Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Atrial fibrillation, Blood bicarbonate decreased, Blood bilirubin increased
Clinical narrative: Hospitalized (5.28.22 - 5.29.22); COVID-19 positive (5.28.22);  fully vaccinated PLUS Booster - moderna x 4 H&P:   CHIEF COMPLAINT:    CC:  ?I did not feel good  HISTORY OF CC:   Obtained from the patient.  States that he has felt a little bit worse each day for the last three weeks.  Has dyspnea on exertion and some shortness of breath at rest.  Is bringing up copious amounts of clear sputum.  He typically will cough up some sputum every other day but now is coughing up quite a bit every day.  No hemoptysis.  No fever.  No rigors.  No headache.  No visual changes.  No nausea/vomiting/bowel changes.  No chest pain.  No dizziness.  Tried Mucinex the last two mornings.  In ER he was hypoxic at 83% on his home 3 L. placed on non-rebreather for a period of time and after nebs and Solu-Medrol was able to be brought back down to his 3 L. at my exam he is on 6 L.   ER course:  CXR.  Basic labs.  COVID positive.  Albuterol 7.5 mg nebulizer, DuoNeb, Solu-Medrol 125.  Being admitted for COPD exacerbation 2° COVID.  Exam 36.6°, 76, 26, was 140/66, 99% 6 L General:  WDWN, NAD. HEENT:  EOMI, PERRLA, TMs intact, septum midline, oropharynx w/o erythema or exudate, MM moist. Neck:  no masses, JVD, bruits, thyromegaly Heart:  RRR, no S3/S4/m Lungs:  CTA, no rales, ronchi, wheeze.  +cough with clear sputum Abd:  Soft, NDNT, no G/R/R/M/B  No organomegaly Ext:  No C/C/E Neuro:  CN 2-12 intact, No focal deficites Psych:  Calm, cooperative Skin:  no rashes or open sores MSK:  strength 5/5 b/l UE and LE IMPRESSIONS/PLAN  AE COPD with acute on chronic hypoxic respiratory failure 2° COVID              S/p Solu-Medrol 125 in ER              Solu-Medrol 40 q.12h              Albuterol four puffs q.i.d.              Symbicort two puffs bid              Zithromax 500 mg daily x3              Oxygen requirement:  6 L              Home oxygen:  3 L  COVID positive              Oxygen requirement:  6 L              Remdesivir              Daily CRP, D-dimer  DM 2.  Very low-dose CSI Home:  Metformin 500 mg bid  HTN Lopressor 25 mg bid Cozaar 25 mg daily  AFib, chronic. S/p cardioversion 4/5/2021 Eliquis Lopressor 25 mg bid  Chronic diastolic CHF Lasix 40 mg daily Potassium 20 mEq daily  CAD s/p stent.  Stable.  Statin, BB, Eliquis  History of CVA.  Stable.  Statin, Eliquis  HLD.  Lipitor 40 mg q.h.s.  Valvular heart disease, mild (mild MR, mild MS).  Stable    Remote prostate cancer.  S/p TURP DVT prophylaxis:  Eliquis Code status:  Do not resuscitate  Discharge Summary DO (Physician) ? ? Hospitalist BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider: MD Admission Date: 5/28/2022 Discharge Date: May 29, 2022 PROCEDURES 1. Mild chronic pulmonary parenchymal changes.  Moderate chronic obstructive pulmonary disease. 2. COVID positive, 5/28/2022. HOSPITAL COURSE Patient presented to the hospital complaining of dyspnea on exertion and shortness of breath at rest along with bringing up copious amounts of clear sputum.  He believes symptoms started about three weeks ago but got progressively worse over the last 2-3 days.  In ER he was hypoxic at 83% on his home 3 L. He was placed on a non-rebreather for a short period of time then after nebs and Solu-Medrol was able to be brought back down to 3 L. his COVID test was positive.  Chest x-ray did not show any acute infiltrates.  He was admitted and started on Solu-Medrol, albuterol, oral Zithromax and remdesivir.  Initial oxygen requirement 6 L when I admitted him.. Over the next 24 hours the patient had improvement in his symptoms.  On the day of discharge he was able to maintain sats above 90% on 4 L, with only a brief desaturation with ambulation into the high 80s on 4 L. He quickly recovered.  He feels well enough to go home.  He has received two doses of Remdesivir and further doses are not necessary.  He received two doses of Zithromax and will take one additional tomorrow.  Being sent home on a prednisone taper.  I discussed that he can check his O2 sats with his home pulse oximeter and decrease his home oxygen back to his baseline of 3 L when his sats stay above 90% on 3 L. patient states he is comfortable with discharge at this time. DISCHARGE EXAM 36.9, 76, 16, 126/57, 94% 4 L Heart regular rate and rhythm Lungs clear to auscultation Abdomen nondistended nontender Extremities trace edema. DISCHARGE RECOMMENDATIONS 1. Follow up with Dr. June 3rd 2. Can titrate himself back down to 3 L based on his home pulse oximetry reading 3. Diabetic diet 4. Activity as tolerated