chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: White blood cell count increased, White blood cells urine positive, pH urine normal
Clinical narrative: Narrative:  12/21/22 - Pt sent to ED from community residential care facility for hypotension, generalized body weakness (GBW), body aches x 1 day. Pt reported chills and muscle pain. In ED, Pt tested COVID +. Pt given 1L NS IVF considering tachycardia / likely dehydration, rectal Tylenol, cefepime IV. Pt will be admitted to hospital 12/21 d/t COVID-19, GBW, body aches and abnormal chest x-ray (possible pneumonia). Pt admitted 12/21/22 through 1/20/23. PRINCIPAL DIAGNOSIS (Reason for admission after study): Acute hypoxic respiratory failure secondary to COVID and possibly aspiration pneumonia. ADDITIONAL DIAGNOSES: Acute on chronic dysphagia due to cervical osteophyte complex COVID viral pneumonia Schizoaffective disorder Syncope Hypothyroidism Hospital Course: 1. Acute COVID 19 infection/pneumonia - clinically resolved. Completed course of remdesivir and decadron. 2. Acute hypoxic respiratory failure due to COVID 19 and possible bacterial pneumonia - resolved. No evidence of PE on Chest CTA. S/P cefepime x 7 days 3. Dysphagia - Failed MBSS badly, per both SLP and radiologist there is little change of recovery short of potential surgery. Osteophyte complex. Community provider has accepted for transfer, but no beds right now. Pt will be transferred to facility for evaluation of osteophytes once bed is available. 4. Hypothyroidism - TSH high nl range cont levoxyl repeat TSH in 4- 6 weeks 5. Syncope, resolved - likely related to hypotension. No further evaluation. 6. Schizoaffective ds, PTSD - Stable, at baseline. Cont Haldol 150mg q4weeks (last dose 12/8/22) Given mentation/sensorium concerns and low plts MH recommended to d/c Valproate (mood instability hx). Can be reconsidered in future as an outpatient, with close monitoring of labs 7. DVT ppx- hep sc
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Allen's test, Anion gap, Atrial fibrillation
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Base excess, Basophil count decreased, Basophil percentage decreased, Blood bicarbonate increased, Blood calcium decreased
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Blood chloride normal, Blood creatinine increased, Blood glucose normal, Blood pH increased, Blood potassium decreased
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Blood sodium normal, Blood urea normal, Body temperature increased, Brain natriuretic peptide increased, Bundle branch block right
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Carbon dioxide normal, Cardiac failure, Cardiac failure congestive
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Coronary artery disease, Diuretic therapy
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Echocardiogram abnormal, Ejection fraction, Electrocardiogram QT interval, Electrocardiogram abnormal
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Eosinophil count normal, Eosinophil percentage, Glomerular filtration rate normal, Granulocyte count, Granulocyte percentage
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Haematocrit decreased, Haemoglobin decreased, Hypokalaemia, Hypotension, Hypovolaemia
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoxia, Laboratory test, Lung opacity, Lymphocyte count normal, Lymphocyte percentage decreased
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume increased, Mean platelet volume normal, Monocyte count normal
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Monocyte percentage increased, Oedema peripheral, PCO2 normal, PO2 decreased, Platelet count normal
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Pleural effusion, Pulmonary congestion, Pulmonary oedema, Red blood cell count decreased, Red cell distribution width increased
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Right ventricular dilatation, Right ventricular dysfunction, SARS-CoV-2 test positive, Troponin I normal, Troponin normal
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: White blood cell count normal, X-ray
Clinical narrative: Narrative:  1/15/23 at 10:33 - Pt presented to ED c/o SOB worsening since diagnosis of COVID on 1/10/23. Pt states he has been increasing his oxygen use. In ED, Pt with oxygen sats of approx. 80% in room. He normally wears oxygen overnight and has a hx of COPD and CHF. Pt also has hx of atrial fibrillation as well, he does have some increased lower extremity edema. He has been continuing oxygen 24/7 instead of just at night, and still feels SOB. Pt administered Lasix 40mg IV, labs and x-rays obtained. Troponin is 0.02. Pt had no chest pain complaint, just dyspnea. EKG showed a-fib with no new changes. Pt to be admitted with diagnosis = COVID +, CHF, CAD AD, A-fib, dyspnea. (Admission 1/15 - 1/18/2023) PRINCIPAL DIAGNOSIS (Reason for admission after study): #Acute Hypoxic Resp Failure #HFrEF Decompensation: AKI, hypovolemia: Resolved #Hypokalemia: Resolved #COVID Infection ADDITIONAL DIAGNOSES - Chronic Problems: #afib on Xarelto #Chronic Hypoxic Resp Failure (on home nightly O2) #Interstitial lung dz (2/2 textiles factory work, pulm fibrosis, PFTs 2/2022 showing no airway obstruction, lung volumes consistent with restrictive lung dz) #OSA - CPAP #CAD #Aortic Root Dilation (mild to mod) #Previous CVA #HTN #T2DM on insulin HOSPITAL COURSE: #Acute Hypoxic Resp Failure - Pt has been off bumex 4mg BID since 12/2022 hospitalization for hypotension, - O2 sats 85% on RA - Home O2 adjusted to 2L/NC continuously #HFrEF Decompensation: - TTE 11/2022: LVEF 50-55%, RV mild-mod dilated w/mild-mod decresed fxn/ - Lasix 40mg IV bid - return to outpatient Bumex dose. - CXR: bilateral increased interstitial opacities with small right pleural effusion (concerning for pulmonary edema although worsening Covid pneumonia cannot be excluded). - BNP: 273 (was 168 on 12/3/2022) AKI, hypovolemia: Resolved - S/P 1 Liter NS - Cr 1.2 #Hypokalemia - K 2.8 -> 3.8 -> 3.4 - KCL 40meq x 2 ordered - will monitor K closely daily, especially in setting of aggressive diuresis #COVID Infection -Clinically, patient appears to be having heart failure decompensation and suspect less contribution from Covid towards patient's dyspnea and hypoxia -Remdesivir ordered: day #3 -Holding off dexamethasone for now due to concern for possibly worsening heart failure decompensation Discharge date = 1/18/23
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Angioplasty, Anticoagulant therapy, Blood creatine phosphokinase increased, COVID-19, Chills
Clinical narrative: Narrative:  Patient is a resident of the nursing home since 11/1/22 - short rehab admission. 01/2/23 - Pt spiked fever overnight 1/1-1/2 = 100.8 and report of cough, congestion (couple of days), and runny nose. Isolation and Signs/Symptoms Assessment following exposure to a confirmed case with a communicable pathogen. Pt admitted to hospital medical floor on 1/2/23 d/t agency institutional policy. Upon admission to medical floor: Pt admits to cough (non productive, started within 24 hours), congestion, fatigue, chills. Pt denies CP, SOB, abd pain, N/V/D. Principal diagnosis (Reason for admission after study) = 1. acute mild COVID infection; 2. acute osteomyelitis of the left foot/TMA on 12/8/22. Additional diagnosis include: 3. PAD - 10/19/2022 S/P Angioplasty; Hx Stents x 2 4. ESRD on HD 5. Diabetes Mellitus, Type 2: 6. HTN: 7. HD: 8. H/O Stroke: 9. GERD: 10. Chronic PTSD: 11. Leukocytopenia: 12. Constipation: HOSPITAL COURSE: Hemodynamically stable. Patient remains with asymptomatic COVID on resp isolation until 1/13/22. 10 day resp isolation from 1/2/23. Pt is returning further tx at nursing home for continued care for mgmt of acute osteo of the left foot/ s/p TMA on 12/8/22. 1. Acute Mild Covid Infection: - Hemodynamically, remains asymptomatic on RA. Resp Isolation will be completed as of today. Continue with the plan for the patient to be transferred back to nursing home to continue hyperbaric treatment s/p TMA 2/2 to VRE. 2. Acute Osteomyelitis of the Left Foot/TMA on 12/8/22: - Followed by ID - Pt is on IV dapto/cefepime until 2/7/23. Pt received abtx with HD sessions - T/TH/S. CPK and LFTs monitored closely 2/2 to pt being on dapto - CPK has stayed elevated but essentially unchanged. Pt denies any muscle pain, chest pain, sob or general discomfort. - See #1 for plan of care for d/c status - Related hx: 10/20/2022 S/P amputation of left hallux 10/15/2022 S/P Left foot sichemia with gangrene of hallux - Ct supportive care, monitoring, prn pain med (lortab 5/325 mg daily prn)and wound/dsg care by WCN. - Ct hyperbaric treatment w/ wound vac as per vascular surgery - Ct monitoring screening labs with PRN supplementation CHRONIC MEDICAL CONDITIONS 3. PAD - 10/19/2022 S/P Angioplasty cont apixiban, asa, gabapentin. Hx Stents x 2 4. ESRD on HD - managed by renal - tu/thus/sat 5. Diabetes Mellitus, Type 2: Ct 32 units glargine qhs and 9 units aspart with meals. ssi - <10 units use noted. 6. HTN: Ct amlodipine 10 mgpo daily 7. HD: Ct to hold lipitor held due to being on dapto/ drug interaction 8. hx of stroke on asa and doac 9. GERD: Ct Prilosec 10. Chronic PTSD: Ct on prozosin 4mg po 11. Leukocytopenia: RESOLVED 12. Constipation: Ct miralax daily, s/p 1 dose of Senna Patient discharged back to nursing home on 1/13/23.
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Constipation, Cough, End stage renal disease, Enterococcal infection, Exposure to communicable disease
Clinical narrative: Narrative:  Patient is a resident of the nursing home since 11/1/22 - short rehab admission. 01/2/23 - Pt spiked fever overnight 1/1-1/2 = 100.8 and report of cough, congestion (couple of days), and runny nose. Isolation and Signs/Symptoms Assessment following exposure to a confirmed case with a communicable pathogen. Pt admitted to hospital medical floor on 1/2/23 d/t agency institutional policy. Upon admission to medical floor: Pt admits to cough (non productive, started within 24 hours), congestion, fatigue, chills. Pt denies CP, SOB, abd pain, N/V/D. Principal diagnosis (Reason for admission after study) = 1. acute mild COVID infection; 2. acute osteomyelitis of the left foot/TMA on 12/8/22. Additional diagnosis include: 3. PAD - 10/19/2022 S/P Angioplasty; Hx Stents x 2 4. ESRD on HD 5. Diabetes Mellitus, Type 2: 6. HTN: 7. HD: 8. H/O Stroke: 9. GERD: 10. Chronic PTSD: 11. Leukocytopenia: 12. Constipation: HOSPITAL COURSE: Hemodynamically stable. Patient remains with asymptomatic COVID on resp isolation until 1/13/22. 10 day resp isolation from 1/2/23. Pt is returning further tx at nursing home for continued care for mgmt of acute osteo of the left foot/ s/p TMA on 12/8/22. 1. Acute Mild Covid Infection: - Hemodynamically, remains asymptomatic on RA. Resp Isolation will be completed as of today. Continue with the plan for the patient to be transferred back to nursing home to continue hyperbaric treatment s/p TMA 2/2 to VRE. 2. Acute Osteomyelitis of the Left Foot/TMA on 12/8/22: - Followed by ID - Pt is on IV dapto/cefepime until 2/7/23. Pt received abtx with HD sessions - T/TH/S. CPK and LFTs monitored closely 2/2 to pt being on dapto - CPK has stayed elevated but essentially unchanged. Pt denies any muscle pain, chest pain, sob or general discomfort. - See #1 for plan of care for d/c status - Related hx: 10/20/2022 S/P amputation of left hallux 10/15/2022 S/P Left foot sichemia with gangrene of hallux - Ct supportive care, monitoring, prn pain med (lortab 5/325 mg daily prn)and wound/dsg care by WCN. - Ct hyperbaric treatment w/ wound vac as per vascular surgery - Ct monitoring screening labs with PRN supplementation CHRONIC MEDICAL CONDITIONS 3. PAD - 10/19/2022 S/P Angioplasty cont apixiban, asa, gabapentin. Hx Stents x 2 4. ESRD on HD - managed by renal - tu/thus/sat 5. Diabetes Mellitus, Type 2: Ct 32 units glargine qhs and 9 units aspart with meals. ssi - <10 units use noted. 6. HTN: Ct amlodipine 10 mgpo daily 7. HD: Ct to hold lipitor held due to being on dapto/ drug interaction 8. hx of stroke on asa and doac 9. GERD: Ct Prilosec 10. Chronic PTSD: Ct on prozosin 4mg po 11. Leukocytopenia: RESOLVED 12. Constipation: Ct miralax daily, s/p 1 dose of Senna Patient discharged back to nursing home on 1/13/23.
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Fatigue, Foot amputation, Gangrene, Gastrooesophageal reflux disease, Haemodialysis
Clinical narrative: Narrative:  Patient is a resident of the nursing home since 11/1/22 - short rehab admission. 01/2/23 - Pt spiked fever overnight 1/1-1/2 = 100.8 and report of cough, congestion (couple of days), and runny nose. Isolation and Signs/Symptoms Assessment following exposure to a confirmed case with a communicable pathogen. Pt admitted to hospital medical floor on 1/2/23 d/t agency institutional policy. Upon admission to medical floor: Pt admits to cough (non productive, started within 24 hours), congestion, fatigue, chills. Pt denies CP, SOB, abd pain, N/V/D. Principal diagnosis (Reason for admission after study) = 1. acute mild COVID infection; 2. acute osteomyelitis of the left foot/TMA on 12/8/22. Additional diagnosis include: 3. PAD - 10/19/2022 S/P Angioplasty; Hx Stents x 2 4. ESRD on HD 5. Diabetes Mellitus, Type 2: 6. HTN: 7. HD: 8. H/O Stroke: 9. GERD: 10. Chronic PTSD: 11. Leukocytopenia: 12. Constipation: HOSPITAL COURSE: Hemodynamically stable. Patient remains with asymptomatic COVID on resp isolation until 1/13/22. 10 day resp isolation from 1/2/23. Pt is returning further tx at nursing home for continued care for mgmt of acute osteo of the left foot/ s/p TMA on 12/8/22. 1. Acute Mild Covid Infection: - Hemodynamically, remains asymptomatic on RA. Resp Isolation will be completed as of today. Continue with the plan for the patient to be transferred back to nursing home to continue hyperbaric treatment s/p TMA 2/2 to VRE. 2. Acute Osteomyelitis of the Left Foot/TMA on 12/8/22: - Followed by ID - Pt is on IV dapto/cefepime until 2/7/23. Pt received abtx with HD sessions - T/TH/S. CPK and LFTs monitored closely 2/2 to pt being on dapto - CPK has stayed elevated but essentially unchanged. Pt denies any muscle pain, chest pain, sob or general discomfort. - See #1 for plan of care for d/c status - Related hx: 10/20/2022 S/P amputation of left hallux 10/15/2022 S/P Left foot sichemia with gangrene of hallux - Ct supportive care, monitoring, prn pain med (lortab 5/325 mg daily prn)and wound/dsg care by WCN. - Ct hyperbaric treatment w/ wound vac as per vascular surgery - Ct monitoring screening labs with PRN supplementation CHRONIC MEDICAL CONDITIONS 3. PAD - 10/19/2022 S/P Angioplasty cont apixiban, asa, gabapentin. Hx Stents x 2 4. ESRD on HD - managed by renal - tu/thus/sat 5. Diabetes Mellitus, Type 2: Ct 32 units glargine qhs and 9 units aspart with meals. ssi - <10 units use noted. 6. HTN: Ct amlodipine 10 mgpo daily 7. HD: Ct to hold lipitor held due to being on dapto/ drug interaction 8. hx of stroke on asa and doac 9. GERD: Ct Prilosec 10. Chronic PTSD: Ct on prozosin 4mg po 11. Leukocytopenia: RESOLVED 12. Constipation: Ct miralax daily, s/p 1 dose of Senna Patient discharged back to nursing home on 1/13/23.