C10012620 / invoice 10000

Admit for mass removal on dorsum of head ,   O rpts this bleeds at times and seems to bother P
, possible second mass R side of face and dental 

lovely girl  as always 

PE,
Body cond 5/9 
Eyes - nuclear scleorsis is present 
CRT - 1-2s
MM pink, wet
Oral -moderate calculus to both lower 309 and 409 in partic
LN - nad
CV - nad
HR -120 
Chest ausc   - normal  BV sounds
Abdo Palp  NAD
Integ - vascular nodule on dorsum of head ~ 5mm diamter , small pedunculated mass R side of face 
Ears - nad 
MSK - nad 
NEURO - nad 

PROBLEM LIST
PLE
skin masses 
dental Dx 
high triglyceride 

methadone .3mg/kg ,medetomadine 6mics/kg 
onto IV fluids w hartmans at 4ml/kg/hr
induced w propofol 4mg/kg 
size 6 et and onto ISO/O2 at 2 L min and 1.5 iso 
routine GA 


excised 5mm mass on dorsum of head w 3-4mm margins , kept  mass for potential histo 
flushed w saline closed w 4-0 pds for sc and simple int sutures for skin, 

~ 4-5mm pedunculated mass R side of face removed w 1mm margins closed w a single simple int suture- Mass to be sent for Histopathology


moderate calculus and gingivtis  partic  309 and 409 
 loss of bone density and some vert asoc  310  and to lesser degree 309 and 309  but only 1-2mm pocket at 310 and none at other teeth 
some early bone loss to lower incisors 
all 5 lower incisors have some vert bone loss but not mobile and no pockets 

405,6,7 and 408 have thining of bone but no pockets 

discussed w O could remove some of these teeth partic 310 but given age no significant gingivtis or pockets O is keen just to Obs 

scaled and polished all teeth ,
buprenorphine 20mics/kg 

will advise home w kids paracetomol only as still on pred for IBD