Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Disorientation, Encephalopathy, Fall, Fibrin D dimer increased, Ischaemic stroke
Clinical narrative: Admit date: 11/14/2023  Discharge date: 11/27/23  Admitting Physician: MD   Attending Physician at the Time of Discharge: MD  Reason for Admission: AMS  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) Patient is not responsive to verbal stimuli.  She provides no information herself.  History obtained by review of current ER record, old medical records and interviewing her POA, who is here in the ED with her.  Patient is an 85-year-old female with history of dementia.  She is of an assisted living center.  She lived with her boyfriend.  Reportedly, today she fell out of bed.  Boyfriend attempted to help her up from the floor when he himself suffered a cardiopulmonary arrest.  Patient was able to be helped up into the bed.  Other residents of the facility who came to help found her on the bed unresponsive and him on the floor unresponsive.  EMS was notified.  Patient is the boyfriend did not survive the event.  EMS found her blood sugar to be in the 200s and brought her to the ER for evaluation.  On arrival to the emergency department patient continued to be unresponsive to verbal or tactile stimuli.  She was afebrile and hemodynamically stable.  She was given a dose of Narcan without any significant change in her mentation.  Stroke workup ensued and patient had a CT of the head that showed no acute abnormalities.  CT angiogram head/neck showed no large vessel occlusion.  Patient did test positive for COVID.  Urine drug screen currently pending.  Patient has remained obtunded in the emergency department.  Hospitalist service has been asked to see for further evaluation and management of altered mental status.(HPI per PA)  Hospital Course: No notes on file patient is an 85yr old female with a history of HTN, T2DM, GERD, Depression, Dementia who presented with AMS. She apparently fell out of bed, was attempted to he helped by her significant other who apparently suffered a heart attack from which sadly he did not survive. She was also found to have a small stroke on admission.   Acute Encephalopathy - Improving clinically. This is in the setting of dementia. Neuro consulted, patient has Small left frontal Acute Ischemic Stroke, but this is likely not the cause of her profound altered mental status. More likely due to dementia and COVID. Delirium precautions - Blinds open during the day, closed at night, frequent reorientation, minimize nighttime interruptions, when possible avoid benzodiazepines   Stroke - MRI revealed small acute infarction involving the left frontal lobe. Neuro consulted - recommended to continue home dose of ASA but will not escalate to DAPT at this time. Continue supportive and symptomatic treatment, focus on risk factor management.   COVID - without pulmonary compromise. Elevated d-dimer but CTA negative for PE. Continue supportive management, she is off Oxygen. Discharge Exam: General - Elderly female, not in obvious distress. HEENT - NC AT. Heart - S1 S2 RRR. Lung - Moderate air entry. Ext - No LE edema. Neuro - AAO to person and place only. Motor - able to move all limbs. Discharged to SNF.