Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Acute respiratory failure, Bacteraemia, Bacterial test positive, Blood culture positive
Clinical narrative: Discharge Summary MD (Physician) ? ? Hospitalist Physician Discharge Summary   Patient ID: Age: 67 y.o. Admit Date: 8/13/2022 12:19 PM Discharge Date:  8/18/2022 Admitting Physician:  Discharge Physician: M.D.   Discharge Diagnosis: Principal Problem:   Acute respiratory failure with hypoxia Active Problems:   Paroxysmal A-fib   Pneumonia of right middle lobe due to infectious organism   Sepsis   Elevated troponin   Pneumonia due to COVID-19 virus   Gram-positive bacteremia   CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min       HPI: "Patient is a 67 y.o. male with a history of shortness of breath has been present for about last week. Patient presented to outside facility tested positive for Covid on August 8 patient states he is vaccinated and boosted ×2. States over last few days has progressively got worse with cough congestion has had sputum production occasionally mixed in hemoptysis. Patient is on chronic oral anticoagulants for a for fibrillation. Has had a fever at home decreased appetite and occasional episodes of diarrhea. Patient seen in emergency room noted to be hypoxic requiring 2 L per nasal cannula imaging studies showing bilateral pneumonia right greater than left. Inflammatory markers elevated with procal 40.  Felt to have both bacterial and Covid pneumonia. Patient marginal blood pressure on admission but responded IV fluids concern for early sepsis as well".   Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.      * Acute respiratory failure with hypoxia o Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Likely a bacterial component. Finished Remdesivir D5/5 and IV Decadron. Continue IV antibiotics as ordered. Sputum culture is pending. Procal up to 40.95 on admission down to 1.93 today. Leukocytosis trending down. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient was weaned off oxygen to room air. Continued nebs and inhalers. Encourage incentive spirometry use and pronating. Continued supportive/symptomatic treatment and supplements as ordered per COVID protocol. Seen by pulmonary, consult appreciated. Followed up daily lab.  Cleared for DC per pulmonary and ID. Follow up outpatient  o Sepsis due to the above with gram-positive bacteremia. Pro-calcitonin and leukocytosis trending down. Blood cultures showing gram-positive bacteria in clusters growing Kocuria rhizophila. Skin contamination per ID. DC IV vancomycin per ID. Infectious disease following. Finish oral ABx course. o Paroxysmal atrial fibrillation. Controlled. Continue home medications including oral anticoagulation. o Chronic kidney o Elevated troponin. Denies any chest pain. Likely type II MI with supply/demand mismatch due to the above. disease stage IIIB. Remains at baseline. Monitor closely with daily lab.     Physical Exam on the Date of Discharge: Stable and improved        Consults:   IP CONSULT TO SOCIAL WORK IP CONSULT TO PULMONOLOGY IP CONSULT TO INFECTIOUS DISEASES   Significant Diagnostic Studies:    Labs, microbiology, radiology, and cardiac graphics: per chart.     Disposition:  home   Discharge Condition:  good