Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Sinus node dysfunction, Syncope, Transfusion
Clinical narrative: Office Visit 3/23/2021 Urgent Care   PA-C Family Medicine 2019 novel coronavirus disease (COVID-19) Dx Covid-19 Screening  Reason for Visit Progress Notes PA-C (Physician Assistant) ? ? Family Medicine ? ? Encounter Date: 3/23/2021 ? ? Signed Cosigned by: MD at 3/24/2021  4:39 PM Expand AllCollapse All    MDM Number of Diagnoses or Management Options 2019 novel coronavirus disease (COVID-19):  Diagnosis management comments: Patient is an 80-year-old male with history of atrial fibrillation and positive POCT COVID-19.  6 days of symptoms.  Excellent candidate for antibody therapy.  The health system treatment navigator was notified of this and will schedule him for antibody infusion treatment.  Patient is stable at present with no severe or concerning symptoms at this time.  Tylenol/continued Eliquis recommended.      Clinical Support 3/24/2021 Health system RN COVID-19 virus infection Dx Progress Notes RN (Registered Nurse) ? ? Encounter Date: 3/24/2021 ? ? Signed    Patient is here for MAB Infusion Consent for infusion prior to this visit reviewed and verified. O2 sats > or = 90% Signs of potential reaction reviewed with patient. Tolerated IV start and MAB infusion without complication. Pt has access to pulse oximeter and thermometer for home monitoring Provided fact sheet for patients, parents and caregivers- Emergency Use Authorization of BAM for Coronovirus Disease 2019 for pt to review. Discharge instructions reviewed. Patient denies any questions   ED to Hosp-Admission Discharged  3/25/2021 - 3/26/2021 (39 hours) Hospital  MD Last attending ? Treatment team COVID-19 Principal problem Chronic anticoagulation  Persistent atrial fibrillation (CMS/HCC)  COVID-19  Confusion  Hypoxemia Hospital Course: In his hospital stay we managed his medical issues as follows;   Confusion/Syncope in the setting of COVID-19 infection Chronic atrial fibrillation/sinus node dysfunction Hypertension Prediabetes Patient received first dose of vaccination on 3/16 and afterwards started having muscle aches and body pains, later on found out to be having Covid 19+ test, he might be having Covid infection before vaccination as well and symptoms showed with vaccination.  On 3/24 he was found out to be having confusion, family called EMS.  They tried to debride patient on his feet and he collapsed for about 10 seconds.  He did mention that he usually get dizziness/lightheadedness upon standing from bed.  Although patient has a history of A. fib but remained rate controlled during hospital stay, we held his antihypertensives including HCTZ and ARBwhile continued his Eliquis.  I believe his syncope was likely due to dehydration with decreased oral intake in the setting of acute illness with COVID-19 symptoms. Before discharge is blood pressure was rising so his ARB were restarted while decision regarding HCTZ will be made by primary care physician. In regard to his COVID-19 infection, initially was started on 2 L of supplemental oxygen but his oxygen demand decreased rapidly and most of the time he remained room air, he was not showing any dyspnea, cough, fever or any other generalized symptoms of Covid 19 infection.  He did get plasma and remdesivir while inpatient, decision was made to discharge him on 3/26 as patient was symptom-free.  He also had received first dose of vaccination. I believe that he would need further remdesivir.  We will continue him on steroids for now after completion of dexamethasone for next 8 days he can recent resume his home medication of prednisone.