Age: 80.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Blood culture negative, Blood gases, COVID-19
Clinical narrative: Hospitalized 11/8/2021; COVID-19 positive 11/6/2021; fully vaccinated  ASSESSMENT / PLAN: Patient is a 80 y.o. F with PMH of afthritis, HLD, and cervical disc disease s/p fusion, who presents to this facility with 5 days of worsening shortness of breath, fever, and fatigue, admitted on 11/8/21 after failed outpatient management of COVID pneumonia now requiring supplemental O2. #Acute hypoxic respiratory failure with COVID pneumonia Patient presents with.... after testing positive for COVID on 11/6/21, CXR 11/8/21 demonstrating interval worsening of bilateral patchy opacities. Patient and daughter requesting monoclonal antibody therapy, but agreeable to Remdesivir if unable to give monoclonal antibodies. Plan: -Supplemental O2 with continuous pulse oximetry, incentive spirometry, and wean O2 as able -Started on Decadron and Remdesivir  -Tylenol prn -Not currently a candidate for monoclonal antibodies in the setting of supplemental O2 requirements, continue to further evaluate  -EKG pending -Consider CTA if patient clinically worsen  11/12/2021 note:  # Acute Hypoxic Respiratory Failure Secondary to Covid Positive Covid test on 11/06/2021, with symptom onset 11/04. Fully vaccinated for Covid with recent booster. Was hospitalized on 11/08 for hypoxia. Had increasing oxygen requirements and was transferred to the ICU. Subsequently intubated on 11/10.  CXR 11/11: Persistent diffuse airspace opacities, mildly worse in the left lung base. Plan: - Protective vent settings - Continue ceftriaxone for CAP coverage for possible superimposed PNA - Continue Dexamethasone 6mg daily - Started on Remdesivir 11/9. Will hold given AKI. - Trial proning 16:8 as tolerated   # Fever Noted to be febrile during hospital course. Started on antibiotics.  BCx 11/9 NG  MRSA PCR neg Plan: - Follow up blood and sputum cultures - Continue ceftriaxone - Monitor fever curve, Tylenol as needed 11/15/2021 note: # Acute Hypoxic Respiratory Failure Secondary to Covid Positive Covid test on 11/06/2021, with symptom onset 11/04. Fully vaccinated for Covid with recent booster. Was hospitalized on 11/08 for hypoxia. Had increasing oxygen requirements and was transferred to the ICU. Subsequently intubated on 11/10.  CXR 11/11: Persistent diffuse airspace opacities, mildly worse in the left lung base. 11/14: ABG's showing improvement, patient having clinical improvement with CXR showing slight improvements from prior studies. Will titrate vent settings with ABG's and clinical data. Plan: - Protective vent settings              - 4ml/kg-8ml/kg, plateau pressure less than 30, driving pressure less than 15              - adjust FiO2 and PEEP to keep low vent settings as tolerated              - Currently on Propofol, fentanyl. Vecuronium PRN if patient becomes asynchronous with vent.              - wean sedation as tolerated - Patient is s/p CAP coverage 11/12 for suspected superimposed pneumonia.  - Continue Dexamethasone 6mg daily (end date 11/17) - Started on Remdesivir 11/9. Held due to AKI (last dose 11/11) - continue to keep patient supine - Chest Physiotherapy as needed for thick copious secretions.  - Lasix 60 this morning - Negative LE dopplers