C09983443 / invoice 10000

Reason: L4: Ate peaches 2 days ago, now unwellREASON: Presented for ingestion of multiple whole peaches and subsequent vomiting.HISTORY:- Presented as a nearly 5-year-old, 27 kg German Shorthaired Pointer.- Consumed at least ten whole peaches over the last two days.- Ingestion occurred the day before yesterday and again yesterday.- Vomited four peach pips this morning. The vomitus was described as a brownish colour.- Exhibiting signs of pain including a tight lip, crinkly ears, and a tucked-up abdomen.- Has been drinking water this morning but has not been offered food.- Has had bowel movements over the last two days, with the last one occurring last night; no pips were noted in the faeces.- Displaying signs of nausea, including salivation and threatening to vomit intermittently during the three-hour car ride to the hospital. They live in Perth but have been on holidays in the south west. The owner described this as coming in waves of pain.- Pre-existing conditions: Known chicken allergy. - skin rash- Access to toxins: Ingestion of at least 10 whole peaches, including pips.- Current vaccination status: not discussed- Current medications: nil mentionedTRIAGE:- HR: 100 bpm- RR: 20 breaths/min- Mm: Pink- Crt: 1-2 seconds- Mentation: QAREXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 1/4Cardiovascular: Cardiac auscultation normal, HR 100 bpm, normal rhythm, pulse pressures normal and synchronous.Respiratory: Thoracic auscultation clear sounds bilaterally, RR 20 breaths/min, respiratory effort normal, no nasal discharge.Neurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performed.Musculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performed.Gastrointestinal:- Oral: NSF- Abdominal: Abdominal palpation performed, findings not explicitly stated.- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: Submandibular lymph nodes WNL on palpation.Eyes: Clean and bright, NSF.PROBLEM LIST:1. Foreign body ingestion (peach pips)2. Vomiting3. Abdominal pain/nauseaDIFFERENTIAL DIAGNOSIS:- Gastrointestinal obstruction: Due to ingestion of multiple peach pips.- Gastroenteritis: Secondary to dietary indiscretion.- Cyanide toxicity: Unlikely, but a potential risk from chewing peach pips. Calculation suggests the amount ingested is below the toxic dose.DIAGNOSTICS:Nil performedASSESSMENT:Lucy presented for the ingestion of a significant number of peaches, including the pips. She has vomited some pips but is showing signs of ongoing nausea and abdominal discomfort, raising concerns for a potential gastrointestinal obstruction. Examination revealed signs of nausea and a normal heart and respiratory rate. The owner expressed concern regarding cyanide toxicity from the peach pips. A risk assessment was performed; given the small size of the pips and the number likely ingested and chewed, the dose of cyanide is considered to be well below the toxic threshold for a dog of her size. Therefore, cyanide toxicity is considered very unlikely.An emetic was administered to empty the stomach and mitigate the risk of obstruction. 1.5 mL of apomorphine was given subcutaneously, which resulted in vomiting of stomach contents, including two additional peach pips. Emesis was not reversed in case there was an obstruction, should any pips remain. She has since stopped vomiting and appears more comfortable.TREATMENT:- Apomorphine 1.5 mL SC to induce emesis.PLAN:- Discharged home for monitoring.- Feed small, frequent meals.- Monitor for any further vomiting, lethargy, inappetence, or signs of abdominal pain.- Recommended that she be muzzled when outside to prevent further dietary indiscretion. This is not her first dietary indiscretion.- Advised to seek veterinary attention if any clinical signs recur or worsen.DISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide Lucy’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today. Post Emesis   Your pet has been administered a medication to induce vomiting (emesis) to try and remove a suspected object or toxin from the stomach. They have not been administered an anti-nausea medication to reduce the risk of further vomiting due to the possibility of an intestinal obstructionThey  have not been given ‘activated charcoal’ to help bind any toxin left in their gastrointestinal tract for the same reason  Monitoring at home: * It is possible that your pet may have a further vomit, if this does occur it is likely to occur within 15-30 minutes of discharge. * The medications administered may also cause some sedation for up to an hour and should be closely monitored for the first few hours once at home. * It is not recommended to feed your pet within the first 2 hours after having induced vomiting. * If there is continued vomiting, your pet becomes dull or lethargic or there are any other concerns, please contact the Perth Veterinary Emergency or your primary care veterinarian immediately.   Medication:Ondansetron wafers 8mg x 4Please give 2 wafers into the cheek pouch and then repeat this in 8 hours. Recheck: We recommend a recheck with your primary care veterinarian within 48 hours to monitor your pet’s condition.   Please offer Lucy small sips of water waiting half an hour between sips and if she can hold water doen then start by offering her small feeds of an easily digested diet such as tuna in springwater. If she is holding these small feeds down then she can transition back to larger feeds and you can bulk these up with rice or pumpkin and topped with some paraffin oil.This is to encourage any remaining pips to slide through. Given the size of the pips they should [ass through a dog of her size.If your pet's condition is not improving and she continues ot vomit after the next few hours  or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call Perth Vet Emergency.  Thank you for trusting our team with the care of your pet    Vital Signs    Weight: 27;       

    Vital Signs    

Reason: L3 - Transfer From YokineREASON: Ongoing regurgitation/vomiting and lethargyHISTORY:- 4-5 days ago experienced vomiting for 2-3 days with lethargy- Initially presented to Vetwest Currambine where presumed regurgitation diagnosed and omeprazole commenced- Regurgitated/vomited the following day- Subsequently improved for 1-2 days with normal appetite and no vomiting- This morning refused breakfast- Last few days vomiting up all food consumed- Extremely lethargic and not displaying usual bouncy, active behaviour- Known scavenger but no access to items that could cause foreign body obstruction- Possible access to sticks from neighbour's tree overhanging yard or mulch in backyard- but havent seen her consuming this recently- Regularly walked on lead with close monitoring- No dietary changes, currently on Blackhawk lamb flavoured biscuits- Known chicken allergy causing hives- Known generalised environmental allergies, specifically to grass- Blood gas at 3pm at VW- metabolic alkalosis (ph 7.5), lactate ok and renal parameters wnlPre-existing conditions: Chicken allergy causing hives, generalised environmental allergies including grass allergyAccess to toxins: No known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavengedCurrent vaccination status: Not discussedCurrent medications: Omeprazole recently commencedTRIAGE:- RR: 28 breaths/min- Temp: 38.3°C- Mm: Pink and hyper-moist- Mentation: BAR- Pain Scale (0-4): 1- Hydration status: Mild skin tent presentEXAMINATION:Body Condition Score: 7/9 overweightCardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performedMusculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: NSF- Abdominal: Comfortable on palpation, no organomegaly, reduced gut sounds- Rectal: Soft formed stool present, no foreign material, moist rectal mucosaUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Ongoing regurgitation/vomiting2. Lethargy and change in personality3. Mild dehydrationDIFFERENTIAL DIAGNOSIS:- Foreign body obstruction- Dietary indiscretion- Viral/parasitic/bacterial infection- Pancreatitis- Oesophageal foreign bodyDIAGNOSTICS:Radiology:Thoracic Views:- Assessment of extra thoracic structures: No significant findings- Evaluation of the diaphragm: No significant findings- Examination of pleural space: No evidence of pleural space disease- Analysis of large airways: No significant findings- Pulmonary assessment: No significant findings. No evidence of interstitial or alveolar lung pattern- Cardiac evaluation: No significant findings. No evidence of cardiomegaly- Oesophageal examination: No evidence of megaoesophagus or foreign bodyInterpretation: No evidence of megaoesophagus or oesophageal foreign body. No significant thoracic abnormalities identified.Abdominal Views:- Assessment of extra-abdominal structures: No significant findings- Evaluation of serosal detail: Good- Liver/spleen examination: No significant findings. Normal location and appearance- Gastrointestinal tract assessment: Gas pockets within small intestine, no obvious obstructive pattern, possible soft tissue opacity within stomach- Kidney evaluation: Normal location and shape- Bladder/Prostate examination: Medium bladder size notedInterpretation: Gas pockets noted within small intestine requiring monitoring for movement. Stool present within colon. No current obstructive pattern. Possible soft tissue opacity within stomach noted but not clearly defined.AFAST/TFAST:- Peritoneum: No free fluid was identified in any quadrant- Pleural space: No free fluid was identified in either hemithorax- Pericardial space: No free fluid was identified in the pericardial space--- 1/12/2024 4:17:57 AM AC7:Repeat Radiology : Abdominal:Extra-abdominal structures: No significant findings.Serosal detail: Good.Liver/spleen: No significant findings. Normal location and appearance.GIT: No significant findings. No obstructive pattern noted.Kidneys: Normal location and shape.Bladder/Prostate: No significant findings.ASSESSMENT:Presenting with ongoing regurgitation/vomiting and lethargy. Radiographs show gas pockets within small intestine without current obstructive pattern. Possible slow-moving foreign body suspected given clinical signs and radiographic findings, though no definitive obstruction identified. Mild dehydration present.--- 1/12/2024 4:22:04 AM AC7:Lucy has been stable and comfortable in hospital though very anxious (barking) and requiring medetomidine CRI. Repeat radiographs do not show evidence of an obstructive pattern and no material can be visualised in the pylorus. Given this and how bright she is, she can be sent home for further monitoring. TREATMENT:- Intravenous fluid therapy- Pain relief- Gastrointestinal medications- See SmartFlow plan for specific detailsPLAN:- Repeat radiographs in 6 hours to monitor intestinal gas pattern movement- Consider specialist abdominal ultrasound if repeat radiographs non-diagnostic- Continue monitoring clinical signs- Monitor hydration statusDISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide your pet’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today. Diagnosis: Vomiting/Regurgitating of unknown cause  Lucy presented to PVE after a history of vomiting and regurgitating. She had xrays performed of her chest and abdomen, her chest xrays were normal and there were no concerns. Her initial abdominal xrays showed some material in her stomach and a small amount of gas in her intestines. Xrays were repeated early this morning and no material can be seen in her stomach and contents are moving through her intestines normally. The cause of her symtoms is not known, though there does not appear to be an obstruction. If she continues to vomit/regurgitate at home she may need further investigation including referral to a specialist.  Vomiting can be  caused by many different things – some much more serious than others. The causes of vomiting can be broken down into two groups – gastrointestinal, which includes stomach and small intestines and extra gastrointestinal, which includes all other organs. Gastrointestinal causes include infection (gastroenteritis, parvovirus), parasites (hookworm), a dietary indiscretion (eating something they shouldn’t have) or a blockage in the stomach or intestines that won’t allow anything to pass. Non gastrointestinal causes include kidney disease, liver disease, pancreatitis or endocrine diseases such as diabetes, addisons disease and cushings disease, or even cancer. Blood tests, along with an abdominal ultrasound and radiographs will help to determine if it is primary gastrointestinal or other organs are involved. If these tests show that there is no obvious underlying cause, this is great news for your pet. Most commonly the vomiting can be attributed to eating something they shouldn’t and they respond very well to supportive therapy. Treatment includes intravenous fluid therapy to rehydrate, pain relief and anti-nausea medications.       DIAGNOSTICS AND MANAGEMENT:PCV/TP and blood gas to assess acid-base and electrolyte status and guide fluid therapy  Abdominal radiographs  Intravenous fluid therapy  Pain relief  Gut protectants SPECIFIC HOME CARE INSTRUCTIONS  Exercise: In order to facilitate your pets recovery, strict rest is recommended until they are back to full health and then gradually reintroducing walks.    Diet: A bland diet of chicken and rice is recommended until all gastrointestinal signs have resolved. Once your pets vomiting has stopped your pet can return to their normal diet.   Medications: > Omeprazole Tabs 20MgGive ONE tablets TWICE daily on an empty stomach. Next due 11am Sunday morning> Paracetamol 500mg tablets (human formulation, no additives)Give ONE tablet TWICE daily. Next due Sunday evening.  What to look for at home: 1. If your pet shows any signs of vomiting, is inappetant or generally lethargic please re-check with Perth Vet Emergency or your regular veterinarian as soon as possible.  2. Regardless of how your pet is doing, it is recommended that they have a check up with your regular veterinarian in 3 days.  If your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital. If your pet’s condition is not improving or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call Perth Vet Emergency.  We are open from 6pm until 8am Monday to Friday and 24h over weekends and public holidays. Phone 1300 040 400    Vital Signs