Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Dehydration, Encephalopathy, Fibrin D dimer increased, Hypophagia, Incoherent
Clinical narrative: Hospitalized 11/16/2021; COVID-19 positive 11/16/2021; fully vaccinated  BRIEF OVERVIEW: Admission Date: 11/16/2021 Discharge Date: Nov 20, 2021   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxia COVID-19 virus infection HOSPITAL COURSE: Patient is a 67 year old woman who presented for increasing weakness and confusion. Family was concerned that she was not coherent; despite the fact that she is usually. Apparently, Patient had not been eating or drinking well.   In the ER, she was found to be dehydrated and COVID-19 positive. Her encephalopathy improved with gentle hydration. Patient was mildly hypoxic and required up to 3 L via NC. As a result, she was started on Decadron and Remdesivir. Clinically, she improved and was weaned from oxygen. She is feeling well and eating/drinking well. We discussed the utility of continuing Decadron at discharge. Since she has diabetes and is now off oxygen, we will trial her off steroids for discharge. If she has return of symptoms she was advised to call her pcp or return to the ER. Discharge instructions were printed and explained. All questions were answered.  Please note that her ddimer was continuing to go up. Intent was to complete work up prior to her departure. Unfortunately, she left before the lab results. I have called her physician's emergency line and asked for them to repeat ddimer in 2 days. US LE/UE +/- CTA will be ordered as indicated per pcp.   Readmission 11/24/21-11/26/2021 discharge note: BRIEF OVERVIEW:  Admission Date: 11/24/2021 Discharge Date: 11/26/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: PE  HOSPITAL COURSE: Patient was recently admitted from 11/16 to 11/20 after presenting for evaluation of confusion and weakness. She was found to be dehydrated and tested positive for COVID-19. Her encephalopathy improved with gentle hydration. Patient was mildly hypoxic during that admission and required up to 3 L via NC. As a result, she was started on Decadron and Remdesivir. Clinically, she improved and was weaned from oxygen. Prior to discharge, she was feeling well and eating/drinking well. We discussed the utility of continuing Decadron at discharge. Since she has diabetes and was now off oxygen, we decided to trial her off steroids for discharge. We intended to evaluate her with US LE/UE +/- CTA but she left before these tests could be completed. I d/w PCP about arranging these outpatient and in follow up her DDimer had further increased. As a result, she was sent back to the ER and found to have a PE as was suspected. Heparin drip was started. She was put back on oxygen given hypoxia (85% RA).   She was later weaned from oxygen again and transitioned from Heparin to Eliquis. Nurse helped arrange coverage for Eliquis outpatient to ensure affordability. I initially planned to keep Patient for more monitor but she was anxious to go home. It is reasonable to trial discharge but she is at moderate risk for needing readmission. I discussed this in detail with her.  Other recommendations for Patient at discharge:  -Hold norvasc b/c bp on low end of normal.   -Continue asa but hold Plavix given initiation of OAC. I can not find evidence of any recent stents and patient also confirms. I asked her to re-discuss this with her pcp.