Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Throat tightness, Treatment noncompliance, Troponin, Urine analysis normal, White blood cell count increased
Clinical narrative: History Of Present Illness (8/22/21) Patient is a 64 y.o. male with a past medical history of CAD s/p PCI x2 (last in 2019), hypertension, COPD, and HCV who initially presented to the hospital with chief complaint of SOA. Patient is a poor historian. He reports have SOA ongoing for several months but progressively worse over the past 3 months. Was just discharged from hospital yesterday (admitted on 19th and treated for CAP and COPD exacerbation) and states that he still had SOA so severe that "I thought I was going to die." He has not taken any meds since his discharge though reports being discharged on Augmentin. He walks around 10 feet before requiring rest to catch his breath and is unable to climb flight of stairs due to SOA. Has been having to sit up at night to breath as well. Finally reports having sensation that throat is "closing up" when he exerts himself and is better with rest. He states that he was diagnosed with a PE 1 month ago; treated with heparin gtt and not sent home with anticoagulation. Has occasional breathing treatments for COPD at home but has not been compliant with medications. Has 2 stents done (last stent in Dec 2019 and has not followed up with a cardiologist since. He was told he has HF in 2011 and was placed on lasix but self discontinued. Reports that his BP usually SBP in 200s and has not been to a PCP in 4 years. Otherwise, he admits to cough, SOA and denies fever, chills, CP, palpitations, abdominal pain, or syncope. In the ED, he was HD. O2 sats 94% and he was hypertensive. Basic labs, BNP, trops, CXR and CT PE obtained with concerns for PNA vs pulmonary edema. He received IV lasix 40mg, duonebs, and dexamethasone. Cardiology consulted for admission. Sepsis In Setting of COVID+ and Recent CAP (8/22/21); Hemodynamic stabile and afebrile; Blood cultures Ordered; CXR Obtained and showing Right basilar opacity; Most recent WBC: WBC    13.96 (H) 08/22/2021; lactate 3.1, procal 0.32; Reports receiving COVID vaccines x2 this year; Started on Vancomycin and Ceftriaxone in ED; s/p dexamethasone 10mg x1 in ED; sats appropriate on RA  PLAN: BCxs x2, UA, respiratory panel and MRSA PCR pending; repeat lactate pending will consider continuing abx vs supportive therapy; Shortness of Breath complicated by COPD, COVID Infection, and Recent Pneumonia (8/27/21) CXR obtained and showing Right basilar opacity as above. Initially meeting sepsis criteria with labs revealing lactate 3.1 -> 2.2, procal 0.32. UA, respiratory panel and MRSA PCR negative. BCxs NGTD on day of discharge. Reports receiving COVID vaccines x2 this year though tested positive on this admission. S/p Vancomycin and Ceftriaxone in ED; s/p dexamethasone 10mg x1 in ED though stopped on admission. It is likely that current COVID infection and recent PNA largely contributing to his presentation of SOA. He was provided Duo nebs q4hrs and responded to treatment well. He is not on home 02. During an episode of hypotension that occurred after standing up to get dressed, patient became SOA. O2 sats and physical exam were unchanged, apart from subjective SOA. CXR revealed no acute pulmonary findings. Patient was started on CPAP at night and Dexamethasone x10 days. Pulmonology was consulted and recommended restarting symbicort and ellipta and doing additional workup for his dysphagia and possible sleep apnea outpatient. He would likely benefit from PFTs outpatient as none were found on file. Will need to follow up with Pulmonology and Sleep clinic outpatient.  Discharged to home 8/27/21