C10017109 / invoice 10000

Reason: RecheckHistory-   Presented for a recheck of an aural haematoma with cellulitis-   much better with ears, less discharge, less inflammation -   on tapering dose for pred EOD -   still on Noroclav BID, has a week worth left ExaminationMentation: BAR  BCS: 3/5  MM: p,m CRT: 1 sec  HR: 120 RR: pant  LN: wnl  Cardiovascular: NAD- no heart murmur or arrhythmias  Respiratory: NAD- no resp depression or effort  Ears: Inflammation of whole pinna has significantly gone down. The distal half ear pinna remains with a moderate amount of fluid palpable. Not painful to touch today Ear canal is NOT exudate today Managed to scope for short time: moderate amound of ceruminous discharge with inflammation; unable to assess Assessment-   Aural haematoma present but ear condition in general appeared much better with less infection and inflammation -  Discussed IM cytology again to find out if ear infection is completely resolved- O consentedIH cytology: yeast ++, cocci++- Discussed options with O; option 1: GA+ ear clean+ assess TM and meds/ option 2: trial poloxamer squalene (TM safe, for yeast infection etc) - O opted for option 1 -also discussed option for haematoma 1/ drain under GA, 2/ surgical repair, 3/ self-limiting, will resolve gradually, however does cause comestic changes; discussed pros and cons for all options; given P not bothered by it and secondary celluitis was resulted, option 3 may be a better option; if O prefers option 1/2, advised O that risk of complications- repeated cellulitis may be happened again- O happy with option 3  Catheter placed Prega blood: unremarkable with mild ALP elevation- high likely age-related vs liver disease vs others0.2ml medet, 0.3ml meth IV given- very sedated Propofol IV titrate to effect (2ml in total)IVFT Hartman 200ml/hr Intubated with ET 9.5Maintained with oxygen and iso Parameters monitored and stable throughout procedureL ear NAD, clean canal, TM intact Routine ear clean performed on R earYellow greasy discharge in canal; TM appeared ruptured? With rough irregular edge of TM visibleUneventful recovery Treatment:-script for polaxamer squalene (dex, keto, enro) 0.5ml BID into R ear for 10 days -cont with pred tapering dose, and noroclav course -add on gaba, paracetamol as neededPlan:-rv in 10 days, repeat cytology to make sure ear infection is resolve, early if concern    Vital Signs    Weight: 39.9;