1/4/22  86-year-old male with a history of ILD with chronic respiratory failure presented with acute on chronic hypoxemic respiratory failure secondary to COVID-19 pneumonia.  He declined rapidly.  We were unable to achieve SPO2 greater than 80 to 100% FiO2 with nonrebreather.  Family did not wish to escalate care further and preferred to proceed with comfort focused care.  Spoke with daughter, POA, and she informed me that the plan was to maintain full treatment until family could arrive.  Family arrived on 1/5 and we initiated comfort focused treatment.  Hospice was consulted.  Consents were signed for inpatient scatter bed. Patient to be discharged/readmitted to scatter bed. Hospice following His symptoms were treated. He appeared to remain comfortable. The patient expired secondary to acute on chronic hypoxemic respiratory failure secondary to covid 19 pneumonia in the setting of advanced interstitial lung disease @ 0203 hours 1/7/2022 REVIEW OF SYSTEMS   Review of Systems  Constitutional: Negative for chills and fever.  HENT: Negative for sore throat and neck pain.   Eyes: Negative for visual disturbance.  Respiratory: Positive for cough and shortness of breath. Negative for chest tightness.   Cardiovascular: Negative for chest pain and leg swelling.  Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting.  Genitourinary: Negative.   Musculoskeletal: Positive for myalgias.  Skin: Negative for rash.  Neurological: Negative for dizziness, syncope and headaches.  Psychiatric/Behavioral: Negative for agitation and behavioral problems.  CBC W/DIFF - Abnormal   White Blood Count 6.16  4.5 - 11.0 10*3/uL   Red Blood Count 4.50  4.5 - 5.9 10*6/uL   Hemoglobin 13.4 (*) 13.5 - 17.5 g/dL   Hematocrit 43.0  41.0 - 53.0 %   Mean Corpuscular Volume 95.6  80.0 - 100.0 fL   Mean Corpuscular Hemoglobin 29.8  26.0 - 34.0 pg   Mean Corpuscular HGB Conc 31.2  31.0 - 37.0 g/dL   Red Cell Distribution Width-CV 12.9  12.0 - 16.8 %   Platelet Count 160  140 - 440 10*3/uL   Mean Platelet Volume 11.3  8.4 - 12.4 fL   Diff Type Hospital CBC w/AutoDiff  (arb'U)   Neutrophils % 71.2  45 - 80 %   Lymphocyte % 14.3 (*) 15 - 50 %   Monocyte % 13.8  0 - 15 %   Eosinophil% 0.0  0 - 7 %   BASO% 0.2  0 - 2 %   Immature Granulocyte% 0.5  0.0 - 1.0 %   Nucleated RBC % 0  0 /100(WBC)   Neutrophil Abs 4.39  2.0 - 8.8 10*3/uL   Lymphocyte-Absolute 0.88  0.7 - 5.5 10*3/uL   Monocyte Absolute 0.85  0.0 - 1.7 10*3/uL   EOS-Absolute 0.00  0.0 - 0.8 10*3/uL   Basophil Abs 0.01  0.0 - 0.2 10*3/uL   Immature Granulocyte Abs 0.03  0.00 - 0.10 10*3/uL COMPREHENSIVE METABOLIC PANEL (CMP) - Abnormal   Sodium 138  136 - 145 mmol/L   Potassium 4.6  3.5 - 5.1 mmol/L   Chloride 94 (*) 98 - 107 mmol/L   Carbon Dioxide 30 (*) 22 - 29 mmol/L   Anion Gap 14 (*) 5 - 13 (arb'U)   Glucose 97  74 - 99 mg/dL   Blood Urea Nitrogen (BUN) 26  8 - 26 mg/dL   Creatinine-Blood 1.20 (*) 0.73 - 1.18 mg/dL   BUN/Creatinine Ratio 21.7  RATIO   Estimated GFR 57 (*) >60 /1.73 m2   Estimated GFR if (Privacy) >60  >60 /1.73 m2   Total Protein 6.3  6.2 - 8.0 g/dL   Albumin 3.6  3.2 - 4.6 g/dL   Globulin 2.7  1.5 - 4.5 g/dL   Albumin/Globulin Ratio 1.3  1.1 - 2.5 RATIO   Calcium 9.0  8.4 - 10.2 mg/dL   Total Bilirubin 0.7  0.2 - 1.2 mg/dL   AST/SGOT 88 (*) 5 - 34 U/L   ALT/SGPT 67 (*) 0 - 55 U/L   Alkaline Phosphatase 57  40 - 150 U/L TROPONIN - Abnormal   Troponin 0.039 (*) 0.000 - 0.034 ng/mL ARTERIAL BLOOD GAS - Abnormal   Allen Test POSITIVE  (arb'U)   Temperature-ABG 37.0  37.0 Cel   pH-ABG 7.45  7.35 - 7.45 PH   PCO2-ABG 47  35 - 48 mm(Hg)   PO2-ABG 56 (*) 83 - 108 mm(Hg)   HCO3-ABG 33 (*) 22 - 30 mmol/L   TC02-ABG 34 (*) 22 - 30 mmol/L   Base Excess-ABG 7.5 (*) 0 - 3 mmol/L   O2 Sat-ABG 90.6 (*) 95.0 - 98.0 %   FIO2-ABG 60.0  20 - 100 % CULTURE, BLOOD CULTURE, BLOOD B-TYPE NATRIURETIC PEPTIDE   B-Type Natriuretic Peptide 111.2  4 - 254 pg/mL LACTIC ACID   Lactic Acid  1.3  0.7 - 2.0 mmol/L  1/4/22 Chest xray   IMPRESSION: Right greater than left patchy infiltrate which could represent pulmonary edema and/or multifocal pneumonia superimposed on chronic volume loss and scarring of the prominently elevated right lung base/hemidiaphragm