C10030657 / invoice 10000

Reason: Unwell, High Temprature SB Appointment Notes: Overdue remindersHistory Currently under the care of dermatologists and oncologists at ARH essendon for osteosarcoma and fungal skin infections Current chemo protocol = carboplatin. On day 16 currently.  Has recently stopped enrofloxacin as skin biopsies have showed that previous MRSP infection is no longer presentToday - acutely unwell. Not interested in food (abnormal) No D+ or V+ Quite lethargic which is unusual, was normal yesterdayDue for repeat CT next friday in melb to assess effectiveness of chemo  Current meds: 20mg pred SID, currently given EOD 300mg antifungal SID (O not sure which one) 2 x 300mg gabapentin given today for pain relief? Examination: QAR BCS: 5/9 DS: 3 MM: slightly tacky, ~2 sec CRT. Pink. CVS: NAD, no murmur. HR 88 Resp; NAD, RR 32. VERY mild crackle in R caudoventral lung field. Not heard anywhere else (does have known metastatic nodule in a lung field) Abdo palp; soft, comfortable MSK: 3 x ambulatory with effort. Temp: 39.4Assessment Unwell ddx flare of skin condition vs paraneoplastic condition vs sepsis vs other?? Laboratory: High normal neutrophil count with bands (confirmed manual) Mild non regenerative anaemia Plan; Options1. Referral for 24 hr care and IVFT/poss imaging at ARH today 2. Admit for IVFT here, with acknowledgement that no supervision overnight 3. Manage as outpatient so O's can monitor Called ARH to confirm not missing anything, Dr Richard advised unlikely to be immunosuppressive related to chemo at this day (day 16 of protocol) 3.7ml enrofloxacin (5mg/kg) SC 5ml prevomax IV 20ml hartmann's fluid bolus IV IV CATHETER REMAINS IN PATIENT, WRAPPED. O will be placing cone tonight. Recheck booked tomorrow to check temp and hydration status.    Vital Signs