Age: 48.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Unresponsive to stimuli, White blood cell count increased
Clinical narrative: 49 yo F w PMH of DCIS managed w mastectomies,  hyperthyroidism (overactive thyroid nodules) >10 years currently managed by Physician--never requiring medications--managed with nodular drainage and biopsies for years.  She presents after having a colonoscopy @ surgery CTR by yesterday or eval of recent hematochezia and change in stools. He biopsied a rectal mass and colon polyps--path pending  (findings detailed below.)  She ate pizza last evening following this and developed sweating, abd cramps, nausea,  and tenesmus.  She then passed a large amount of hematochezia @ 8pm  with bright and dark blood  with clots and has had #3-4 episodes overnight.  She did not sleep. At 5a she again felt tenesmus-- am ambulated to the bathroom, felt sweaty and lightheaded and next think that she recalls was being helped in the bathroom by her husband.  He recalls hearing a thud in the bathroom  at 5a and finding her partially standing but bending forward holding herself on the door then sliding down to the floor.  He witnessed her eyes being open but that she was nonverbal w/ a blank stare  when he spoke to her.  She had a bleeding laceration to her central forehead.  She had 10 seconds of tremorous upper  extremities (also had when fainted years ago postop)  but no head arching back, no eyes rolling back, no tongue biting, and no urinary incontinence .  She was  incontinent of about 2 liters of rectal blood on the floor and between her thighs.  She eventually responded to him and EMS was summoned.  She does not recall falling or hitting her head but it is presumed that she hit it on the toilet.  She has intermittent abd cramping.  She has nausea but no vomitting, no hematochezia, no focal abd or rectal pain.  She has had low back pian x 2weeks ands noticed R>L groin lymphadenopathy 1 week ago.  She developed increased fatigue 3 months ago with recent change in her BMs to smaller caliber,  more explosive evacuation, foul smelling, and noticed that they float.  She had an episode about 1 week ago of hematochezia followed by a few episodes of melena.  This is what prompted yesterday's colonoscopy.    In the ED, she has been hypotensive (90/50s--a few MAPs <65) with no tachycardia and no respiratory depression.  Afebrile.  She has a mid forehead superficial lac (nonsuturable)  w/ dried blood, mild swelling.  She is calm, pale, and in NAD.  She has had no further hematochezia since 05am. Labs:  WBC 13,  Hgb 8.8,  PLts nl. CMP unremarkable except:  gluc 198 (AIC in am), albumin 3.3, LFTS nl.  PT/INR 14/1.2, PTT 25.     I spoke w Dr who plans to observe for further bleeding  and if occurs wil do flex sig.  Dr had also seen pt in the ED.  CT c/a/p: "pelvic congestion,  multinodular goiter; minimal intramural air at the rectosigmoid junction and along the hepatic flexure of the colon related to recent procedure. There is no free air to suggest colonic perforation." NCCT Head, CT c-spine  no acute fractures or acute IC abn. She received 1 liter NS IVF in the ED and is on 125cc/h maintenance.  Her BP is still soft at times but overall fld responsive.  She has had no further hematochezia when seen at 8am since 5am.  Hospitalist has been asked to admit the pt. NOTE re: COVID positive (asymptomatic :  She was exposed to  her positive  COVID daughter on 1/9/22;  Patient tested positive on 1/12/22-- she needs COVID room neg pressure  placement x10 days post testing positive which will be until  tomorrow.  DISCHARGE SUMMARY HAS NOT BEEN UPLOADED AT THIS TIME.