Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood bicarbonate decreased, Blood gases, Blood pH normal, COVID-19
Clinical narrative: Admission Date: 10/12/2022  Discharge Date: 10/13/2022 HOSPITAL COURSE: The patient is a 6 y.o. male with PMHx cerebral palsy on baclofen pump, chronic lung disease of prematurity, developmental delay, epilepsy, G-tube dependence and trach dependence who was admitted on 10/12/2022 for COVID-19.    The patient presented to the ED with difficulty breathing and increased oxygen requirements. While in the ED he was hypothermic and was requiring up to 6 L oxygen via nasal cannula. COVID PCR was positive. Chest x-ray showed patchy airspace disease. After deep suctioning of respiratory secretions the patient significantly improved and was weaned to room air before being transferred to the floor. Infectious disease was consulted and patient was deemed candidate for Remdesivir treatment.   While on the floor, patient's respiratory status remained stable. Pulmonology was consulted and recommended continued yellow zone treatments. One dose of Remdesivir was given the night the patient was admitted. The following day (10/13), the patient was continuing to saturate well on room air. He was still experiencing moderate congestion. The mother expressed to the patient's treatment team that she did not want to continue the Remdesivir treatment, stating she would prefer antibody treatment and would like to go home. A lengthy discussion was had with the mother regarding the patient's current status, and it was recommended the patient would benefit from an additional day of hospitalization for continued monitoring. However, the patient's mother felt comfortable enough to manage the patient's secretions and respiratory needs at home. She was counseled on the signs of symptoms of further decompensation and was agreeable to return to the hospital if the patient's condition worsened.   Readmission on 10/16/2022 for 10 hours: Admission Date: 10/16/2022  Discharge Date: 10/16/2022  HOSPITAL COURSE: The patient is a 6 y.o. male with PMHx born at 29 wks, CP (baclofen pump), CLD of prematurity, developmental delay, epilepsy, Trach/GT dep who was admitted on 10/16/2022 for acute on chronic respiratory failure.    Admitted on 10/12/22 with increased work of breathing and requiring 6L NC; COVID infection s/p Remdesivir x1 treatment was discontinued at Mom's request.  He was discharged with return precautions. His home baseline is trach with HME 24/7.   Since discharge, he continued his yellow zone treatments but continued to have increased O2 needs.  Today, mom also endorsed some seizure like movements vs baseline spasticity.  He was brought to the ED and placed on 6L NC; at time of presentation he was febrile to 39.1, tachypneic to the 40s with mild increased work of breathing but satting in the 95's.  He was given a 1 mg Ativan dose, tylenol, and started on Unsayn; CXR showed no focal consolidation, viral vs RAD changes, and no significant change from CXR from 10/13/22.  Blood gas pH 7.4 with CO2 at 32, but bicarb 20.  CBC without leukocytosis, and CMP and UA reassuring. Blood and Urine cultures pending.     On presentation to the ICU, mom expressed concern that the hospital equipment would "dry (the patient) out" and wanted to use his home HME; he was well appearing, RR in the 20's, lungs clear to auscultation with no retractions.  He tolerated RA with no tachypnea or hypoxia.     Patient was transferred to the floor where the patient continued to be stable on RA.  Patient with no more spasticity.  With patient looking comfortable and stable on room air patient was discharged home.