Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray normal, Chronic obstructive pulmonary disease, Condition aggravated, Dyspnoea at rest
Clinical narrative: COVID Breakthrough Case  J&J Dose 6/8/21 (lot not listed in records) COVID Positive 11/7/21  11/7/21: Patient is 62-year-old male with past medical history of COPD, chronic hypoxic respiratory failure on 4 L oxygen at home, stage IIIB squamous cell carcinoma of the right lung on chemotherapy, pancytopenia, atrial fibrillation on chronic anticoagulation with Eliquis, hypertension, dyslipidemia, chronic hyponatremia, gout, ASD closure, paranoid schizophrenia, tobacco abuse, and obesity. He presented to the emergency room with complaint of shortness of breath. A few hours prior to presenting to the emergency room, patient had sudden onset of shortness of breath at rest. He also reported cough productive of greenish sputum. He also reported associated wheezing. He denied chest pain or palpitations. No fever chills or rigors. No sick contacts in the recent past. Patient is fully vaccinated for COVID-19. Patient still smokes up to 3 piece of cigarettes every day. No nausea vomiting or abdominal pain.  Upon evaluation at the emergency room, patient was in respiratory distress.  He was maintaining saturation with 4 L oxygen via nasal cannula which is his baseline. He was hemodynamically stable and afebrile. Significant lab findings are hyponatremia 131, hypokalemia at 3.3, hypomagnesemia at 1.2, troponin of 0.02 with repeat value at 0.02. CBC was remarkable for pancytopenia which is chronic. Absolute neutrophil count was at 1300. Platelet count was at 37000. Chest x-ray did not reveal any acute cardiopulmonary pathology.  At the emergency room, patient received an hour long DuoNeb nebulization, Solu-Medrol 125 mg IV, Levaquin 750 mg IV.  Potassium and magnesium on supplemented. Patient also received a unit of platelet.  11/12/21: Patient was admitted and underwent treatment for COVID 19 infection and COPD exacerbation  He was given IV abx, steroids, antiviral and bronchodilator therapies  Patient was very dissatisfied with his stay, complained about nursing staff not treating him right, "lying" to him about his compression stockings.  He was given neupogen for pancytopenia as well as PRBC and platelet transfusions. Oncology consulted and followed him, ok for discharge and f/u outpatient with Dr.   ID was consulted due to presence of pseudomonas in sputum culture, this likely is colinization however patient was continued on IV levaquin and will d/c with PO levaquin  Rate control medications were adjusted with favorable response  Patient was counceled extensively on RTC precautions, the importance to follow up with PCP , pulmonology, oncology, and ID as soon as he can make an appointment upon discharge  CBC, BMP on Monday, result to PCP and Dr.  Patient is at high risk of re-admission. He has been admitted at least once a month for the past several months  Patient cleared for discharge by specialty services involved  On the day of discharge patient states he will go home and smoke, despite my objection and discouragement. He states he doesn't want to "come back to hospital in 2 days" yet states he is ready to " get out of here"  Total time spent on d/c 50 minutes