Age: 74.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Computerised tomogram thorax, Depersonalisation/derealisation disorder, Diarrhoea
Clinical narrative: Chief Complaint  covid + on the 11th, arrived via ems c/o increased lethargy, n/v, and "not acting like himself" per family. recieved monoclonal antibodies at hospital recently. 88%RA - 96%2L History of Present Illness  75-year-old male presents emergency room complaining of shortness of breath fever for the past couple weeks.  Patient was diagnosed with COVID on 09/11/2021.  He is unsure as to how long he had had symptoms prior to this time.  Patient states that he has had nausea vomiting and diarrhea over that period of time.  Patient is a very vague historian.  I am suspicious that he has some element of dementia but he currently seems oriented to time place and person.  He states that he did receive History has been obtained from the emergency room physician that the patient received monoclonal antibody therapy last week.  When asked about this the patient did not know what I was talking about but does remember receiving 4 subcutaneous injections in his abdomen which he thinks was at the 1st of the week.  The patient's wife was admitted earlier in the day after a fall.  The patient is hypoxic in the emergency room with pulse ox readings of 89% on room air.  On ABG the patient has a PO2 of 50 on room air.  Patient has a past history of diabetes mellitus type 2, hyperlipidemia, hypertension, BPH. Review of Systems   Constitutional:  [Patient denies fever, chills, sweats, and weight changes.] Eyes:  [Patient denies any visual symptoms] ENT:  [No difficulties with hearing. No symptoms of rhinitis or sore throat.] Cardiovascular:  [Patient denies any chest pain, palpitations, orthopnea, or PND.] Pulmonary:  As in HPI Gastrointestinal:  As in HPI GU:  [No urinary hesitancy or dribbling. No nocturia or urinary frequency. No abnormal urethral discharge.] Musculoskeletal:  [No myalgias or arthralgias. No hot, swollen joints.] Neurologic:  [No headaches, no seizures. Patient denies numbness, tingling, or weakness on either side of the body. There are no visual symptoms.] Psychiatric: [Patient denies problems with mood disturbance or anxiety.] Endocrine: [No excessive urination or excessive thirst noted. No heat or cold intolerance. No weight gain or changes in skin or hair.] Dermatologic:  [Patient denies any rashes or skin changes.]  Physical Exam  Vitals & Measurements  T: 99.8  °F (Oral)  HR: 68(Peripheral)  HR: 74(Monitored)  RR: 26  BP: 132/68  SpO2: 93%  WT: 81 kg   VITAL SIGN               LAST CHARTED          MINIMUM                 MAXIMUM            Blood Pressure        132/68 (09/27 00:45)   125/76 (09/26 22:45)    149/76 (09/26 22:00) Heart Rate                68      (09/27 00:45)      68     (09/27 00:45)      85  (09/26 20:48) Respirations             26      (09/27 00:45)      20     (09/26 20:48)     27     (09/27 00:00) Temperature            99.8    (09/26 20:48)     99.8   (09/26 20:48)     99.8  (09/26 20:48) SpO2                         93      (09/27 00:45)      89     (09/27 00:00)      96    (09/26 21:45) O2 Flow Rate           4        (09/27 00:45)        2     (09/27 00:15)       4     (09/27 00:45) Weight                      81     (09/26 20:48)      81     (09/26 20:48)     81     (09/26 20:48)   DIAGNOSTIC STUDIES: 1. Multiple chest x-rays showing patchy perihilar left-sided airspace disease. 2. CT angiogram of the chest showing bilateral patchy airspace opacities.  HOSPITAL COURSE: A 75-year-old male, primary care patient of Dr., presented to the emergency room with shortness of breath.  He actually states he was feeling fine and did not want to come to the ER, but his son insisted and dropped him off.  In the ER, he was COVID positive with infiltrates on x-ray and was 89% saturating on room air.  He was therefore admitted, was started on supplemental oxygen.  He was not given any specific treatments and monitored and did not have any worsening of his oxygenation.  He was saturating 93% to 94% on room air at the time of discharge.  With ambulation his oxygen saturation went down to 84% and so he did qualify for home oxygen temporarily.  It is felt to be stable for discharge home on this.  Dexamethasone was withheld due to non-severe disease and his already profound hyperglycemia from diabetes.  DISCHARGE DISPOSITION: CONDITION:  Stable.