Age: 57.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Dyspnoea exertional, Fibrin D dimer increased, Full blood count abnormal, Granulocyte percentage
Clinical narrative: This is a 58-year-old male with a past medical history of chronic obstructive pulmonary disease and recent CVA this past November, that presents to the emergency room by way of EMS with complaints of cough and shortness of breath.  The patient states that symptoms started yesterday.  He describes his cough as being productive.  The patient is legally blind and cannot describe to sputum.  He states that shortness of breath usually occurs with exertional activity including wall walking around.  The patient denies any chest pain, abdominal discomfort, nausea, vomiting, diarrhea or urinary symptoms such as dysuria, hematuria or increased/decreased urinary frequency.  He denies any dizziness or lightheadedness.  Again the patient is legally blind and has visual disturbance including blurry vision secondary to this.  He states that this does not feel like his normal chronic obstructive pulmonary disease exacerbation.  The patient's family has tested positive for COVID within the last 90 days, but he himself has had no known exposure as family members did self isolate during the normal quarantine time.  He is vaccinated against COVID-19.  Ultimately, the patient comes to the emergency department for evaluation and care.  Patient is a 58 year old male with a history of left sided multifocal ischemic stroke at the end of November and returned home on December 10, COPD, legally blind, congenital glaucoma, hypothyroid, hypertension, and a lung mass suspected to be cancer who presented to the ER with complaints of worsening shortness of breath and cough over the last 24 hours. He denied fever, chills, loss of taste or smell, nausea, vomiting, diarrhea, headaches, body aches, or falls. While in the ER he was put on 2 liters of oxygen and he maintained oxygen saturations in the mid 90s.  Lab work showed an elevated WBC at 18.72, elevated blood glucose at 129, and the patient tested Covid positive. His chest xray confirmed COPD, a nodular opacity near the right costophrenic angle as per previous CT, and parenchymal scarring, though no acute disease. The patient was transferred and admitted observation in hospital with COPD exacerbation, hypoxia and Covid for further monitoring and treatment. He was weaned to room air on arrival to the inpatient; the monoclonal antibody team was contacted as he is a potential candidate for therapy.   The patient received one dose of remdesivir and then qualified for monoclonal antibodies which was given on 12/30. He did not require supplemental oxygen while inpatient though he did have episodes of shortness of breath that resolved with time or inhalers. The patient states he has a nebulizer and duoneb solution at home that he normally uses 4 times per day.  He also has a walker.  He understands that he is to be following up with oncology regarding the CT results from his previous admission.  A walking oxygen saturation test was completed and he did not need supplemental oxygen. The patient is being discharged in stable condition on room air to complete a course of azithromycin and steroid taper for COPD exacerbation.    Active Issues Requiring Follow-up 12/10/21 CT that identified new lung mass