C10030664 / invoice 10000

History: Presented ytd afternoon with malaise and pyrexia. Currently under the care of dermatologists and oncologists at ARH Essendon for osteosarcoma (Amputated LHL) and fungal skin infections Current chemo protocol = carboplatin. On day 16 currently.  Due for revisit dermatology on Thu and repeat CT scan on FriHas recently stopped enrofloxacin as skin biopsies have showed that previous MRSP infection is no longer presentNo D+ or V+ Much improved from ytd. Current meds: 20mg pred SID EOD 300mg antifungal SID (O not sure which one) 2 x 300mg gabapentin BID Enrofloxacin DailyAdded Panadol 500mg TID - can increase to 1000mg Examine: QAR BCS: 5/9 Severe lichenified skin disease. MM: remaining slightly tacky, ~2 sec CRT. Pink. CVS: NAD, no murmur. HR 96Resp; NAD, RR 24. field) Abdo palp; soft, comfortable MSK: 3 x ambulatory Temp: 39.7 (increased from 39.4 ytd) Assessment: General malaise with Pyrexia Differential Diagnosis: Flare of skin condition vs paraneoplastic condition vs sepsis vs metastatic OSA Laboratory: WBC WNL (High normal neut ytd  with bands)Mild non regenerative anaemia Discussion: Options1. Referral for 24 hr care and IVFT/poss imaging at ARH sooner than Friday2. Admit for IVFT here, dc no supervision overnight 3. Manage as outpatient so O's can monitor Plan: Continue on current meds with increase of Panadol when required. Wash today as long enough since biopsies and sites healed. He is very pruritic.To continue 9.00 x Enrofloxacin Tablets 150mgOne & half (1.5) tablets twice a day so as to have full cover for 5 days in total ( has been off for 1 week until started again yesterday) Review in am    Vital Signs    Weight: 46.5;