Age: 54.0
Sex: M
Vaccine: COVID19
Symptoms: Hepatic mass, Human rhinovirus test positive, International normalised ratio increased, Leukocytosis, Liver function test normal
Clinical narrative: ED Provider Note 2/12/24:  The patient is a 55 year(s) old Male complaining of shortness of breath, lower back pain. Pt states that he is having trouble breathing and he is having lower back pain.  Pt family states that pt had fever at home last night that broke around 0100 this morning.  Temp normal this morning.  Pt is concerned about pneumonia, has chronic lung issues and is on home oxygen. Pt family did not bring oxygen in with them from the car, states it is too bulky to carry, pt is satting 70's on room air. Pt placed on oxygen in triage, 6L NC. 02-12-2024 19:43 55-year-old male with history of anemia, lung injury will on oxygen chronically, hypertension, diabetes, hemophilia A, hep C with hepatocellular carcinoma presents to the ED for evaluation of shortness of breath.  Since yesterday the patient's been coughing, having fevers.  Complaining of low back pain.  Denies any difficulty urinating.  Has a wet sounding cough and feeling short of breath.  Denies fevers but says he is felt body aches and chills.  His nebulizer at home broke and he has not been able to use his inhalers for the last several days.  Arrives on room air because he does not have a portable oxygen machine.  Patient is on 20 mg of prednisone daily.  Review of systems negative except as documented in the HPI. Emergency Department Course and Clinical Decision Making Patient arrives in respiratory distress but has been off his oxygen for some time getting to the hospital.  He was placed back on nasal cannula, complaining of back pain and his pain was treated with Tylenol.  Chest x-ray significant for bilateral consolidation concerning for pneumonia.  He test positive for COVID, rhinovirus and enterovirus on bio fire testing.  Labs concerning for leukocytosis of 20, platelets are normal, stable anemia, lactic acid was 3, PT is also elevated with INR of 1.4, patient is not on anticoagulants.  BUN and creatinine are in the normal range, potassium is 3.3, because of patient's elevated bilirubin new back pain in the setting of leukocytosis CT scan of the abdomen was obtained which shows increased dilation of the CBD approximately 10 mm on the CT, his known hepatic mass is stable consistent with treated neoplasm, CT pulmonary angiogram does not show evidence of PE but does show bilateral pneumonia consistent with what was seen on the chest x-ray.  For concerns of sepsis patient was given Rocephin and azithromycin initially but with a concerning abdominal findings was started on Zosyn.    At 2000 I called regional hospital to arrange transfer for the patient to go to their facility given the hyperbilirubinemia and the likely need of MRCP which we cannot obtain at this time, will also likely need ERCP and GI to intervene during this hospitalization.  Currently waiting to hear back from hospital, patient is unwilling to be transferred elsewhere because of frustration with hospital stay has had at another location before.  His pain is better after Tylenol and he was given his home dose of Suboxone.