Age: 47.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Anticoagulant therapy, Blood HIV RNA, COVID-19
Clinical narrative: 47 y.o M with hx of methamphetamine use, HIV on treatment (last  Viral load < 48 on 8/30/21), HCV, pulmonary HTN secondary to HIV and Methamphetamine use (follow at Dr. office), h/o cerebellar infarct, OSA on CPAP, pulm nodules,  history of STDs, history of thyroid nodule, last hospitalization 7/2021 for colitis, who presented on 1/8/22 with 1 day of fever, chills, cough, shortness of breath. Last dose of methamphetamine 6 days PTA.  He was found to have severe sepsis due to covid pneumonia with acute hypoxemic respiratory failure requiring 6L NC, at night required HFNC FiO2 50% on 40-60 LPM. CTA no PE, pulm nodule. He was started on steroids and remdesivir and admitted.  He wanted to leave AMA 1/10/22, at the end convinced to stay. Refusing HFNC. He was been on RA most of the time at rest with O2 sats 96%. On exertion (bedside road test) he desaturates to 87-88% on RA. He feels well and wishes to go home, he is aware of risks of worsening and even death. He still prefers to go home. He has agreed to have home O2, which we will order for exertion.    Severe sepsis with acute hypoxemic respiratory failure due to covid pneumonia:  Symptom onset on 1/8. COVID positive on 1/8. Last fever on 1/8   - Self-proning as tolerated at home.  - Decadron 10 mg BID started on 1/09/22 - 01/18.   - Received Remdesivir 200mg IV x 1 on 1/8 then 100mg IV daily until 01/11/22.  D4/5 - on Baricitinib 4 mg daily x 14 days, D3 nocturnal CPAP for OSA, - pt aware if worsening to return to the hospital, if worsening hypoxemia will most likely not benefit from iNO ( pulm HTN) and given pulm HTN and RV dysfunction, not a good candidate for BiPAP. Case was discussed by Dr. with Dr.  from pulmonology.  - LFTs normal.  - will check CRP as outpt.  - protonix 40 mg daily GI prophylaxis - As inpt he received Lovenox 40mg SQ daily  - continue isolation in hospital per guidance. 1/8-1/28.    History of pulmonary HTN: RVSP 61 mmhg per echo in 4/2021.              - On Tadalafil 40 mg daily & ambristen 10 mg daily.              - Aldactone on hold.    History of HIV: PTA Triumeq 1 tablet daily  History of neuropathy: PTA gabapentin and tylenol  History of methamphetamine use: last use 6 days PTA. Seems in outpatient program. Inpatient rehab per patient bur currently with covid.    Diet: DIET, REGULAR Mobility: ambulatory without assistance, able to get up from bed by himself and ambulate around his bed several times for me today, no assistance.  DVT prophylaxis: As above. Will discharge on ASA.  Code Status: Full Code  EDD/Dispo: discharge today with home O2., HHRN. He is high risk given both covid infection and pulmonary hypertension. He understands the risks of leaving the hospital. Clinically seems stable as his O2 sats are normal on RA at rest and requires minimal O2 on exertion.    Subjective: Feeling well, no SOB, ambulating, eating ok, wishes to go home today.   Reason for Hospital Admission (Admitting Diagnosis):  Acute hypoxemic respiratory failure due to Covid PNA Pt readmitted to Hospital on 1/24 and still in hospital on 1/28