Age: 84.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood bicarbonate decreased, Blood glucose normal, Blood sodium decreased, Bronchial secretion retention, Bronchitis
Clinical narrative: Hospitalized (twice:  3.22.22-3.26.22 and 3.28.22-4.1.22); COVID-19 positive ((3.22.22)): fully vaccinated PLUS BOOSTER   BRIEF OVERVIEW: Discharge Provider:  DO Primary Care Provider at Discharge: DO  Admission Date: 3/22/2022 Discharge Date: 3/26/2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19  HOSPITAL COURSE: Patient presented to the emergency department on 3/22/22 with chief complaint of cough, shortness of breath, body aches and congestion.  Appetite was diminished.  Was seen at urgent care on 03/20/2022, tested negative for influenza, was not tested for COVID, was diagnosed with right lower lobe pneumonia and started on doxycycline. On presentation, she was found to be hypoxic at 89% with tachypnea.  She was placed on 2 L nasal cannula during workup.  Chest x-ray showed no acute pulmonary process.  COVID-19 testing was positive.  Influenza was negative.  White blood cell count was within normal limits.  She was admitted to the hospitalist service with diagnosis of COVID-19. During hospitalization, supplemental oxygen with continued for hypoxia.  Remdesivir was declined.  Dexamethasone was administered.  D-dimer and CRP did begin to climb.  CT angiogram of thorax was without evidence of pulmonary embolism.  H required oxycodone for chest pain associated with coughing.  This controlled pain well. Physical and occupational therapy evaluations completed.  Recommended home health.  He also qualified for home oxygen.  Appreciate respiratory therapy and care management. Today, she is ambulating to the bathroom with minimal assistance utilizing a walker.  She remains on 2 L with ambulation or activity.  Saturations stable.  Although cough remains, states that she feels much improved.  Daughter is at the bedside.  Understand plan for discharge.  Home health and home oxygen therapy has been arranged.  No dizziness, nausea or significant difficulty breathing. Patient is stable for discharge home with assistance of family and home health care.  BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: DO Admission Date: 3/28/2022 Discharge Date: Apr 1, 2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Sepsis  Acute febrile illness  Type 1 myocardial infarction without ST elevation HOSPITAL COURSE: A 84-year-old female with recent COVID pneumonia with respiratory failure with hypoxia on 2 L oxygen presented with worsening shortness of breath. On arrival to the ED she was noted to have temp 39.6, RR 42, O2 saturations 90% on 2L. Chest x-ray was unremarkable and CT was negative for PE but showed bronchitis with mucus plugging. Significant labs included Na 132, bicarb 19, Glu 156, A phos 132, AST 112, Alt 163, WBC 14,8. initial hsTnT was 59 without ischemic changes on EKG. Follow up EKG was 192 so EKG was repeated without ischemic changes. Cardiology contacted and felt elevation was due to Type 1 myocardial infarction without ST elevation with recommendations for no heparin gtt but admission for ECHO and monitoring. On admission, patient was started on antibiotics for presumed secondary bacterial pneumonia with her recent COVID pneumonia.  Continued on 2 L nasal cannula support.  Her D-dimer and CRP were monitored and with up trending and concerns of COVID related inflammatory process, she was started on weight based Solu-Medrol IV that her CRP and D-dimer had shown down trending after 3 days and subsequently tapered off with prednisone.  She continued to receive prophylactic Lovenox during this stay.  Her CT thorax did not show PE.  Follow-up chest x-ray had shown improvement.  She was weaned off oxygen during stay. Cardiology had seen her, echocardiogram performed did not show wall motion abnormality. Given no symptoms of angina, patient suspect myocardial injury related to COVID-19 pneumonia and hypoxia.  They recommended no further workup from their standpoint.