Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Obesity, Obstructive sleep apnoea syndrome, Pain, Positive airway pressure therapy, Pulmonary arterial pressure
Clinical narrative: Patient is a 74 y.o. female with a PMH of multiple VTE's (PE and DVT) s/p Greenfield filter and remote pulmonary embolectomy at CCF maintained on anticoagulation (Xarelto), CTEPH followed by the pulmonary hypertension clinic, chronic hypoxemic respiratory failure maintained on 2 L NC, reactive airway disease, OSA (on CPAP), morbid obesity who presented from home on 4/18/2023 with shortness of breath, cough, fever, myalgias. Referred to the ED by her pulmonologist. Found to be positive for SARS-CoV-2 on admission. Initiated on dexamethasone and remdesivir.      Assessment and Plan   COVID-19 - Presented with: Shortness of breath, cough, fevers, myalgias  - Symptom onset: 4/12/23 - Positive COVID-19: 4/17/23   - Vaccination status: Vaccinated with Moderna and boosted with Moderna with booster dose on 8/26/21 - CT Chest on admission showed: Ill-defined scattered ground-glass consolidations with a lower lobe predominance, suggestive of atypical pneumonia. Main pulmonary artery enlargement, a nonspecific finding which can be seen with pulmonary hypertension. - Oxygen status: 2 L NC (baseline) - Decadron: Yes. Expected end date 4/27/23 - Remdesivir: Yes - DVT prophylaxis: Currently on full anticoagulation - S/p 40 mg IV Lasix on 4/20 and 4/21 . Resume home Lasix on discharge    Chronic hypoxemic respiratory failure - At baseline oxygen requirements of 2 L NC, continue    CTEPH  History of multiple VTE's (PE and DVT) status post Greenfield filter and remote pulmonary embolectomy at CCF maintained on anticoagulation (Xarelto), chronic thromboembolic pulmonary hypertension followed by the pulmonary hypertension clinic. RHC 6/20 showed improved PA pressures with mPAP 24, PVR 3.4 WU, preserved CI - Cardiology consulted on admission. Unlikely will recommend RHC this admission during acute COVD-19 infection  - Continue home Xarelto, riociguiat and Opsumit as per home regimen - Pulmonology consulted (patient known to Dr.)   AKI SCr 1.28 on admission; baseline ~0.7-0.8. Suspect prerenal in the setting of recent poor PO intake - Held home Lasix - S/p 1 liter LR bolus, gentle hydration   - Renally-dose medications as indicated  - Resolved    Reactive airway disease Prior PFTs without obstruction. Maintained on Symbicort, Duonebs q6h, prn albuterol   - Continue Symbicort, prn albuterol  - Substitute scheduled Duonebs with Spiriva (avoid nebulizers given +COVID-19) - On Decadron for COVID-19 infection  Dysphagia  History of esophageal stricture - Continue daily PPI   Abnormal finding on imaging CT on admission demonstrated: "Hyperattenuating foci in the right atrium are nonspecific, but consider correlation with echocardiogram to assess for right atrial thrombus."  - Echocardiogram this admission unremarkable  - The patient is on anticoagulation with Xarelto, continue   History of tachycardia  Follows with Heart and Vascular.  Previous 48-hour Holter monitor did not show any sustained arrhythmias - Continue home Toprol 50 mg daily  - Monitor on telemetry    CAD Mild nonobstructive coronary artery disease defined by LHC in 3/2012 with subsequent negative stress testing and historically preserved LV systolic function. Most recent nuclear stress test on 3/30/23 without evidence of inducible myocardial ischemia. Follows with cardiology  - Continue statin therapy    OSA - Continue nocturnal CPAP (endorses compliance at home). Hospital order placed    Chronic pain  - Has been prescribed recent bursts of steroid per OP review   Dry eyes - Continue prednisolone drops as per home regimen    Morbid obesity BMI 44.62 - Encourage weight loss through aggressive lifestyle modifications