Age: 74.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Fibrin D dimer increased, Infection, Malaise, Nephrolithiasis, Pyelonephritis
Clinical narrative: Hospitalized 11/6/2021; COVID-19 positive 11/6/2021; fully vaccinated  Discharge Summary                                                   Discharge Information:   Procedures to be scheduled by PCP: None Results/Procedures requiring PCP followup: None Admission Date: 11/6/2021 Discharge Date: 11/09/2021 Admitting Diagnoses: COVID-19 Details of Hospital Stay PRESENTING PROBLEM:  Acute respiratory disease due to COVID-19 virus  COVID-19 [U07.1] HOSPITAL COURSE: a 75 y.o. female  who presents to hospital with cough and dyspnea with a positive COVID-19 test..  Patient was sent in from her home after concerns of increasing cough ?raspy? and exposure to COVID-19.  Patient was exposed on 11/1 started having symptoms on 11/02 and tested positive on 11/04.  She was given monoclonal antibodies on 11/01 after positive test. She was admitted and started on dexamethasone.  She did not receive remdesivir.  Her oxygen was weaned to her baseline requirements and she was watched for an additional day to ensure stability.  She did have a positive MRSA screen and received a single dose of vancomycin, but after discussion with ID it was felt that this did not represent acute infection and antibiotics were discontinued.  She was at her baseline mental status and doing well so she was discharged back to her AFC home with outpatient follow up.  She will self isolate through 11/12.  Readmission today 11/16/2021 note: CHIEF COMPLAINT: COUGH Assessment/Plan  DIAGNOSIS at time of disposition: 1. Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present  2. Pyelonephritis  3. Nephrolithiasis  MEDICAL DECISION MAKING: Patient brought in by ambulance with complaints of low pulse ox at home, patient is nonverbal at baseline which limits the history.  On exam she appears to be chronically ill but is in no acute distress.  She is tachycardic, maintaining her pulse ox on 2 L baseline nasal cannula.  Blood pressure remained stable.  She is afebrile here. Patient's workup is remarkable for a significantly elevated white blood cell count, urinalysis grossly positive for infection.  Patient does also have an elevated D-dimer, and in the setting of her recent COVID-19 diagnosis and immobility she was scan to rule out PE.  I did follow through the remainder of her abdomen pelvis due to meeting septic criteria with a white count and tachycardia, this shows findings concerning for pyelonephritis as well as a stone.    Patient was fluid resuscitated with 2 L which is greater than 30 mL/kilogram.  Her lactic acid is normal.  She was started on Rocephin for antibiotic coverage, but did add zosyn with findings of infected stone and pyelonephritis.  On multiple re-evaluations she continued to maintain her pulse ox, continued to be in no acute distress.  I discussed by phone with Urology who is recommending transfer downtown for Urology to be available for care.  I talked to the hospitalist by phone who accepts her for transfer.  Patient's guardian is in agreement with the plan, she was transferred in stabilized condition.