Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram thorax abnormal, Cough, Culture urine positive, Dysphagia, Dysphonia
Clinical narrative: Presented to ER on 11/27/21 and 10 day prior was having some  trouble breathing, cough, so tested twice for COVID and they were positive.   Her son, their kids, wife, etc., also positive.  Patient did not feel too  well, could not get any better.  Called the primary care provider and she was  told to take Tessalon Perles but did not seem to help her much.  She kept on  getting worse.  She came to the emergency room day on 11/26.  A workup  was done.  Patient was treated with antibiotic, steroids, bronchodilators and regerone.  Discharged on  antibiotics, steroids and inhaler, etc., but went home and did not feel any  better, so prompted to come back, started having hemoptysis.  She is complaining of generalized weakness,  shortness of breath, and cough, now productive of hemoptysis.  In the ER, she  was evaluated.  Day before, she had normal WBC count, but now it is mildly  elevated, probably due to steroids, but she is also quite hypoxic requiring  5-6 L of oxygen and the CT was done due to elevated D-dimer without contrast  since she is allergic to dye, which shows extensive bilateral COVID  infiltrates and then V/Q scan was done, which was indeterminate as far as PE  is concerned.  Venous Doppler study of both lower extremities are negative.   Patient's main complaint is now cough, hemoptysis, weakness, etc. Placed on azithromycin and ceftriaxone.  On oxygen so placed on remdesivir and steroids. Oxygen saturation and respiratory distress continued to worsen and she required mechanical ventilation.  Was intermittently prone.  Inflammatory markers followed.  Had elevated LFTs likely secondary to illness the trended down over the course of her hospital stay.  Had an episode of hypotension on 12/05/2021 and was off of her blood pressure medications at that point but did respond to fluid bolus.  She was extubated on 12/08/2021.  Initially was doing pretty well on 3 L of oxygen.  Started having significant amount of coughing and dysphonia.  Was very cautiously trialed on some p.o. but swallow study revealed that she aspirated with even minimal p.o..  Was noted on 12/11/2021 to have hematuria and urine cultured positive for Pseudomonas.  Was placed on Maxipime.  On 12/12/2021 required intubation.  Was extubated on 12/15/2021.  Had been started on vancomycin in addition to cefepime for aspiration pneumonia.  Continued to have very poor swallowing with aspiration and underwent PEG tube placement on 12/16/2021.  Continued very weak and was felt with need significant rehabilitation.  Case Management consulted to facilitate placement in rehab type setting.  Continue to work with speech therapy to optimize swallowing.  There was some improvement prior to discharge.  By 12/28/2021 all antibiotics courses had been completed.  Nursing home placement proved difficult but it was felt by patient's daughter and the rest of the family that they could care for her at home and arrangements were made to continue with tube feedings and appropriate follow-up with physical therapy, speech therapy etc..  She was discharged to home with home health care to follow on 12/30/2021.