Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Fibrin D dimer, Haemoglobin normal, Hip arthroplasty, Hip fracture, Hypoxia
Clinical narrative: PROVIDER PROGRESS NOTE 2/8/2022 ASSESSMENT/PLAN Principal Problem:   Closed left hip fracture, initial encounter (HCC)     Surgical Incision Left;Outer Hip (Active) Incision Date/Incision Time: 01/31/22 0945   Type: Incision  Orientation: Left;Outer  Location: Hip   Wound Simple Scab Left;Right Elbow;Knee (Active) First Observed/Origin Date/First Observed/Origin Time: 02/04/22 0100   Wound Type: Scab  Orientation: Left;Right  Location: Elbow;Knee   Pressure Injury: Blanchable Erythema Coccyx (Active) First Observed/Origin Date/First Observed/Origin Time: 02/01/22 1645   Type: Blanchable Erythema  Location: Coccyx     Patient is a 86 y.o. male with a past medical history of  dementia, bilateral hearing loss, DMII, hypertension, CAD with prior CTA in 1994 of OM,  permanent atrial fibrillation on Coumadin,  complete heart block s/p PPM in 2016,  history of CVA, prior history of alcohol use disorder  was brought to the ED after a fall. Patient lives in an independent senior apartment.  Per report, patient fell on the morning of 1/29.  His daughter found him lying on the floor a few hours after and called EMS.  Patient was found to have a small skin tear on his left elbow. He was able to stand but could not bear weight.     He was taken to ED where he complained of low back and left hip pain.  Imaging studies including CXR, left femur x-ray, CT pelvis, CT lumbar spine, CT cervical spine and CT head were carried out.  He was found to have an impacted fracture of the left femoral neck.  Labs are significant for CK of 326, alcohol was negative, WBC was elevated at 18.4, hemoglobin 16.3, lactate 3.8.  Troponin was initially at 0.394 but increased to 0.864.  Patient was started on IV ceftriaxone.  He was also given IV fluids with normalization of his lactate.  He was found to be COVID-19 positive.  Patient was transferred to Hospital for cardiology and orthopedics consult.     #Left femoral neck fracture following a mechanical fall: -s/p L hip arthroplasty (1/3/2022) -Orthopedics following -Pain control with scheduled Tylenol, PRN Dilaudid/oxycodone -Zofran PRN -Ok to discharge per Ortho.   #COVID-19 pneumonia #Hypoxia -X-ray at outside facility revealed diffuse bilateral airspace opacities, right greater than left concerning for asymmetric edema versus viral pneumonia -elevated CRP, D-dimer -Not on anticoagulation at this time pending surgery -Currently on room air. Decadron has been discontinued -full barrier precaution   #Suspected Acute on Chronic Systolic CHF  -Echo returned with decrease in LVEF of 40-45% with apical hypokinesis.   -Likely stress-induced cardiomyopathy. Ddx includes underlying CAD.   -Repeat ECHO in 4 weeks -Carvedilol 6.25 mg twice daily -CXR -2/3 revealed findings consistent with congestive heart failure -BNP > 600 -Currently on IV furosemide 40 mg daily.  Switch to oral furosemide 40 mg daily -Daily weights -Accurate I/O's   #Acute Urine Retention -Bladder scan with >999 L -Foley catheter placed -Start Flomax 0.4 mg daily.   #Elevated CK: was down for some hours.  -CK normalized.  IVF discontinued.   #HTN: -Blood pressures stable -Continue Losartan 25 mg daily    Elevated troponin: Likely non-MI troponin elevation in the setting of COVID-19 infection, rhabdomyolysis.  Patient was evaluated by cardiology during this hospital stay   Acute Metabolic Encephalopathy/Delirium History of alcohol Abuse -CIWA's discontinue, there is no evidence of alcohol withdrawal -Patient was confused post operatively likely hospital delirium. -Mental status has improved   History of CAD with prior PTCA of the OM in 1994 -Continue statin   Complete heart block status post dual-chamber pacemaker   Permanent atrial fibrillation: Anticoagulated with warfarin -Pharm.D. dosing Coumadin   History of dementia Hard of hearing -Continue supportive cares   Type 2 diabetes mellitus: Continue SSI   3.5 cm infrarenal abdominal aortic aneurysm: Noted on CT lumbar spine