Age: 71.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Pyrexia, Respiratory failure, SARS-CoV-2 test positive, Sputum discoloured, Wheezing
Clinical narrative: Patient is a 72-year-old male with past medical history of COPD, thyroid cancer, renal cell carcinoma, type 2 diabetes, hypertension, and hyperlipidemia who presents to the emergency department for evaluation of shortness of breath.   He tells me he was in his normal state of health up until 3 days ago he began having an increased cough with some green sputum production.  Of note he states that this began immediately after mowing his yard for the 1st time of the year.  His cough and shortness of breath progressively worsened and became significantly worse last night which prompted him to seek evaluation.  He normally wears 2 liters of oxygen at night but began wearing it around the clock yesterday.   On arrival Patient  is a 72-year-old male with past medical history of COPD, thyroid cancer, renal cell carcinoma, type 2 diabetes, hypertension, and hyperlipidemia who presents to the emergency department for evaluation of shortness of breath.   He tells me he was in his normal state of health up until 3 days ago he began having an increased cough with some green sputum production.  Of note he states that this began immediately after mowing his yard for the 1st time of the year.  His cough and shortness of breath progressively worsened and became significantly worse last night which prompted him to seek evaluation.  He normally wears 2 liters of oxygen at night but began wearing it around the clock yesterday.   On arrival to the emergency department patient's vitals were 99°, HR 110, RR 20, BP 171/70 and SpO2 91% on 3 liters of oxygen.  An ABG was performed and was 7.27/56/78/25.6.  His chest radiograph was stable from previous films on record without evidence of acute infiltrate.  He was noted to be positive for COVID-19.  He completed a Moderna Covid-19 vaccine series with a Pfizer booster earlier this year. The remainder of his laboratory evaluation was fairly benign.  He was given Solu-Medrol and DuoNeb updrafts in the emergency department with improvement in his dyspnea.  At the time of my exam the patient is resting comfortably and remains on 3 liters of oxygen.  He has some mild expiratory wheezes.  He denies fever or chills, nausea vomiting or diarrhea.  He denies loss of taste or smell.  He does have a port present in his right subclavian vein which she states was placed due to prior difficulty with laboratory and IV access.     Is worth noting of the patient underwent radiation therapy for thyroid cancer 6 years ago.  He also underwent a left nephrectomy with partial right nephrectomy in 1986 due to renal cell carcinoma.  He follows Dr. of Oncology Group.   DISCHARGE:  Patient is a 72-year-old male with past medical history of COPD, thyroid cancer, renal cell carcinoma, type 2 diabetes, hypertension, and hyperlipidemia who presents to the emergency department for evaluation of shortness of breath. He was in his normal state of health up until 3 days ago he began having an increased cough with some green sputum production.  Of note he states that this began immediately after mowing his yard for the 1st time of the year.  His cough and shortness of breath progressively worsened and became significantly worse last night which prompted him to seek evaluation.  He normally wears 2 liters of oxygen at night but began wearing it around the clock the day prior to admission..  On arrival to the emergency department patient's vitals were 99°, HR 110, RR 20, BP 171/70 and SpO2 91% on 3 liters of oxygen.  An ABG was performed and was 7.27/56/78/25.6.  His chest radiograph was stable from previous films on record without evidence of acute infiltrate.  He was noted to be positive for COVID-19.  He completed a Moderna Covid-19 vaccine series with a Pfizer booster earlier this year. The remainder of his laboratory evaluation was fairly benign.  He was given Solu-Medrol and DuoNeb updrafts in the emergency department with improvement in his dyspnea.  At the time of my exam the patient is resting comfortably and remains on 3 liters of oxygen.  He has some mild expiratory wheezes.  He denies fever or chills, nausea vomiting or diarrhea.  He denies loss of taste or smell.  He was  admitted with acute on chronic respiratory failure with hypoxia and hypercapnia  COVID-19 plus COPD exacerbation possibly provoked by mowing his yard. Improved with Solu-Medrol and DuoNebs. He did not have evidence of acute infiltrate on his chest x-ray and is on usual home O2 requirements now after being on higher flow earlier Fully vaccinated w/ Moderna series, Boosted w/ Pfizer early 2022.  Low grade temp overnight 5/17 -  repeat CXR 5/18 am, has remained afebrile and CXR still clear  can dc on oral steroids No other COVID-specific therapies indicated and using solumedrol transitioned to prednisone rather than Dex due to DOAC interaction Probably on around day 5 of symptoms - given that he has multiple comorbids, is on his usual O2 requirements and under 7 days of symptoms, it is likely he could benefit from monoclonal antibodies  We discussed risks/benefits and he would like to get this infusion prior to discharge to give him the best chance of not developing severe symptoms due to COVID  This was given around 1PM and he was monitored after per protocols