Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Vomiting, White blood cell count normal
Clinical narrative: Date of Service Jul-27-2022 0925  Date of Admission Admit Date: Jul-26-2022  Date of Discharge Date of discharge Jul-27-2022  Allergies No Known Allergies  Chief Complaint weakness  Procedure(s) Performed None  Lab Results Jul-27-2022 0410 Chemistry GLUCOSE  113BUN  18CREAT  0.9MDRD GFR  86NA  139K  3.6CL  105CALCIUM  7.9CO2  27.3OSMO  280.2ANION GP  10.3BUN/CRE  20.0LDH  150PROBNP  373 Jul-27-2022 0410 Coagulation D-DIMER  1.50 Jul-27-2022 0410 Hematology WBC  5.0RBC  4.17HGB  13.1HCT  37.0MCV  88.7MCH  31.4MCHC  35.4RDW  13.2RDWSD  42.9PLT  156MPV  9.6AUTONEU%  87.6AUTOLYM%  5.6AUTOMON%  6.0AUTOEOS%  0.2AUTOBAS%  0.0AUTONEU#  4.4AUTOLYM#  0.3AUTOMON#  0.3AUTOBAS#  0.0AUTOEOS#  0.0NRBC%  0.0NRBC  0.0IG#  0.03IG%  0.6 Jul-26-2022 1630 Ct CTA PULM   Jul-26-2022 1500 Coagulation D-DIMER  0.85 Jul-26-2022 1420 Rad 1610163   Jul-26-2022 1310 Chemistry GLUCOSE  117BUN  20CREAT  0.8MDRD GFR  99NA  138K  3.4CL  103CALCIUM  8.5ALK PHOS  70CO2  26.1AST  26ALT  41AST/ALT  0.6TL PROT  7.7ALBUMIN  3.6TBILI  0.4DBILI  0.1OSMO  279.3ANION GP  12.3BUN/CRE  25.0LDH  218CRP  2.70MAGNESIU  1.7TROPI-HS  6 Jul-26-2022 1310 Hematology WBC  7.1WBC  7.2RBC  4.69RBC  4.69HGB  14.8HGB  14.7HCT  40.8HCT  41.3MCV  87.0MCV  88.1MCH  31.6MCH  31.3MCHC  36.3MCHC  35.6RDW  13.2RDW  13.2RDWSD  42.5PLT  185PLT  189MPV  9.6MPV  10.6AUTONEU%  88.0AUTOLYM%  2.1AUTOMON%  8.0AUTOEOS%  0.3AUTOBAS%  0.4AUTONEU#  6.3AUTOLYM#  0.2AUTOMON#  0.6AUTOBAS#  0.0AUTOEOS#  0.0NRBC%  0.0NRBC%  0.0NRBC  0.0HGB/HCT  2.8IG#  0.09IG%  1.2 Jul-26-2022 1310 Serology COVID  PosINFLUA  NegINFLUB  NegCVD1TEST  NCVDEMPHC  NCVDSYMP  YCVDSYMDT  UCVDHOSP  NCVDICU  NCVDRESID  NCVDPREG  N Imaging Results Chest x-ray 07/26/2022 Impression: Hyperinflation with bronchial wall thickening and chronic appearing coarsening of the interstitium. Component of superimposed bronchitis possible. Bibasilar subsegmental atelectasis/scar. Tortuous atherosclerotic aorta, borderline cardiomegaly.  CT angiography 07/26/2022 impression: No acute abnormalities. No pulmonary emboli. Mild bilateral bronchiectasis.  Social History tobacco use Former Smoker, 20 yrs, Smoking Cessation Refused occ cigars  marital status Divorced  occupation pet care store  Health Concerns Headache  Hypertensive disorder  Former Smoker, 20 yrs  Father Deceased Diabetes mellitus  Father Deceased Cerebrovascular accident  Mother Deceased Diabetes mellitus  Mother Deceased Malignant tumor of breast  Brother Alive Diabetes mellitus  Sister Alive Diabetes mellitus  Vital Signs Jul-27-2022 0400 T 98.4 HR 77 RR 14 BP       99  / 71 O2Sat 96 Jul-27-2022 0200 HR 69 RR     13 BP   102 / 66 O2Sat 93 Jul-26-2022 1800 T 99.3 PHYSICAL EXAM Constitutional:  Acutely ill-appearing.  Appears of stated age.  Cardiovascular: Regular heart rate and rhythm without murmurs, rubs or gallops. There is  No pedal edema. Peripheral pulses are 2+/4 in the upper and lower extremities.  Respiratory: lungs are CTA BL. Respiratory effort is not labored.   Crackles are not present bilaterally. On room air during exam saturating 96%.    GI: Abdomen is without lesion.   Well-healed surgical incision scar below the  umbilicus. Bowel sounds are normoactive in all quadrants. Abdomen is soft, non-tender, and non-distended. No organomegaly appreciated on palpation.  Musculoskeletal/osteopathic: Range of motion in the shoulders, elbows, hips, and knees is grossly intact. The patient is ambulatory. Muscle strength is 5/5 UE LE BL.  Neurologic: Alert and oriented to person place and time. Cranial nerves 2-12 are grossly intact.  Language is clear. Sensation to light touch is intact in upper and lower extremities.  Psych: The patient's mood is euthymic. The patient's affect is appropriate. Patient is calm.  Heme: There is no bruising on the face or extremities.There is no blood in the external nares.  Hospital Course Was brought in for  observation due to hypoxic respiratory failure secondary to COVID-19.  Patient's COVID-19 is a mild coarse currently and requires no additional oxygen after some steroids and single dose remdesivir.  Patient possibly has some component of this hypoxia attributed to obstructive sleep apnea.  Recommend outpatient sleep study and potentially positive pressure at night in the outpatient setting.     We will go ahead and discharge the patient to home with further follow-up from his primary care provider.  Discharge Medications ACETAMINOPHEN 650 MG ORALLY EVERY 4 HOURS AS NEEDED for FEVER OR MILD PAIN 1-3 ON PS Adderall XR Oral Capsule Extended Release 24 Hour 15 MG 15 MG ORALLY ONCE A DAY Aspirin Adult Low Dose Oral Tablet Delayed Release 81 MG 81 MG ORALLY ONCE A DAY Dexamethasone Oral Tablet 2 MG 6 MG ORALLY ONCE A DAY (ePrescribed on Jul-27-2022 1250) diphenhydrAMINE 25 MG ORALLY DAILY AT BEDTIME hydrochlorothiazide 25 mg tablet 25 MG ORALLY ONCE A DAY HYDROcodone-Acetaminophen Oral Tablet 5-325 MG 5 MG ORALLY ONCE A DAY AS NEEDED for MODERATE PAIN (4-6 ON PS) Ibuprofen Oral Tablet 200 MG Continue taking same as home Ondansetron Oral Tablet Disintegrating 4 MG 4 MG ORALLY EVERY 8 HOURS AS NEEDED for NAUSEA (ePrescribed on Jul-27-2022 1250) Sildenafil Citrate Oral Tablet 20 MG Continue taking same as home Plan impression: -Acute hypoxic respiratory failure secondary to COVID-19 ,  improved - COVID-19 pneumonia - vomiting and  mild dehydration secondary to the above - profound weakness secondary to the above -GERD - hiatal hernia - history of acute esophageal obstruction secondary to impacted food bolus - history of esophageal polyp - history of gastritis - history of duodenitis  Assessment:   patient did fail his   Nocturnal oximetry test overnight. he spent over an hour and a half with SpO2 less than 88 %.  Supplemental oxygen will be prescribed to the patient on discharge today.  Discharge the patient home as he is not requiring high levels of O2.  We will discharge him with 6 mg of dexamethasone daily for 3 additional days for total of 5 days of steroids.  I have prescribed some Zofran in case of additional episodes of nausea so that he can tolerate oral intake better.  A  significant portion of his hypoxia could be related to apneic episodes.  As such, I have ordered for outpatient sleep study to be completed after discharge with primary care physician follow-up.  Patient has been instructed to return to the ED if he feels short of breath or his symptoms worsen.  Primary Care Provider UNKNOWN PRIMARY CARE PHY  Electronically signed on Jul-27-2022 1303