Age: 65.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Bacterial infection, Brain natriuretic peptide normal, C-reactive protein, COVID-19, COVID-19 pneumonia
Clinical narrative: Hospitalized (10.16.21 - current; still admitted);  COVID-19 positive (10.16.21);  fully vaccinated  CHIEF COMPLAINT:  Acute respiratory failure due to COVID-19 HISTORY OF PRESENT ILLNESS: Patient is a 65 y.o. male who presents today with increased shortness of breath and fatigue.  Patient has history of hypertension, diabetes, obesity, OSA, paroxysmal AFib, and CKD 3. Patient also has chronic respiratory failure in which he requires 2-3 L nasal cannula at baseline.  Patient states over the last 5 days he has had decreased urination, appetite, loss of taste and smell, and increasing shortness of breath.  Patient does also report 1 day of multiple loose stools approximately 3 days prior to evaluation.  Patient also complains of chronic back pain but has had more increase in body aches.  Patient does not does not endorse identified fever, chest pain or abdominal pain.  Due to increasing shortness of breath and fatigue with continued symptoms patient presented to Emergency Room for further evaluation. In the emergency room, patient was found to have worsening renal function, elevated troponins with decrease on repeat.  BNP was normal without leukocytosis.  COVID-19 virus was detected upon swab.  D-dimer was within normal range however chest x-ray showed concern for focal pneumonia versus large mass.  CT thorax was performed without contrast and showed dense infiltrate in right upper lobe with suspected right upper lobe pneumonia.  Patient was given IV Rocephin, azithromycin, and Decadron.  Patient was also found to be slightly hypoxic on baseline 2-3 L therefore requiring increase of nasal cannula oxygen 4-5 L. admission was accepted to a hospitalist service for care of COVID-19 pneumonia as well as secondary bacterial pneumonia and hypoxia.   Acute respiratory failure due to COVID-19  Assessment & Plan Patient had chronic respiratory failure needing 2-3 L supplemental oxygen consistently throughout the day and night.  Patient currently requiring 4-5 L while awake and 10 L bleed into BiPAP at night.  Acute on chronic respiratory failure secondary to COVID pneumonia.  Symptom onset 10/10/2021 with fatigue and weakness.  Progressive increased shortness of breath.  Due to renal function patient is currently not a candidate for remdesivir if improvement in a.m. will need to reconsider starting.  Patient with chest x-ray consistent of right upper lobe pneumonia, elevated procalcitonin and leukocytosis, will treat for secondary bacterial infection as well. Plan: Continuous pulse ox monitoring and supplemental oxygen to maintain saturation greater than 90%. Rocephin and azithromycin day 1 of 5. Daily Dexamethasone 6 mg. Monitor daily complete blood count and BMP with CRP and D-dimer Progress Note 10.26.21: Pneumonia due to COVID-19 virus Assessment & Plan Echo yesterday similar to previous Feeling slightly improved today. Able to be weaned to 6L 02 per nasal cannula.   Will trial home CPAP again tonight.   GOAL SATS 88-92   Daily Dexamethasone 6 mg, (completed 10/26) Continue home eliquis for anticoagulation Monitor daily CBC, CRP and Ddimer Lasix 40mg IV bid Supportive care Position change from side to side, does not tolerate prone position Monitor on continuous pulse oximetry and cardiac telemetry. Acute respiratory failure due to COVID-19 Assessment & Plan Able to be weaned to 6L 02 per nasal cannula.   Continue to monitor on continuous pulse oximetry and tele Wean off oxygen as able.