Age: 88.0
Sex: M
Vaccine: COVID19
Symptoms: Mitral valve incompetence, Physical deconditioning, Platelet count decreased, Pleural effusion, Prone position
Clinical narrative: 12/6/2021 - present (4 days) inpatient admission HCF -  Hospital HISTORY OF PRESENT ILLNESS: Pt is a 89 y.o. male with past medical history of chronic diastolic HFpEF, Afib, restrictive lung disease and recent hospitalization for L1-L2 compression fracture and multiple rib fractures after ground level fall. Patient resides at (PRIVACY) where he recently tested positive for COVID-19 on 12/3. Patient presented to the ED with chief complaint of worsening hypoxia.   Patient was reported to have oxygen saturations in the 80's. He wears 2L oxygen at baseline and reports having a new cough and intermittent SOB. He thinks his symptoms started 1 week ago but is unsure and tested positive on 12/3 for COVID. He is vaccinated with Pfizer although has not received his booster yet. He reportably had monoclonal abx infusion on 12/4. Patient does not recall the infusion and states he received 4 shots for COVID as treatment. He denies having any fever, chills, abdominal pain, vomiting or diarrhea. While in the ED, patient was noted to be in a-fib RVR thus, received cardizem 5mg IV and subsequently became hypotensive.    Upon arrival to the ED, patient was afebrile, tachycardic HR 132bpm, otherwise hemodynamically stable on 4L oxygen. Labs were notable for Na 132, alk phos 145, bilirubin 1.2, wbc 3.29, hgb 9.9, plt 52. CXR showed bilateral pleural effusions slightly decreased in size compared to 11/20/21. No new or worsening opacity. No findings suspicious for overt heart failure. Patient received cardizem 5mg IV subsequently resulting in hypotension. His blood pressure improved with 2L IVF and home midodrine.    Patient will be admitted to HCF for further treatment and evaluation. ASSESSMENT / PLAN:   Iatrogenic hypotension, improving - secondary to IV cardizem - s/p 2L IVF and midodrine - check LA - will hold home lasix and aldactone for now and consider resuming tomorrow - continue BB and midodrine - monitor bp   A-fib RVR- resolved - noted to be recurrent per previous hospitalization - continue BB - tele - keep Mg>2, K>4   COVID-19 infection - vaccinated, did not receive his booster - COVID + 12/3, symptom onset roughly 1 week ago per pt - reported to have had monoclonal abx infusion on 12/4, attempted to call facility to confirm but unable to reach staff - prone positioning daily, tele, continuous pulse ox - trend daily crp, d-dimer - consider monoclonal abx infusion pending discussion with facility    Acute on chronic thrombocytopenia - suspect r/t COVID-19 - monitor cbc   Right arm laceration - wound nurse consult   Chronic diastolic HFpEF - not in acute exacerbation - 9/15/21 ECHO- EF 50-55%, grade 3 diastolic dysfunction, mod AR, mod to severe MR, mod-severe TR - holding lasix and aldactone d/t hypotension, resume when able - continue BB - daily wts, I&O's   Chronic hypoxic respiratory failure Restrictive lung disease Bilateral pleural effusions, stable - stable, baseline 2L oxygen   Deconditioning - lives at facility, own decision maker - PT/OT   DVT prophylaxis: lovenox subq Code status: DNR/DNI Diet: general