Age: 66.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Auscultation, C-reactive protein normal, COVID-19, Chest X-ray normal, Chronic obstructive pulmonary disease
Clinical narrative: ED for COVID (5.8.22);  Hospitalized (5.10.22 - 5.13.22) with COVID-19 and COPD exacerbation;  COVID-19 positive;  Fully vaccinated PLUS BOOSTER ED Course:  MEDICAL DECISION MAKING: Supervising Physician:  DO   Presents emergency department for evaluation of shortness of breath, has known emphysema.  Has been sick for 6 days, is vaccinated and boost against COVID-19.  She did however take a home COVID test was noted be positive.  She does have significant wheezing on auscultation.  She will be given 8 puffs of an albuterol inhaler, will check baseline labs get a confirmatory COVID testing per our records as she has no proof with her.  Patient is not tachycardic nor hypoxic, she has no leg swelling or calf pain.  She does have known emphysema, and known COVID likely contributing to her dyspnea.  I see no indication for D-dimer testing this point time.  However, should patient have marked infiltrates on her chest x-ray, or require admission this test may need to be ordered in order to stratify her risk from COVID-19.  Patient's chest x-ray is without infiltrate, laboratory studies are reflective COVID-19, no leukocytosis, but mild lymphopenia.  Are confirmatory COVID testing is positive.  Patient does have chronic obstructive pulmonary disease, I am going to treat her for chronic obstructive pulmonary disease exacerbation, likely secondary to COVID.  I am going to discharge her home.  I did give her IM Solu-Medrol here will maintain her on prednisone for the next 3 days at home.  I do not feel she requires antibiotic coverage.  She was given strict return precautions and home pulse oximetry reader.  Patient was given the phone number for the monoclonal antibody clinic, however I did caution her that she is on day 6, most therapies need to be started by day 5.    Hospitalization information:  BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: NP Admission Date: 5/10/2022 Discharge Date: May 13, 2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxemia [R09.02] COPD exacerbation [J44.1] COVID [U07.1]   HOSPITAL COURSE: Patient is a 66 y.o. female who presents today with about a 1 week history of progressive shortness of breath.  She was seen in the emergency department about 3 days ago and had a COVID-19 test which was positive.  She was treated with prednisone.  In spite of that her shortness of breath has progressed and today was acute and scary for her in that she had difficulty being able to walk to the bathroom because of the severity of the shortness of breath.  In the emergency department her pulse oximetry at rest was in the upper 80s.  She had CT a imaging of her chest which showed no evidence of pulmonary emboli or of pulmonary infiltrates.  It was noted that inflammatory markers such as CRP were not elevated in spite of the positive COVID testing.  Patient has a longstanding history of smoking and is currently trying to quit.  Her examination showed diffuse wheezing throughout all lung fields consistent with chronic obstructive pulmonary disease exacerbation At the time of admission, although the patient did have a positive COVID-19 test, was felt that this is most likely a chronic obstructive pulmonary disease exacerbation not directly related to COVID-19.  She was treated with high-dose IV Solu-Medrol, frequent nebulizer treatments, azithromycin, and IV Remdesivir.  She had good improvement over the 1st couple of days with decreasing wheezing.  However by the 4th hospital day she continued to have borderline hypoxemia which on room air with dip into the upper 80s with mobility.  She was agreeable to home oxygen therapy at discharge.  She remains committed to discontinuing smoking and recently was started on Wellbutrin, and in addition will have a nicotine patch. Medication changes at discharge: 1. Nicotine patch 21 mg daily for 6 weeks, then 14 mg daily for 2 weeks, then 7 mg daily for 2 weeks. 2. Azithromycin (antibiotic) 250 mg once in a.m. on 5/14 to complete antibiotic treatment. 3. Prednisone 20 mg twice daily for 5 days for COPD and COVID. 4. Oxygen at 1 liter per minute continuous. May remove if resting in chair. 5. Albuterol per nebulizer up to 4 times daily for the next week, then as needed as before.