Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Back pain, Blood bicarbonate decreased, Blood culture, Blood lactic acid, Blood pH normal
Clinical narrative: COVID Breakthrough  Pfizer Dose 1 4/15/21 (Er8732) Pfizer Dose 2 5/21/21 (EW0168) COVID Positive 8/25/21  8/25/21: Patient is a 55 year old female with a history of COPD, pulmonary embolism on anticoagulation, HTN, tobacco abuse, sickle-cell anemia who presents for evaluation of shortness of breath.   Patient notes that she started feeling sick on Monday. She initially presented to clinic on Monday for evaluation. Patient's primary symptom is shortness of breath.  She notes that going upstairs she has more difficulty than normal.  Patient has also had increased cough productive of white/yellow sputum.  Patient notes that she has had some right sided rib pain, but is currently denying chest pain. She denied recent sick contacts or exposure to COVID. Patient is not vaccinated for COVID.  No hemoptysis, recent travel or calf tenderness.  Patient notes she had a left rotator cuff surgery recently.  No other concerns today. In the emergency department patient's vitals showed tachycardia to 111.   Patient's initial oxygen saturation was 82% on room air, but improved into the mid 90s on 4 L. labs were obtained and showed mild transaminitis, lactic acid 4.0, troponin 0.01.  ABG showed pH 7.36, pCO2 34, HC03 19. Blood cultures X 2 ordered.  COVID rapid antigen positive.  Chest x-ray showed evidence heart failure with small bilateral pleural effusions and moderate pulmonary vascular congestion as well as airspace disease in the bilateral lower lobes. Patient received breathing treatments, Solu-Medrol and gentle hydration.  She was subsequently admitted to inpatient.   Social history:  Patient admits to drinking approximately 0.5 gallons of vodka per week.  She denies ever having issues withdrawing from alcohol.  Patient smokes half pack per day since the age of 12.  Other past medical history reviewed and updated in the chart.  8/30/21: Brief hospital course: Patient is a pleasant 55 yo F who presented on 8/25/21 with SOB x 3-4 days. She had exposure to husband who was COVID+ and patient was subsequently found to be COVID+. In the ER, O2 sat was 82%, which improved after supplemental oxygen. Afebrile, no CP, no EKG changes, troponin negative. CXR did reveal findings concerning for possible heart failure. Echo during hospital course showed moderate mitral regurgitation with EF 52%. Given Solu-Medrol, Levaquin in ER. CRP was elevated, thus oral prednisone was added along with Mucinex and albuterol inhaler. Patient's hospital course notable for pain in lower back that patient attributed to sickle cell crisis which she endorsed that she has not had for approximately a decade. Her pain regimen was modified to be a PCA. Patient was on CIWA protocol due to alcohol use history. Of note, patient was found to have alcohol in the hospital that was confiscated. On 8/30, patient was deemed stable for discharge with close follow-up on outpatient basis. Patient placed back on home oral pain regimen (MS Contin and Dilaudid). Patient on room air and breathing comfortably, able to move all extremities and ambulate. ER precautions were thoroughly discussed, patient verbalized understanding.