Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Adenovirus test, Biopsy, Blood creatinine increased, Blood lactic acid normal, Blood pressure systolic decreased
Clinical narrative: ED  Discharged  10/8/2021 (4 hours)    COVID-19   Clinical impression  Fever  Chief complaint  Chief Complaint Patient presents with ? Fever         HPI & Medical Decision Making     HPI:   Patient is a 71 y.o. male presenting to the ED with fever and mild confusion.  Patient is really unable to report why he is here, is alert to himself and place.  Recently had a right foot biopsy on October 1 out of concern for osteomyelitis, biopsy negative, continued on amoxicillin clavulanate for 3 weeks as an outpatient in consultation with infectious disease and podiatry.  Conversation with wife over the phone notes that patient had been feeling fine night before presentation, awoke with a fever and confusion per daughter, who recommended EMS be called.       MDM: This is a 71-year-old male presenting with fever and confusion per family.  Hemodynamically stable on arrival on exam, transient dip to the mid 90s systolic that has stabilized with liter of crystalloid.  Undifferentiated 71-year-old with fever will work broadly up for sepsis, the wound on his right heel appears to be healing adequately with no signs of infection.  Confusion may also be seen by electrolyte abnormalities, which will be assessed for on his sepsis work-up.   Work-up broadly negative for changes from baseline, with a stable hemoglobin of 10.9, stable creatinine of 1.27, and a bland urinalysis with a normal lactate.  He is COVID-19 positive, which likely explains his temperature.  Spoke with daughter, who notes patient was having some issues with short-term memory and following commands this morning, which were not present on exam or during my interview.   Patient passed his pulse oximetry ambulation test, staying above 95%.  Given that he is COVID-19 positive without hypoxia, will plan on sending patient home with reminder to self isolate and to follow-up with his primary care physician, which patient and his wife who is in the room is amenable to.  Findings of the emergency department visit outlined to patient and wife, who expressed understanding, as well as expressing understanding of the return precautions and follow-up instructions.  Patient left in good condition with wife.  ED to Hosp-Admission  to Current 10/11/2021 - present (3 days) COVID-19  Principal problem  Assessment and plan:   71-year-old male with pneumonia secondary to COVID-19 despite vaccination x2, patient with multiple medical problems including untreated OSA, history of A. fib on chronic warfarin, subtherapeutic INR, severe disability with ambulatory dysfunction, DM2 w hyperglycemia on chronic insulin--   Plan is admission for O2, remdesivir and decadron Insulin long and short acting and ISS  lovenox and coumadin since subtherapeutic (and high risk for PE) (once therapeutic on coumadin,stop lovenox)     dispo--PT/OT and likely SNF (severe tremor and slow to move)-almost parkinsonian features   Cont augmentin for infection on R heel   DNR (discussed w pt and daughter)     Chief complaint: Cough and shortness of breath   HPI: This is a 71-year-old male who had 2 vaccines for Covid months ago was hospitalized recently for right foot infection (osteomyelitis neg per biopsy)- discharged on a 3 wk course of augmentin (end date 10/25) -came back to the hospital 4 days after his discharge with cough and fever tested positive for Covid was discharged home because of normal oxygen saturation comes back in today because he has continued cough chills shortness of breath and his oxygen saturation was 84% on room air currently stable on 5 L of oxygen.