Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Infection, Insulin therapy, Intensive care, Intentional medical device removal by patient, Left ventricular failure
Clinical narrative: Patient is a 58 yr old female presented to ED on 12/27 with SOB and hypoxia.  Patient was tried on BiPAP but was still hypoxic in the 60s hence was intubated in the ED.  COVID was positive.  Patient admitted to ICU and self extubated yesterday was placed on 6 L nasal cannula.  Patient is doing better she has been nitroglycerin gtt. for hypertensive emergency which is improved.  Transferred to intermediate care and PRIVATE is consulted for transfer of care.   Covid-19 Virus Infection Severe sepsis - POA Date of onset of symptoms:  Symptoms present on admission: SOB Date of covid positive test: 12/27/2022 Vaccination status: vaccinated Imaging: CXR showed pulmonary vascular congestion with left lower lobe atelectasis and/or airspace disease CT PA negative for PE, did show partial collapse of the bilateral lower lobes with superimposed consolidative opacities along with multifocal areas of groundglass opacity. Oxygen requirements on admission: Intubated Current oxygen requirements: 3 liters nasal cannula Home oxygen: 2-3L baseline Medical therapy: steroids and rocephin Consultants following: ID Anticipated special isolation end date: 01/05/2023  Recheck PCT wnl, ok to dc home per ID recs off abx. Complete steroid course for 10 total days. Medically stable for dc home   Acute on chronic respiratory failure with hypoxia Secondary to above Patient intubated on admission Self extubated on 12/29/2022 Patient currently on 3 L nasal cannula Wean as able to home 2-3L Procalcitonin 0.54, recheck today wnl. Chest x-ray and CTA as above Patient initially was started on cefepime and vancomycin De-escalated to ceftriaxone, ok to stop on dc.   Nonischemic cardiomyopathy with combined systolic and diastolic heart failure with recovered EF Echo in July 2022 showed EF of 60 to 65% BNP 4100. Echo showed concentric LVH EF 50+/- 5% Continue atorvastatin, Coreg, lisinopril and hydralazine Coreg dose reduced given bradycardia. On Lasix 40 mg daily IV, on 20 PO BID at home Resume PO lasix on dc.  Hypertensive crisis Was initially on nitroglycerin gtt. Weaned off, BP improving Nifedipine, hydralazine and coreg resumed Reduced coeg dose. Tolerating IV lasix well, on  Resume home PO lasix on dc.   Elevated troponins Troponin of 27 -- > 37 EKG nonischemic Likely demand ischemia secondary to acute infection Echocardiogram with EF of 50% and grade 2 diastolic dysfunction   Paroxysmal A. fib Takes Coreg 25 mg twice daily at home Dose decreased to 6.25 due to bradycardia Home Eliquis resumed   Hypertension Takes Coreg, hydralazine and nifedipine at home Coreg dose decreased due to bradycardia, continue hydralazine and nifedipine On IV lasix, resume home PO on dc. Added lisinopril    OSA with obesity hypoventilation syndrome Obesity with BMI of 34.49 Patient unable to complete sleep study outpatient advised patient to follow-up with PCP. Uses CPAP at night at home  Type 2 diabetes without long-term insulin use Takes metformin 1000 mg twice daily at home Hemoglobin A1c 6.5 Continue sliding scale insulin while inpatient