Age: 57.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Acute pulmonary oedema, Acute respiratory failure, Agitation, Alanine aminotransferase increased, Anxiety
Clinical narrative: Hospitalized 12/1/2021; COVID-19 positive 12/1/2021; fully vaccinated  BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider at Discharge: MD Admission Date: 12/1/2021 Discharge Date: 12/5/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxia [J96.01]   HOSPITAL COURSE: This is a 57-year-old female with a history of chronic obstructive pulmonary disease, ongoing tobacco abuse, hypertension, ADD.  Patient was transferred here from Hospital for chronic obstructive pulmonary disease exacerbation, COVID-19 pneumonia.  History is very limited as patient is extremely anxious and tachypneic, wearing BiPAP 35%.  On review of records patient apparently at Hospital was started on IV Solu-Medrol, BiPAP as well as anxiolytics with Ativan, with improvement in her symptoms. On presentation to Hospital patient was in respiratory distress and immediately placed on BiPAP.  She was anxious and tachypneic and hypertensive.  Patient was transferred to Hospital for further treatment and management, parent route she became extremely agitated requiring ketamine.  On arrival to the floor patient was breathing at about 50 per minute, anxious, hypertensive.  She was able to tell me her name, where she is, and tells me she has been sick for just 2 days.  Patient was moved to the intensive care unit to allow for Precedex infusion.  She was also given 1 dose of Ativan 1 mg IV, as well as 40 mg Lasix IV.  A stat ABG is ordered.   Laboratory studies show sodium 140 potassium 5.5 chloride 96 CO2 31 BUN 19 creatinine 0.58.  AST 187 ALT 159 total bili 0.7 white blood cell count 28.5 hemoglobin 13.8 platelet 348083 segs 10 bands COVID-19 PCR positive.  Blood cultures were performed.  Patient was started on empiric antibiotics with Rocephin and azithromycin.  Chest x-ray showed interstitial edema concerning for CHF.  No obvious COVID-19 findings.  Chest x-ray also showed severe chronic obstructive pulmonary disease changes, hyperexpansion with flattening of the diaphragms.   Patient denies using any drugs, denies alcohol use.  She does admit tobacco use.  She was subsequently admitted for respiratory failure, sepsis due to pneumonia, chronic obstructive pulmonary disease.  She responded well to antibiotic therapy.  One blood culture grew Moraxella catarrhalis.  Levaquin was continued and she stabilized.  On the day of discharge she was seen doing well.  Her Levaquin was converted to oral doxycycline and she was discharged home to follow-up with her primary care provider as an outpatient.  She could return to diet and activity as tolerated.  She resumed her medications as previously ordered.  She could return to diet and activity as tolerated.  She understood all these instructions and was discharged home in stable condition.  ED visit 12/13/2021 note: CHIEF COMPLAINT: CHEST PAIN and RESPIRATORY DISTRESS  Assessment/Plan   DIAGNOSIS at time of disposition: 1. Pneumonia of right upper lobe due to infectious organism Active 2. Acute pulmonary edema Active   Patient is a 57-year-old female presenting with cough and shortness of breath.  She is positive for COVID-19 on 12/1/2021 and was recently discharged 4 days ago from Hospital for sepsis secondary to bacterial pneumonia.  On presentation she is in moderate respiratory distress.  She is tachypneic requiring 6 L nasal cannula.  She does wear 3 L nasal cannula at home baseline.  Lung sounds are diminished with crackles and wheezes bilaterally.  She does have 1+ pitting edema of lower extremities bilaterally. IV was established and blood work drawn.  She was given a 20 mg continuous albuterol treatment as well as 125 mg Solu-Medrol.  She does appear fluid overloaded and was given 40 mg of IV Lasix.  Complete blood count with a white blood cell count of 11.5.  CMP is reassuring.  VBG without evidence of acidosis or significant CO2 retention. Chest x-ray is consistent with pulmonary edema as well as a concern for a right upper lobe pneumonia.  Patient is feeling improved after breathing treatment and she is on her base 3 L nasal cannula. As patient has failed outpatient antibiotics and has recurrent pneumonia I did recommend her be admitted for diuresis as well as IV antibiotics.  She was given a dose of IV vancomycin as well as IV Levaquin after speaking to pharmacy regarding her penicillin and cephalosporin allergies. Prior to transfer however patient is requesting discharge.  She tells me that she has to ?attend to some business ?.  I did again recommend she be admitted however she does have capacity to make this decision.  She understands risks and benefits of this.  I will prescribe her oral Levaquin for 5 additional days however she was given strict return precautions to return to the emergency department if symptoms were to worsen.  She was also written a small prescription for Lasix.