Age: 76.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Influenza virus test negative, Laboratory test, Left atrial appendage closure implant, Metabolic function test, Oedema
Clinical narrative: Patient was hospitalized 3.15.22 - 3.22.22.  COVID-19 positive (3.15.22).  Fully vaccinated PLUS booster.  (just discharged today) Admission note H&P Summary:  77-year-old man is admitted to Hospital on 15th March 2022 for acute exacerbation of chronic obstructive pulmonary disease likely secondary to acute COVID infection.  At this time plan to treat with IV Solu-Medrol, azithromycin, scheduled albuterol, Spiriva, and Symbicort.  Patient uses supplemental oxygen to sleep at night with his BiPAP machine.  At this time he has mild respiratory insufficiency with 1 L oxygen need.  Continue to wean this as able.  Goal SpO2 for this patient to be between 88 and 94%. H&P:  HISTORY OF PRESENT ILLNESS: Patient presents the hospital today with complaints of cough and shortness of breath.  He has history of chronic obstructive pulmonary disease, atrial fibrillation on Eliquis, CHF (EF 54% Oct 2020), pulmonary and renal vasculitis, OSA on CPAP, and diabetes.  He reports that he recently was admitted for Watchman device placement this past February.  Shortly after this he was admitted for bilateral pneumonia and heart failure exacerbation.  He recovers from this and returned home.  He states that his current symptoms began on Sunday.  He has been short of breath with exertion, wheezing and coughing.  He does admit to some orthopnea stating that he "breathes easier sitting up" however at this is not new or worse.  He denies any leg swelling.  He denies fevers, chills, congestion, rhinorrhea, loss of smell, loss of taste, diarrhea. He states that he does have a history of smoking of approximately 5 pack years.  He has history of chronic obstructive pulmonary disease and uses trilogy ellipta.  He does state that he uses 2 L oxygen as needed nightly. Due to his symptoms he presented to the emergency department.    In the emergency department, his oxygen saturation was 87% on room air but this improved to the mid 90s when he was placed on 1 L of oxygen by nasal cannula.  The remainder of his vital signs were within normal limits.  COVID 19 PCR was positive, influenza negative.  He does have evidence of an AKI with creatinine of 1.90 up from a baseline of 1.3.  BNP was within normal limits troponins were 40, 36 with a delta of negative 4. Electrocardiogram showed sinus rhythm with a first-degree AV block.  Chest x-ray showed no acute cardiopulmonary process.  He was admitted to the hospital for treatment of chronic obstructive pulmonary disease exacerbation in the setting of a COVID 19 infection.  Progress note from 3.21.22:  Patient was seen and examined in bed 2519.  His wheezing and shortness of breath are improved. Edema much improved. He has been wearing nasal canula for comfort without oxygen turned on. He had an episode of chest pain yesterday that resolved. Work up was negative for evidence of ACS. He has no chest pain this morning.  Patient is a 77 year old male with a past medical history of atrial fibrillation on Eliquis, CHF, coronary artery disease, prior MI, vasculitis, OSA on CPAP, chronic obstructive pulmonary disease, diabetes mellitus type 2 who presents with cough and shortness of breath.    Chronic obstructive pulmonary disease acute exacerbation, improved COVID-19 infection - symptoms began 03/13/2022.  Positive test 03/15/2022.  - no evidence of pneumonia on chest x-ray - diffuse wheezes throughout all fields, no crackles to suggest fluid overload or consolidation - this is most likely an exacerbation of chronic obstructive pulmonary disease the in the setting of COVID-19 infection - daily CBC and CMP - continue patient's home Eliquis for anticoagulation and DVT prophylaxis - oxygen supplemented through nasal cannula, wean as tolerated - Decreased to prednisone 40 mg daily - azithromycin 500 mg today followed by 250 mg daily for 4 days - Spiriva daily - albuterol inhaler q.4 hours scheduled - Symbicort 2 times a day