Age: 78.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Wheezing
Clinical narrative: 78 y/o  male with history of combined CHF, HTN, CAD who p/w increased sob. The patient states he has been feeling poorly for some time, cannot remember exactly how long. Has had increased sob and has had increased confusion. He was here on 10/2 in the ER with similar complaints. At that time, it was deduced that he had not been taking his medications as prescribed. He was given 80 mg of IV lasix and felt improved, so was sent home. It is of note that he was afebrile at that time (actually mildly hypothermic), and was on room air, and a covid swab at that time was negative. Today he comes in febrile to  101.2, still on room air. CXR shows some cardiomegaly with chf pattern vs possible atypical pneumonia. CXR on 10/2 just showed cardiomegaly. In the ER, the patient was started on sepsis IVF, receiving almost 5L. Covid swab then came back positive and his fluids were immediately stopped, and he has been given 80 mg of IV lasix. He currently is wheezing audibly, and states that he has been doing so at home as well. He does have a history of asthma. He is currently on room air. He does endorse diarrhea and lack of appetite with nausea, but he denies any emesis. He lives at Assisted Living and his wife lives with him. He states she has no symptoms and denies any sick contacts. It is of note that he had his full covid vaccine series in March 2021, has not yet had a booster. Admission is requested. Discharged on 10/9/2021.     Acute hypoxia- not likely covid driven, may be more related to heart failure based on imaging . We increased diuresis to BID 80mg furosemide. Chronic combined heart failure with possible acute exacerbation -- echo done, looks OK. as above bump up diuresis. -- gram neg bacteremia - E Coli, does appear to be urine source, await ID/sensitivities from blood to make sure match, de-escalated to cefazolin after 3 days IV therapy and can transition to PO if afebrile can go to oral abx after today's afternoon dose - rx sent to his pharmacy. ----Covid-19 positive status-  he is febrile with GI symptoms  however also bacteremic -  He is not hypoxic and so does not warrant any specific treatment for covid at this time. Likely exposed and positive in nasopharynx but vaccine worked. Received monoclonal antibodies 10/6 due to risk factors and has not received booster - recommend getting it in 90 days now. ----CAD- continue statin, ----pAfib- continue eliquis, sotalol, ---- HTN crisis - continue hydralazine and norvasc, resume losartan and prns, SBP up to 200, ----DM II- low dose ssi - all CBgs 181 or less, ----DVT ppx- on eliquis. Procedures and Treatment Provided. Physical Exam, Vitals & Measurements, T: 97.7  °F (Oral)  TMIN: 96.5  °F (Oral)  TMAX: 97.8  °F (Oral)  HR: 92(Peripheral)  HR: 98(Monitored)  RR: 23  BP: 124/64  SpO2: 93%, VITAL SIGN, LAST CHARTED, MINIMUM, MAXIMUM, Blood Pressure 124/64 (10/09 13:00)   106/62 (10/09 01:00)    174/72 (10/09 09:00) Heart Rate  92 (10/09 13:00) 60  (10/08 23:22) 92  (10/09 13:00), Respirations 23 (10/09 13:00) 19 (10/09 05:00)  26  (10/09 07:00) Temperature            96.7    (10/09 09:16) 96.7   (10/09 09:16)     96.7  (10/09 09:16) SpO2 93 (10/09 13:00) 91 (10/09 10:00) 95 (10/08 20:52) Discharge Plan Home health.