Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Blood alkaline phosphatase increased, Blood creatinine, Blood folate normal, Bordetella test negative, Bundle branch block left
Clinical narrative: ED to Hosp-Admission Discharged   10/29/2021 - 11/3/2021 (5 days)  Hospital Course     COVID 19 Pneumonia Acute respiratory insufficiency (resolved) o Prior to discharge patient satting mid 90s on room air  -- > Home O2 evaluation completed 11/3: Patient did not qualify for oxygen at home o Discharged on oral dexamethasone 6 mg daily x5 days (last dose 11/8) o S/p IV remdesivir x5 days--last dose 11/3 o Continue OPEP, incentive spirometry, mucinex, encourage proning at home   Iron deficiency anemia o Normal B12 and folate o S/p IV venofer x 3 doses -- > oral iron supplement at home o Heme occult negative o Patient without any active bleeding prior to discharge and hemoglobin 11.6 at baseline   Acute on chronic congestive heart failure Elevated troponin -likely demand ischemia in setting of above o Cardiology consultation --recommended increasing home oral lasix to 40 mg twice daily at discharge o EKG 10/30: Sinus rhythm with chronic LBBB, QTC 470 o Low-salt diet at home o Plan for follow up on 11/22/21 @1030 AM at the heart failure clinic   Chronic kidney disease stage III, baseline 1.6 to 1.8  o Currently at baseline creatinine prior to discharge and patient voiding without difficulty o Liver ultrasound demonstrated mild increased echotexture and cortical thinning of right kidney may suggest chronic renal parenchymal disease.   Elevated alk phos (improved) o Likely due to Covid infection o GGT elevated o Liver ultrasound -- evidence of gallstones but no acute cholecystitis. No intra or extrahepatic bile duct dilatation  o Please check LFTs outpatient within 1 week o Avoid hepatotoxic agents   Diabetes Mellitus Type 2, A1c 6.6 o Diet controlled at home   Paroxsymal atrial fibrillation on xarelto  o Rate controlled with carvedilol,  given heart rates in the 50s and Covid infection will reduce home Coreg to 3.125 mg twice daily   Ambulatory dysfunction -PT/OT recommend home with PT/OT -- > Home health has been ordered and case manager has been notified   Stage 2 pressure injury left buttock, POA -Wound care consulted: Frequent repositioning use of waffle seat cushion when out of bed to provide offloading and pressure redistribution  -Needs further monitoring by PCP outpatient   Updated patient's daughter-in-law via phone 11/3, she agreed with above plan. ED Current   11/4/2021 - present Hospital ED    Last attending ? Treatment team Syncope, unspecified syncope type    AKI (acute kidney injury) (CMS/HCC)  Dehydration  Hypoxia  Syncope, unspecified syncope type  COVID-19    Clinical impression Syncope    The patient is a 85 y.o. yo female presenting to the ED with syncope.  Patient states that she felt lightheaded on the way to the bathroom and then woke up on the floor.  Her daughter states that when she got home tonight, she was able to eat.  She said she was more weak and off-balance than she has been and they did not feel it was safe for her to go up and down the stairs on her own.  They had heard her fall in the bathroom and went to see her.  They said initially she was not responding to them.  Patient said that she did have some lower abdominal cramping, but that has since resolved.  No chest pain.  Has had some dyspnea, but daughter states that it was not significantly worse, but patient states that it seemed worse tonight.  Patient also complaining of left elbow pain since the fall.  Tetanus is up-to-date.  She does have a skin abrasion.  She does not know if she hit her head.