-19 infection  - Presented with: worsening SOB  - Symptom onset: unclear  - Positive COVID-19: 1/29 - Vaccination status: Vaccinated with Moderna with last dose 3/4//2021 - CT Chest on admission showed Right middle lobe pneumonia with bronchiolitis and pneumonitis in the right upper lobe and right lower lobe - Decadron: Yes. Expected end date 2/8   Pneumonia  - CXR shows Right lower lung haziness may suggest atelectasis or developing infiltrate - CTA chest RLL PNA with bronchiolitis and pneumonitis in the RUL and RLL - Possible viral PNA with COVID infection -Patient will need repeat CT chest 2 to 3 months after hospitalization for lymphadenopathy and right middle lobe opacification   COPD  -in the setting of continued smoking with a 105 pack year smoking  -Possible mild exacerbation in setting of COVD and PNA on admission -Home regimen including  albuterol Proventil nebulizer, albuterol ventolin,  Symbicort, Spiriva Respimat.  -We will complete Decadron for COVID after discharge  Hx of lung adenocarcinoma -s/p chemoradiation 2018. -Not currently receiving treatment.    Suspected metabolic alkalosis with compensatory respiratory acidosis, resolved -Per patient, had been discharged on lasix 60 mg BID and was supposed to transition back to his home 40 mg BID but did not. -Lasix initially held, now resumed   HFpEF -Per history. Follows with Dr.   -TTE 12/31/22 showed LVEF 63%, abnormal diastolic dysfunction indicative of elevated L atrial pressure. - BNP 1891 on admission, was 785 on 12/30  Lower extremity Dopplers negative for DVT -Lasix resumed at 40 mg twice daily   BLE edema -Acute on chronic problem related to CHF and venous stasis -Doppler US BI LE negative for DVT. ABI R 1.02, L 0.72, unchanged from 12/2022. -Keep leg elevated. Compression stocking if tolerated -Lasix resumed     DM2 -Hgb A1c 7.8  -A1c was 7% 1 year ago; will have patient carb restrict his diet and follow-up with PCP   CAD -Per history. Follows with Dr. -S/p recent PCI for OM1 and in-stent restenosis of mid RCA. -Continue at home Plavix 75 mg BID and ASA 81 mg.    Essential HTN -Continue home Toprol 25 mg.    HLD - Prescribed atorvastatin but nooncomplaint     GERD -Continue at home Protonix 40 mg daily.    RA -Per history. -Doesn't currently take anything.    Tobacco use disorder -Current smoker, 1 ppd with year smoking history. -Encourage cessation.