Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Hypertensive encephalopathy, Impulsive behaviour, Ingrowing nail, Intensive care, Loss of consciousness
Clinical narrative: HOSPITAL COURSE: Malnutrition : Does not meet malnutrition criteria (two required)     Wound Simple Abrasion Anterior;Right Toe (Active) First Observed/Origin Date/First Observed/Origin Time: 02/03/22 0000   Wound Type: Abrasion  Orientation: Anterior;Right  Location: Toe  Wound Observance : Prior to Admission       Patient is a 64 y.o. male with a past medical history of hypertension, hyperlipidemia, non-insulin-dependent type 2 diabetes mellitus, history of throat cancer status post radiation was brought to the ED by EMS on 2/2/2022 for unresponsiveness.  Patient had complained of a severe headache the night prior. Headache returned on the day of presentation.  His wife noticed that he exhibited some seizure-like activity so she called EMS.   Patient was intubated on arrival, initial blood pressure 169/90, WBC was elevated at 18.5.  D-dimer was mildly elevated.  CT head did not show any acute findings. MRI was concerning for PRES. he was admitted to the ICU under the intensivist service.  Neurology was consulted.  Patient extubated on 2/04.  He had some atrial fibrillation RVR post extubation.   Patient's blood pressure medications were adjusted. He was started on Keppra.  His blood pressure stabilized and his mental status gradually improved.  He remains impulsive with physical therapy and TCU versus home with 24/7 supervision recommended.  Patient and his wife would prefer to go home with 24/7 supervision and home care PT.   On the day of discharge, patient reported feeling well.  He is anxious to go home today.  He denies chest pain, cough, shortness of breath.  We reviewed his discharge instructions.  I offered to call his wife but he declined     Acute respiratory failure 2/2 to acute LOC HX of COPD, not on home oxygen - extubated on 2/4/22 - started Breo, incruse while in the ICU. He is being discharged on Breo and Spiriva  -F/u with PCP and pulmonary outpatient   Hypertension Hyperlipidemia Afib/Atrial flutter -Patient had atrial fibrillation with RVR post extubation -Overnight on 02/06-02/07, he went into atrial flutter.  His wife notes that he has a history of atrial fibrillation but is not on a blood thinner. -CHA2DS2-VASc score 2 (Hypertension, Diabetes).  Discussed with patient and wife and they were agreeable to anticoagulation but did not want Coumadin. -Testing carried out for Eliquis which is $47 a month.  Discussed with patient and he states that he can afford the copay  -Aspirin discontinued to decrease risk of bleeding  -During this hospital stay, he was started on lisinopril 5mg daily and amlodipine 5mg BID  -PTA Toprol-XL was increased from 50 mg to 100 mg daily    Hypertensive encephalopathy Seizure Impaired cognition-improving  -MRI brain was consistent with PRES -Neurology recommends continuing Keppra 750 mg BID  -No driving for 3 months per state law -We will follow up with neurology outpatient - SLUMS 12/30, no cognitive issues at baseline, cognition appears to be improving   Noninsulin dependent DM2   Ingrown toenail - evaluated by podiatry, need to follow up as outpatient, continue to apply bacitracin   History of Anxiety   History of squamous cell carcinoma of the vocal cord s/p radiation