Alvin Myon

Residential Care Nurse

ATK Care Home
58 spencer HillRd, Wimbledon, London SW19EL, UK

August 27, 2016

Re: Mr Alfie Coleman, aged 55

Dear Mr Myon,

I am writing to transfer Mr Alfie Coleman, who was admitted on August 17 due to abdominal
pain. Your continued care is requested. 20

Mr Alfie Coleman presented to hospital complaining of pain, dizziness and weakness. His
symptoms started two days prior to his admission; however, did not consult a doctor. He has
mild pitting edema on both lower extremities and left side of his abdomen showed an
abdominal mass. CT scan revealed enlargement of left lower abdomen with a huge hematoma
and a maximal diameter of 5.5cm. Severe hypersplenotrophy, peritonitis, hepatocirrhosis and
seroperitoneum were observed. 71

During hospitalization, Mr Coleman was placed on continuous flow of oxygen, red cell
concentrates, one L saline restriction and paracenthesis of chest performed. Antibiotics
initiated and before pleural effusion. Also, FFP and vitamin K were administered daily. He was
commenced on human serum albumin, Furosemide 20mg per day, combined spirolactone
60mg a day, somatostatin, Diisopropylamine Dichloroacetate and Glutathione. Abdominal
bandage compression and hemocuagulase were used to enhance the effect of hemostasis.
Despite the treatments, his condition deteriorated as evidenced by difficulty of breathing which
was relieved by chest puncture. Enlarged echymosis on his left addomen, perineal and waist
was observed.99

After 5 days of stay in the hospital his showed improvement which was confirmed by his
laboratory findings with results attached. Hardly any paraneumonic effusion and
pyoperitoneum reported. Mr Coleman was discharged on August 27 in fair condition. We
request a 3 month stay in your facility for further management as suggested by his physician.
52

For any questions about Mr Coleman, please do not hesitate to contact me.

Yours sincerely,
Nurse