Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Cerebral small vessel ischaemic disease, Chest X-ray abnormal, Chlamydia test negative, Computerised tomogram abdomen abnormal, Computerised tomogram head abnormal
Clinical narrative: ED to Hosp-Admission  Discharged  10/19/2021 - 10/26/2021 (7 days)  Hospital MD  Last attending ? Treatment team Acute hypoxemic respiratory failure due to COVID-19   Presenting Problem/History of Present Illness/Reason for Admission Patient is a 70 y.o. male who presents accompanied by his daughter who was present at bedside provided most of the history. Patient is currently awake alert and calm, oriented to self only, appears confused upon conversation.   Patient's daughter states that patient came to the ED yesterday due to fever at home after receiving his Covid vaccine few days prior. Denying any other symptoms such as fever vomiting, abdominal pain diaphoresis diarrhea or urinary symptoms. In the ED patient was evaluated and started on Bactrim antibiotics for recurrent cellulitis of the abdominal wall. Patient took Bactrim last night after going home and did not eat anything and went to bed, at that time patient's daughter states that he was staring blankly on the wall and acting abnormal. The morning patient stayed in bed until 1 PM, did not eat anything after getting up and later on was witnessed by family members to be walking the hallway acting strangely and apparently hallucinating stating that they were bad guy that he was trying to hide.   Upon further questioning, patient's daughter admits that patient follows up with psychiatry and has had a diagnosis of poor short-term memory and forgetfulness.  She also admitted that patient had minor similar episodes of strange and bizarre behavior.   Hospital Course Patient is admitted to Hospital due to acute encephalopathy, and was found to have acute hypoxic respiratory failure due to COVID-19 pneumonia as well.  Patient was admitted and started on treatment for his infectious issues.   His encephalopathy will resolve during the course of the admission and was thought to be caused by polypharmacy with multiple sedating medications, in addition to his acute infectious issues.  His mental status was back to baseline by the time of discharge.   For his COVID-19 infection, he initially required oxygen but was subsequently weaned by the time of discharge.  He was treated with Decadron, with improvement in his symptoms.  He will need 3 additional days of Decadron therapy to complete a full 10-day course of treatment.   There was also concern for possible umbilical/abdominal cellulitis at the site of a prior ulcer.  He was treated with 5 days of vancomycin, and local wound therapy.  This resolved, and he will need continued outpatient follow-up for this.   He was orthostatic during the tail end of his hospitalization which was caused by overdiuresis as he was taking both Lasix and hydrochlorothiazide during the admission as well as at home.  His medications were adjusted so that he is only on Lasix, his hydrochlorothiazide was discontinued.  Losartan was decreased to 25 mg daily, and will continue propranolol as previously prescribed.  With adjustment of medications he improved, and he was less symptomatic.   He was otherwise stable and was seen by physical therapy on 10/26 who recommended home with home health.  He was discharged home with home PT and OT, and will need to follow-up with PCP within 7 days of discharge.