Age: 92.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory failure, Asthenia, Blood urea increased, COVID-19, COVID-19 pneumonia
Clinical narrative: Hospitalized 10/9/2021; COVID-19 positive 10/09/2021; fully vaccinated  DATE OF DICTATION:  10/09/2021 ADMISSION DATE:  10/09/2021   CHIEF COMPLAINT Shortness of breath and weakness.   HISTORY OF CHIEF COMPLAINT This is a 92-year-old gentleman who lives independently who came to the hospital for progressive weakness.  His daughter is here and provides much of the history.  The patient says that on Monday 10/04, he developed what he thought was a cold.  This started with a cough and then progressed to some shortness of breath.  He has gotten progressively weak.  The patient's daughter says he fell 3 or 4 days ago but seemed to be okay.  Today, he could not get out of bed for a very long time and then finally was able to get up and make it to the bathroom.  He then was unable to get up off the toilet.  She came over to check on him and found him stuck on the toilet.  He was brought to the ER for evaluation.  He denies emesis, chest pain, urinary symptoms, and fever.  He admits to some chronic diarrhea.  Workup in the ER showed positive COVID.  Chest x-ray showed moderately extensive bilateral airspace disease.  BUN 23.  He had sinus tachycardia with a rate of 109 on EKG.  Initial heart rate in ER 117.  SpO2 89% on room air.  He received 6 mg Decadron and 1 L normal saline.  We are admitting for treatment for COVID. 10/11/2021 note:  IMPRESSIONS/PLAN 1. Severe COVID 19 Pneumonia with hypoxic resp fail              -First Symptoms:  10/4              -Symptom Day #8              -MAB:  no              -Decadron:  #3              -Remdesivir:  #3              -Oxygen requirement:  1L              -Daily renal and liver function monitoring for kidney and liver toxicity due to Remdesvir is required.              -Daily CMP, CBC w diff, D-Dimer              -DVT Prophy:  Lovenox 10/13/2021 note:  IMPRESSIONS/PLAN 1. Severe COVID 19 Pneumonia with hypoxic resp fail              -First Symptoms:  10/4              -Symptom Day #10              -MAB:  no              -Decadron:  #5              -Remdesivir:  #5              -Oxygen requirement:  4L NC              -Daily renal and liver function monitoring for kidney and liver toxicity due to Remdesvir is required.              -Daily CMP, CBC w diff, D-Dimer              -DVT Prophy:  Lovenox 10/16/2021 note: IMPRESSIONS/PLAN  1. Severe COVID 19 Pneumonia with hypoxic resp fail          First Symptoms:  10/4          Symptom Day #12              -MAB:  no              -Decadron:  #8              -IV Lasix 40 daily              -Remdesivir: completed 5 day course              -Oxygen requirement:  2L              -Daily renal and liver function monitoring for kidney and liver toxicity due to Remdesvir is required.               -Daily CMP, CBC w diff, D-Dimer              -Procal              -DVT Prophy:  Lovenox Disposition:  Increased oxygen requirements. Plan was to discharge today but significant desaturation during ambulation test. Will remain inpatient.   10/17/2021 note: IMPRESSIONS/PLAN 1. Acute Hypoxic Respiratory Failure 2/2 severe COVID-19 pneumonia with superimposed HAP              -First Symptoms:  10/4              -Symptom Day #13              -MAB:  No              -Zosyn 4.5g 16h (day 2)              -Vanc 500mg BID (day 2)              -Decadron:  #9              -IV Lasix 40 daily              -Remdesivir: completed 5 day course              -Oxygen requirement:  2L              -Daily renal and liver function monitoring for kidney and liver toxicity due to Remdesvir is required.               -Daily CMP, CBC w diff, D-Dimer              -CXR              -MRSA screen              -DVT Prophy:  Lovenox               MRSA screen neg -- > dc Vano               CXR shows persistent b/l GGO.  I think it looks much worse on the right than left today, and compared to admit the left looks improved and right is worsened. Disposition: Started on ABx on 10/16 due to increased WBC, increased O2 requirements, procal. Obtain CXR today.  Likely DC in next 1-2 days.