Age: 64.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Asthenia, C-reactive protein increased, COVID-19
Clinical narrative: Hospitalized 10/9/2021; COVID-19 positive 10/9/2021; fully vaccinated  Patient with past medical history significant for hypertension, hyperlipidemia, type 2 diabetes on insulin, OSA, BPH, chronic pain, history of type B aortic dissection with mild aortic aneurysm who presented for this hospitalization with fatigue, fever, cough, shortness of breath for the past 2 days.  Symptoms began on 10/07/2021.  Patient is fully vaccinated with Moderna vaccine, last dose given March 2021.  Patient attended his son's wedding on 10/09/2021, and presented with the above symptoms thereafter.  Patient endorsed decreased oral intake over the past couple of days with these symptoms, no changes with urination, no diarrhea, no abdominal pain, nausea, vomiting or constipation.  No chest pain, subjective fevers without checking temperatures at home.  Patient denied all other review of system questioning.  COVID-19 PCR positive in the emergency department.  CT angiogram negative for PE, showed stable aortic dissection and aneurysm, positive for airspace disease consistent with COVID-19 pneumonia, as well as some subcarinal and mediastinal reactive lymphadenopathy consistent with infection.  Patient desaturated into the mid 80% range on room air, required 4 L nasal cannula for stable pulse ox measurements.   Chief Complaint Patient presents with ? WEAKNESS ASSESSMENT/PLAN: Acute hypoxic respiratory failure due to: COVID-19 pneumonia:  In the context of Complete vaccination against COVID-19 with Moderna: Sepsis due to above - onset of symptoms 10/07/2021, will be out of isolation on 10/16/2021 if needing institutional protocol - heart rate 103, respiratory rate 31, source is pneumonia from COVID-19 - CT angiogram negative for PE, noting chronic type B aortic dissection and mild aneurysm, positive for classic airspace disease consistent with COVID-19 pneumonia - requiring 4 L nasal cannula, wean as tolerated - prone as tolerated - check baseline D-dimer and monitor for 3 days - CRP daily for 3 days to monitor for worsening inflammation - lovenox daily for VTE ppx - check lactic acid per sepsis protocol - discussed benefits and risks of remdesivir, patient declined - received decadron in the ED, continue daily for total 10 days - cough, deep breathe, incentive spirometry. Note from 10/11/21:  Chief compliant: COVID 19 infection. ASSESSMENT/PLAN: COvid 19 infection: Acute hypoxic respiratory failure due to above: Sepsis due to above: Oxygen requirements are increased and now he is on high-flow nasal cannula. CRP level increased. Given these 2 findings discussed about remdesivir patient agreed to receive.  Start remdesivir. Continue dexamethasone day # 3.. Encourage prone position and Spirometer. 10/14/21: ASSESSMENT / PLAN: No new Assessment & Plan notes have been filed under this hospital service since the last note was generated. Service: General Medicine COVID 19 pneumonia Acute hypoxic respiratory failure Sepsis - Transferred to ICU as CC2 on 10/12. Now on HFNC FiO2 100%, still requiring NRB  - CRP increased, now trending down - Remdesivir x5 days. Decadron 20mg x5 then 10mg x2 per ICU recs - Cont CAP coverage for now - Encourage prone position and Spirometer - CXR 10/12 showing worsening severe COVID19 -pneumonia. Repeat CXR today.