Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Asthenia, Atelectasis, Blood lactate dehydrogenase, Blood magnesium
Clinical narrative: Patient admitted 7/6/2021 for cough, dyspnea and lethargy, found positive for COVID 7/6/2021 2305, vaccinated 2/24/2021  discharged 7/9/2021  Received Moderna vaccines on 1/27/2021 and on 2/24/2021  Moderna inpatient for COVID + despite both vaccinations COVID + 7/6 at UK.  Was also positive at urgent care clinic Dose 1: health dept.  Arm.  Lot 007M20A (was difficult to read) Dose 2: health dept.  Arm.  Lot 022M20A (was difficult to read)  Patinet is a 73 y.o. male with past medical history as listed below. He presents with acute onset of lethargy (symptom onset: Saturday 07/03), somnolence and hypoxia as noted by home O2 monitor (approx 88% on room air) along with dry cough. Patient has his sense of taste and smell intact but reports diarrhea. Per wife (who is at bedside) he also has intermittent confusion and appears much weaker than his usual self. She states they got a COVID test at an urgent care and came back positive (COVID test done here is pending). Patient mostly c/o congestion and mild dyspnea and does not report any wheezing or labored breathing. He states he uses 2L O2 at night (although was tested for sleep apnea and was tested negative; during the extended testing he tested positive for narcolepsy). He is a lifelong non-smoker and does not have a prior h/o CHF or lung disease. As I entered the room the patient was noted to be bradycardic and an EKG was done and reviewed by me showing frequent PVC's but otherwise normal sinus rhythm and no evidence of heart block. Per wife he has had issues with "bigeminies" and fluctuant heart rate and has had 30 day cardiac monitoring (per her description no malignant arrhythmias were noted - they have never seen a electrophysiologist).   Patient was flully vaccinated in Feb/March (Moderna). Point of sick contact was likely his dentist (who tested positive and patient had a dentist appointment Wed 06/30)  XR Chest 1 View  Result Date: 7/6/2021 Narrative:  FINDINGS: Underinflated lungs. Vascular congestion. Bibasilar atelectasis. Mildly prominent cardiomediastinal contour.  EKG - no ischemic changes  Start: Remdesevir  Acute resp failure with hypoxia # Viral PNA sec to  SARS-COV2 # Leucopenia - Symptom onset 5 days PTA - Vaccinated in Feb/March 2021 (Moderna) - Risk factors: underlying asthma, diabetes, age - Tested positive at urgent care PLAN: Admit to progressive with telemetry O2 protocol > 94% Start Dexamethasone 6mg po daily x10 days Start Remdesivir x5 days (discussed with patient and wife at bedside). Check LFT's daily while on remdesivir Albuterol q6h prn and q6h sch Dulera BID Check baseline LDH, Ferritin, CRP, Ddimer Contact precautions per protocol    # Bradycardia with PVC's and Bigeminy # NSVT - 4 beat run of VT notes on telemetry strip in ED - EKG done: no heart block noted - known issue and has been addressed outpatient by patient's cardiologist PLAN: Observe for now and consider cardiology consult in AM if bradycardia/NSVT persists Telemetry monitoring Check Mg K goal > 4 Mg goal >2    # T2D - NIDDM - Last reported A1c 7% - On Metformin + Semaglutide inj  at home PLAN: Hold home meds and cover with correction scale insulin Monitor FSBG and add basal lantus per trend    # Asthma - Well controlled on daily symbicort - Flares every 2-3 months - No wheezing on exam with fair a/e PLAN: Bronchodilators sch and prn On systemic steroids for COVID related viral pneumonia/resp failure. Resume montelukast   Chronic: T2D - not insulin dependent. On Metformin + Ozempiq. Last A1c reportedly around 7%. HTN - Controlled. Hold all home meds for now and resume as needed. Home meds onclude losartan 100mg daily and metoprolol 25mg (schedule not known) Gout - on allopurinol. Hold for now. Asthma - attacks once every few months. On Singulair and Symbicort at home Prostate Cancer - s/p radiation Narcolepsy - takes modafenil    DVT ppx: pLOV