Age: 78.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood culture, Blood lactic acid, Body temperature increased, Bundle branch block right, COVID-19
Clinical narrative: Hospitalized (9.17.21-present);  COVID-19 positive (9.17.21);  Fully vaccinated  SUBJECTIVE: Pt is a 79 yo male with hx of bronchogenic Carcinoid Tumor, DMII, HTN, Afib, HLD, presented to the ER today with a complaint of fatigue. He noted fighting a head cold for 2 days with associated fatigue. This AM, he awakened profoundly weak and was unable to get himself up out of bed and instead ended up sliding out of bed and onto the floor without head trauma but he was too weak to get himself up and he remained there for 4 hours, after which, he was able to contact his wife in the living room sleeping. She was unable to assist him up, but she got a neighbor to help and then brought him to ER. During exam he was coughing profusely and he noted this was new for him. He was 38 temp on arrival, blood cultures obtained and serum labs. His CK was 295. Initial troponin was 87 and lactic acid was 2.0. He was dehydrated with hyponatremia and hypochloridemia. AKI with Cr of 2.11. Follow up troponin was 98 but no complaints of chest pain or SOB or palpitations. EKG showed A fib with RBBB. It was felt that he did not suffer from ACS and more likely related to acute illness. Covid test was obtained and it was positive. He has not had a previous positive test and is fully vaccinated. He was admitted due to acute deconditioning and dehydration with AKI and Covid.   Carcinoid Hx: -Dx May of 2008, Sp left upper lobe resection. -On observation through 2012 -Surveillance imaging showing right LL nodule and liver nodules, biopsy proven carcinoid -2013 Sandostatin shots with initial good response -New disease in liver and right pelvic bones with subsequent Lutathera clinical Trial 12/2017 into 2018. -2018-2019 he had disease progression on imagine and started Temodar and Xeloda July of 2020 -Stable disease with occasional treatment holiday due to cytopenias and fatigue. -Most recent MRI 09/2021 with stable and improved liver disease, stable osseous disease. -Most recent CT chest 09/2021 with new left lower lobe nodule, 5 mm, nonspecific. And stable sub 2 mm nodules bilaterally.  ASSESSMENT / PLAN: Profound General Weakness              -Multifactoral, likely related to discovered Covid disease, associated dehydration.              -IVF's. Hold home lasix for now              -AM labs              -PT/OT eval              -Empiric Cefepime for possible RLL PNA              -Supportive care for Covid PNA              -CXR with Right basilar opacities              -Abx for now              -BC's obtained              -IS to bedside              -Mobilize as able              -Follow up CXR in 48 hrs to eval for resolution Covid 19 respiratory infection              Contact Isolation              No need for steroids given absence of hypoxia              Remdesivir ordered Given cancer tx on myelosuppressive regimen, hx IDDM, advanced age, he likely qualifies for emergency use of Regeneron, will consult ID for eval.  Elevated Troponin              Not felt to be ACS and more likely related to acute illness and initial Afib with RVR in ER              Cardiology consulted for official input              ECHO pending Family member called to let us know he is still hospitalized and that he's on an IV antibiotic and will most likely be in the hospital another 6 days but she will let us know when he is discharged.