Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Blood bicarbonate increased, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine increased
Clinical narrative: Narrative: -12/5/2022 - Pt presented to ER with c/o multiple cold/flu/covid like symptoms x 1 week (chills, cough, diarrhea, fever, HA, nausea, runny nose, SOB, sore throat). Pt also experiencing chest wall pain d/t coughing. -In ED, heart rate up to 118, O2 sats above 95% on room air (later was satting high 90s on high flow nasal cannula 40% FiO2 at 40 L/min, unclear why this was placed). Lymphocyte count 0.7, platelet 164. Bicarb elevated at 34. BNP 465 (previously 144). Covid positive. CTA of chest done: Negative for PE, central bronchial thickening consistent with bronchitis, unchanged tree-in-bud opacities in right upper lobe suggesting chronic minor infection/inflammation. EKG: Heart rate 123, atrial fibrillation, narrow QRS, nonspecific T wave changes seen on lateral leads (overall similar to previous EKG). Patient given methylprednisolone, albuterol treatments. Patient also later given metoprolol 50 tartrate. -Patient admitted to medical floor with following diagnosis: acute dyspnea, COVID-19 positive, COPD exacerbation, acute chest pain, CHF. -Patient stay lasted from 12/5/22 to 12/7/22. -PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure: Resolved #COVID Infection #COPD Exacerbation #Persistent A. fib w/ RVR #RUL Tree-In-Bud Opacity #Abnormal Electrolytes - Low Magnesium: Resolved - Low Phosphous: Resolved **HOSPITAL COURSE: Pt presented with coughing and SOB x 1 week. He had flu-like symptoms and was positive for COVID infection. He underwent 3 days of Remdesivir treatment along with steroids. He will continue a total of 5 days of Dexamethasone. His heart rate was poor controlled from his Afib. Cardiology recommended increasing his Metoprolol Succinate. His blood pressure was monitor closely to see if he could tolerate the increase BB dosage. His bp is 112/73 and he will be prescribed Metoprolol Succinate 200mg qAM and 100mg qPM. He is scheduled to f/up with cardiology for further evaluation for cardiomegaly. He is stable for d/c'ed home. Assessment and plan below: #COVID Infection - remdesivir and steroids: Day #3 - Treat COPDe #COPD Exacerbation - Increase in cough, sputum, DOE - CTA chest neg for PE, no pulm edema - Possibly d/t COVID infection - s/p methylprednisolone 125mg x 1 in ED - Dexamethasone 6mg 3/5 daily - supplemental O2 to keep SaO2 88-92% - Duonebs (albuterol/ipratropium) Q6hr + PRN - Doxycycline at d/c #?Acute Hypoxic Resp Failure: Resolved - Pt was on 40% FiO2 HFNC upon my interview, unclear why HFNC was placed, no documented evidence of hypoxia. -CTA chest neg for PE, no pulm edema - Goal O2>88%, supplemental O2 PRN - Continue Home O2 #Persistent A. fib w/ RVR: Recent dx Sept/Oct '22 timeframe - HR 110s to 120s in ED - s/p metoprolol tartrate 50 PO once in ED - c/w home apixaban - home metoprolol succinate 100mg BID, now increase to 200mg qAM & 100mg qPM #RUL Tree-In-Bud Opacity - CT scan showing: unchanged tree-in-bud opacities in right upper lobe suggesting chronic minor infection/inflammation - Doubt this is contributing to current symptoms - Pulmonary inpatient e-consult-> requesting LDCT scan to r/o cancer #Abnormal Electrolytes - Low Magnesium (1.8) - Supplement - Low Phosphous (1.7) - Supplement