C09983966 / invoice 10000

Reason: VomitingAppointment Notes: Special payment terms exist14.9kg BAR, RR: 32, RE: 0/3, MM: pink, CRT: 1sec, Strong pulses, HR 108Record Entered by: MEL History:Presents at 0330h for vomiting many times in the last 5 hours.Slight language barrierThe owner explained that about 5 hours ago, Meteo started vomiting a lot. Frequently. Owner provided a picture of the vomitus - it looked like frothy spittle. While in consult, Meteo started coughing, and then hacked up two piles of clear fluid with a frothy layer of spittle.Meteo had been inside when the episodes started. There was no aerosolized irritants such as deo, perfume, plants. Meteo has not been to the park or dog boarding in the last week.  Physical Examination: Demeanour: BARBCS: 6/9EENT: unremarkablePeripheral lymph nodes: small, symmetrical, not enlargedIntegument: clean coat, no parasites/debrisCardiovascular: HR 90, MM pink, no appreciable murmurs or arrhythmias Respiratory: RR30, no crackles or wheezing. Normal bronchovesicular sounds in all quadrants. Negative on tracheal pinchAbdominal: no discomfort on abdominal palpation, no appreciable massesMusculoskeletal: unremarkableNeurological: normal mentation and gaitRectal: temp 38.9. Slight wet faeces on rectal, no palpable abnormalitiesUrogenital: externally unremarkablePOCUS: no b-lines, no pleural effusion, glide sign present in all quadrants Assessment:Problem list:- coughingDdx: LRT disease including infection, thoracic disease, transient aerosolized irritantThe owner's description of a vomit had in fact been a productive cough. Explained ddx for coughing to owner. Possible language barrier despite best effort to reduce use of jargon. Offered: continued at home monitoring with the view to re-present if the coughing persists or Meteo becomes worse. Described worse as breathing faster, looking like he is having difficulty breathing, not eating, not wanting to walk or play, vomiting. Explained to the owner that if the problem is something like an irritant Meteo has breathed in, such as grass or an insect, he will stop coughing when he has coughed up the irritant. Alternatively, Meteo can be admit for monitoring and investigation. Recommended at-home monitoring first.Explained to the owner that the recheck in the next 24h is free. Described recheck as another visit here in the next 1 day, noting that the cost of other tests such as xrays would be an additional cost.Owner elected for at-home monitoring. Plan (incl. alternative options): Owner to monitor the coughing and re-present for diagnostic investigation if signs persist or worsen.Record Entered by: Record Checked by: History:  Physical Examination: Demeanour: BCS:EENT: Peripheral lymph nodes: Integument: Cardiovascular:Respiratory:Abdominal: Musculoskeletal: Neurological: Rectal: Urogenital:  Assessment:  Plan (incl. alternative options): Client Communication:    Vital Signs    Weight: 14.9;