Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Atrial fibrillation, Blood creatinine, COVID-19, Chest X-ray normal
Clinical narrative: Patient is a 69 y.o. male who presented from home on 1/12/2023 with shortness of breath, cough, fevers/chills; found to have covid 19.         Assessment and Plan   Acute hypoxemic respiratory failure -secondary to COVID-19 infection superimposed on underlying COPD and OHS, not on O2 at basline initially requiring 4L NC on admit.  - suspect pt has large component of undiagnosed OSA/OHS.  - Chest x-ray on admission unremarkable - pt started on decadron and remdesivir for covid  - weaned oxygen off while awake prior to discharge; pt had oxygen evaluation done while sitting awake and ambulating and oxygen saturations remained at 90% or above; however, he then desaturated while sleeping suggesting he has underlying OSA and obesity hypoventilation syndrome  - pt discharged on 2 L NC to wear at home at night and while napping during day - recommend sleep study outpatient.    COVID-19 infection Sepsis - Presented with: Cough, shortness of breath and chills.  Had a fever of 101.3 in the emergency department. Sepsis secondary to COVID s/p IVF bolus, abx not indicated due to viral infection.  - Symptom onset:1/11/23 - Positive COVID-19: 01/12/2023 at a local Hospital - Vaccination status: Vaccinated with a total of 4 vaccines.  Last vaccine in 5/5/2022 - Oxygen status: On 2-4 L oxygen on admission and weaned off oxygen by discharge while awake and ambulating; though had desaturations while sleeping suggesting underlying OSA; pt discharged on 2 L NC while sleeping  - Decadron: Yes.  Started on 1/12 and discharged to finish total of 10 day course.  - Remdesivir: Yes.  Started on 1/12 and received total of 3 doses though awake and ambulating saturations adequate on discharge and did not require last 2 doses.  - respiratory status stable and pt hemodynamically stable on discharge.    Diabetes mellitus type 2, insulin dependent  - On Lantus 30 units in the morning and 20 units in the evening along with Humalog 15 units with meals - HgA1c 7.9% - pt with hyperglycemia while on steroids; increased lantus to 35 units in am and 25 units in pm and lispro to 20-22 units with meals (depending on glucose) while on steroids; resume home insulin regimen once off steroids.  COPD -Not in true exacerbation without wheezing -Decadron as above, continue home inhalers, spiriva, with prn albuterol    Atrial fibrillation with RVR -Has history of atrial fibrillation.  Noted to be in A. fib RVR on admission. -Restarted home medications, Lopressor and Cardizem p.o. with improvement in heart rate. -Continue home dose Eliquis and home lopressor and cardizem on discharge.    Seizure disorder -no acute issues during hospitalization  -cont on Keppra and Depakote at discharge.    History of right MCA CVA -Has some mild residual left hand numbness from right MCA CVA in 2018 -Continue Eliquis and Lipitor   Hypertension -Continue home medications losartan, Lopressor and Cardizem   Factor V Leiden -On Eliquis   Prostate cancer -Recently diagnosed last year in September.  Follows at the hospital.  Is on hormone shots every 6 months.  Has received 1 shot.  Has an appointment with radiation oncology on 1/23.  Solitary kidney -History of nephrectomy in childhood from Wilms tumor. -Creatinine stable on discharge.