Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Differential white blood cell count, Dyspnoea, Dyspnoea exertional, Electrocardiogram, Electrocardiogram S1-S2-S3 pattern
Clinical narrative: ED Provider Notes 7/5/2021  8:14 AM History   Patient is a 50 y.o. male.   Chief Complaint Patient presents with ? Chest Pain .  Pt presents with complaints of chest heaviness and shortness of breath.  He states that nothing was out of the ordinary yetserday.  Never had any known medical problems.  No headache, no vision changes.  No fevers or chills.  No other complaints.  No leg pain or swelling.     The history is provided by the patient.      History reviewed. No pertinent past medical history.   History reviewed. No pertinent surgical history.   History reviewed. No pertinent family history.   Social History   Tobacco Use ? Smoking status: Never Smoker ? Smokeless tobacco: Never Used Substance Use Topics ? Alcohol use: Yes     Comment: 1 ? Drug use: No     Review of Systems Constitutional: Negative for fever. HENT: Negative for sore throat.   Eyes: Negative for redness. Respiratory: Positive for chest tightness and shortness of breath. Negative for wheezing.   Cardiovascular: Positive for palpitations. Negative for chest pain. Gastrointestinal: Negative for abdominal pain, diarrhea and vomiting. Genitourinary: Negative for dysuria. Musculoskeletal: Negative for neck pain. Skin: Negative for color change. Neurological: Negative for headaches. Psychiatric/Behavioral: Negative for behavioral problems.  All other systems reviewed and are negative.     Vital Signs BP 107/88  | Pulse (!) 104  | Temp 97.2 °F (36.2 °C)  | Resp 20  | Ht 182.9 cm (72")  | Wt 225 lb (102 kg)  | SpO2 96%  | BMI 30.52 kg/m²    Physical Exam Physical Exam Vitals reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: He is well-developed.  HENT:     Head: Normocephalic and atraumatic.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:     Rate and Rhythm: Tachycardia present. Rhythm irregular.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Abdominal:     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Neck supple.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: He is alert and oriented to person, place, and time.      Orders Placed This Encounter Procedures ? SARS-CoV-2 (Aptima) (LAB2974) ? X-ray Chest AP Portable ? Troponin-I (High Sensitivity) ? Troponin-I (High Sensitivity) ? Troponin-I (High Sensitivity) ? CBC with Differential ? Comprehensive Metabolic Panel ? B-Natriuretic Peptide ? Supplemental oxygen Nasal Cannula; 3; No ? ECG 12-Lead ? Place in Observation   Medications sodium chloride (NS) flush 2 mL (has no administration in time range) aspirin 81 MG chewable tablet 324 mg (324 mg Oral Not Given 7/5/21 0815) diltiazem (CARDIZEM) 125 mg in dextrose 5 % in water 125 mL infusion (0 mg/hr Intravenous Hold 7/5/21 0845) sodium chloride 0.9 % bolus 1,000 mL (0 mL Intravenous Stopped 7/5/21 0910) diltiazem (CARDIZEM) injection 20 mg (20 mg Intravenous Given 7/5/21 0812) diltiazem (CARDIZEM) tablet 30 mg (30 mg Oral Given 7/5/21 0853)   Procedures   EKG:  afib 173 with RVR, no STEMI, normal axis   Pulse Oximetry: 8:15 AM Pulse oximetry on room air is 98 % and this is normal     PPE: Personal Protective Equipment (PPE) was used during the entire patient encounter including face mask, eye protection, gloves, hand washing/hand sanitizer before and after the encounter. This is above standard precautions as there is heightened alertness of an unconfirmed viral transmission route of the novel coronavirus.    MDM Number of Diagnoses or Management Options Diagnosis management comments: eval for afib cardizem Labs reassess     Amount and/or Complexity of Data Reviewed Clinical lab tests: ordered and reviewed Tests in the radiology section of CPT®: ordered and reviewed Review and summarize past medical records: yes Discuss the patient with other providers: yes Independent visualization of images, tracings, or specimens: yes   Risk of Complications, Morbidity, and/or Mortality Presenting problems: high Diagnostic procedures: high   Final diagnoses: New onset atrial fibrillation   New Prescriptions   No medications on file     CRITICAL CARE was provided to prevent clinically significant and life threatening deterioration of the patient's condition. Patient required GREATER THAN 35 MINUTES OF CRITICAL CARE TIME. This includes initial evaluation, time spent at bedside with patient/family, and discussion with consultants. This time also includes time reviewing medical records, labs and imaging results. This time excludes any and all procedures.      Results for orders placed or performed during the hospital encounter of 07/05/21 Troponin-I (High Sensitivity) Result Value Ref Range   Troponin I (High Sensitivity) 6.32 2.50 - 53.00 ng/L CBC with Differential Result Value Ref Range   Auto WBC 7.7 3.7 - 10.4 10*3 /uL   NRBCs Absolute Count 0.00 <=0.01 10*3 /uL   NRBC Relative percent 0 <=0 /100 WBC   RBC 5.69 (H) 4.35 - 5.56 10*6 /uL   Hemoglobin 17.1 (H) 13.2 - 16.8 g/dL   Hematocrit 49.1 (H) 39.2 - 48.8 %   MCV 86.3 81.2 - 96.7 fL   MCH 30.1 27.5 - 33.1 pg   MCHC 34.8 32.1 - 36.1 g/dL   RDW 12.5 11.5 - 14.3 %   Platelets 351 (H) 131 - 340 10*3/uL   MPV 9.4 8.7 - 12.7 fL   Neutrophils Relative 44.1 %   Immature Granulocytes Relative 0.3 %   Lymphocytes Relative 43.1 %   Monocytes Relative 8.1 %   Eosinophils Relative 3.5 %   Basophils Relative 0.9 %   Neutrophils Absolute 3.4 1.6 - 6.4 10*3/uL   Immature Granulocytes Absolute 0.0 0.0 - 0.1 10*3/uL   Lymphocytes Absolute 3.3 0.6 - 3.3 10*3/uL   Monocytes Absolute 0.6 0.2 - 1.2 10*3/uL   Eosinophils Absolute 0.3 0.0 - 0.4 10*3/uL   Basophils Absolute 0.1 0.0 - 0.1 10*3/uL Comprehensive Metabolic Panel Result Value Ref Range   Total Protein 7.2 5.7 - 8.2 g/dL   Albumin 4.5 3.3 - 5.2 g/dL   Globulin 2.7 1.5 - 3.0 g/dL   A/G Ratio 1.7 1.0 - 2.6   Total Bilirubin 0.9 0.1 - 1.2 mg/dL   Alkaline Phosphatase 93 46 - 116 U/L   AST 28 13 - 40 U/L   ALT 31 10 - 49 U/L   BUN 13 9 - 23 mg/dL   Creatinine 1.12 0.60 - 1.30 mg/dL   BUN/Creatinine Ratio 11.6 10.0 - 20.0   Calcium 10.1 8.7 - 10.4 mg/dL   Glucose 116 (H) 70 - 99 mg/dL   Sodium 141 136 - 145 mmol/L   Potassium 4.1 3.5 - 5.1 mmol/L   Chloride 108 (H) 98 - 107 mmol/L   CO2 23 21 - 32 mmol/L   Anion Gap 10 5 - 15   GFR >60 >60 mL/min/1.73 sq.m   GFR(Others) >60 >60 mL/min/1.73 sq.m B-Natriuretic Peptide Result Value Ref Range   BNP 55 0 - 100 pg/mL       X-ray Chest AP Portable Final Result Normal chest.          CRITICAL CARE was provided to prevent clinically significant and life threatening deterioration of the patient's condition. Patient required GREATER THAN 35 MINUTES OF CRITICAL CARE TIME. This includes initial evaluation, time spent at bedside with patient/family, and discussion with consultants. This time also includes time reviewing medical records, labs and imaging results. This time excludes any and all procedures.      07/05/21 0921   Discharge Summary 7/5/2021  3:15 PM Inpatient Discharge Summary   BRIEF OVERVIEW Admission Date: 7/5/2021     Discharge Date: 07/05/21   Discharge Diagnosis   1. New onset atrial fibrillation w/ RVR 2. Elevated hemoglobin (17.1)   Discharge Disposition Home   Discharge Activity As tolerated   Diet Regular   Active Issues Requiring Follow-up New onset atrial fibrillation   Outpatient Follow-Up No future appointments.   Test Results Pending at Discharge Pending Labs    Order Current Status   SARS-CoV-2 (Aptima) In process        Discharge Medications    Home Medication Instructions  Printed on:07/05/21 1515 Medication Information                                   apixaban (ELIQUIS) 5 mg tab Take 1 tablet (5 mg total) by mouth every 12 (twelve) hours.                   metoprolol tartrate (LOPRESSOR) 25 MG tablet Take 1 tablet (25 mg total) by mouth every 12 (twelve) hours.                           DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness New onset atrial fibrillation Please see HPI:    "Patient is a 50y M w/ no known PMHx who presented via EMS with chest heaviness and DOE. Says he was in his usual state of health yesterday. Has been working in the yard more than usual. At baseline, he is very highly functional (weight lifts, walks >3 miles several times per week, former runner). He had one beer yesterday. Went to bed feeling fine and then woke up ~0100 to urinate. Felt SOB after just walking to and from the bathroom. Then woke up again ~0430 and did the same thing. Fell asleep again, but woke up ~0630 and felt very weak and had chest heaviness. He was so weak that he fell while trying to ambulate. No LOC or trauma. His family called EMS and he was brought to the ED.    In the ED, he was found to be in Afib w/ RVR. Labs significant for Hb 17.1, but otherwise normal. CXR unremarkable. Pt was admitted for further management. Was seen by cardiology and was started on Eliquis and metoprolol for rate control."   Hospital Course (Please See H&P, Consultant Notes and Labs/Imaging for full details)   Patient is a 50y M w/ no known PMHx who presented via EMS with chest heaviness and DOE. Found to be in Afib w/ RVR, which is a new diagnosis. Labs, including TSH, unremarkable. CT PE negative for PE. Seen by cardiology and started on Eliquis and metoprolol. Echocardiogram could not be done due to the July holiday. Cardiology was ok with echocardiogram being done as OP. He will need to follow-up with cardiology in 1-2 weeks for continued management.    Of note, hemoglobin was 17.1 during admission. Could be slight dehydration. Consider OSA and OP sleepy study as well.    Operative Procedures Performed     Physical Exam at Discharge Discharge Condition: fair Heart Rate: 99 Resp: (!) 22 BP: 110/70 Temp: 98.3 °F (36.8 °C) Weight: 102 kg (225 lb) Gen: NAD HEENT: MMM Neck: No JVD CVS: Normal S1/S2, no murmur appreciated. Irregularly irregular rhythm  Resp: CTAB Abd: Soft ND/NT; +BS Ext: No edema Neuro: AAO, no focal neurological deficit Skin: no rash Psych: Calm, cooperative   Instructions 1. Patient is advised to adhere to above Medication/Diet/Activity 2. Patient is advised to follow up with Primary Care Doctor in 1-2 weeks  3. Patient is advised to return to Emergency Room if symptoms return or condition worsens   Time Spent: Greater than 35 min with more than 50% spent in D/C preparation/coordination, exam and discussion with patient and/or family/DPOA    Hospitalist H&P 7/5/2021 12:14 PM  History and Physical      Date of Admission: 7/5/2021   Chief Complaint New onset atrial fibrillation   History of Present Illness Patient is a 50y M w/ no known PMHx who presented via EMS with chest heaviness and DOE. Says he was in his usual state of health yesterday. Has been working in the yard more than usual. At baseline, he is very highly functional (weight lifts, walks >3 miles several times per week, former runner). He had one beer yesterday. Went to bed feeling fine and then woke up ~0100 to urinate. Felt SOB after just walking to and from the bathroom. Then woke up again ~0430 and did the same thing. Fell asleep again, but woke up ~0630 and felt very weak and had chest heaviness. He was so weak that he fell while trying to ambulate. No LOC or trauma. His family called EMS and he was brought to the ED.    In the ED, he was found to be in Afib w/ RVR. Labs significant for Hb 17.1, but otherwise normal. CXR unremarkable. Pt was admitted for further management. Was seen by cardiology and was started on Eliquis and metoprolol for rate control.    Past Medical History Past Medical History: Diagnosis Date ? Known health problems: none       Past Surgical History Past Surgical History: Procedure Laterality Date ? BLADDER SURGERY     ? ELBOW FRACTURE SURGERY     ? KNEE ARTHROSCOPY W/ ACL RECONSTRUCTION         Home Meds No medications prior to admission.     Allergies Allergies Allergen Reactions ? No Known Drug Allergies       Family History History reviewed. No pertinent family history.   Social History Social History   Socioeconomic History ? Marital status: Married     Spouse name: None ? Number of children: None ? Years of education: None ? Highest education level: None Tobacco Use ? Smoking status: Never Smoker ? Smokeless tobacco: Never Used Substance and Sexual Activity ? Alcohol use: Yes     Comment: only occasional ? Drug use: No ? Sexual activity: Yes     Partners: Female Social History Narrative ? None   Social Determinants of Health   Food Insecurity: Unknown ? Worried About Running Out of Food in the Last Year: Patient refused ? Ran Out of Food in the Last Year: Patient refused     Review of Systems 12 point system reviewed. Negative except HPI   Physical Exam BP 110/70 (BP Location: Left upper arm, Patient Position: Sitting)  | Pulse (!) 105  | Temp 98.3 °F (36.8 °C)  | Resp (!) 22  | Ht 182.9 cm (72")  | Wt 102 kg (225 lb)  | SpO2 96%  | BMI 30.52 kg/m²  Temp:  [97.2 °F (36.2 °C)-98.3 °F (36.8 °C)] 98.3 °F (36.8 °C) Heart Rate:  [78-179] 105 Resp:  [10-28] 22 BP: (107-146)/(58-119) 110/70   Gen: NAD HEENT: MMM Neck: No JVD CVS: Normal S1/S2, no murmur appreciated Resp: CTAB Abd: Soft ND/NT; +BS Ext: No edema Neuro: AAO, no focal neurological deficit Skin: no rash Psych: Calm, cooperative   Labs, Imaging, EKG (if any) reviewed independently by myself Recent Results (from the past 72 hour(s)) Troponin-I (High Sensitivity)   Collection Time: 07/05/21  8:11 AM Result Value Ref Range   Troponin I (High Sensitivity) 6.32 2.50 - 53.00 ng/L CBC with Differential   Collection Time: 07/05/21  8:11 AM Result Value Ref Range   Auto WBC 7.7 3.7 - 10.4 10*3 /uL   NRBCs Absolute Count 0.00 <=0.01 10*3 /uL   NRBC Relative percent 0 <=0 /100 WBC   RBC 5.69 (H) 4.35 - 5.56 10*6 /uL   Hemoglobin 17.1 (H) 13.2 - 16.8 g/dL   Hematocrit 49.1 (H) 39.2 - 48.8 %   MCV 86.3 81.2 - 96.7 fL   MCH 30.1 27.5 - 33.1 pg   MCHC 34.8 32.1 - 36.1 g/dL   RDW 12.5 11.5 - 14.3 %   Platelets 351 (H) 131 - 340 10*3/uL   MPV 9.4 8.7 - 12.7 fL   Neutrophils Relative 44.1 %   Immature Granulocytes Relative 0.3 %   Lymphocytes Relative 43.1 %   Monocytes Relative 8.1 %   Eosinophils Relative 3.5 %   Basophils Relative 0.9 %   Neutrophils Absolute 3.4 1.6 - 6.4 10*3/uL   Immature Granulocytes Absolute 0.0 0.0 - 0.1 10*3/uL   Lymphocytes Absolute 3.3 0.6 - 3.3 10*3/uL   Monocytes Absolute 0.6 0.2 - 1.2 10*3/uL   Eosinophils Absolute 0.3 0.0 - 0.4 10*3/uL   Basophils Absolute 0.1 0.0 - 0.1 10*3/uL Comprehensive Metabolic Panel   Collection Time: 07/05/21  8:11 AM Result Value Ref Range   Total Protein 7.2 5.7 - 8.2 g/dL   Albumin 4.5 3.3 - 5.2 g/dL   Globulin 2.7 1.5 - 3.0 g/dL   A/G Ratio 1.7 1.0 - 2.6   Total Bilirubin 0.9 0.1 - 1.2 mg/dL   Alkaline Phosphatase 93 46 - 116 U/L   AST 28 13 - 40 U/L   ALT 31 10 - 49 U/L   BUN 13 9 - 23 mg/dL   Creatinine 1.12 0.60 - 1.30 mg/dL   BUN/Creatinine Ratio 11.6 10.0 - 20.0   Calcium 10.1 8.7 - 10.4 mg/dL   Glucose 116 (H) 70 - 99 mg/dL   Sodium 141 136 - 145 mmol/L   Potassium 4.1 3.5 - 5.1 mmol/L   Chloride 108 (H) 98 - 107 mmol/L   CO2 23 21 - 32 mmol/L   Anion Gap 10 5 - 15   GFR(African American) >60 >60 mL/min/1.73 sq.m   GFR(Others) >60 >60 mL/min/1.73 sq.m B-Natriuretic Peptide   Collection Time: 07/05/21  8:11 AM Result Value Ref Range   BNP 55 0 - 100 pg/mL TSH/Rflx Free T4/Rflx Total T3/Rflx aTPO   Collection Time: 07/05/21  8:11 AM Result Value Ref Range   TSH 1.367 0.450 - 5.500 uIU/mL Troponin-I (High Sensitivity)   Collection Time: 07/05/21 11:29 AM Result Value Ref Range   Troponin I (High Sensitivity) 13.37 2.50 - 53.00 ng/L D-dimer, quantitative   Collection Time: 07/05/21 11:29 AM Result Value Ref Range   D-Dimer, Quant 385 <=499 ng/ml FEU     Assessment: 1. New onset atrial fibrillation w/ RVR              - CHADSVASc = 0              - Started on Eliquis, per cardiology, in case of need for DCCV or ablation              - Metoprolol 25mg BID              - Check CT PE              - TSH WNL              - Needs echo (cannot be done inpatient today due to the holiday)              - OP sleep study              - F/u cards in 1-2 weeks   2. Elevated hemoglobin               - Slight dehydration? Suggestive of underlying OSA?              - OP follow-up   FEN:               IVFs: none              Electrolytes: Will monitor and replete PRN              Nutrition: Regular   DVT Prophylaxis: Eliquis   Dispo: Continue observation. Anticipate discharge later today  (Timing of the note does not necessarily correlate with the timing of the visit)  Consults 7/5/2021 11:26 AM Consult Orders 1. Inpatient consult to Cardiology ordered by MD at 07/05/21 0912 untitled image     Cardiology Consult Note     Date of Admission: 7/5/2021    History of Present Illness Patient is a 50 y.o. male.  Healthy, very high function. Designs/manufactures technology for "swiping" into computers.  Exercises vigorously No PMH. Nothing to suggest OSA Recent fights to Northern California with several stops. No leg symptoms   Usual state until last night. BBQ. No change in etoh or caffeine intake. Noted ill feeling. Difficult sleeping. Noted palpitations and had to urinate twice which is unusual  Awoke this am and felt worse when trying to walk the dog Had to sit down/lie down Called ems: afib 160's; bp 111/83 Iv  Aspirin     Past Medical History Past Medical History: Diagnosis Date ? Known health problems: none       Medications No current facility-administered medications on file prior to encounter.   No current outpatient medications on file prior to encounter.     Current Allergies Allergies Allergen Reactions ? No Known Drug Allergies       Surgical History Past Surgical History: Procedure Laterality Date ? BLADDER SURGERY     ? ELBOW FRACTURE SURGERY     ? KNEE ARTHROSCOPY W/ ACL RECONSTRUCTION         Social History Social History   Socioeconomic History ? Marital status: Married     Spouse name: None ? Number of children: None ? Years of education: None ? Highest education level: None Tobacco Use ? Smoking status: Never Smoker ? Smokeless tobacco: Never Used Substance and Sexual Activity ? Alcohol use: Yes     Comment: only occasional ? Drug use: No ? Sexual activity: Yes     Partners: Female Social History Narrative ? None   Social Determinants of Health   Food Insecurity: Unknown ? Worried About Running Out of Food in the Last Year: Patient refused ? Ran Out of Food in the Last Year: Patient refused     Family History History reviewed. No pertinent family history.   Review of Systems Review of systems was positive for There is no unusual bruising or bleeding.  There are no new neurologic symptoms. .  All other systems negative.     PHYSICAL EXAM: Vitals:  BP 119/58 (BP Location: Left upper arm, Patient Position: Sitting)  | Pulse (!) 119  | Temp 97.2 °F (36.2 °C)  | Resp 16  | Ht 182.9 cm (72")  | Wt 102 kg (225 lb)  | SpO2 97%  | BMI 30.52 kg/m²      Intake/Output Summary (Last 24 hours) at 7/5/2021 1126 Last data filed at 7/5/2021 0910 Gross per 24 hour Intake 1000 ml Output 800 ml Net 200 ml     General/Pyschiatry:  NAD, awake/alert.  Normal Mood Skin:  No rashes HEENT:  Head normocephalic and atraumatic.  Eyes PERRLA, EOMI.  No Jaundice.  No Thrush Neck:  No neck vein distention Cardiovascular:  Normal S1 and S2, no murmur or S3 gallop Pulmonary:  Lungs clear bilaterally to auscultation and percussion.  No wheezes or rales Abdomen:  Soft, nontender, no palpable masses Extremities:  Warm, no ankle edema Neurologic:  No focal abnormalities.   Cardiographics ECG:  afib rvr at 173bpm   Lab Review  Results from last 3 days Lab Units 07/05/21 0811 SODIUM mmol/L 141 POTASSIUM mmol/L 4.1 CO2 mmol/L 23 BUN mg/dL 13 CREATININE mg/dL 1.12 CALCIUM mg/dL 10.1   Results from last 3 days Lab Units 07/05/21 0811 WBC 10*3 /uL 7.7 HEMOGLOBIN g/dL 17.1* HEMATOCRIT % 49.1* PLATELETS 10*3/uL 351*   Results from last 3 days Lab Units 07/05/21 0811 TROPONINIHS ng/L 6.32 BNP pg/mL 55   No results found for: CHOL, No results found for: TRIG, No results found for: HDL, No results found for: LDLCALC No results found for: TSH, T3TOTAL, T4TOTAL, THYROIDAB       We had a careful review of atrial fibrillation.  We discussed risk for embolic ("clotting") stroke in detail with attention to each aspect of the CHADS2VASc score.  His score is zero We discussed aspirin vs anti-coagulant with emphasis on the key differences: length of clinical experience, efficacy, safety and reversibility. We discussed the four currently available novel anti-coagulants including: Eliquis, Xarelto,Savaysa and Pradaxa.  Ultimately, the decision was made to use eliquis only for short term We further discussed rate vs rhythm strategy.       Assessment/Plan:   Principal Problem:   New onset atrial fibrillation     Plan:   eliquis in case dccv or pharm cardioversion needed Bb for rate control D-dimer. ?pe as trigger given recent travel outpt echo. If normal, consider fleainide which can also be used in the future as "pill in the pocket" Exercise is fine Likely home later today as long as he is feeling better I can see him in the next 1-2 weeks   11:26 AM    07/05/21           Progress Notes 7/5/2021  3:34 PM                         Care Coordinator Progress Notes       07/05/21 1533 Discharge Planning Patient's Discharge Placement Need Home without Home Health Case Management Additional Notes Per pt's spouse, pirmary Pharmacy is (unlisted), and has pt's insurance information. Per Pharmacist, Eliquis prescription supply for 30 days with $60 co-pay. Notified patient and spouse at bedside. Discharge Plan - Follow-Up Discharge Plan Follow-Up 7/5 Pt for discharge home. To follow-up with Cardiologist. No further discharge planning needed Final Discharge Disposition Plan Final Discharge Disposition Home without Home Health Discharge Mode of Transportation Car   7/5/2021  2:39 PM                         Care Coordinator Progress Notes       07/05/21 1435 Discharge Planning Patient's Discharge Placement Need Home without Home Health Case Management Additional Notes Spoke with patient regarding Eliquis Prescription. Pt's pharmacy listed is (unlisted), pharmacy currently has no insurnace information, Eliquis cost $585.00.    Per pharmacy, pt's insurance is not in-network, and eliquis might night be covered. Provided info to patient, and given discount coupon. Discharge Plan - Follow-Up Discharge Plan Follow-Up 7/5 Pt for discharge home. To follow-up with Cardiologist. No further discharge planning needed Final Discharge Disposition Plan Final Discharge Disposition Home without Home Health Discharge Mode of Transportation Car   7/5/2021 12:16 PM                         Care Coordinator Progress Notes       07/05/21 1212 Discharge Planning Patient's Discharge Placement Need Home without Home Health Discharge Plan - Follow-Up Discharge Plan Follow-Up 7/5 Pt in ED with New Onset Afib. Lives with spouse at home. Independent with ADls and IADLs, drives, physically active. No discharge planning needs anticipated, follow-up as needed Care Progression 7/5 Pt with no significant medical Hx, in ED with new onset Afib. Started on po lopressor and Eliquis. Evaluated by Cardiologist.   ED Triage Notes 7/5/2021  8:04 AM Pt arrives to D9 via EMS from home with CP and heaviness started this AM. Reports CP and heaviness at 130 am with shortness of breath. No pmh, family hx CAD, father. Given 4 baby ASA en route. Noted Afib with rvr en route. HR In 140-170, pt reports chest tightness and hyperventilating on arrival.    Vaccinated 2nd dose Moderna 6/29