Age: 80.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Memory impairment, PO2 decreased, SARS-CoV-2 test positive, Syncope, Urinary incontinence
Clinical narrative: 81-year-old male who presents to the emergency room mainly for excessive weakness.  He reports that he has had difficulty with weakness and ambulating for the past couple of days.  He has had a couple of episodes where he has tried to make it to the bathroom but has been unable to do so until he urinated in the floor.  Today he was on the toilet using the bathroom and could not get up due to weakness and actually slid himself in to the floor.  There was no loss of consciousness.  There was no actual fall.  Patient states that he has chronic back pain and receives an injection in his back every 3 months from Dr. (Privacy), a local chronic pain specialist, and is due for this 1 week from today.  Patient states that he always gets weak like this just prior to needing his injection in his back.   The patient was diagnosed with COVID on 01/25/2021, it appears from his medication list he was started on a Medrol Dosepak and azithromycin at that time.  The patient really does not complain of any shortness of breath.  He states that he takes a pulse ox reading nightly at home.  He is not on home oxygen.  He denies any chest pain or fever.  In the emergency room the patient is borderline hypoxic with pulse ox readings in the low 90% range.  On blood gas the patient has a PO2 of 58.  He has been started on oxygen by the emergency room physician.  The patient has been fully vaccinated.  I think he has had a booster.  The patient has a significant short-term memory deficit and is unsure about this.   Patient has a past history of coronary artery disease, peripheral artery disease, and paroxysmal atrial fibrillation.  He is not on full anticoagulation now due to multiple nose bleeds in the past.  He is on Plavix.  He does not think he is on aspirin although this is on his medication list.  The patient's cardiologist is Dr. (Privacy).  He has a history of chronic kidney disease and is followed by Dr. (Privacy).  He also has a history of hypertension, hyperlipidemia, BPH, and hypothyroidism.  He denies tobacco use.  He denies alcohol use.   DISCHARGE: The patient is an 81 yo M with history of CAD/PAD on DAPT, pA-fib (not on AC due to heavy nosebleeds in past), HTN, CKD, hypothyroidism, chronic back pain with regular steroid injections who presented from home for generalized weakness and collapse without syncope in setting of mild COVID infection.  He is fully vaccinated and boosted.  Tested positive for COVID on 1/25/2022 and was prescribed azithromycin and methylprednisone dose pack by PCP which he had taken for 6 days prior to admission.  Mildly hypoxic on admission requiring 3L NC without major findings on CXR.  Treated with dexamethasone for 3 additional days while here and hypoxia resolved.  Did not meet criteria for home O2.  Did not received IL-6 inhibitor or remdesivir.  Evaluated by PT who recommended home health.  HCTZ and ARB held here due to mild hyponatremia and minor AKI, which improved and ARB resumed.  Discussed medications at discharge with his wife and recommended holding HCTZ until PCP follow-up.  He's holding plavix for 7 days for anticipated routine lumbar steroid injection next week.  Discharged in improved condition with family, home health PT, and PCP follow-up.