Age: 59.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Superinfection, Tobacco abuse, Tobacco user
Clinical narrative: Patient with Moderna vaccination x2, last dose 05/28/21 who admitted to hospital with COVID complications.  Provider discharge note below:  "59 year old female with past medical history significant for longstanding nicotine dependence (100+ pack year starting at age 9 now down to less than half pack per day), emphysema, chronic respiratory insufficiency typically wears supplemental oxygen only at night and recent hospitalization for acute appendicitis with possible perforation being managed conservatively as an outpatient with IV Ertapenem and IR pigtail drain presented with worsening hypoxia from home after recent diagnosis of COVID 19.     Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  Acute respiratory failure due to Covid-19 Pneumonia superimposed on emphysema - Vaccinated patient not boosted who tested positive last week at home, confirmatory positive test here on 2/3.  Now requiring 4 liters NC at rest to keep peripheral sats in low 90s, per family at baseline does not use supplemental oxygen during the day, had just started doing that in the past week with her acute illness *CT Angio of Chest on 2/3/22 ruled out PE but did show marked emphysematous changes with interstitial and alveolar infiltrates in the mid to lower lungs consistent with COVID 19 pneumonia *Agree with continuing Decadron 6 mg daily for total of 10 days of therapy *Completed five day IV Remdesivir protocol with high risk patient, last dose 2/7 prior to discharge *Encouraged prone positioning during hospitalization *Will follow D-dimers daily, 1,640 -> 910, was given Heparin subq for DVT prophylaxis *No evidence of superimposed bacterial infection *Continued on home Trelegy (fluticasone/umeclidinium/vilanterol) per patient preference *Continue scheduled Albuterol inhaler QID *Aggressive pulmonary toilet *Extensive counseling regarding smoking cessation   Hypotension on admission - may be close to baseline with normal lactate and renal function at baseline *Received 3 liters of normal saline IV Fluids during hospitalization, negative orthostatics, further IV fluids held and encouraged oral hydration   History of recent Phlegmonous Appendicitis- diagnosed back on ER visit on 1/19/2022, failed outpatient oral antibiotic therapy with ciprofloxacin/flagyl presenting with mild sepsis on 1/21/2022 at general surgery clinic visit, hospitalization from 1/21 - 1/25, given IV Fluids, IV Ertapenem and had a pericecal abscess drain placed into a 4.5 cm fluid collection show on CT with plan for IV Ertapenem through 2/7 to complete 14 days of therapy *No residual abdominal pain with repeat CT showed no evidence of significant residual abscess with minimal drainage from drain *Continued IV Ertapenem *Consulted General Surgery who agreed with discontinuation of IV Ertapenem and removal of PICC line on day of discharge (2/7) *Recommendation to keep drain in and flush with a few ccs of NS every other day with planned outpatient follow-up with general surgery in one week for planning for appendectomy in 4-6 weeks after COVID 19 recovery   Mild Hyponatremia- resolved     History of nicotine dependence with ongoing nicotine abuse - Smoked 2-3 packs per day for 50 years, started smoking at age 9. Now smoking less than half a pack per day. Encouraged cessation. Discussed triggers and use of NRT and other medication options, would like to try nicotine gum prn on discharge.  No physical craving for nicotine at time of discharge so did not start Chantix   Depression  Discussed with patient, she is willing to trial Lexapro 10 mg daily, hx of hallucinations with Bupropion   Hyperlipidemia With risk factors for vascular disease and recent LDL 137 started on high intensity STatin   Issues Requiring Follow Up: (Who, what, when, and how communicated?)  Follow-up resolution of acute respiratory failure with hypoxia in setting of COVID 19 pneumonia superimposed on emphysema with PCP and pulmonology; follow-up smoking cessation with PCP and pulmonology; follow-up recent appendicitis with abscess with residual drain with planning for appendectomy with general surgery"