Age: 58.0
Sex: F
Vaccine: COVID19
Symptoms: Blood gases, Blood lactic acid, Blood pH increased, Blood potassium decreased, Blood sodium decreased
Clinical narrative: Last updated: 10/8/2021  6:46 AM Have you tested positive for COVID-19 in the last 90 days?  No Please select any symptoms you are experiencing:  Fever or Chills   Cough   Shortness of Breath   Fatigue   Muscle or body aches  Headache   Sore throat When did symptoms start?   10/7/2021  10/08/2021 Urgent Care- Chief Complaint Patient presents with ? Sore Throat     sore throat, fever, body ache, fatigue, chest tightness/burning upon inspiration x2 days     Fatigue, headache, fever, bodyaches, sore throat, chest tightness, SOB, diarrhea COVID test done today  Sister sick with similar symptoms COVID -  COVID FULLY  vaccinated  ***ED to Hosp-Admission  Discharged   10/10/2021 - 10/14/2021 (4 days)  MD Last attending ? Treatment team Acute respiratory failure with hypoxia Principal problem Hospital Problems          POA   * (Principal) Acute respiratory failure with hypoxia Yes       Hyperlipidemia Yes       Irritable bowel syndrome, unspecified type Yes       GERD (gastroesophageal reflux disease) Yes       2019 novel coronavirus-infected pneumonia (NCIP) Yes       Hypokalemia Yes       Hyponatremia Yes       Lactic acidosis Yes           Patient is an 58 y.o. female with past medical history of Hodgkin's lymphoma, OSA, hyperlipidemia, irritable bowel syndrome, neuropathy,and  depression who presented to the ED for evaluation of worsening shortness of breath, dry cough, pleuritic chest pain, fatigue, nausea, and occasional vomiting.  She tested positive for COVID-19 on 10/8/2021.      Plan      Chief Complaint Patient presents with ? Shortness of Breath 1 Acute hypoxia respiratory failure:Likely secondary to COVID-19 pneumonia.  Noted in the ED SPO2 of 86% on room air.Was placed on oxygen at 4 L SPO2 currently is 94% on 4 L. CTA chest was negative for PE. However, noted  infectious/inflammatory process consistent with COVID-19 pneumonia. o Continue oxygen supplementation to keep SPO2 greater than 94%.   2 COVID-19 pneumonia:CTA chest was negative for PE.  However,noted infectious/inflammatory process consistent with COVID-19 pneumonia.Normal WBC, no fever, o Will check procalcitonin to determine if antibiotic is warranted.   o Trend daily procalcitonin and inflammatory markers o Will initiate investigational therapy with remdesivir and Decadron, o Encourage good pulmonary hygiene with incentive spirometer, mucolytic, o Encourage out of bed to chair if feasible o DVT prophylaxis with Lovenox and GI prophylaxis with PPI.   3 Lactic acidosis, resolved.On initial presentation lactate was 3.0, current lactate is 0.7   4 Hypokalemia potassium is 3.4. o  will replenish and follow-up potassium level   5 Hyponatremia, mild sodium is 133 o Encourage oral hydration.  Avoid IV fluid due to COVID-19 o Follow-up with sodium level 6 Hyperlipidemia: o  Continue Lipitor 20 mg p.o. daily 7 Irritable bowel syndrome:  o Continue Bentyl 10 mg p.o. daily and nortriptyline 10 mg p.o. daily, uses nortriptyline off label for irritable bowel syndrome.   7 GERD: Continue PPI   8 Neuropathy: Continue gabapentin   9 Arthritis: Continue Celebrex. 10 Depression: Denies suicidal or homicidal ideations: Continue Celexa 20 mg p.o. daily   Hodgkin's lymphoma, states it is in remission   OSA.  On supplemental oxygen, will offer CPAP if needed   1. Nutrition: Heart healthy diet 2. VTE prophylaxis: SCDs and Lovenox subcu 3. Disposition: Admit to 2 E. 4. Code Status: Full code 5. Family Doctor: withheld 6. Estimated length of stay: 2 to 3 days of hospital stays    Patient is an 58 y.o. female with past medical history of Hodgkin's lymphoma, OSA, hyperlipidemia, irritable bowel syndrome, neuropathy,and  depression who presented to the ED for evaluation of worsening shortness of breath, dry cough, pleuritic chest pain, fatigue, nausea, and occasional vomiting.  She tested positive for COVID-19 on 10/8/2021.   Patient stated that on Wednesday she started having dry cough, fever off and on, chills, past 1 day ago, fatigue, arthralgias, nausea, occasional vomiting, and worsening shortness of breath.  Her symptoms started 5 or 6 days ago.  She was diagnosed with COVID-19 on 10/8/2021 after she was tested for due to her symptoms.  Today she states that she had worsening shortness of breath, with dyspneic, pleuritic chest pain, and worsening dry cough, due to precisely worsening dry cough, pleuritic chest pain, progressively worsening shortness of breath, she presented to the ED for evaluation.  She states that she checked her pulse oximetry at home and it indicated SPO2 of 86%, her heart rate at that time was 150s. She denies GU symptoms,or lightheadedness,   In the ED she was noted to have acute hypoxemic  respiratory failure as it was  indicated by ABG which noted pH 7.49, PCO2 32, PO2 60, bicarb 24, her SPO2 was 86% and was placed on oxygen supplementation at 4 L via nasal cannula.  CTA chest was negative for PE.  However, noted infectious/inflammatory process that is consistent with COVID-19.  Baseline labs with CBC was unremarkable, CMP indicates sodium of 133, potassium 3.4, initial lactate level was 3.0, repeated lactate level is 0.7. Urinalysis was negative for UTI.   ED treatment course. Toradol 15 mg, Solu-Medrol 125 mg and Zofran.