Sent 02/23/2026 12:10:21, Page - 14

FRASER HEALTH AUTHORITY Emerg Nete
Royal Columbian Hospital HOLAND,MARK THOMAS
RCO161840/25

Medications:
Bilastine 20 mg daily
Sumatriptan 25 mg PRN

Physical exam:
BP 100/62, HR 50, RR 18, Tamp 36,7, O2 sat 98% on RA
Orthostatic vitals: sitting 97/61, standing 100/62

Appears well, no acute distress

PERL, EOM full, face symmetrical, equal palate elevation, tongue is midline
Normal $1 $2, no EHS or murmurs, radial pulses regular bilaterally
Breathing comfortably on RA, chest clear

Abdomen is soft, non-distended, epigastric tenderness

Investigations:

WBC 5.7

Hb 160

Liver funetlon, kidney function, Ilpase within normal Ilmits

EcG: SInus bradycardla

Holter 18/05/2025:
Normal Holter Monitor
Low average heart rate of 49 beats per minute

Assessment and plan:

The cause of Mark's abdomina! pain is not clear. There are no signs of active bleeding ulcers, given
his Hb is normal and there is no hemoptysis or blood in the stool. We consulted GI who advised clear
fluid diet times 24 hours with abdominal pain, repeat CBC in 3 days, H pylori screening, and
pantoprazole 40 mg BID. We referred him to gastroenterology, Dr. Atkinson, for further management
and consideration of out patiant scopa; per GI request he has been CBC. With regards to his 2-week
history of presyncope, we are reassured by the results of his orthostatic vitals and Holter monitor. He
will follow-up with his family doctor for further management and to discuss the results of hls out
patient labs.

Bianca Te MSI3
For Dr. K Eppler

Staff note: Patient reviewed, assessed and examined. 46-year-old male who had duodenal ulcer

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Moditech Report iD: 1905-00211 3of4

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