Age: 89.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Urinary sediment, Urinary sediment present, Urine analysis, Urine ketone body absent, Urine leukocyte esterase
Clinical narrative: 2/8/22 90-year-old male brought in by EMS after his wife found him on the ground next to his bed.  She states for the past several weeks he has been having cough productive of mucus.  She states that initially discussed with his physician and he was given Mucinex which helped briefly however the cough then returned.  He is not typically on supplemental oxygen.  Was seen again yesterday and apparently had a negative Covid swab and was given an oral penicillin which she has been taking.  He went to bed this evening and then his wife states around midnight he heard him "moaning and groaning in the bedroom" and she found him on the ground next to the bed.  The patient is notably an extremely poor historian due to severe The patient is notably an extremely poor historian due to severe hearing loss but denies pain anywhere.  It is unclear whether he struck his head.  They state he has not had any nausea/vomiting or diarrhea.  No report of abdominal pain.  The did not know he had a fever.  They do report some worsening fatigue, decreased p.o. intake with approximate 8 pound weight loss. REVIEW OF SYSTEMS      Review of Systems  Constitutional: Positive for fatigue and unexpected weight change.  Respiratory: Positive for cough.   Gastrointestinal: Negative for diarrhea and vomiting.  Musculoskeletal: Negative for neck pain.  Psychiatric/Behavioral: Positive for confusion.  All other systems reviewed and are negative.        CT Chest, Abdomen, & Pelvis Wo IV Con Without Oral Contrast: IMPRESSION: Findings compatible with pneumonia, IMPRESSION: No acute process detected in abdomen or pelvis  Hospital Course:  Patient is a 90 yr/o male with history of hypertension, dyslipidemia, other medical problems who presented to the emergency room because of altered mental status, fall and fever.  Was uncertain whether the patient hit his head.  He apparently had been sick with respiratory symptoms few weeks prior to this event and was seen by primary medical doctor the day prior to presentation and was prescribed oral penicillin.  Patient will try to emergency room because of worsening symptoms.  Evaluation in the emergency room showed BUN of 27 creatinine 1.95, COVID-19 was positive and CT angiogram of the chest showed new consolidative pulmonary infiltrate with predominant involvement of the right lower lobe and a small additional region of consolidation in the right upper lobe consistent with pneumonia.  Other findings as reported below.  CT of the head was unremarkable.  Patient was admitted to intensive care unit on aggressive pulmonary toilet, bronchodilators, systemic corticosteroids, remdesivir, antibiotics.  Patient also required IV hydration.  Patient also remarkable improvement and is currently saturating at 98% on room air.  Renal function has improved with a BUN of 22 and creatinine of 1.14.  COVID-19 inflammatory markers, specifically fighting and procalcitonin remain elevated.    Discharge plan: Patient will follow up with primary medical doctor   2/17/22 F/u with PCP: Here with wife for hospital follow-up Admitted to  hospital from February 8February 12, 2022 for pneumonia, hypotension and sepsis due to COVID-19.  Presented to ER with altered mental status, fever and a fall at home. Admitted to the ICU. EMR review showed BUN 27, creatinine 1.95 CT angiogram chest showed new consolidative pulmonary infiltrate with predominant involvement of the right lower lobe and right upper lobe consistent with pneumonia. CTA head was negative. CT abdomen pelvis showed 2 prominent cysts on mid and lower pole of right kidney.             Of note, there is mention of a 6 mm poorly defined soft tissue nodule in the right lower lobe that was measured at 4 mm on a CT chest 20 months prior. Nodule appeared larger on most recent scan. Repeat CT Chest recommended-   Patient reports feeling better but still fatigued/weak at times. No shortness of breath, chest pain, fever, chills. Wife reports patient has gotten his appetite back.  He was not eating in the hospital, but now she reports he has been eating double portions of meals over the past couple days.  Patient has been able to walk around the house, even walking up and down the stairs. Patient denies syncope, dizziness or any falls.  Reports he does not feel like he is going to fall but has some orthostatic hypotension when he gets up after sitting for a while. Discussed with wife to hold 1 dose of his carvedilol until his hypotension and fatigue are better. Will see them back in the office in 1 week. Has upcoming follow-up appt with nephrology