C09982876 / invoice 10000

Reason: Hosp Dif DX Melioidosis , GI obstruction/InfectionVN:   SG            Time: 8:40Drinking: ++ offered a small amount and drank all Eating: noneUrinating: none Defaecating: noneVomiting: noneDiarrhoea: noneExamine: Flat, lying on side in cage. unwilling to move. offered some water and he managed to stand up but had a very splayed stance. Breathing heavily. Very difficult to hear heart over breathing sounds  Treatment:IV Fluids:  Hartmanns 92ml/hr rate, 317ml iused o/night. Increased to 2x maintenance 180ml/hr VET: SE.Examine: Dull and listless, mod tachypnoea/dyspnoea, clear lungs but difficult to hear heat due to increased airway sounds, tacky gums.Abdominal palpation - mod resented.Auscultation of chest - unable to assess heart.No vomiting or diarrhoea overnight.Anorexia but wanting to drink water.Problems: Hx of melioidosis and eating a nappy, dull, dehydration, tachypnoea/dyspnoea, uncomfortable abdomen.Differential Diagnosis: Relapse of melioidosis, GIT FB, thoracic dz, other.Plan: Rec sed/GA, X-ray abdo and thorax and abdo u/s.Phone Call:  RB rang Amy.Updated condition and need to do imaging .Cost of $2473 for that .OK`d with Amy to go ahead . IV Fluids: IV Catheter going subcutaneously - replaced L cephalicVET: RB.Anaesthetic:   Anaesthetic VN: BS12:22pm  Premed 3.6mL Premix (15% ACP 2mg/mL / 23% atropine 0.65mg/mL / 30% methadone 10mg/mL) SC.    1:20pm: GA induction 5mL Propofol IV, size  10.0mm  cuffed ETT; 1.5% iso / 2L O2 circle circuit maintenance of GA.Radiographs: Thorax: R lat view:* Severe cardiomegaly present - globoid heart with severely increased sternal contact and tracheal elevation.Diagnosis: Cardiac disease with generalised cardiomegaly.Differential Diagnosis: Pericardial effusion or DCM most likely.Examine: 1:25pm: cardiac arrest with agonal gasping. Treatment: Immediately moved off x-ray table and began cardiopulmonary resuscitation.Adrenaline 1mL IV Atropine 2.6mL IV after 5 mins stopped for rhythm check, no pulseAdrenaline 1mL IV another 5 minutes stopped for rhythm check, no pulseAdrenaline 1mL IV Pupils fixed and dilated, no pupilary reflexMM purpleno pulse or heartbeat when auscultation of chestExamine: TOD: 1.45pm.Phone Call: RB spoke to Amy - gave the bad news that Norman went into cardiac arrest and resuscitation was unsuccessful.    Vital Signs    MMColour: pink/red;       Temperature: 38.8;       Weight: 36.5;       HeartRate: 100;       BodyScore: 7;       RespirationRate: 60;       CRT: <2;       

Reason: multiple problemsAppointment Notes: Limping, vomiting, can't keep water down but trying to drink large amounts. O said he is breathing 'funny'. I think they were deep breaths from what she described. O said he has rapidly declined o/night. - pbConcern is a relapse of the Melioidosis that Norman had last year .Some similarities in how he is presenting and declining . Examine : Dull .MM`s Pink .Resp Rate rapid : 60 / min .Lung sounds normal .Heart sounds muffled . Abdomen maybe a bit pendulous- fluid ? Profound Polydipsia and then vomiting . Revisit :Vomiting multiple times since going home . Can`t hold medication .Hospitalise , IV fluids .Treat Nausea with inj Cerenia .Treat Infection - injectable TMPS Assess possibility opf GI obstruction form eating soiled Nappy .Rectal Examine : Normal faeces palpableVN:    SG          Time: 5:30pmDrinking: +++ drank all offeredEating: offered 3 tspn i/d wet not interestedUrinating: noneDefaecating: noneVomiting: noneDiarrhoea: noneExamine: Flat, lying in cage, opened door to let him walk around but had no interest in getting up.Temp:   38.6             HR: 66              RR: 38mms pink, CRT<2sTreatment: IV Fluids: Hartmanns 1.25 x maintenance 120ml/hr over the day 172ml infused . dropped to maintenance o/night 92ml/hr.    Vital Signs