Age: 96.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Coinfection, Computerised tomogram head normal, Costochondritis
Clinical narrative: Patient is a 97 y.o. female with history of atrial fibrillation, HTN presented to Hospital with respiratory failure with hypoxia secondary to COVID-19 infection.  Hospital course notable for transient aphasia likely secondary to weakness, IV dexamethasone administration.  CT head obtained nonacute    Acute respiratory failure with hypoxia DDx multifactorial: COVID PNA +/- coinfection bacterial PNA Normal HR and BP seems less likely d/t PE F/u procalcitonin negative, holding off on abx for now See plan for COVD On admission required BiPAP transitioned to NC, now weaned to RA   Covid-19 Virus Infection Date of onset of symptoms: 11/26/22 Symptoms present on admission: sob Date of covid positive test: 11/26/22 Vaccination status: vaccinated (states she's had her boosters) Imaging:   - CXR (12/4) multifocal PNA Labs:   - CRP: 56, procalcitonin negative Blood cultures negative after 5 days Oxygen requirements on admission: bipap Current oxygen requirements: now weaned to RA Medical therapy: completed remdesivir, continue steroids- on day 10?finished course during hospitalization Consultants following: infectious disease Isolation discontinued 12/07 Liquid Robitussin and PEP on discharge to help with cough   Acute encephalopathy Transient episodes of unresponsiveness Patient was noted to be suddenly unresponsive after IV dexamethasone administration 12/05 Patient was minimally responsive to sternal rub.  This however resolved quickly.  She returned to baseline in 15 to 20 minutes CT head obtained stat was nonacute Noted to have similar symptoms again  12/06 which resolved spontaneously. Did not coincide with iv medication administration today Consult Neurology.  Appreciate assistance Seizure a possibility, patient placed on continuous EEG monitoring.  No spells captured during monitoring MRI brain non acute Given lack of clear evidence for seizure AED not initiated Resolved   Atrial Fibrillation S/P PPM F/w other doctor ED EKG per my review: junctional rhythm Resuming home regimen: amiodarone 200 mg daily, coreg 12.5 mg BID, and eliquis Troponin mildly elevated but appears to be chronically elevated as well CP overnight 12/12. Troponin back to normal at 13 and 4 with negative delta. Doubt cardiac source, likely costochondritis. Lidocaine patch ordered Few episodes of heart rate in the 40s on point-of-care vital signs. EP consulted?device interrogation showed 6-year battery life remaining with stable lead parameters and RV paced 23% with RV paced 42% with 15% atrial tachycardia/atrial fibrillation burden over the past year with the last episode on 9/10/2022.  Programmed DDDR with LRL 60 bpm.  Normal device function. Telemetry reviewed.  No heart rates less than 60.  There were times when she had frequent PVCs which could cause a pseudobradycardia.  Recommendation to continue present medication regimen as well as continuation of anticoagulation and routine follow-up with cardiology and device clinic follow-up outpatient   Patient seen and examined with family member present at bedside.  Per patient her breathing has been doing okay.  Admits to some cough.  Is amenable to Robitussin liquid for cough and chest congestion.  Discussed recommendations of PPM plan to keep beta-blocker at current dose and amiodarone.  Encouraged PCP in hospital and on discharge.  Currently has transportation set up for 1130 today for transfer home.  PT did have improved AM PAC up to 18