Age: 80.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Altered state of consciousness, Angiogram cerebral normal, COVID-19, COVID-19 pneumonia
Clinical narrative: COVID+ 1/20/23.  Vaccination status - pfizer x4 + Pfizer BIVALENT booster x1 Discharge Summary 1/23/2023  4:52 PM    Attestation signed at 1/23/2023  4:52 PM (Updated)   ATTESTATION: Patient personally seen and interviewed on the date of discharge. Case was discussed in detail with the author of this document. I repeated pertinent portions of the examination and reviewed the relevant imaging and laboratory data. Agree with documentation below with the following additions or corrections:   COVID-19 pneumonia. Improving. On room air. Finished 3 days of remdesivir, complete decadron. 34 minutes for this discharge.    Meets sepsis criteria on admission, fever, tachycardia.      BRIEF OVERVIEW: Discharge Provider: Primary Care Provider: Admission Date: 1/20/2023 Discharge Date: 1/23/2023    Active Hospital Problems   Diagnosis Date Noted POA ? Dysphagia 01/23/2023 Yes ? Pneumonia due to COVID-19 virus 01/21/2023 Yes ? History of seizures     ?  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Transient alteration of awareness Seizure Transient speech disturbance   HOSPITAL COURSE: Patient is a 80 y.o. male with past medical history of seizure on carbamazepine, eosinophilic esophagitis, BPH who presented for altered mental status with concern for stroke versus seizure. Patient's wife reported increasing confusion and EMS found R side weakness and L eye visual field deficits. Neurology was consulted given neurological history and potential stroke etiology. Outside of window for thrombolytics.    Acute CVA workup unrevealing, including negative brain MRI, CTA, and CT. EEG also negative for seizures. Neurology was consulted and, based off MRI and EEG findings, assessed toxic encephalopathy 2/2 COVID as most likely cause. Given the unilateral weakness and confusion upon arrival has gradually improved and since resolved, the time course of recovery also consistent with this etiology. Family was seen at bedside prior to discharge and confirmed patient back to baseline mentation and ambulation. PT/OT initially recommending SNF but, at final assessment on day of discharge, recommended home with no services.   Patient was also treated for acute hypoxic respiratory failure secondary to an acute COVID-19 infection initially requiring 4L oxygen. He was given 3 days of remdesivir, decadron. He was able to be weaned to room air at rest and while ambulating. Patient to be discharged with decadron taper. Two nights prior to discharge, a 10 second run of V Tach was observed on telemetry, which resolved without intervention. Subsequent echo showed somewhat asymmetric septal hypertrophy but normal EF of 63% and no significant valvular abnormalities. Recommended outpatient cardiology f/u for further investigation into potential arrhythmia, communicated this to patient prior to d/c. CONSULTS / RECOMMENDATION: Inpatient consult to neurology - stroke workup negative for acute process, EEG and MRI consistent with covid encephalopathy Inpatient PT/OT/SLP - cleared for discharge home without assistance Outpatient cardiology - recommended outpatient followup on potential arrythmia