Age: 67.0
Sex: M
Vaccine: COVID19-2
Symptoms: Fatigue, Hypotension, Hypoxia, Influenza like illness, Joint injury
Clinical narrative: Patient is a 68 y.o. male who presented from SNF on 9/13/2023 with flu like symptoms; dizziness, cough, weakness. Pt tested covid + on 9/13 at ECF.  Patient remained afebrile, hemodynamically stable on room air following hospitalization.  Has only nocturnal hypoxia in the setting of untreated sleep apnea.  Patient was started on Paxlovid after consultation with infectious disease. Discharged back to his nursing facility in stable condition         Assessment and Plan   COVID 19  - Presented with: "feeling fluish"; cough, dizzy, sore throat, weakness, mild confusion  - Symptom onset: 9/13 - Positive COVID-19: 9/13 at SNF - Vaccination status: vaccinated  - CXR on admission showed no abnormality  - Only complaint is sore throat.  Denies shortness of breath or cough - Oxygen status: Continues to have adequate oxygen saturations on room air.  Has nocturnal hypoxia due to untreated sleep apnea discussed with nursing not to place patient on oxygen without indication - Decadron: Does not qualify due to SpO2>94% on RA.  - Remdesivir: Does not qualify due to SpO2>94% on RA.  - e consult to ID - ordered paxlovid and tolerated well   Fevers  - due to above; pt with prior multiple hospitalizations for sepsis with UTI's, cellulitis, hx of osteomyelitis  - Afebrile currently and hemodynamically stable   Metabolic toxic encephalopathy  - pt's wife noted pt with some confusion on admission - probably related to above - pt with chronic weakness in context of underlying syringomyelia; with increased generalized weakness in context of above; exacerbation of chronic symptoms; no new focal neurological deficits  - pt oriented on exam; appropriate in conversation  - cont supportive care for above; monitor  Syringomyelia  - history of thoracic osteomyelitis in 1992; may have precipitated syrinx - pt has been seen by neurology; neurosurgery; followed at clinic - no intervention  - also with development of Charcot joint right elbow - currently following with PM&R - MRI in 10/2022 showing syrinx 1.1 cm extending from C2-T11 - pt's wife states pt is wheelchair bound; considered C1 incomplete tetraplegic  - chronic paresthesias and pain to shoulders, torso and limbs - per PM&R note 7/18/23- with incomplete right sided tetraparesis (R>L), paresthesia, spasticity, neurogenic bladder, neurogenic bowel and fatigue - pt typically has exacerbation of chronic symptoms with concurrent infections  - cont supportive care; cont home gabapentin, morphine tid, flexeril prn, cymbalta; PT/OT   Left knee pain  - pt's wife noted atrophy left lower extremity; pt also with prior abrasions after knee injury knocking it on side of rails  - with increased left knee pain leading up to admission  - on exam no clear edema or erythema; no tenderness; no clinical concern for septic joint at this time      Recurrent UTI's - in context of indwelling foley catheter with underlying syringomyelia  - pt's wife states catheter was changed just a few days prior to admission  - currently on keflex daily for UTI prophylaxis - UA ordered by ED and pending  - cont home keflex prophylactically   BPH with urinary retention - S/p greenlight laser in 2016 complicated by bladder neck contracture.  - in context of above as well - pt with chronic foley catheter  - cont home flomax and outpatient follow up; if no plans for foley removal in future; not clear flomax still needed    History of CVA - Seen on MRI in 2014, was recommended to be on aspirin but patient has not been taking - no current concerns for acute stroke.    Nonsustained V. tach - Noted hospitalization in 4/2023 when pt was admitted for sepsis - TTE at that time with normal EF and no wall motion abnormalities. - EP evaluated at that time, added metoprolol and recommended 1 month of oral amiodarone-now off - pt has just finished wearing 30 day cardiac event monitor per wife  - does not appear any concerns on monitor per family reports - cont home toprol XL; monitor on telemetry.    Anxiety Depression  - cont home welbutrin, cymbalta    HTN  - BP low/normal  - cont home toprol XL; will discontinue losartan for now