Age: 78.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Tachycardia, Tricuspid valve incompetence, Type 2 diabetes mellitus, Ultrasound Doppler abnormal, Vertebral osteophyte
Clinical narrative: ED to Hosp-Admission Discharged  4/16/2021 - 4/19/2021 (3 days) Hospital  Doctor Last attending - Treatment team COVID-19 Principal problem Medical Problems     Hospital Problems        POA    * (Principal) COVID-19 Yes         Hypercholesterolemia Yes         Hypertension Yes         Type 2 diabetes mellitus Yes         Major depressive disorder Unknown         Acute respiratory failure with hypoxia  Unknown         Hypertensive urgency Unknown   Presenting Problem/History of Present Illness/Reason for Admission COVID-19   Hospital Course   (Patient) is a 78 y.o. male with medical history of hypertension, type 2 diabetes on insulin, and hyperlipidemia presents with SOB and she was admitted for acute hypoxic respiratory failure with sepsis .Patient was diagnosed with Covid on 4/15 and repeat COVID-19 was positive on admission.     Acute hypoxic respiratory failure likely from COVID-19-improving o On admission satting low 90% ,required supplemental oxygen, normal lactic acid & CRP, elevated LDH 263 o CXR (4/16/21): mild basilar atelectasis. o Continue remdesivir (4/16-4/21, Day 4) and dexamethasone (4/16-) since O2 sat <94% on room air, requiring supplemental oxygen o Patient currently satting 95-97% on 2 L nasal cannula.  Bedside study does not qualify patient for home oxygen while resting and/or ambulating.  PT recommends safe discharge home.  Patient clinically stable to be discharged home today.  Patient to follow-up with PCP. Sepsis likely from COVID-19 -resolved o On admission HR >90, RR >20 + source of infection COVID= sepsis, procalcitonin neg- antibiotics not indicated Elevated D-dimer likely from SARs-COV-2 o On admission D-dimer elevated 0.59, patient was tachycardic  o CTA significant for No pulmonary embolism. No lung consolidation. Hypodense renal lesions.  Hypertensive urgency - resolved Essential hypertension o On admission BP >180/120 o Continue home losartan and amlodipine.  Diabetes mellitus type 2  o A1c (11/18/20):7.9, repeat A1c 6.7 (4/17) o Home meds metformin 500 BID, Novolin 70-30 : 40 unit AM, 75 unit PM. Home novolin 70-30 = lispro 34 units, glargine 80 unit approximately o Started SSI, lispro TID 5 units, Glargine 10 units BID, confirmed dose with pharmacy based on his home Novolin 70-30 conversion. Patient to continue home medications and follow-up with PCP. MDD-Continue home paroxetine, venlafaxine Hyperlipidemia - Continue home statin Treatments: steroids: Dexamethasone 6 mg and remdesivir 100 mg, benzonatate capsule 100 mg Procedures: None Consults: pulmonary/intensive care Pertinent Test Results:  CXR: There is mild atelectasis at the lung bases. There is no effusion or pneumothorax. The cardiac silhouette is normal size. The trachea is midline. The osseous mineralization is normal. CTA: IMPRESSION: 1. No pulmonary embolism. 2. No lung consolidation. 3. Hypodense renal lesions as described above.  ED to Hosp-Admission Discharged  4/26/2021 - 5/6/2021 (10 days) Hospital  Doctor Last attending ? Treatment team Acute pulmonary embolism, unspecified pulmonary embolism type, unspecified whether acute cor pulmonale present Principal problem    HPI:   (Patient) is a 78 y.o. male with past medical history of T2DM, HTN, HLD, and depression/anxiety who presented to the ED on 4/26 with COVID pneumonia and acute bilateral PE.   Orthostatic Hypotension. Improved with IV fluids. No orthostasis this morning.  TTE done yesterday showing preserved EF.    Acute hypoxemic respiratory failure secondary to Covid 19 Pneumonia with some contribution from PE. Patien.t now on room air.  Patient  completed Remdesivir. Completed 10 days of Dexamethasone. He will be transitioned to prednisone 20 mg daily for 7 days, 10 mg daily for 7 days then 5 mg daily for 7 days. He was givenTocilizumab: 8 mg/kg, 4/29. He is not a candidate for convalescent plasma.   Acute bilateral PE: Mild clot burden without evidence of RV strain. Was initially started on therapeutic Lovenox, transitioned to Eliquis 4/29. Eliquis priced and affordable to the patient.    T2DM: On lantus 23 units nightly and Humalog to 10 units with meals    HTN: Continue losartan and amlodipine with holding parameters   HLD: Continue statin    Depression with anxiety: Continue paroxetine and Effexor   BPH: Continue Flomax   Suspected OSA: Per his daughter concern for OSA. Will need outpatient sleep study.