Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac failure, Chest pain, Chronic obstructive pulmonary disease
Clinical narrative: "Admit Date: 1/7/2022  Discharge Date: 1/22/22  This is a 71 yo male w/ extensive PMhx pertinent for severe COPD on 4L and Prednisone 20mg daily  W/ recurrent admissions, HFpEF, cor pulmonale, OSA noncompliant w/ CPAP, morbid obesity, and recurrent DVT that presented to ED for evaluation of shortness of breath. Patient known to me from prior admission, 10/27-11/1/21 w/ severe COPD exacerbation. Required up to 10L. COVID negative. D/c home on his usual therapies. Has had 4 days of increasing SOB/severe dyspnea, nonproductive cough w/ mild sputum changes, myalgia, fatigue, headache. Denies fevers, chills, rigors. Received COVID vaccine, but is overdue for booster. Baseline of 3-4L but on EMS arrival was 64% on 5L. In ED, is afebrile and normotensive. HR 110s, sinus. Labs w/ WBC 12.8 w/ shift, lactic 2.3, nml ProBNP and troponin.  Was transitioned to HHFNC on arrival, initially required 60lpm now down to 45lpm. Procal back at 0.6, was given cefepime and solumedrol. COVID returned positive after call to me for admission. On exam, speaking in short sentences w/ pursed lips. Toxic appearing.    Hospital Course by Problem List: 71yo male with chronic respiratory failure due to COPD and HFpEF/cor pulmonale admitted to hospital with acutely worse hypoxia due to COVID 19 pneumonia and AECOPD.  He had slow recovery but is near prehospitalization condition at time of discharge, he is able to ambulate in room and feels well.     #Acute on chronic hypoxemic respiratory failure (Baseline 4L NC) #Severe COPD with acute exacerbation #COVID19 pneumonia COVID+ on 1/7/22; day 1 of symptoms 1/3/22. Overdue for pfizer vaccine #3 Pulmonologist: Dr. On chronic prednisone 20mg daily and PJP prophylaxis CTA PE: no PE, bilateral parenchymal opacities c/w acute pneumonia - s/p remdesivir x5 days; briefly on baricitinib - Dexamethasone tapered - Resume home Prednisone 20mg daily 1/19  - RT protocol, nebs -  oxygen to baseline 4LNC and stable - continue home PJP prophy - pulm consult greatly appreciated-d/w Dr who fill continue to follow post discharge -COVID isolation completed    #Atypical chest pain - troponins negative - given covid positive and resolution/atypical pain will defer further ischemic workup at this time - if recurrent issues would check d-dimer and consult cardiology   #Sepsis, POA-resolved Possibly due to viral illness,  possible bacterial pneumonia on top of COVID19. PCL 0.32 1/9. MRSA PCR negative. Completed course of IV Cefepime   #Chronic HFpEF #Cor pulmonale - continue home lasix & spironolactone - strict I&Os - heart healthy diet with 2L fluid restriction   #T2DM with neuropathy #Steroid induced hyperglycemia (SIHG) - uncontrolled at baseline-A1C 9.1 - hold metformin - continue glargine at discharge, patient's family taught how to do injections, f/up with PCP, as he gets farther from high dose steroids may be able to wean back to oral therapy, if uncontrolled may need dose titration vs resume achs correction factor, patient instructed to monitor glucose qam and document for review with PCP - titrate PRN   #Non-obstructive CAD LHC 2018: 30% LAD, 50% LCx, 30% RCA - continue coreg, aspirin, statin   #OSA: intolerant of CPAP   #Obesity: Body mass index is 37.45 kg/m².   #h/o recurrent DVT w/ IVC filter in place. Not on anticoagulation due to hx of GI bleed "