C10010534 / invoice 10000

Appointment Notes: check wound, some bleeding but not dripping KEHistory: Seen 4d ago for castrate Developed coagulopathy post-op with 4 min ACT, PCV 33.4 - suspected genetic (haemophilia A vs vwf) as rat bait exposure is unlikely. Given Koagulon, transexamic acid IV here - transferred to TPS and started fentanyl 2ug/kg CRI  + 15ml/kg FFP given over up to 4hrs- started with TPS, finished with NEVS, NEVS did whole blood transfusion with target PCV 35 Current meds - transexamic acid 1/4 500mg, paracetamol100mg/mL 1.1mL BID-TID just given, trazocalm 100mg BID. TPS dispensed vitamin K 25mg tablets- x 25- 0.75 tablets BID PO - later discontinued K based on normal PT.NEVS PCVs:pcv/tp 11.00pm ( sat) 31/74pcv/tp 8.00am (sun) 27/66Os report haven't noticed strong effect from trazodoneGot home from work and noticed bleeding again from scrotum. BIB Mrs, reports mild volume on blanket. Unmonitored since 9am (6hrs) so unsure how long for. Exam: QAR painful CRT 2s MM pale pink, moistHR  152 no murmur RR panting, clear lung fields Abdomen softScrotum - Not bleeding from incision. Weeping blood from laceration to superficial skin - not rapid enough to drip. Scrotum severely distended and extremely painful on palpation. Able to get around soft e-collar and go for surgical site. When left alone will traumatise. PCV/TP 30/68Assessment: PCV not dropped too significantly, tachypnoea and tachycardia more likely related to pain. Needs increased sedation to reduce trauma to surgical site, increased pain relief, and close monitoring. Hard e-collarPlan:Gabapentin hard collarmonitoring - pale gums, recurrent bleeding, reduced activity then NEVScontinue paracetamol and transexamic acid as prescribed    Vital Signs