Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Anticoagulant therapy, Aortic aneurysm, Aspiration, Asthenia
Clinical narrative: Moderna Dose 1  3/24/21 (016B21A) Moderna Dose 2 4/21/21 (048B21A) COVID Positive 2/6/22  2/8/22: Patient is a 79-year-old male with a past medical history significant for abdominal aortic aneurysm, CKD, COPD, CAD, nocturnal hypoxemia requiring 2 L of supplemental oxygen at night, and obesity.  The patient presented to the ED on 02/06/2022 with complaints of decreased appetite and fatigue for 2 weeks.  The patient's accompanying symptoms included diarrhea, nausea, emesis, fever, chills.  He denies any chest pain or worsening shortness of breath other than from baseline.  He denies any abdominal cramping or abdominal discomfort, dysuria. He subsequently tested positive for COVID-19 infection. The patient is vaccinated against COVID-19.  He has not received booster vaccination yet however.  Upon further examination a CT of his chest revealed a significant finding for a thoracic abdominal aneurysm measuring 7 cm with mural thrombosis.  The patient was subsequently transferred to hospital and Clinics due to significance of this finding for further evaluation with vascular surgeon.  The vascular surgeon determined that at this time there is no immediate surgical intervention needed and recommended transferring back to our facility for further management of his other conditions.   He subsequently returned to our facility this evening after it was recommended by the vascular surgeon at hospital. The patient was seen and examined at the bedside on the cardiac step-down unit.  The patient states he overall is beginning to feel improved from his arrival to the hospital.  He denies any abdominal pain or nausea currently.  He denies any chest pain or worsening shortness of breath.  The patient is seen on 2 L oxygen that he wears at night for nocturnal hypoxemia.  The patient continues to complain of fever, chills, diarrhea.  He states however that his diarrhea is slowing down.  He currently has an indwelling Foley catheter in place that was inserted upon arrival on 02/06/2022.  2/13/22: 79-year-old male with history of abdominal aortic aneurysm s/p repair, CKD stage 3, history of COPD, chronic hypoxic respiratory failure on 2 L by nasal cannula, CAD, presented to days ago to the hospital with a complaint of generalized weakness, imaging showed exam measuring 7.7 cm with mural thrombus, patient was transferred to the hospital for vascular surgeon evaluation who deemed the patient stable for transfer back since there is no need for immediate intervention.  Chest x-ray showed right lower lobe community-acquired pneumonia that thought to be secondary to aspiration.  Patient was started on Zosyn, had also UTI.  He developed new onset atrial fibrillation with RVR for which she was started on metoprolol, his heart rate was fluctuating and difficult to control and cardiology were consulted.  His metoprolol will switch to XL.  He was briefly on Cardizem but blood pressure was dropping due to low ejection fraction.  Echocardiogram showed new onset severe systolic dysfunction and EF of 20-25%.  Patient received contrast as part of imaging upon admission that most likely contributing to his acute kidney injury, Nephrology were consulted and patient was started on bicarb drip slow rate, kidney function plateaued, fluids were discontinued.  Cardiology recommended to start the patient on Coumadin with a goal of INR 1.5-2.  Patient meantime was on heparin drip.  Overall patient condition slightly improved and was back to his baseline.  He is usually we on 2 L by nasal cannula and had some chronic shortness of breath.  Offered to watch the patient for a day or 2 however he is adamant about being discharged to home. Will discharge to home with PT/OT.