Age: 61.0
Sex: M
Vaccine: COVID19-2
Symptoms: Sepsis, Serum ferritin increased, Sputum culture, Streptococcus test negative, Transferrin saturation decreased
Clinical narrative: COVID+ 1/19/2023.  Vaccination Status - moderna x3 + moderna BIVALENT booster x1 Discharge Summary MD (Resident) ? ? Hospitalist Cosigned by: MD at 1/21/2023  4:06 PM    Attestation signed by MD at 1/21/2023  4:06 PM   I have seen and examined patient independently. Discussed with Dr. I agree with the subjective and physical exam findings and assessment and plan.   35 minutes spent on performing this hospital discharge.    -  MD, Attending Physician, Im/hospitalist.       BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: GNP Admission Date: 1/19/2023 Discharge Date: Jan 21, 2023    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 01/21/2023 Unknown ? Closed displaced fracture of left patella with nonunion, unspecified fracture morphology, subsequent encounter    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Severe sepsis [A41.9, R65.20] Acute hypoxemic respiratory failure [J96.01] Closed displaced fracture of left patella with nonunion, unspecified fracture morphology, subsequent encounter [S82.002K] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 62-year-old male with a past medical history significant for CAD s/p stenting, DVTs on eliquis, ischemic cardiomyopathy (65%), HLD, HTN, COPD without home O2, and urothelial carcinoma w/ metastasis to bone/cerebellar s/p NS sx removal 12/18/22 & pall radiation/chem since 11/2021 who presents to the emergency department all with fever and shortness of breath.  Patient's symptoms began on January 19th in the morning with fever shortness of breath.  He presented to the emergency department on January 20th and was placed on 4 L nasal cannula.  Patient's chest x-ray was done which showed consolidations and his COVID test came back positive.  Respiratory array also came back only positive for COVID.  Patient was started on Solu-Medrol and given Rocephin, azithromycin for community-acquired pneumonia coverage.  Patient was also found to have 2+ pitting edema for the past 2 weeks, consistent with exam.  Echo was done which showed 55% ejection fraction down from 65% in the past with elevated right ventricular systolic pressure of about 63 consistent with pulmonary hypertension.  Patient elevated CRP at 2:45 a.m., ferritin was 415, procalcitonin was 1.11, and proBNP was 2728 up from 2 days ago when it was 411 in his previous emergency department visit.  Blood cultures, sputum cultures, and central line cultures were drawn and remained negative throughout hospitalization.  he was started on Decadron and remdesivir.  Patient was stable on room air since 5:00 a.m. on January 20th without any need for supplemental oxygen, and symptomatically feeling a lot better.  Patient's strep pneumo and Legionella antigen came back negative.  Patient did have some normocytic anemia on admission and had a hemoglobin of 10.6 with a baseline around 15, iron deficiency was seen and lapses and iron saturation of 7%.  Iron replacement was deferred in the setting of sepsis,. CTA was done given recent fracture, cancer, history of DVT, and stopping of Eliquis which showed chronic right lower lobe PE that was very small , emphysematous changes, mild to moderate right lobe airspace disease, no signs of right heart strain.  He did recently present to the emergency department on January 17th due to falling off a ladder on Sunday January 14th, was found to have a left patellar fracture at the location of his urothelial cancer metastasis.  At the time, orthopedics saw him and recommended surgery in the coming days and asked him to hold his Eliquis.  However, reaching out to the surgeon who saw him, he recommended to consult Orthopedics.  Orthopedics saw the patient and recommended non operative management, the mobilization, and outpatient follow-up.  They were okay to restart Eliquis per Medicine perspective while Eliquis is restarted.  Patient examined again on January 21st, and was very comfortable and ready to be discharged.  He had no need for oxygen.  Patient still had some 2+ pitting edema on the left leg and 1+ pitting edema on the right leg, and had crackles and rhonchi dry on exam.  He also had elevated BNP as mentioned above.  Decision was made to start the patient on 20 mg of oral Lasix with instructions to follow-up with the primary care provider to decide to stop will continue.  Patient's cultures remain negative throughout the admission.    Patient was discharged with 30 days of oral iron supplementation with instructions to follow-up with his primary care physician. , patient was discharged with 2 remaining days of Augmentin.  Patient was  asked to follow-up with orthopedics outpatient.  Recommended following up with palliative again outpatient for goals of care discussions.  Patient was stable at time of discharge all questions were answered.