Age: 41.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Dyspnoea
Clinical narrative: Hospitalized (12.25.21 - 12.28.21); ED visit (12.29.21); COVID-19 positive (12.22.21); Fully vaccinated Admission Date: 12/25/2021 Discharge Date: 12/28/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 virus infection [U07.1] HOSPITAL COURSE: Patient is a 42 y.o. male who presented with chief complaint of shortness of breath, fatigue and cough.  Patient reports his symptoms started on 12/19.  Patient felt very fatigued  He did a COVID-19 test at home which came back negative.  He continued to have symptoms like cough, nasal congestion and fatigue.  He repeated his test on Wednesday at home and came back positive.  Patient had progressive worsening of his breathing, generalized fatigue and cough.  Patient presented to the emergency department today for further evaluation and treatment.  Patient denies any diarrhea, abdominal pain, headache.  He has no loss of taste or smell sensation.  Has intermittent nausea and headaches. On admission patient was found to be hypoxic requiring 2 L of oxygen to keep sats above 90%.  Chest x-ray showed patchy infiltrate in the left mid and upper lung.  COVID 19 PCR test was positive.  Patient received 1 dose of dexamethasone 6 mg.  Patient was admitted to hospitalist service for further management of COVID-19 pneumonia. His O2 requirement increased to 4 L . He received dexamethasone and Remdesivir. Patient was able to be weaned down to 2 L of o2. He was evaluated for home O2 and was found to require 2 L at rest and 2 L on ambulation. He was discharged home in stable condition on supplemental oxygen.   ED visit 12.29.21:  CHIEF COMPLAINT: FEVER and SHORTNESS OF BREATH DIAGNOSIS at time of disposition: 1. Pneumonia due to COVID-19 virus  2. Shortness of breath  Wed Dec 29, 2021 1042 Patient with active COVID-19 presents with shortness of breath especially at nighttime.  He reports hypoxic readings on his pulse oximeter at night last night.  He was discharged from the hospital after over a 3 day admission on 2 L nasal cannula.  The patient typically wears a CPAP at night for obstructive sleep apnea but has only been wearing his nighttime O2.  He had increased his O2 requirement to 3 L last night and would wake up significantly out of breath. I talked respiratory therapy as he is 95% on 2 L here and ambulated at 95% on 2 L as well.  I do not think further radiographs or laboratory studies as needed.  Vital signs otherwise stable.  We did try to calibrate his home pulse oximeter which is rating about 5% less than our pulse oximeter in the emergency department.  Patient was outfitted with a new fingertips pulse oximeter.  I additionally called his CPAP supplier and we discussed options to get him an adapter for his O2 at nighttime.  Patient will go to Care Center to purchase a pressure line adapter.  He also has the option of producing a heated hose with an adaptor built-in but this would require 3-4 days for shipping.  As he is on day 10 of his COVID-19 symptoms I feel the pressure landed after will be more useful immediately.  Patient understands reasons to return.  Discussed continuing see his symptomatic therapies including finishing his steroid.   The patient was discharged home in stable condition. Patient verbalized understanding.  Will follow up with primary care physician.  Understands reasons that would require a return visit to the emergency department.  All questions answered.