Age: 58.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Metabolic acidosis, Metabolic function test, Musculoskeletal chest pain, Nausea, Oxygen saturation decreased
Clinical narrative: Hospitalized (9.11.21 - present);  COVID-19 positive (home test - 8.31.21);  Fully Vaccinated  HISTORY OF PRESENT ILLNESS: Patient is a 59 y.o. female with a past medical history of obesity and osteoarthritis who presents today with hypoxia.  The patient states that she came down with COVID symptoms on 08/30.  She took a COVID test 8/31 which was positive.  She has been managing at home, however today she randomly checked her oxygen level with pulse oximeter and noted that it was in the 70s.  She has had a severe, unrelenting cough that hurts her chest and ribs.  She has had intermittent fevers, nausea, anorexia, loss of taste and smell (now improving), and headaches.  She does have a history of reactive asthma but has no other history of lung disease.  She is a lifelong nonsmoker.  She did receive the Moderna vaccine x2 (last dose in April, 2021). In the ER the patient had tachypnea with a respiratory rate of 31, and hypoxia with SpO2 of 88% on room air.  She was placed on 2 L nasal cannula and did recover to 92%. CXR with extensive patchy airspace disease seen throughout the lungs. The patient was given 500 mL of IVF and 6 mg of Decadron.  ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Acute Respiratory Failure with pneumonia Vaccinated with Moderna x 2 (last dose 4/2021) -CXR with extensive patchy airspace disease seen throughout the lungs -SpO2 88% in the ER, noted to be in the low 70s on home pulse oximeter yesterday morning Symptom Onset: 8/30, positive test 8/31 Symptoms: Cough, Fevers, Nausea, Anorexia, loss of taste and smell (improving), headaches, chest pain with coughing, nausea.   Treatment: Decadron 6 mg daily x 10 days (started 9/11), VTE prophylaxis with Lovenox, supportive care with PRN Lovenox, supplemental O2 - wean as able, IS, PRN anti-pyretics/pain, PRN anti-tussives, PRN nausea medications, prone as tolerated. Hyponatremia Mild AGMA -NA 130 -Received 500 mL of IVF in the ER -No N/V/D - will re-check BMP in the AM Brief history and medical decision making:  59-year-old woman who had received Moderna COVID vaccine in April 2021.  She is admitted with acute respiratory failure with hypoxemia secondary to COVID-19 pneumonia.  Symptoms started on 08/30, tested positive 8/31.  Outside the window for remdesivir.  Continue Decadron 6 mg daily for 10 days from 08/12.  She is requiring 2 L of supplemental oxygen.  Encourage prone ventilation and aggressive pulmonary hygiene. P.r.n. albuterol due to her underlying asthma.  Progress Note 9.20.21: (still on O2) Pneumonia due to COVID-19 virus Acute hypoxemic Respiratory Failure due to COVID-19 pneumonia Vaccinated with Moderna x 2 (last dose 4/2021) Symptom Onset: 8/30, positive test 8/31 Symptoms: Cough, Fevers, Nausea, Anorexia, loss of taste and smell (improving), headaches, chest pain with coughing, nausea.   supportive care supplemental O2 - wean as able, IS, PRN anti-pyretics/pain, PRN anti-tussives, PRN nausea medications, prone as tolerated. -recommended prone as much as possible -patient weaned off high-flow overnight back on nasal cannula -appreciate pulmonology input.  Patient has a history of sarcoidosis.  Decadron was changed to prednisone starting 9/18.  Plan to wean prednisone by 10 mg weekly.   Right upper lobe PE -therapeutic Lovenox-consider transition to Eliquis when ensured no further bleeding issues