Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough
Clinical narrative: Hospitalized 12/20/2021-still admitted currently; COVID-19 positive 12/20/2021; fully vaccinated  ASSESSMENT / PLAN:    Patient is a 74-year-old female with past medical history significant for nonischemic cardiomyopathy last known ejection fraction 42%, diabetes (poorly controlled last known A1c of 9) pulmonary embolism and hypertension who is listed as being vaccinated with J and J on July 26th presented to an outside emergency department with extreme exhaustion, cough, fatigue of approximately 2 weeks duration.  That has been associated with a poor appetite and weight loss approximately 12 lb.  In the emergency department she was found to be COVID positive with an oxygen saturation of 84% on room air.  Chest x-ray showed patchy areas of opacification consistent with COVID-19 pneumonia and received 6 mg of IV dexamethasone. She was admitted to hospital approximately 24 hours ago and continued on high-flow nasal cannula with combination of non-rebreather mask.  Overnight she has had increasing respiratory distress with tachypnea and progressive desaturation.  A repeat chest x-ray approximately 24 hours after the emergency department evaluation looked essentially unchanged with continued moderate airspace disease. Given the patient's respiratory failure, increased work of breathing she has been transferred to the intensive care unit. Assessment and Plan Acute hypoxemic respiratory failure Possibly multifactorial, however most likely secondary to COVID-19 pneumonia -given 1 dose of furosemide prior to transfer -will update chest x-ray -had discussed care at length with patient, daughter updated by hospitalist team, if desires to be full code likely should undergo intubation mechanical ventilation.  Told her at length she is at high risk for mortality, complications, tracheostomy. COVID-19 Vaccinated with Johnson & Johnson in July of this year.  Multiple family members have been ill with it. -had symptoms approximately 7-10 days before presentation -would not be a candidate for remdesivir -did receive Decadron -steroids have been increased to 50 mg of IV Solu-Medrol 2 times a day, approximately 1 mg per kg body weight -rising D-dimer, possible history of pulmonary embolism past, will check upper and lower extremity Dopplers -if undergoes endotracheal intubation, will likely obtain CT angiogram of thorax pending clinical stability. 12/27/2021 notes: Patient currently still intubated and in ICU * COVID-19 Infection, noted 12/20/21. Assessment & Plan Vaccinated with Johnson & Johnson in 7/26/21. Multiple family members tested positive for Covid. Symptom onset: 7-10 days prior to admission, ~ 12/12. Test positive: 12/20 Admission: 12/20 Intubation: 12/22/21 Remdesivir: not candidate, outside window Steroids: decadron 6mg daily (12/20-12/21), solu-medrol 50mg IV BD (12/22-   - management of acute hypoxic respiratory failure as above - continue steroids for minimum 10 days then re-evaluate - continue prophylactic anticoagulation, trend d-dimer - continue antibiotics and follow-up secondary infection work-up