Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary congestion, Respiratory failure, SARS-CoV-2 test positive, Tobacco abuse, Vomiting
Clinical narrative: DISCHARGE DIAGNOSES: 1. Acute hypoxic hypercapnic respiratory failure d/t COVID-19 pneumonia 2. Secondary bacterial RLL CAP 3. Acute exacerbation of suspected COPD 4. Abdominal pain and vomiting, resolved 5. HTN 6. Tobacco dependency 7. History stroke 8. Depression 9. Peripheral neuropathy, chronic pain 10. Mediastinal and hilar lymphadenopathy HOSPITAL COURSE: This is a 74 y.o. female with a history of probable COPD, ongoing tobacco use, HTN, chronic pain syndrome, depression who presented with cough, SOB, abdominal pain.    Acute hypoxic hypercapnic respiratory failure d/t COVID-19 pneumonia: Vaccinated and boosted. Symptom onset gradual over a couple weeks. Cough started ~1/12. Tested positive 1/15. Secondary bacterial RLL CAP: RLL consolidation on top of coarse bilateral infiltrates and procal elevated so empirically treated.  Acute exacerbation of suspected COPD: No prior formal diagnosis of COPD, suspected given symptoms and tobacco use.  - CXR and CT PE study negative for PE but with bibasilar coarse interstitial opacities with a RLL consolidation, small R pleural effusion and suggestion of pulmonary vascular congestion. - Treated with Solu-medrol 40mg IV daily (for COVID-19 PNA and COPD). Transitioned to Prednisone 40mg daily with a short taper prescribed on d/c. - Procalcitonin 0.58. Completed Zithromax therapy and was transitioned from ceftriaxone to cefdinir to complete 10 total days for CAP. - Tocilizumab / baricitinib not indicated d/t secondary bacterial infection and not requiring high flow oxygen - CRP normalized 8.7 -- > less than 1 - Hypercapnic, improved on VBGs with supplemental O2  - Required up to 2L NC. Weaned to RA at rest. - Home O2 eval done recommending 2L with exertion otherwise RA. - Scheduled and prn bronchodilators provided. Incruse started for suspected COPD.  - Encouraged use of IS, aerobika. She was ambulatory and up in chair.  - PTA Dyazide held, Lasix 20 mg IV given a couple days in place of PTA Lasix 20mg - On d/c resumed Lasix 20mg daily. Did NOT resume Dyazide. - Recommend outpt Pulmonary referral once recovered from Covid to obtain formal PFTs  Abdominal pain, vomiting: Resolved. CT A/P unremarkable for acute intra-abdominal pathology. Tolerating a regular diet.    HTN: BPs elevated throughout much of her stay, SBPs in the 160s primarily. Her dyazide was held while on IV Lasix. Amlodipine 5mg daily continued; did not want to increase d/t risk of increased peripheral edema (mild edema at baseline). Metoprolol 25mg BID was added but BPs dropped quite quickly and significantly from 180s to 109 systolic and HRs 80-90s to low 60s. It was felt safest to d/c on amlodipine 5mg daily, Lasix 20mg daily and have her f/u with her PCP. She plans to purchase a BP cuff and monitor at home. She will hold the Dyazide for now as two diuretics not felt necessary (and not hyponatremic during stay, e-lytes stable).    Tobacco use disorder - Encouraged ongoing cessation. NRT available during stay.   History stroke: No acute neurologic concerns - Continue BP meds as above, atorvastatin and Plavix    Depression - PTA Lexapro   Peripheral neuropathy  - PTA gabapentin, Robaxin, hydroxyzine, oxycodone   Mediastinal and hilar lymphadenopathy: Noted on CT, presumably benign per Radiologist. - Recommend f/u with PCP