Age: 83.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood thyroid stimulating hormone, Blood urea nitrogen/creatinine ratio, Blood urea normal, Carbon dioxide normal, Cardiomegaly
Clinical narrative: RN's ED note- Per EMS Timeout:Pt brought to E.D. for c/o shortness of breath, was seen here 3 days ago , pt lives alone, EMS was called by daughter. Iv # 20 Ga to LAC with blood drawn via EMS.  Dr. ED note- Chief Complaint:  Shortness of Breath HISTORY OF PRESENT ILLNESS The patient is a 83 y.o. male who presents to the Emergency Department complaining of shortness of breath. The patient arrives to the ED via ambulance. The patient states that he was last here in the ED on 12/11/21 for the same condition of shortness of breath. The patient states that he has had this condition for "a long time", and states that he came in here today under persuasion of his daughter. The patient is currently using an inhaler called stiolto (2.5/2.5 micrograms) for his respiratory symptoms, but he has felt no alleviation. The patient states that he has also had difficulty speaking as well for the last 2 days, which he states has never occurred before. The patient states that he is able to ambulate slowly, and he states that he is still able to drive a vehicle. The patient denies any physical pain, fever, diaphoresis, coughing, and bilateral lower edema. The patient has seen a cardiologist for the shortness of breath symptoms, and they suggested that the patient have a sleep apnea test performed. The patient last saw the cardiologist in 2018. The patient has a past medical history of COPD, hypothyroidism, aneurysm, hypertension, lung cancer, and CAD among other conditions. The patient has a past cardiac surgery of an aortic aneurysm endovascular stent and a coronary artery bypass graft. The patient has a dual chamber pacemaker for atrial fibrillation as well. The patient is currently taking the blood thinner Eliquis.    APRN H&P note- PCP: MD COVID status Has the patient ever had a COVID infection? no Has the patient had a COVID vaccination? YES; Moderna x 3 doses Chief Complaint:  Slurred speech, short of breath Admission diagnosis: Acute CVA (cerebrovascular accident) (CMS HCC) HPI: The patient is a 83 y.o., male who presents with shortness of breath (chronic) and difficulty speaking. He reports the breathing is under control but he and family were more concerned about his speech difficulty, which reportedly began sometime yesterday, 12/12. Work-up in the ED reveals lab work that is largely reassuring, however, a CTA of head and neck reveals subacute infarct within the lenticular striate distribution involving the right putamen extending towards the right periventricular white matter. He will be admitted for further evaluation of CVA.   Dr. note- Chief Complaint:  Slurred speech and shortness of breath History of Present Illness:  History was obtained from a review of the electronic record and discussion with the patient and family. The patient is a 83 y.o. male with recent history of right MCA territory stroke who presented to the hospital on 12/13/2021 with having shortness of breath and slurred speech.  The patient says that he knew what he wanted to say but he had trouble getting the words out.  The patient cannot get MRI due to having a pacemaker.  He did have a CTA head and neck which showed the subacute previously noted stroke and areas of stenosis as mentioned below.  The patient was admitted and neurology evaluated the patient at bedside.  The patient was feeling much better today.  He denied any clinical worsening.  He did say that he was aware of his surroundings when this happened.  He feels much better.