Sent 02/23/2026 12:10:21, Page - 30

Signed

FRASER HEALTH AUTHORITY Patient: HOLAND, MARK THOMAS
Royal Columbian Hospital Unit/MRN: RCO3030788
DOB/vage: 04/09/1978/43

Admitted: 08/03/22 Gender: M
Discharged: PHN: 9128549738
LOC: RC-ERIN1 Acct/Encounter: RC404198/21
Pat Type/Reg Cat/Care: RC.ACU

***FINAL REPORT***
ROYAL COLUMBIAN HOSPITAL Patient Location: RC-ERIN1
CONSULTATION

Name of Patient: HOLAND, MARK THOMAS
Medical Record Number: RC03030788
Account/Encounter: RC404198/21

Date of Consultation: 08/03/2022
Consulting Service: GASTROENTEROLOGY
Consultation Requested By: Dr. Koehn

IDENTIFICATION

Mr. Holand is a 43-year-old gentleman who Is previously healthy. He presents
with an approximately 5-week history of central substernal chest pain and a new
onset of hematemesis and hematochezia this morning.

REASON FOR REFERRAL
Upper Gl bleed.

HISTORY OF PRESENTING ILLNESS

Early this morning, Mr. Holand woke up and reports feeling nauseous. He
subsequently vomited a large volume of frank red blood. Following this, he had
a syncopal episode that was witnessed by his wife. There is also a report of
query tonic-clonic activity that was noted by his wife as well as mention of the
patient's "eyes rolling back." |t appears that he did not have any loss of
consciousness and was not found to have any evidence of being in a postictal
state. He then also had 1 large bloody diarrhea at home. He did not have any
accompanying abdominal pain, chest pain, or fever. EHS was called and on
arrival, Mr. Holand’s blood pressure was 70/50. An EV bolus was started en
route by EHS. Mr. Holand’s blood pressure was 88/54 on arrival to the emergency
department. He was resuscitated with 2 units of packed red blood cells and IV
fluids. He has had 1 additional bloody diarrhea in hospital.

He has had no prior history of hematemesis, bright red blood per rectum, or
melena. He does not endorse any history of odynophagia or dysphagia. He has
regular bowel movements with no constipation or diarrhea.

Mr. Holand's history is also significant for an approximately 5-week history of
substernal chest pain. He reports he initially noted this when he was working a
night shift and reports that it came on suddenly but resolved on its own. He
reports his pain to be sharp and burning in nature and does not report any
radiating features. He reports that the pain ranges from a 1/10 to 9/10 and

. Meditech Report ID: 0803-2911
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PAGE 30/47 * 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