Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Joint dislocation postoperative, Mitral valve incompetence, Pain, Pericardial effusion, Red blood cell schistocytes present
Clinical narrative: Patient with history of 3 COVID vaccines who had routine COVID test for facility placement and was found to be COVID detected.  Provider d/c note:  "Reason for Admission:  She reports that she sustained a ground level fall earlier today and has been experiencing ongoing pain since then.  She typically does have chronic pain in this hip.  She has history of joint replacement several years ago.  She has had signs of chronic loosening of her joint for the past couple years and she has been referred to a University.  She reports that she has follow-up with the orthopedic team next month.  She denies numbness, weakness, paresthesias.  Did not hit her head or lose consciousness.    Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) See below note for details re: this brief hospitalization.   Hospital Course: No notes on file  These were her acute medical issues addressed:   Patient is a 56 YO female with a PMHx of sickle cell disease, chronic opioid use, right hip replacement with complications who presents with mechanical fall and right hip pain.  Found to have signs of hip arthroplasty displacement and inability to ambulate.     Mechanical Ground level fall Right hip replacement and revision with complications Unable to ambulate CT shows acetabular vertical displacement with fractured screws with age indeterminate fractures of acetabulum, femoral head subluxed from acetabular component. She has had signs of chronic loosening of her joint for the past couple years and she has been referred and has follow-up next month Trialed crutches in ED, still needed asisstance -Ortho consult: Transfer to a  center due to complexity of her THA dislocation. -transitioned Eliquis to Argatroban in case of procedure.  Last dose of Eliquis was 12/4  -PT/OT; non weight bearing right hip -cautious with pain management; avoid over sedation.   Heart failure with reduced ejection fraction 45-50%, grade 2 diastolic dysfunction, moderate to severe MR, mild elevation RVSP, small pericardial effusion on echo 11/26 -continue home Demadex.   -beta-blocker and ACE-inhibitor/Arb contraindicated due to cocaine use and previous hyperkalemia   Recent History of DVT Heparin allergy Last dose of Eliquis 12/4:00 p.m. -transition to pharmacy to dose agatroban due to renal function and possibility of surgery   Sickle cell disease with chronic pain-no evidence of sickle cell pain crisis, folic acid, hydroxyurea.  Continue home methadone.   Chronic obstructive pulmonary disease/asthma with chronic hypoxic respiratory failure of 3 L, pulmonary hypertension-no exacerbation.  Symbicort, p.r.n. albuterol.  Oxygen p.r.n.   OSA-CPAP.  Patient would like to go home with a hospital provided CPAP if possible.  Apparently this was provided to her during her last hospitalization but she forgot it at the hospital   CKD stag 4, chronic hyperkalemia- baseline Cr 2.3, stable, monitor.  Continue Lokelma.   Tobacco abuse-nicotine patch NM anemia, stable 12/2-schistocytes noted which is intermittent/chronic  Elevated transaminases, bilirubin-chronic Right inguinal hernia with bowel Polysubstance abuse, cocaine abuse Tracheomalacia    Stable patient but in pain. Patient is non ambulatory on RLE. Transfer to a center for further eval and MGT of dislocated, chronic R THA apparatus. Spoke to Hospital. Spoke to Dr the Orthopedic surgeon on call. Dr. accepted patient for transfer to their total joint team. Dr. will consult and be the lead surgeon in her case. I also spoke to Admitting Hospitalist Dr likewise accepted patient to their service."