Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Sepsis, Spinal fusion surgery, Troponin increased, Ultrasound Doppler abnormal, Viral test negative
Clinical narrative: ED to Hosp-Admission Discharged  9/18/2021 - 10/1/2021 (13 days)  Last attending ? Treatment team Fever Presenting Problem/History of Present Illness/Reason for Admission Fever and chills  Low blood potassium Low magnesium level COVID-19 Sepsis     Hospital Course Patient is a 75 y.o. male admitted to hospital with complaint of lower extremity swelling and then worsening.  Patient recently had surgical intervention on his spine 9/10.  Patient admitted for further evaluation and concern for possible heart failure.  During hospitalization it was found that patient had concerning signs for Covid.  -Patient underwent stress test without any significant signs of reversible ischemia.  Echocardiogram was not performed secondary to patient being positive for Covid during hospitalization.  Recommend outpatient echo after resolution of Covid.  Follow-up with cardiology in the outpatient setting. -Patient had progressive worsening right-sided lower edema of which patient underwent ultrasound and showed signs of DVT.  Patient started on Eliquis.  Will need to be followed by primary care doctor in regard to duration of treatment.  Likely to need to complete at least 6 months with the therapy. -Patient had nausea and vomiting which seem to be related a.m.  After further questioning it was determined that patient was likely lactose intolerant.  Patient was switched to a dairy free diet.  Recommended continue monitoring by primary care provider.   #Fever  likely due to Covid pneumonia; now afebrile >48 hrs -CT chest consistent with a multifocal pneumonia  - ID initiated 9/24 pt on recommending remdesivir and convalescent plasma (completed) - completed IV ceftriaxone and vancomycin   Troponin elevation likely demand related   Right-sided lower extremity edema with extensive DVT noted -Continue Eliquis at this time. -We will need to follow-up with primary care provider in the outpatient setting for monitoring after being discharged on chronic anticoagulation. Consider dc in the outpatient setting after 6 months of AC.    Nausea and vomiting seems to be related to dairy products- resolved -Abdominal x-ray negative for any significant signs of ileus/obstruction. -Made patient free diet.  Spoke with nutrition services which they are recommending transition to Glucerna if patient even needs Ensure supplementation.   Chest pain- resolved- EKG NSR. Negative troponin. cxr does not show any acute abnormalities.   History of  Dm- continue ISS   S/p lumbar surgery L2-L4 fusion at OSS 9/10. -Seen by orthopedic spine team; no need to obtain MRI  no acute concerns  -Sutures removed. Seen patient with hypergranulation at proximal edge of incision line: silver nitrate stick X 1 applied. Recommendations: Cleanse Back wound with bath wipes and flush with 0.9NS. Apply Remedy antifungal powder with no-sting skin prep surrounding wound. Cover with Silvercel antimicrobial dressing. Secure with Gentle island dressing or adhesive foam dressing. Change every other day and PRN. Check placement every shift. f/u with orthopaedic as directed.     Grade 1 diastolic heart failure  -Recommend outpatient TTE after complete resolution of Covid.  Patient had a recent PET stress test which was negative. -We will increase the patient Lasix to 60 mg p.o. twice daily from home dose normally of 40 mg twice daily.              -We will need outpatient follow-up with primary care doctor in regard to obtaining a BMP to evaluate electrolytes in the outpatient setting.  ATTENDING ADDENDUM: I have personally seen and examined this patient along with the medical resident.  I agree with the discharge summary, physical examination and discharge follow up recommendations with the following exceptions/additions:  75-year-old male With past medical history of diabetes, obstructive sleep apnea, recent lumbar spine surgery with OSS who presented to Hospital with fever for further evaluation.  Patient was found to have COVID-19.  He was treated with improvement in symptoms.  Spinal evaluation was performed by orthopaedic but did not reveal any concern for postoperative infection.  Patient has deconditioning and will be sent to rehab for further PT/OT services.   Prior to discharge, he had developed worsening leg swelling and he has right-sided lower extremity DVT in the setting of COVID-19.  He has been started on anticoagulation with Eliquis which she will require for 6 months.  Physical examination: General: AAOx3. NAD. HEENT: Normal conjunctiva. PERLA. Neck: Supple, NT.  Cardiovascular: S1S2 RRR.  Pulmonary: CTA bilaterally. No rales rhonchi or wheezing. Normal expansion. Abdomen: Soft, nontender. Normal bowel sounds. Extremities: No cyanosis.  Integument: Warm. No petechiae