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The Emergency Consultant

Emergency Department

Holy Spirit Hospital

15 July 2019

Dear Doctor,

Re: Ms Helen Marshal, DOB:29 January 1968

I am referring Ms Helen Marshal, whose signs and symptoms are suggestive of acute myocardial infarction, for urgent assessment and appropriate management.

On 12 July 2019, Ms Marshal complained epigastric pain and indigestion following the evening meal, which was settled with buscopan. One day later, she was unable to sleep due to aches in the shoulder, which was managed with 2 Panadol and diclofenac 75mg intramuscularly.

Today at 7-45pm, Ms Marshal felt tired and general weakness and her blood pressure was 180/95 mm of hg. Buscopan and Panadol 2 tables was given upon her request. She did not take evening meal, was unable to sleep and her blood pressure was 175/95 mmofhg. She was anxious, felt something wrong with her son and expressed strong desire to see her son.

At 8-25pm, Ms Marshal appeared distressed, pale and sweaty. She complained chest tightness and pain which was radiating to the shoulder and the neck and her blood pressure was190/100 mm of hg. Oxygen two liters per minute was administered and in spite of applying introderm transdermal patch she is still complaining of pain.

Ms Marshal mobilization is possible with the support of walking stick. She requires continence pads. Her son crippled for life after right side- paralysis occurred a month ago but she is not aware of it. She has hypertension and glaucoma for which she is on medications. She also takes known prescription medications such as golden glow glucosamine and vitamin C complex sustained release. She used to smoke regularly but stopped currently whereas consumes two glasses of wine at bedtime daily.

It would be greatly appreciated if you could assess MS Marshal and provide treatment accordingly. Allergy to codeine was reported.

If you require any additional information, please do not hesitate to contact me.

Yours sincerely,

Registered Nurse


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