Age: 84.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Asthenia, C-reactive protein increased, COVID-19
Clinical narrative: Hospitalized 9/30/2021; COVID-19 positive 09/30/2021; fully vaccinated  CHIEF COMPLAINT: Pneumonia due to COVID-19 virus  Weakness, found down at home  Assessment/Plan  ASSESSMENT/PLAN: Principal Problem:  Pneumonia due to COVID-19 virus  Sepsis due to COVID 19 PNA with concern for superimposed bacterial pneumonia  Positive Test: 9/30 Symptoms Onset: 9/23 First Date of Eligible clearing of covid restrictions: pending review Symptoms: weakness, cough, emesis and diarrhea Tachycardic, tachypnic, WBC 27, LA 2.1   Treatment: Started on Decadron 6 mg and Remdesivir  Supplemental O2, wean as able. Worsening tachypnea with RR 30s. STAT VBG pending. There was a question of a possible bacterial component in the ED and vanc cefepime ordered. CXR seems viral. Procal added and elevated - will cover for superimposed bacterial pneumonia with Rocephin/Zithromax  Supportive Care with PRN anti-emetics, anti-tussives, anti-pyretics. Isolation and prone as much as possible and as frequently as possible. Daily CMP, daily complete blood count and D-dimer x3. VTE prophylaxis with Lovenox.   Current oxygen requirement: SpO2: 94 % O2 Flow Rate (l/min): 2 l/min Note from 10/4/2021: Note from 10/4/2021: CHIEF COMPLAINT: Pneumonia due to COVID-19 virus  Assessment/Plan   ASSESSMENT / PLAN:  Acute Hypoxic Respiratory Failure COVID19 Pneumonia Sepsis secondary to above  S/P vaccination earlier this year Symptom onset was on 9/23, tested positive on 9/30 Initial CXR with diffuse abnormal parenchymal opacities, left greater than right  Follow up CXR on 10/4 with increase bilateral airspace disease and less likely vascular congestion  Currently requiring HFNC with 100 % FiO2 at rest- increased in past 24 hours  Immune labs including CRP and D-dimer very elevated but improving Patient also with elevated Procalcitonin  On Decadron 6 mg daily x 10 days Remdesivir started on 9/30 x 5 days Continue with antibiotics for superimposed bacterial pneumonia coverage x 5 total days Give one time dose if Diuril with findings of possible CHF component on follow up CXR  Encourage proning Continue with anti tussive medication PRN Follow immune labs which are improving  Lovenox SQ increased to treatment dose due to high d dimer and superficial thrombus seen on venous US Note from 10/7/2021: CHIEF COMPLAINT: Pneumonia due to COVID-19 virus Assessment/Plan  ASSESSMENT / PLAN: Acute Hypoxic Respiratory Failure COVID19 Pneumonia Sepsis secondary to above S/P vaccination earlier this year. Symptom onset was on 9/23, tested positive on 9/30 Initial CXR with diffuse abnormal parenchymal opacities, left greater than right. Follow up CXR on 10/4 with increase bilateral airspace disease and less likely vascular congestion Currently requiring HFNC with 100 % FiO2 at rest Patient also with elevated Procalcitonin On Decadron 6 mg daily x 10 days Remdesivir 9/30 x 5 days Completed abx course x 5 total days  Encourage proning. Lovenox 1mg/kg BID for DVT. Patient remains critically ill and receiving maximum non-invasive oxygen support. DNR/DNI