Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Dizziness, Electrocardiogram, Troponin I, Vertigo
Clinical narrative: History; Chief Complaint; Patient presents with dizziness. Referred from (see note) for dizziness x5 days. Denies CP, n/v, abd pain. Reports staying hydrated. Had first Pfizer Covid vaccine dose on 4/16. The history is provided by the patient and medical records. Dizziness; Quality:  Vertigo; Severity:  Mild; Onset quality:  Sudden; Duration:  6 days; Timing:  Intermittent; Progression:  Partially resolved; Chronicity:  New; Context: head movement and standing up; Context: not with loss of consciousness. Relieved by:  Being still. Worsened by:  Movement and standing up. Ineffective treatments:  None tried. Associated symptoms: no chest pain; No headaches; No nausea; No palpitations; No shortness of breath; No syncope; No vision changes and no vomiting. Past Medical History: Diagnosis. Date; History of PSVT (paroxysmal supraventricular tachycardia). Dx'd > 10 years ago. No interventions; Past Surgical History; No past surgical history on file. Review of Systems. Respiratory: Negative for shortness of breath.  Cardiovascular: Negative for chest pain, palpitations and syncope.  Gastrointestinal: Negative for nausea and vomiting. Neurological: Negative for headaches.  All other systems reviewed and are negative. Physical Exam ED Triage Vitals [04/25/21 0010]; BP: 111/73; Pulse: 67; Pulse from O2 sat: n/a; Resp: 16; Temp: (!) 96.9 °F (36.1 °C); Temp src: Temporal; SpO2: 96 % ; BP 101/65  | Pulse 68  | Temp 97.9 °F (36.6 °C) (Oral)  | Resp 16  | SpO2 98% ; Physical Exam; Vital signs and nursing note reviewed. Constitutional: Appearance: He is well-developed. HENT: Head: Normocephalic and atraumatic. Right Ear: External ear normal. Left Ear: External ear normal. Eyes: Conjunctiva/sclera: Conjunctivae normal. Neck: Musculoskeletal: Normal range of motion and neck supple. Cardiovascular: Rate and Rhythm: Normal rate. Pulses: Normal pulses. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Abdominal: General: Abdomen is flat. Musculoskeletal: Normal range of motion. Skin: General: Skin is warm and dry. Neurological:  Mental Status: He is alert and oriented to person, place, and time. Psychiatric: Behavior: Behavior normal. Procedures; ED COURSE. Reviewed previous: previous chart Interpreted by Provider: labs, ECG and pulse oximetry. Patient Reevaluation: Patient with intermittent symptoms of vertigo that for started 6 days ago.  Usually just when he turns over in the morning to get up.  Lately has had several times a day.  No recent URI.  No symptoms at rest.  No focal neuro deficits.  No history of any medical problems.  Referred from for evaluation.  Labs within normal limits. with nonspecific ST changes.  Machine read as pericarditis but no PR depression and minimal ST elevation in the inferior leads primarily.  No chest pain or shortness of breath.  Non exertional symptoms.  Troponin was negative.  Repeat unchanged.  Bedside echo reveals no evidence of pericardial effusion and normal aortic root diameter.  Patient states he feels normal now.  Will discharge with meclizine similar to ED therapy.  Instructed to follow up with his primary doctor this week. Patient progress: resolved. Clinical Impressions as of Apr 25 0326. Vertigo ED Disposition. Discharge.