Age: 88.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Mobility decreased, Oxygen saturation decreased, Pain, Pain in extremity, Pancytopenia
Clinical narrative: Hospitalized (9.24.21);  COVID-19 positive (9.24.21);  fully vaccinated  Diagnosis ? Closed intertrochanteric fracture of hip, right, initial encounter ? Closed fracture of intertrochanteric section of femur, right, initial encounter  HISTORY OF PRESENT ILLNESS Patient is a 89 y.o. male with past medical history significant for ESRD on dialysis MWF, HTN, prostate cancer who presented to the ED after sustaining mechanical fall.  The patient, he lost his footing going down a step in his kitchen.  Notes that he landed on his right side and felt immediate pain.  Patient was not able to get up after the fall.  Patient denies any loss of consciousness and states he did not hit his head.  Patient is not currently on any anticoagulation.  Scratch that he is currently having right hip pain which radiates into his groin and down his leg.  Denies any new numbness or tingling.  Patient denies any lightheadedness or dizziness prior to the fall.  States that he has been in his normal health prior to the incident.  Denies any recent fevers, chills, lightheadedness, dizziness, nasal congestion, sore throat, chest pain, shortness of breath, abdominal pain, nausea/vomiting, constipation/diarrhea, urinary symptoms, edema, changes in appetite.  Patient states that he does have a cough but notes that it is chronic and is currently at his baseline.  Denies any recent increase in his cough or sputum production.  The patient notes he has dialysis Monday, Wednesday, Friday.  He states that he was not able to get his running today but does note that he had a small run yesterday afternoon after getting his dialysis access site ?cleaned out" up North.  Patient notes that he is fully vaccinated but is unable to recall which vaccine he received.  States he got it up North in a city where his sister is a nurse.  Patient is unsure if he had any sick contacts recently but notes he is frequently around people as he works as a professional clown.  He notes that he does not require any assistance with ambulation.  States he has had able to get up and down a flight of stairs but will have to go very slowly. Notes that he will occasionally have to stop to catch his breath if he ambulates long distances.  Patient denies any prior diagnoses of heart failure, coronary artery disease, valvular disorders, chronic obstructive pulmonary disease or asthma.  Patient is a nonsmoker.  He also denies any history of complications with anesthesia with his prior surgeries. Emergency department, patient's vital signs were stable.  Baseline blood work was obtained showing minor pancytopenia with WBC 3.14, hemoglobin 11.2 (baseline), platelet 121, mildly elevated potassium at 5.1, creatinine 7.6, INR 1.0, normal CK.  EKG was obtained showing sinus rhythm with first-degree AV block and left anterior fascicular block.  X-ray of right femur was obtained showed markedly comminuted, foreshortened displaced fracture of the intertrochanteric femur with extension of fracture line and femoral neck.  X-ray pelvis again demonstrating her right hip fracture, otherwise negative for acute pathology.  CXR was obtained showing patchy gastric light right upper and left lower airspace opacities, possibly reflecting atelectasis and/or infiltrate.  The patient was given a dose of morphine for pain control and had episode of desaturation 10-15 minutes later.  He was placed on 2 L nasal cannula and was able to be weaned back to room air.  Patient was given a 1 L NS bolus for soft blood pressure.  He was then admitted to general medicine for further evaluation and management Patient moderate risk for surgery with incidental finding of COVID. No further tested or work-up needed prior to OR. Covid positive, chronic cough Transient episode of hypoxia - patient admits to cough but notes its chronic and at baseline. Denies any fevers, chills, rhinorrhea, sore throat, CP, SOB, N/V, diarrhea. - had documented desaturation in ED but question if 2/2 narcotics vs COVID as desaturation occurred about 10-15 minutes after morphine administration. Did have nursing trial off O2 and has been stable on RA. - found to be COVID positive on routine pre-op testing - states he was vaccinated up in a city but unsure which one he got  - CXR showing patchy and streak-like right upper and left lower airspace opacities, possibly reflecting atelectasis and/or infiltrate - will continue to monitor off oxygen               - if becomes hypoxic will start on dexamethasone  - monitor on pulse ox Patient still admitted currently