The Emergency Consultant
Holy Spirit Hospital
Emergency Department
15 July 2019
Dear Emergency Consultant
Re: Ms Helen Marshal, D.O.B: 29 January 1968
Thank you for accepting Ms Helen Marshal, who has signs and symptoms suggestive of Acute Myocardial Infraction, requires urgent assessment and appropriate management from your facility.
Today, Ms Marshal at 1945H, appeared tired and weak. Blood pressure recorded 180/95mm of Hg, also, confined to bed. Upon request buscopan and Panadol administered for indigestion and shoulder pain respectively. On re-assessment, blood pressure shooted, anorexia and insomnia was observed. Exhibited anxious, since her son has not visited.
Despite the above management, Ms Marshal condition become worsened and looks pale, swety along with tightness and pain on the chest, which radiates to shoulder and neck with rating of 8/10 on pain scale. Blood pressure showed 190/100 mmofHg. She has been commenced on 2 litres of oxygen via nasal prongs and nitrogen transdermal patch applied. She is being transferred to your services by ambulance.
Ms Marshal, a widow, resident at the Wellness Retirement Village. She has had hypertension for the last ten years. Of note, he is allergic to codeine. Eventhough she has arthritis in hands, she walks independently with the help of walking frame. However, she needs continence pad. She prefers to consume two glasses of wine every day bedtime. List of her medications are attached with the letter.
Based on the aforementioned circumstances, immediate health check-up and appropriate medical care to enhance the health condition of Ms Marshal would be extremely beneficial.
If any additional information is required, please do not hesitate to contact me.
Yours faithfully
Registered Nurse
Wellness Retirement Village
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