Sent 02/23/2026 12:10:21, Page - 4

FRASER HEALTH AUTHORITY Emerg Note ~ Complex
Royal Columbian Hospital HOLAND,MARK THOMAS
RC0437506/25

The ear canals were normal. Cranial nerve examination was normal. There was no carotid bruits.
Renee and Webber tests were normal.

I discussed the case briefly with Dr. Zahabl from ENT. Dr. Zahabl does not think this Is ENT of origin
given the audiology tests and the year examination were completely normal. The ENT specialist
suspect that the nalsy environment might have triggered his migraine headache leading to the
patient's symptoms. both ENT and Neurology does not think outpatient follow up is warranted at this
point.

On reassessment at 2145 hours, the patierit's migraine headache improved. He is frustrated with the
worsening symptoms and the persistent migraine. He asked for a prescription for sumatriptan. He
agreed to a trial of prednisone 50 mg once dally for the next 5 days. I gave him a 2 weeks’ worth of
Pantoloc 40 mg once daily to protect his stomach while he is taking the prednisone. I have suggested
him to follow up with his family doctor after the completion of the prednisone.

Medications and Allergies

Allergies:
Allergies
Allergy/AdvReac Type Severity | Reaction Status | Date / Time
No Known Drug Allergies | Allergy | Unknown | Not Verified | 25/01/2026 16:41
Applicable
LACTOSE Ajlei Unknown | Unknown | Unceded | 25/01/2026 16:41
Exam
Physical exam
Glasgow Coma Scale total score | 15/15 36/61/2026 20:76 |
Glasgow Coma Scale total score | 15/15 30/01/2026 | |

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Meditach Report ID: 3001-00387 2of4

PAGE 4/47 * RCVD AT 2/23/2026 12:10:26 PM [Pacific Standard Time] * SVR:FAXP21/3 * DNIS:9777 * CSID: * ANI:17783680130 * DURATION (mm-ss):21-27