Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Blood alkaline phosphatase increased, Blood magnesium normal, Body temperature increased, Brain natriuretic peptide increased, C-reactive protein increased
Clinical narrative: Patient was vaccinated and receive  Pfizer: 2/24/2021 EN6200,  Pfizer: 3/17/2021  ER2613    Moderna: 12/1/2021 045J21A  Moderna: 7/3/2022 059A22A This patient presented to the Emergency Department via EMS with a complaint of cough and tachycardia, COVID-positive. The patient's husband was currently admitted to the hospital with COVID. She took a home COVID test which was positive. Her son called EMS because she appeared to be having worsening dyspnea and cough. The patient stated that she felt generally fatigued but did not feel short of breath per se. She denied chest pain, abdominal pain, vomiting, and diarrhea. Noted to have slight swelling of bilateral lower extremities on review of systems. EMS reported a temp of 102 on their arrival. EMS also found the patient to be tachycardic with atrial fibrillation and she was given diltiazem 10 mg in route. The patient stated she had no history of atrial fibrillation. No previous EKGs available to evaluate. Echocardiogram from 2016 states the patient was in sinus rhythm. Patient admitted 8/28/22. This patient presented to ER with cough, dyspnea, and tachycardia. The patient was febrile at 99.4 with heart rate of 130, blood pressure of 121/56, respirate of 18, pulse ox 93% on room air. The patient did not appear to have significant increased work of breathing or tachypnea but was audibly rhonchorous. Lungs were rhonchorous bilaterally. Heart rate was irregular and tachycardic. No significant edema of the lower extremities on my exam. Stat EKG showed atrial fibrillation 120 bpm with a wide-complex QRS, poor R wave progression, no previous EKG available for comparison.  The patient CBC showed normal white blood cell count, anemia with a hemoglobin of 8.9, slightly down from 9.3 earlier this month, magnesium was slightly low 1.5 and this was repleted with IV magnesium. Troponin was elevated at 70. BNP was elevated at 2700. CMP showed mild hypokalemia and elevations of alkaline phosphatase at 1700 and AST of 45, consistent with the patient's previous results on August 5, but otherwise normal liver function tests. The patient's D-dimer was elevated at 1410. A CT angiogram was obtained which was negative for pulmonary thromboembolic disease. Patchy bibasilar infiltrates; left worse than right likely pneumonia associated tiny bilateral pleural effusions were seen. It was determined she warranted IV antibiotics which were empirically initiated. Patient was admitted to hospital for further work-up and management. The patient's heart rate improved on the diltiazem drip and she was transferred to the stepdown bed in stable condition. Unknown when patient was discharged from 8/28/22 admission. Readmitted on 9/4/22 from nursing home (UNKNOWN NAME OF NURSING HOME) with worsening shortness of breath and hypoxia. Patient was on oral antibiotics at the nursing home. In ER, needed oxygen 3L per nasal cannula. Per notes, on exam the patient had rales throughout the lungs without JVD or peripheral edema. Chest x -ray shows worsening right middle lobe infiltrate. Cefepime for IV antibiotics was given for worsening pneumonia and recent hospitalization.  States that her shortness of breath is continued to increase despite treatment at the nursing home. Labs done today showed elevated white blood cell count, BNP, and D-dimer. Of note the patient had a elevated D-dimer while in the hospital and had a CT scan at that time which showed no evidence of PE.  Patient completed a course of dexamethasone. She was also started on Coumadin for anticoagulation while in the hospital. She denied vomiting or abdominal pain. She denied any diarrhea. Patient started on Zosyn and doxycycline. Continue both antibiotics while awaiting sputum culture. Problem list per hospital note of Probable superimposed bacterial pneumonia -Recently completed 5-day course of ceftriaxone and azithromycin -Presented back with worsening respiratory symptoms and chest image findings COVID-19 pneumonia with hypoxia -Symptom onset date on 8/23/2022 -Received COVID-19 vaccines and boosted last with Moderna on 7/3/2022. -Dexamethasone was started on 8/28 -Currently on 2 L of supplemental oxygen. -High CRP at 31, BNP of 3,360 Leukocytosis -WBC elevated at 31 -Most likely related to above.  Health department has no further information on this patient?s hospitalization or outcome or current condition. Please contact Hospital for further information.