Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cardiac monitoring abnormal, Cardioversion, Cast application, Connective tissue disorder, Electromyogram abnormal
Clinical narrative: HISTORY OF PRESENT ILLNESS Patient is a 69 y.o. male who presented to the ED via EMS with a right ankle injury that he sustained while experiencing a syncopal event while in the shower.  He is being admitted to the Hospital. He has medical comorbidities including, but not limited to, nonischemic cardiomyopathy, LV ejection fraction 30%, bradycardia/complete heart block status post ICD, atrial fibrillation/flutter on Eliquis, hypertension, obstructive sleep apnea, minimal coronary artery disease by angiogram 2011, medically complicated obesity, and history of clostridium difficile causing hypovolemic shock.     Today patient was taking a shower and experienced a syncopal episode with complete loss of consciousness and awoke to find that he had sustained a right ankle injury.  He denied other injury, but is anticoagulated.  In the ED he was hemodynamically stable and conversant with an obvious deformity to the right ankle.  Bedside interrogation of pacemaker/ICD revealed two episodes of ventricular tachydysrhythmia within the past 24 hours, one corresponding to his syncopal event during which he received appropriate antitachycardia discharge.  Available EGM appears to show VT at a rate of 185-210 bpm, rate eventually sustained long enough for device to start therapies.  Device delivered (1) unsuccessful ATP and then a 41J shock with a type I break.  Device also reported 6 VT episodes that occurred on 10-23-21 between the times of 3:27am to 4:20.  Ventricular rates ranged between 171-183 bpm which were under detection therapy rate.  Longest episode was 31 seconds which appears to show no conversion of VT but just going below monitor zone of 171 bpm. Dr. was notified and  VT-1 zone was programmed at 160 bpm with ATP and shocks at max outputs. Monitor zone was programmed at 140 bpm.    Radiographs of the right ankle demonstrated a fracture dislocation of the tibiotalar joint with lateral dislocation of the talus relative to the tibial plafond with frank diastasis of the tibiofibular syndesmosis. Ortho was consulted in the ED and he was placed in a plaster splint, his leg should be elevated above the level of the heart for 23 out of 24 hours each day to assist with reduction of swelling and preparation of the soft tissues for surgical intervention.  He will be contacted by ortho with a cast room appointment in 1-2 weeks and should arrive at that appointment fasting in order to be prepared for surgery if indicated.  Strict nonweightbearing on the injured extremity   Upon arrival to the PCU, patient is resting comfortably in bed, denies any chest pain or shortness of breath.  Reports a cold with congestion that began last Monday, Wednesday was the worst day and since then has improved.  He has been taking Mucinex DM (guaifenesin and dextromethorphan).  Denies any fevers.  His right ankle is in a soft cast and toes are pink and warm. He reports at home he sleeps flat on one pillow, he takes torsemide only as needed.  He does not weigh himself but does not feel he has gained any weight or is retaining fluid.