Age: 58.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Streptococcus test negative, Swallow study abnormal, Tachycardia, Tachypnoea, Toxic encephalopathy
Clinical narrative: Hospitalized (11.23.21);  COVID-19 positive (11.16 and 12.13.21);  fully vaccinated  Admission Date: 11/23/2021 Discharge Date: 12/13/2021  DISCHARGE DISPOSITION: Subacute rehab HOSPITAL COURSE : 59 yo male with history of MS, chronic HFpEF, HLD, and recent COVID-19 who presented to the ED with expressive aphasia first noted 11/23 (1800). As baseline, spouse reported patient to be conversant.  In the ED patient noted to be mildly tachycardic with tachypnea. Initial lab work demonstrated an AKI. Stroke code was initiated with CT head, CTA head/neck and CT perfusion scan unremarkable. Neurology was contacted by ED and recommended admission to the medicine service for MRI. # Toxic/Metabolic Encephalopathy  # Early Onset Dementia In Setting of MS MRI brain w/ and w/o contrast (11/24) without acute findings, and notable for global atrophy and sequelae of chronic MS. 2 hour EEG (11/24) without epileptiform activity. UA without evidence of infection and VBG without Co2 retention. Neurology signed off given lack of stroke and/or seizure findings. Etiology felt secondary to progression of dementia and/or COVID-19 PNA. On 11/30 stroke code was called overnight due to increase in expressive aphasia and generalized weakness, head CT without bleed and neurology re-evaluated patient and felt no neurological deficits and therefore signed off.  # Bilateral Pulmonary Embolism with Acute LLE DVT Left lower extremity venous US (11/25) with extensive VTE extending to the common femoral vein. CTA thorax (11/25) with bilateral PE with at least moderate clot burden and no evidence of heart strain. Echo obtained and confirmed lack of heart strain. Etiology felt secondary to COVID-19 and initially given dose of Apixaban in the ED, with heparin gtt while hospitalized. IR was consulted and felt no intervention needed for PE. CT abd/pelvis (11/25) was obtained to determine extent of LLE DVT which showed IVC to be patent and no evidence of extension superior to left inguinal region and therefore IR recommended no intervention regarding DVT. However, IR placed an IVC filter.  # Right Iliopsoas Retroperitoneal Hematoma Patient was noted to have down trending Hgb and therefore GI was consulted with recommendation for CT abd/pelvis w/o contrast due to AKI. Imaging revealed retroperitoneal hematoma for which IR was consulted. As hemoglobin remained stable, recommending monitoring closely while on heparin gtt.  He was subsequently switched to Eliquis which he tolerated well.  CT abd/pelvis w/o contrast was repeated on 11/30 with stable hematoma, the hemoglobin was monitored and remained stable.. COVID-19 PNA with Acute Hypoxic Respiratory Insufficiency Patient was initially diagnosed with PCR (11/15) and fully vaccinated x2 with Moderna (albeit >6 months ago). CTA thorax demonstrated mild-moderate GGO. Strep pneumonia and legionella testing was negative. Complete 1.5 gm of Azithromycin for atypical coverage and 5 days of IV Rocephin for typical coverage while hospitalized. He was also treated with Decadron during hospitalization. Resp failure worsened on 12/1. CXR updated. Unasyn added. Blood cx sent (for fever).  Infection was controlled under Unasyn was discontinued.   His hemoglobin remained stable. While on steroids he was noted to have high blood sugars.  His hemoglobin A1 c was 6.3.  He required insulin during hospitalization.  He was subsequently discharged on metformin.  The patient the was continued on tapering dose of prednisone.  He will subsequently go back to his usual dose of prednisone of 2 mg. The patient noted to have malnutrition.  He failed the swallowing study.  Patient's wife agreed for PEG tube placement and tube feedings. The patient had a tube placed and was started on tube feeding which he tolerated well.  He was subsequently discharged to subacute rehab