Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Enterovirus test negative, Human metapneumovirus test, Human rhinovirus test, Hypervolaemia, Hypoxia
Clinical narrative: ED to Hosp-Admission  Discharged  9/13/2021 - 9/15/2021 (2 days)  Hospital Doctor   Last attending ? Treatment team Severe sepsis; Medical Problems     Hospital Problems        POA    * (Principal) Severe sepsis. Yes         Essential hypertension Yes         Paroxysmal atrial fibrillation Yes         Coronary artery disease involving native coronary artery of native heart without angina pectoris Yes         History of coronary artery stent placement Not Applicable         Restrictive airway disease Yes    Overview Addendum 7/14/2021 11:17 AM by (doctors name omitted)       02/08/2019 Pre-BD:  FEV1/FVC: 1.25/1.44 (67% / 58%) ratio: 87% Post-BD: FEV1/FVC: 1.20/1.20 (64% / 48%) ratio: 100% DlCO: 31% DlCO/VA: 82%   07/09/2021 Pre-BD:  FEV1/FVC: 1.52/1.85 (83% / 77%) ratio: 82%  DlCO: 45% DlCO VA: 61%   06/29/2021 1. Findings most consistent with new CHF/volume overload. (Patient was in CHF @ time of CT) 2. No pulmonary emboli are seen.  3. New mild pulmonary edema.  4. New small bilateral pleural effusions.  5. Stable mild cardiomegaly and significant appearing left ventricular dilation.  6. Incidental findings as described.    06/30/2021 Echo  Low normal left ventricular systolic function.  Left ventricular ejection fraction is estimated at 50%.  Abnormal septal motion consistent with pacemaker.  Mild to Moderate mitral valve regurgitation.            Morbid obesity Yes         Pulmonary hypertension Yes         OSA (obstructive sleep apnea) Yes    Overview Signed 7/12/2020  9:51 AM by (doctors name omitted)       Declined treatment            Gastroesophageal reflux disease Yes    Overview Signed 10/2/2020 11:13 AM by Update, (name omitted)       Regulatory Update to replace inactivated diagnosis.            Acute respiratory failure with hypoxia Yes         Chronic systolic (congestive) heart failure Yes         Type 2 diabetes mellitus with complication Yes         Diabetic peripheral neuropathy Yes         Pneumonia due to COVID-19 virus Yes         Acute hypoxemic respiratory failure due to COVID-19 Yes   Active Issues Requiring Follow-up Front Page AVS: o Admitted to the hospital with hypoxia secondary to COVID-19 infection. o You were admitted, you were started on Decadron Remdesivir for treatment of the COVID-19 infection. o You respiratory status improved, eventually weaned down to room air, tolerating well. o Continue taking oral Decadron, continue supportive therapy with albuterol nebs, Tessalon Perles. o Please follow-up with your PCP in 1 week, continue COVID-19 precautions/isolation for additional 7 days after discharge per protocol.  Please see information below regarding COVID-19 infection and Covid isolation. Presenting Problem/History of Present Illness/Reason for Admission Shortness of breath Third degree AV block Paroxysmal atrial fibrillation Essential hypertension OSA (obstructive sleep apnea) Hypoxia Diabetic peripheral neuropathy Restrictive airway disease Acute respiratory failure with hypoxia Intractable back pain Postsurgical cardiac pacemaker in situ Severe sepsis Type 2 diabetes mellitus with complication Chronic systolic (congestive) heart failure Acute hypoxemic respiratory failure due to COVID-19 Pneumonia due to COVID-19 virus COVID-19     Hospital Course 77-year-old female with a past medical history of congestive heart failure, atrial fibrillation, third-degree heart block status post pacemaker, obstructive sleep apnea on 2 L nightly, type 2 diabetes, diabetic neuropathy, restrictive lung disease, pulmonary hypertension who presented to the emergency department with 1 week history of cough, shortness of breath.  Notes that her cough and shortness of breath has been getting worse over the past week, no GI symptoms, denied significant fevers and chills.  Reports that she does not wear mask when she goes out in public, she is vaccinated, just got back from vacation.  Patient presented with hypoxia emergency department, was admitted to hospital service for treatment of COVID-19 pneumonia.   1.  Severe sepsis, COVID-19 pneumonia, hypoxic respiratory failure Presented with severe sepsis with her tachycardia, tachypnea, COVID-19 and source of infection.  Hypoxia is source of her organ failure.  She was started on Decadron and Remdesivir for her COVID-19 infection, no indication for therapeutic improvement therapy, steroids, Mucinex, and Tessalon Perles.  Inflammatory markers trended down, she was weaned down to room air at time of discharge.  Patient was medically cleared and stable for discharge, she denied oxygen with activity stating that she has oxygen at home and can use it if she needs.    2.  Systolic heart failure, atrial fibrillation History of systolic heart failure, who is euvolemic and without exacerbation during this hospitalization.  Does have some mild rales however this is likely from her COVID-19 infection, continued on her home dose of Lasix and Coreg, stable for discharge.  She was rate controlled, continue on Coreg and Eliquis   3.  OSA, check lung disease, pulmonary hypertension Previous history of OSA, does use oxygen at home occasionally however notes that she is not always compliant.  Her respiratory status improved well with Decadron and Remdesivir, she was weaned down to room air at time of discharge.  We will continue home medications at discharge, follow-up with PCP in 1 week.   On day of discharge, her symptoms significantly improved, she was weaned to room air, notes that her shortness of breath and coughing has improved.  Stable for discharge, will be sent home on p.o. Decadron to complete course, instructed to follow-up with PCP in 1 week.