Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiac failure chronic, Chronic obstructive pulmonary disease
Clinical narrative: Admit date: 1/18/2024  Discharge date:  1/22/2024  Admitting Physician: DO   Attending Physician at the Time of Discharge: MD  Primary Care Physician: MD Reason for Admission: 78 YO female with past medical history significant for chronic respiratory failure with hypoxia on 2-3 L at home in the setting of severe emphysema with longstanding nicotine dependence in recent remission, synchronous non-small-cell carcinoma of the lung status post radiation therapy currently felt to be slow-growing and being followed by surveillance only, chronic heart failure with preserved ejection fraction, coronary artery disease status post multiple remote PCIs with coronary artery stents most recently 2022 in paroxysmal atrial fibrillation on Xarelto re presenting from home after observation admission for mild acute on chronic respiratory failure thought to be due to left upper lobe consolidation consistent with community-acquired pneumonia with mild chronic obstructive pulmonary disease exacerbation sent home on prednisone and doxycycline plus cefdinir with patient at baseline oxygen status.  Patient reportedly went home and felt winded and saw that her house was a disaster and that everybody was sick and returned to the hospital and was found to be COVID-19 positive with worsening hypoxia 48 hours after having a negative COVID-19 test.  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  In summary, patient was admitted with worsening respiratory failure in the setting of likely COVID-19 pneumonia.   Patient initially was requiring a non-rebreather at 15 L.  Patient was started on IV remdesivir protocol and Decadron 6 mg daily while continued on oral cefdinir and doxycycline to complete a 5 day course of antibiotics for community-acquired pneumonia initiated on discharge from prior observation admission.  With concerns for high-risk for progression of respiratory failure patient completed the 5 day IV remdesivir protocol prior to discharge and at time of discharge was back on her home oxygen requirement of 3 L.    Hospital Course: Acute on chronic hypoxic respiratory failure due to COVID with possible community-acquired left upper lobe pneumonia and chronic obstructive pulmonary disease exacerbation- patient recently admitted with viral syndrome and sick contacts at home, now admitted with COVID.  on 3 liters by NC at home but initially requiring FiO2 70% with non-rebreather at 15 L. - will continue decadron and remdesivir (started 1/18) given her worsened hypoxia as she has significant risk factors for developing severe disease. She remains on her home xarelto -resume aerosol therapy, home aerosols including Yupelri - procalcitonin remains unremarkable, we will continue cefdinir and doxycycline through 1/21 complete 5 days of treatment for possible superimposed bacterial pneumonia although COVID-19 pneumonia seems more likely clinically -monitor patient's oxygen requirements currently on 4 L with baseline 3 L requirement at home, initially requiring non-rebreather at 15 L equal to 70% FiO2 in the setting of peripheral oxygen saturation of 82% on 3 L  Chronic heart failure with mildly reduced EF and diastolic heart failure- last echo revealed EF of 45 -- 50% in July.  No evidence of fluid overload on chest imaging, pBNP 6568 which is consistent with prior numbers.  She is not on diuretics at home.  Patient had no signs of volume overload during admission and was continued on her home beta-blocker with lisinopril restarted on discharge  Discharged to Home