C10027230 / invoice 10000

Reason: Lump Removal Appointment Notes: please mention something about suspect cancer lump rx for insurance NCHistory: In for susepct neoplastic mass removal. Based on last weeks in house fna. No new issues has been bandaged since last here was rebandaged at home. DUDE normal no vdsc Examination: BAR crt < 2mm pm HR/RR wnl pulses good abdo palp nad. Laboratory: Pabs- nadAssessment: Continue with sx. Treatment: Surgery: Premed- medetomidine 5mcg.Kg and 0.3mg/kg methadone good effect. IV placed induced with propofol intubated sz 10  Site- L flank over ribs. Approach- elliptical incision around pedunculated mass skin on body wall looked slightly thicken and more red than surrounding so opted to remove this too. Large elliptical incision around site mix of blunt and sharp dissection down to the muscle of the chest wall hoping for a deep margin. Closed in 3 layers deep with 3-0 monoplus sub cut with 2-0 monocyn then intradermals with 2-0 monocyn. Closed well applied small tissue glue along edge to help with final apposition . Consent has been given by the client to proceed with this treatment  -  YesGiven 0.17ml anti of recovery and inj metacam for analgesia tgh with oral metacam to start tomorrow. Bup top up given 4 hours after premed - Discussed with o clean contaminated wound due to infection in mass so will cover with amox course as extra cover. Keep quiet adv if needed 5 mon lead walk only. Needs to wear cone to stop interference if scratching at it adv place t shirt over to give some protection. POC in 5-7 days Await histopathology to figure out neoplasia and what is needed post op.    Vital Signs