C09980753 / invoice 10000

--- 02/03/2026 17:09:49 ABA:Treatment (See invoice items and client information): Fentanyl patch placed over bare R shoulder - Trouble picking spot for patch due to procedure being bilateral TTO, so could not use either back leg. I have gone through with James and Jacqui regarding patch safety at home, especially with a baby in the household. Recommended popping either one of his shirts or a baby singlet to protect the patch overnight. Have also given them a cone to go home with. Bloods also taken via jugular vein - tolerated well with tight restraint. Will run these prior to tomorrow to have results ready.Laboratory ( See attachments): CBC: - Mild reticulocytosis 184.5 (10 - 110)- Marked thrombocytopenia 2 (148 - 484)- Mod inc MPV 16.9 (8.7 - 13.2)- Severe dec PCT 0 (0.14 - 0.46)BIOCHEM: - Mild hyperglob 48 (25 - 45)Fresh blood sample drawn to reassess thrombocytopenia, sample formed significant clot in syringe prior to being placed in tube. PT run on fresh sample - 12 (11 - 17) - after discussion with Ben Porter prior to induction, elected to proceed with procedure today. Examine: Haematoma formed at site of jugular blood draw this morning, very mild bruise present from yesterdays blood draw. Small bruise present at side of fentanyl patch clip on back of neck.SMLNs, L PSLN, PLNs all noted to be enlarged at time of abnormal bleeding events.Treatment (See invoice items and client information): Induction with Ketamine 2mg/kg IV + propofol IV to effect.Post induction hypotension observed, 10ml/kg/hr hartmanns bolus administered over 15 minutes and isoflourane reduced to lowest effective dose. Atimapezole same volume reversal administered IM. Normotension achieved.During surgical prep, petechiae on inner thighs where clipped and haematomas at sites of nerve blocks observed. Elected to abort procedure at this stage pending further investigation of coagulopathy.Hypothermic during recovery, active warming with socks, blankets and bare hugger continued until normothermic. Fresh sample for PT and APTT obtained to be sent to the lab as urgent. Samples of lymph nodes obtained for cytology.Assessment: Coagulopathy - primary (petechiae) and secondary (haematomas) DDx DIC, rodenticide ingestion, IMT, other - diagnosis open Plan (See medication labels, reminders and instructions): MRP to relay results of further testing once available To commence vitamin K +/- immunosupressive dose of glucocorticoids.--- 03/03/2026 11:24:05 MRP:Spoke to Jacqui, advised problems with clotting observe and not safe to proceed with procedure today. Discussed additional samples for testing have been obtained to be sent to the lab, Jacqui happy to proceed today. Discharge booked for 5:30 with view to discharge home to James and Jacqui unless any concerns at time of discharge or deterioration prior to then.    Vital Signs