Sex: M
Vaccine: UNK
Symptoms: Cough, Culture, Hypotension, Incisional drainage, Leukocytosis
Clinical narrative: Date of Admission: 9/23/2023   Date of Discharge: 10/2/2023   Issues to be Addressed at Follow-up: Econsult to Urology follow up post op scrotal abscess & voiding trials for foley catheter. Discussed with patient that he should have outpatient follow-up and testing to rule out a hyperfunctioning adenoma. Discussed with patient that he will need outpatient monitoring of his abdominal aortic aneurysm.   Pending Study Results at Discharge:  Unresulted Lab Orders    No orders found from 9/2/2023 to 10/3/2023.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION       Presented with mild leukocytosis and hypotension treated with saline lactate now normal   ? CAD WO ANGINA, PRESENCE OF STENT       Cardiac cath 7/31/14 in SFO by Dr. 1) severe disease in the major Obtuse Marginal branch of the LCx; the other vessels have no significant disease  2) successful ad hoc PCI to the LCx/OM with a single DES  3) Plavix until 7/31/2015   6/11 MPS: IMPRESSION 1. Normal appearing SPECT myocardial perfusion scan with the patient achieving a max HR of 118 bpm representing 68% of his max predicted HR.  2. There was normal left ventricular wall thickening and contractility with a resting LVEF estimated to be about 74%.  11/15/2010 CCL Left dominant coronary system with mild plaquing throughout Normal left ventricular systolic function   ? HTN (HYPERTENSION)   ? CKD STAGE 3B (GFR 30-44)   ? OBSTRUCTIVE SLEEP APNEA       6/13- Estimated Body mass index is 40.89 kg/(m^2) as calculated from the following:  Height as of 6/19/13: 5' 7"(1.702 m).  Weight as of 6/19/13: 261 lb 0.9 oz(118.414 kg).  - Severe obstructive SLEEP APNEA with an AHI of 6.5 (normal <5)  - A therapeutic intervention (i.e. nasal CPAP) is suggested  - Treatment will be initiated by Respiratory Care Services  - The severity of the current study would justify starting therapy without delay  - A 20% reduction in body weight is recommended  MD 6/21/2013 4:55 PM AHI 36.2 study 4/18/08 SpO2 <90% for 240.8 minutes Doesn't wear mask   ? DM 2 W DYSLIPIDEMIA   ? ADRENAL INCIDENTALOMA   ? ABDOMINAL AORTIC ANEURYSM, UNSPECIFIED PART       4.5 cm on CT scan 9/24/2023   ? HYPONATREMIA   ? NONTRAUMATIC ACUTE KIDNEY INJURY   ? SCROTAL ABSCESS   ? COVID-19 DISEASE   ? ATRIAL FIBRILLATION, PAROXYSMAL   ? TOBACCO SMOKER     Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  SNF   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: Per Dr. 9/25: "The patient is 58 years old, is not a facility ember, and has a PMH significant for former tobacco user, hypertension, type 2 diabetes, coronary disease with history of stent, ischemic cardiomyopathy (echocardiogram 2019 with LVEF 40-45%/mild biatrial dilatation/mild AI/mild TR/moderate MR/mild cLVH/mild pulmonary hypertension), paroxysmal atrial fibrillation on apixaban, chronic kidney disease stage IIIb (unclear baseline creatinine-was 1.5 in February), hyperlipidemia, obstructive sleep apnea on CPAP, COPD, anemia, anxiety, rectal bleeding, obesity, proteinuria, back surgery, rotator cuff surgery, and I&D of groin abscess who was admitted to the hospital on 9/23/2023 with a scrotal abscess, severe sepsis, was also diagnosed with COVID-19 and acute kidney injury.  The patient had developed a pimple or abscess on scrotum he tried to squeeze.  There was no drainage but then the scrotum had become increasingly painful, red, and swollen.  The patient presented emergency department was seen by urology.   A contrast-enhanced CT scan of the abdomen & pelvis was performed that showed the scrotal abscess, a 1.6 cm right adrenal nodule, a 4.5 cm abdominal aortic aneurysm, and some enlarged lymph nodes.  Blood cultures were sent.  The patient was treated with broad-spectrum antibiotics (Zosyn and IV vancomycin).  The patient was volume resuscitated with LR.  The patient's apixaban and clopidogrel were held.  The patient was taken to the OR on 9/23 and approximately 100 cc of pus was evacuated.  Cultures were sent from the OR.   The patient states that he lives with his grandson.  He and his grandson had had a "cold" last week and have gotten over it.  He thinks that, in retrospect, the "cold" he experienced may have been due to COVID.  However, the patient tested negative for COVID at that time.  The patient reports that he only has a "very light" cough at this point.  The patient is unsure if he ever had COVID and was never vaccinated as his cardiologist did not recommend it due to "fluid around my heart".  We discussed the risks/benefits/alternatives of treatment with remdesivir and it was decided not to treat with remdesivir.  The patient's last day of inpatient isolation is October 3.   Discussed the abdominal aortic aneurysm that patient should have follow-up monitoring.  The patient understood and will follow up with his usual doctors.   The patient stated that he had been scheduled to have a Watchman device placed this coming week to hopefully allow him to come off of anticoagulation.   Discussed the adrenal adenoma and that the patient should have testing performed once he is back to his baseline health to rule out a hyperfunctioning nodule.  The patient understood and will follow up with his usual doctors."   Primary Procedures:  Procedure(s): SCROTUM INCISION AND DRAINAGE   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):  Scrotal Abcess Urinary retention    Complications: none   Consults:  UROLOGY - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Full Code       Note Details  Author (M.D.) File Time 10/2/2023 12:28 AM Author Type Physician Status Signed Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct  Admit Date 9/23/2023  ED to Hosp-Admission (Discharged) on 9/23/2023  ED to Hosp-Admission (Discharged) on 9/23/2023   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders Procedures   Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Linked Episodes  SCROTUM INCISION AND DRA From 9/23/2023 to 9/25/2023  Hospital Problem List   ATRIAL FIBRILLATION, PAROXYSMAL  ADRENAL INCIDENTALOMA  ABDOMINAL AORTIC ANEURYSM, UNSPECIFIED PART  TOBACCO SMOKER  SCROTAL ABSCESS  NONTRAUMATIC ACUTE KIDNEY INJURY  COVID-19 DISEASE  HYPONATREMIA  CAD WO ANGINA, PRESENCE OF STENT  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION  HTN (HYPERTENSION)  OBSTRUCTIVE SLEEP APNEA  CKD STAGE 3B (GFR 30-44)  DM 2 W DYSLIPIDEMIA Care Timeline  09/23   Admitted from ED 1817    SCROTUM INCISION AND DRAINAGE 10/02   Discharged 1346  Discharge   SNF - Skilled bed (or Subacute)   SNF Orders (Printed 10/2/2023) Medication List at Discharge   amlodipine besylate 5 mg Take 2 tablets by mouth daily  Patient taking differently:  Take 1 tablet by mouth daily  amoxicillin/potassium clav 875-125 mg 1 tablet Oral 2 TIMES A DAY  apixaban 5 mg Oral 2 TIMES A DAY  atorvastatin calcium 80 mg Oral DAILY  carvedilol 25 mg Oral 2 TIMES A DAY  clopidogrel bisulfate 75 mg Oral DAILY  dulaglutide 4.5 mg Subcutaneous EVERY 7 DAYS  empagliflozin 10 mg Oral EVERY MORNING  finerenone 10 mg Oral DAILY  furosemide 20 mg Oral EVERY OTHER DAY  hydrocodone/acetaminophen 5-325 mg 1 tablet Oral EVERY 4 HOURS AS NEEDED  insulin glargine-yfgn 16 Units Subcutaneous EVERY BEDTIME  isosorbide mononitrate 60 mg Oral DAILY  L. acidophilus/L.bulgaricus 100 million cell 1 Packet Oral 3 TIMES A DAY WITH MEALS  nitroglycerin 0.4 mg Sublingual EVERY 5 MINUTES AS NEEDED  phenyleph/mineral oil/petrolat 0.25-14-74.9 % 1 Ampule Rectal EVERY MORNING AND EVENING  potassium chloride 10 mEq 10 mEq Oral DAILY  sennosides 17.2 mg Oral 2 TIMES A DAY  simethicone 80 mg Oral EVERY 6 HOURS AS NEEDED  tamsulosin HCl 0.8 mg Oral DAILY pt is not vaccinated