Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness postural, Essential tremor, Fall, Lethargy, Mental status changes
Clinical narrative: 3/21 admit HPI: 80-year-old white female with a past medical history for oxygen-dependent COPD who presents to the emergency room today due to falls and possible confusion.  According to the family member, he does not think her oxygen was set at the right level.  He thinks it was set up higher because she tends to get confused and fall when this happens.  The patient really has fallen twice of late.  She said she aches all over. She also cites dizziness when she stands up.   Because of the symptomatology, she came to the emergency room for evaluation.  Workup, including chest x-ray imaging, was fairly unremarkable.  The patient did not, however, feel safe going directly home.  At the present again, she just feels achy.  There is no chest pain or shortness of breath.  No abdominal pain or urinary symptoms.  No rash.  3/26/21 admitted 80 y.o. female with a PMH notable for COPD, atrial fibrillation, hypertension, diabetes and obesity who presented on 3/26/2021 for evaluation of physical deconditioning.  Patient presents to our facility yesterday after hospital stay from hospital from 03/21 through 3/26/2021.    Hospital course - The patient is an 80-year-old white female with a past medical history for oxygen-dependent COPD who presents to the emergency room today due to falls and possible confusion.  According to the family member, he does not think her oxygen was set at the right level.  He thinks it was set up higher because she tends to get confused and fall when this happens. The patient really has fallen twice of late.  She said she aches all over. She also states dizziness when she stands up.   Because of the symptomatology, she came to the emergency room for evaluation.  Workup, including chest x-ray imaging, was fairly unremarkable.  The patient did not, however, feel safe going directly home.  In ER, patient's ABG showed significant CO2 retention. Pt is supposed to be using CPAP at home but admits it has not been used lately because of some problem with the machine.    Since admit, patient admitted to pain in her back. CT spine showed L1 compression fracture which appeared new. PT worked with patient and felt she should go to rehab for continued therapies.Neurosurgery has ordered bracing for patient. No surgical intervention required. They also consulted neurology for myoclonic jerking and essential tremor.  Patient is then to follow-up with neuro surgery and 3-4 weeks.  4/17 ER: 80 y.o. female who presents with increased somnolence and lethargy.  Patient was discharged from the hospital 2 days ago after having a stay on swing bed.  She has multiple medical problems and was admitted following a hospitalization at Hospital.  She has generalized debilitation and advanced COPD with CO2 retention.  Patient has been instructed to utilize a BiPAP machine.  According to her family, she has been none a compliant with this and did not utilize it last night.  Patient noted this morning that she was somnolent and lethargic.  Prior to that she had been doing well since discharge.  Other than the lethargy and somnolence there are no other complaints. 4/18/21  ER to admit: dx sepsis  80 y/o F with PMHx COPD with chronic CO2 retention and respiratory failure on 2L NC, OSA, non-compliant with CPAP, myoclonic jerks, essential tremor, type 2 DM, HTN, paroxysmal a.fib on eliquis, essential tremor and recurrent falls with recent L1 compression fracture s/p brace placement, presented to ED on 4/18/2021 for shaking and AMS.