Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: C-reactive protein increased, COVID-19, Chest X-ray abnormal, Chest pain, Cough
Clinical narrative: Patient presented with multiple complaints including shortness of breath, cough, nausea, vomiting, diarrhea, weakness and fatigue.   His workup was notable for COVID-19 positive.  He is immune suppressed due to his transplant status.   He has been treated with dexamethasone, Remdesivir, ceftriaxone, azithromycin, and oxygen support. ID and Pulmonology have been following. He worsened and required HFNC.      March 20, has high-flow nasal cannula requirement has increased to 60L 70%. BUN/Cr 59/1.2. D Dimer on March 18 1,616. PCT on March 17 0.32. Will start IVF, doxycyline, and check CTA Chest. Encouraged incentive spirometer.   March 22, O2 requirement had been trending down yesterday and this morning it increased. He was not in distress and complained of only minimal dyspnea. He had been weaned to 50L 50% but then increased to 60L 90% with NRB overlay. CXR is consistent with covid without evidence of acute changes. CTA is negative for PE and notable multifocal infiltrates consistent with covid.    March 23, O2 requirement HFNC 60 L 75%. CRP down-trending, now 1.29; will reduce dexamethasone to 6 mg by mouth once daily from twice daily. BMP notes stable renal function BUN/Cr 47/0.8.    March 24, patient had brief episode where his O2 requirement dramatic the increased.  He denied any shortness of breath during that episode.  Pulmonology has encouraged him to lay prone.  His CRP has continuously trended down so we will not change his dexamethasone dose at this time.  Laboratory studies demonstrate stable kidney function with BUN creatinine 44/0.8.  Potassium was 5.3 reported as hemolyzed.  Nephrology has made no changes to his medications or attempted to correct that potassium.   March 25, his O2 requirement has been reasonably stable at 60 L and 75% high-flow nasal cannula.  He is encouraged to prone and alternate side laying.  Will begin weaning dexamethasone currently at 6 mg daily.  Will wean to 4 mg and then 2 mg and then resume his prior to admission prednisone 5 mg daily.   March 26, O2 requirement improved to HFNC 50 L 60%. He has oral thrush. Dexamethasone is stopped and home dose of prednisone 5 mg daily is resumed; Nystatin suspension S/S is ordered.    March 27, O2 requirement is continuing to improve he is now at 45 L 45%.  Will try him on nasal cannula today.  We will try to get him out of bed today as well.  Renal function stable with BUN creatinine 51/0.9.  Chest x-ray notes improvement in his multifocal bilateral opacities.  Patient has no new complaints today.  March 28, patient complained of an episode of chest pain last night, currently on HFNC 55 L 70%.  Chest x-ray stable infiltrate in the left mid lung with possible increasing consolidation in the retrocardiac space with mention of possible left pleural effusion.  Neither Pulmonology nor Nephrology have significant changes to the POC today.  Labs are essentially unchanged BUN creatinine again 51/0.9.   Patient was reevaluated by specialty HCF on March 28 and accepted. He will discharge from 1st HCF and transfer to the Specialty Hospital