Age: 88.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Asymptomatic COVID-19, Asymptomatic bacteriuria, Blood culture negative, Blood lactic acid normal, Bradycardia
Clinical narrative: Hospitalized 11/23/2021-currently still admitted; COVID-19 positive 11/17/2021; fully vaccinated  ASSESSMENT / PLAN: Patient is an 89 year old male with past medical history significant for CKD stage 3, chronic afib not on anticoagulation, CAD, chronic combined systolic and diastolic heart failure, and HTN. He was recently admitted 11/17 - 11/20 with fever and AKI. COVID positive but without respiratory symptoms. Discharged in prn 2L nasal cannula (felt to be more related to underlying OSA than COVID). ED reported patient was brought in for SOB although patient denied this. He was noted to have difficulty with ambulation in the ED and then became hypotensive requiring vasopressors. Labs were significant for AKI on CKD, troponin 301, procal .28, and mild leukocytosis. UA was unremarkable. Chest XR diffuse bilateral infiltrates (COVID vs bacterial pneumonia vs vascular congestion). He was started on vancomycin and Zosyn. NE weaned off shortly after arrival to ICU.  Sepsis: Etiology likely pneumonia given chest XR findings  COVID positive 11/17 (but patient reports no symptoms) Procalcitonin mildly elevated at .28 LA WNL  Blood cultures NGTD  Legionella and strep pneumo pending  MRSA screen pending  Sputum culture ordered  NE for MAP >65mmHg, weaned off shortly after arrival to ICU Vancomycin and Zosyn for empiric coverage COVID: Vaccinated in March COVID positive 11/17 Has denied current symptoms  Chest XR with bilateral infiltrates  Decadron 6mg daily  11/29/2021 note: Assessment & Plan: # Septic Shock (Resolved) # Aspiration PNA Presented 11/23 with fever and hypotension and presumed respiratory etiology. Placed on vasopressors Norepi (11/24) and weaned the same day. UA unremarkable. Started on Zosyn and Vancomycin while in ICU and Vancomycin discontinued as MRSA screen negative. Strep pneumonia and legionella antigen negative. Unable to provide sputum sample ---follow peripheral blood cultures x2 (11/23) and no growth to date, maintain MAP >65 ---IV Zosyn (3.375 mg q6 day #6) and continue for now given worsening hypoxia and plan for 5-7 days ---SLP consulted and recommending NPO until respiratory status improves, aspiration precautions ---consult nutrition and likely if respiratory status not improved by tomorrow will need CorPak  # COVID-19 PNA with Acute Hypoxic Respiratory Failure Admitted to hospital (11/17-11/20) with fever and AKI. Treated with UTI at the time with Fosfomycin. Tested positive for COVID-19 (11/17). CXR (11/23) with diffuse bilateral airspace opacities (worsening when compared to prior). Remdesivir (11/18-11/19), Decadron (11/17-11/20). States he is vaccinated against COVID-19, received 2 vaccines a couple months ago.  ---Decadron (6 mg IV daily day #6 - did receive prior to hospitalization),  ---continous pulse oximetry, hold on further lasix at this time given given NPO status    Discharge Coordination/Progress: Pt is currently on high flow O2, per nursing pt continues to aspirate Plan: Pt to d/c when medically stable, to return to assisted living