Age: 83.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Cough, Death, Dysstasia, Fall, Hypoxia
Clinical narrative: Patient is DECEASED (12.18.21); Hospitalized (12.14.21); COVID-19 positive (12.14.21); Fully vaccinated PLUS booster Admission Date: 12/14/2021 Date of Death: 12/18/21 Time of Death:  3:38 PM HISTORY OF PRESENT ILLNESS: Patient is a 83 y.o. female who presents today as a transfer from a local hospital there for multiple right-sided rib fractures, compression fracture of thoracic vertebra, pneumonia secondary to COVID-19 and hypoxia.   Patient was evaluated at an outside facility after a fall and being too weak to get up from the floor at approximately 4:00 a.m..  Patient reported that she was unsure if she had struck her head and family members found her on the floor and she had been incontinent of urine and was too weak to stand so she was brought to the emergency department.  She was noted to been diagnosed with COVID pneumonia approximately 10 days ago.  X-rays ordered at the outside facility demonstrated fractures of right ribs 4 through 6 along with age-indeterminate fractures of T5 through T7, T11 and T12. While at the outside facility developed persistent hypoxia satting 88% room air requiring 2 L nasal cannula. She was transferred to our facility for multiple rib fracture, COVID pneumonia and hypoxia.   The patient states that today around 4:00 am she was using the bathroom and when she stood up she was attempting to ambulate with her walker but was too weak and fell. The patient states that she remembers the entire fall and denies any syncopal symptoms. Patient states that she was not having any chest pain, vision changes, palpitations, lightheadedness or vertigo. Patient denies any cardiac history, or history of prior seizures or strokes. Patient states that she is not on any blood thinners. The patient's daughter is present at the bedside and states that she had attempted to contact the patient this morning but she did not answer. She went over to the patient's assisted living facility and they let her into the apartment where she found the patient wedged between the toilet and the cabinet. The daughter states that she got there around 10:30am so the patient had been down for approximately 6 hours. The daughter states that when she arrived she did not note any blood on the scene. Daughter also reports that the patient was alert and oriented x 4 when she arrived and displayed no post-ictal or post-concussive symptoms. Daughter contacted EMS as she was not strong enough to lift the patient off of the ground. The patient and daughter endorse that the patient is on day 10 of COVID-19 symptoms, she took a home test that was positive last Friday. The patient also admits to 2 prior falls earlier this month again stating that she fell because she was just feeling too weak. On evaluation here in the ED the patient's oxygen saturation is 95% on 2L NSL. The patient had tenderness to palpation over the right lateral chest wall, breathe sounds were equal and intact bilaterally. Patient states that she has pain in her back while lying flat and has tenderness to palpation over her right elbow and over the right fibular head. The patient was log rolled and had tenderness to palpation in the upper thoracic spine and upper lumbar spine. Gluteal squeeze was intact. Patient had intact sensation and strength throughout all extremities. Patient had multiple coughing episodes during the interview and evaluation. Given her continued chest wall pain a CT scan of the Chest abdomen and pelvis will be obtained to better evaluate her rib fractures. An x-ray of the right elbow, knee and tib-fib will also be obtained as she had tenderness to palpation over these points. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Closed fracture of multiple ribs of right side, initial encounter  Multiple fractures of ribs, right side, initial encounter for closed fracture  Pneumonia due to COVID-19 virus  COVID-19  HOSPITAL COURSE: 83-year-old female presents as a transfer from outside facility for fall with multiple right-sided rib fractures, compression fracture of thoracic vertebra, pneumonia secondary to COVID-19 and hypoxia.  She was admitted to hospital, she and her family decided to change? to comfort measure only, she deceased at 3:30 p.m. 12/18/2021