Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Oxygen saturation decreased, Pain, Positive airway pressure therapy, Pyrexia, Respiratory syncytial virus test negative
Clinical narrative: ED to Hosp-Admission Discharged 9/18/2021 - 9/21/2021 (3 days) Hospital, MD Last attending ? Treatment team COVID-19 Principal problem Date: 9/18/2021 Admission Date: 9/18/2021 PCP: CRNP  Hospitalist: DO   Hospital Problems       POA   * (Principal) COVID-19 Yes      Pneumonia due to COVID-19 virus Yes      HTN (hypertension) Yes      Hyperlipidemia Yes      COPD (chronic obstructive pulmonary disease)  Yes   Medical Problems    74-year-old gentleman who has had cough and cold symptoms for the last 48 to 72 hours.  He received his first Covid vaccine a couple days ago, and is only partially vaccinated.  Patient complains of cough, fevers chills, achiness.  Notable fatigue.  He has a history of hypertension and COPD and does use an nebulizer machine at home 4 times a day.  Discussion about end-of-life with patient he wishes to be DNR/DNI but does want aggressive treatment.   Plan: Inpatient admission to MedSurg.  Troponin slightly elevated but no acute EKG changes, I do not think at this point he needs cardiac telemetry.  Remdesivir and Decadron have been initiated.  We will check D-dimer, C-reactive protein and pro calcitonin level.  No antibiotics at this time.  Chest x-ray shows bilateral interstitial infiltrates.  Because of slightly elevated troponin will make sure he is on Lovenox and baby aspirin daily.  In addition he is already on a statin.  If cardiac enzymes trends up, will reconsider full anticoagulation and other cardiac medications.  Anticipate length of stay 5 to 7 days.   VTE prophylaxis: Lovenox 40 subcu daily DNR (Do Not Resuscitate)  ED to Hosp-Admission Current   9/26/2021 - present (10 days) Hospital  MD  Last attending ? Treatment team Acute hypoxemic respiratory failure due to COVID-19   Hospital Problems          POA   * (Principal) COVID-19 Yes       COPD (chronic obstructive pulmonary disease)  Yes            Medical Problems            74-year-old man who was admitted a week and a half ago with Covid pneumonia and COPD.  He was treated with Remdesivir and steroids and discharged home with remote patient monitoring.  Today he was sent in with low oxygen levels in the 60s to 70s despite home O2 at 3 L nasal cannula.  Currently is on BiPAP.  Denies any fevers chills, but has been short of breath.  Denies any active chest pain, no hematemesis or melena.  No focal weakness in the arms or legs.  CAT scan on admission shows centrilobular COPD and no evidence of any acute pulmonary emboli.   Plan: Inpatient admission to MedSurg.  BiPAP, steroids and antibiotics.  We will check a procalcitonin level.  Patient is already been through Remdesivir a much sure there is any other treatments for Covid, I think we probably need to treat this as COPD exacerbation.  Because of current Covid status we cannot use nebulizers at this time.  I did address CODE STATUS on admission and he wants to remain a full code at this time.   VTE prophylaxis: Lovenox Full Code     History of Present Illness      Patient is an 74 y.o. male.    Worsening hypoxemia at home after recent infection with Covid.  Has been getting remote patient monitoring and they have noticed his oxygen levels decreasing.   Review of Systems: Gen: Generally has been weak and notably short of breath. Skin: No rash, no itching no changes in hair or nails Head: Denies any headaches or head injury. Eyes: Denies any eye pain or changes in vision. Mouth: Denies any sore throat or hoarseness. Neck: Denies any neck pain or stiffness or swollen glands. Respiratory: Denies extended significant amount of cough or sputum, but has been notably short of breath.  No pleuritic pain. Cardiac: Denies any chest pain, diaphoresis,  exertional dyspnea or palpitations GI: Denies any change in appetite or weight gain or weight loss, problems swallowing, vomiting or nausea diarrhea denies any hematemesis or melena. GU: Denies any dysuria or frequency of urination, denies any hematuria Musculoskeletal: Denies any pain or joint swelling, or decreased joint motion Neurologic: Denies any headache seizures loss of consciousness or weakness in the arms or legs. Psych: Denies any anxiety, depression or suicidal ideation.