Age: 89.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Hypotension, Immunodeficiency, Laboratory test, Lung infiltration, Lung opacity
Clinical narrative: COVID+ 12/16/2022  Vaccination Status - Moderna x3 12/12/22 - 12/19/22 - transferred 12/19/22 for convalescent plasma treatment BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider: MD Admission Date: 12/12/2022 Discharge Date: 12/19/22 DISCHARGE DIAGNOSES 1. Persistent COVID infection in the setting of Rituxan 2. Sepsis 3. PNA 2° COVID-19 4. Acute hypoxic respiratory failure 2° all the above 5. Acute on chronic Chronic combined systolic and diastolic CHF 2° IVF 6. Follicular lymphoma - last Rituxan dose October 2022 7. HTN 8. Difficulty urinating--Foley catheter placed 9. Persistent AFib 10. Acute metabolic encephalopathy, POA.  Improving. 11. Intermittent expressive aphasia (MRI negative for acute change) 12. Mild persistent asthma 13. Poor oral intake HOSPITAL COURSE  Prior history 11/18-11/19:  Observation for COVID.  No treatment.   Current history 12/12 - Fever, tachycardia, tachypnea.  Bilateral lower lobe infiltrates.  COVID positive.  Started Rocephin, Zithromax.  Room air 12/13 - IVF started.  2 L. .  Rocephin/Zithromax 2. 12/14 - IVF stopped.  2 L. Metoprolol increased to 25 bid.  Echo.  ?Looks better.?  Rocephin/Zithromax 3.  12/15 - Lasix 40 IV x1.  2.5 L. 38.4°.  Lisinopril, metoprolol held due to hypotension.  Cardizem 30 q.6 started for heart rate control.  MRI brain obtained.  Rocephin 4.  12/16 - found on the bathroom floor.  Tachycardic, short of breath, febrile--  evidence for worsening sepsis.  3 L. 38.9°.  Rocephin 5. Vancomycin, cefepime started.  Cardizem increased to 60 q.6 hours.  Diuretic held.  Cardiology consult indicated heart rates up to 130 were acceptable.  Consider digoxin. 12/17 - 3 L. Cefepime 2. Vancomycin 2, then discontinued.  Remdesivir 1. .  Attending talked.  Cardizem discontinued. 12/18 - 3 L. Cefepime 3, then DC'd.  Remdesivir 2.   12/19 - 3 L. Remdesivir 3. Discussed case with Dr. who reviewed the patient's Covid cycle threshold.  The patient meets the criteria for convalescent plasma.  However, this is only given therefore a transfer as necessary.  The patient was given the convalescent plasma fact sheet and was told that a nurse practitioner from the team would contact him via phone.  He agrees to transfer. 12/19/22 -12/21/22  d/c summary: Discharge Summary MD (Physician) ? ? General Medicine  BRIEF OVERVIEW:   Discharge Provider: MD Primary Care Provider: MD Admission Date: 12/19/2022 Discharge Date: Dec 21, 2022    Active Hospital Problems   Diagnosis Date Noted POA ? Acute respiratory failure with hypoxia (HCC) 12/20/2022 Unknown ? COVID-19 12/19/2022 Unknown ? Unspecified severe protein-calorie malnutrition (HCC) 12/16/2022 Yes ? Follicular lymphoma (HCC) -low grade    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 [U07.1] HOSPITAL COURSE: 91 y/o male with history of mild persistent asthma, follicular lymphoma (on rituximab), VTE (2016), HFrEF, and AF who was a direct transfer from united hospital to receive convalescent plasma for worsening COVID-19 pneumonia; supply for convalescent plasma is limited thus patient was transferred to hospital as there was reported to be one available unit here. patient was hospitalized at united 12/12-12/19  where he was treated for COVID-19 pneumonia with 5 days of ceftriaxone and azithromycin.  He had decompensated with acute hypoxic respiratory failure requiring 3L O2 thus, antibiotics were broadened to cefepime and vancomycin on 12-16 and Remdesivir was started on 12-17.  was contacted, d/t immunocompromised state of patient, who recommended treatment with convalescent plasma. Due to the limited regional supply of convalescent plasma, patient was transferred to Butterworth Hospital where there was reported to be 1 remaining unit of convalescent plasma. Hospitalization was complicated by acute CHF exacerbation following IV fluid administration, echo was updated on 12/14 revealing EF 40% with moderate global systolic dysfunction, RV is mildly dilated.  Patient was noted to have intermittent expressive aphasia thus, MRI brain was performed to r/o stroke which was negative. Foley catheter was placed due to concerns for urinary retention. Patient transferred, patient was given the plasma and promptly was able to be brought down to room air at rest and and 2L with ambulation. patient discharged with instructions to follow-up. remdesivir stopped at discharge, patient never received steroids, unclear why, but given his improvement without them he was not discharged on them.