C10027471 / invoice 10000

Reason: Lumps & DentalAppointment Notes: JHO moved appt from 16/04 FVHistory: admitted for mass removals + dental scale polish. Plan to FNA masses prior to removal to ascertain margins required etc. No other concerns.Physical Examination: MM pink, no abnormalities on thoracic auscultation or abdominal palpation.Laboratory: pre GA bloods- midlly low creatinineMild increased ALT + ALKP.Discussed with O options:1- abdominal ultrasound to investigate liver2- recheck liver parameters in 1 month. O opts to recheck.Treatment: 22G IV catheter left cephalic veinPremed medetomidine + methadone IVPropofol IV to effectCuffed ET tube placed.IV hartmanns @ 5ml/kg/hrMasses FNA'd:1- left shoulder- epithelial cells. No obvious malignancy2- left lateral abdomen- no cells3- left cranial lateral thorax- debris only4- wartlike mass behind left shoulder- blood and some oamy/glandular cells.5- right fore small dark wartlike mass- blood only6- subcutaneous mass left ventral chest cranial- adipocytes- lipoma7 subcutaneous mass just behind this- adipocytes- lipoma8- subcutaneous mass sternum- adipocytes- lipomaConcerns re resorptive lesions on 305, 308, 408, 409.Some periodontal disease of 404 + furcation 108.Dental radiograph machine not working properly.Recommend to O stage dental component so can safely radiograph these teeth to assess and treat.Lump removal today then dental in a couple of weeks.O okays.O elects to remove external masses and keep lipomas.Clipped and prepped masses for removal.Elliptical incisions around each mass. Blunt dissected beneath and removed.Closed subcutaneous layer simple continuous 3-0 pds.Close skin interrupted cruciate 3-0 polypropaline sutures.Recovered from GA.Meloxicam sc.Meloxicam PO for home.Suture removal in 10 days.Consider dental in 2 weeks once radiology working.Estimated Band 3 but will take $500 of repeat anaesthesia fee off.Brought todays cost closer to estimate provided.Dental. Pre-med: Methone-0.24 ml DOM-0.05 ml s/cInduction: Repose- 3ml IVET Tube Size: 6.5IVF Therapy: 45 ml/hr Pain Relief: Meloxicam-0.38 ml s/c on recovery.Anaesthetic Notes: smooth induction. Mainitained anaesthetic on 1.5-2% isoflurane, HR and RR stable throughout, SPO2 maintained between 98-100%, temperature within normal ranges. Recovery unremarkable. Scale and polish by SFDental Grade:3Plaque:+ Tartar:+Pocket Depths:less then 2mm Halitosis: +Gingivitis: +Radiographs:x-ray unavailable Teeth of concern 308, 305, 408, 409, 203, 108, 404Upper Jaw:101- C:0   G:1                                               201- C:0   G:1102- C0:   G:1                                               202-  C:0   G:1103- C0:   G:1                                               203- C:0   G:1104- C:2   G:2                                               204-  C:2   G:2105- C:1   G:1                                               205- C:1   G:2106- C:1   G:1                                               206-  C:1   G:1107- C:1   G:1                                               207-  C:1   G:1108- C:3   G:3 F2                                          208- C:1   G:2109- C:missing   G:                                        209-  C:missing   G:110- C:missing   G:                                        210-  C:missing   G:Lower Jaw:401- C:missing   G:                                        301- C: missing  G:402- C:missing   G:                                        302-  C:missing   G:403- C:missing   G:                                        303- C:missing   G:404- C:1   G:1                                               304-  C:1   G:2405- C0:   G:0                                               305- C:2   G:2 resorbing406- C:1   G:1                                               306-  C:1   G:2407- C:1   G:2                                               307-  C:1   G:2408- C:resorbing    G:                                    308- C:1   G:1 split reobsorbing 409- C1:   G:1 resorbing                                309-  C:1   G:1410- C:missing   G:                                        310-  C:1   G:1411-C:1   G1                                                  311-C0     G:0 Nails clipped and ears cleaned.Discharge: discussed routine anaesthtic home care and post dental instructions. Recheck with nurses in 7 days.    Vital Signs    Weight: 9.6;