C09986688 / invoice 10000

04/03/2026 Reason: Plastic ingestion

History:
O came home and found part of Havana thong missing (plastic Y part that goes on top of feet, approx 3/4 of it gone). Unsure if Coco has ingested it but certain it would have happened within the last 40-60 minutes
Prior to this was EDDU well, no CVSD
No hx of fb ingestion

Induced emesis 1/3 apormorphine tablet PO
- Approx 5 minutes later chewed up pieces of plastic vomited up
- Total 40+ pieces of small plastic bits brought up with digested food

Vital Signs:
Temperature:  not taken
Heart Rate: 128  bpm 
Pulse rate:  128
Pulse character: strong and synchronous. 
Respiration Rate: 24. 
MM: pink, moist
CRT: <1 sec

Dehydration assessment: Euhydrated MM moist no skin tent

PHYSICAL EXAMINATION:
Appearance: BAR; BCS 5/9
Eyes: nad. no redness, discharge, blepharospasm. responds to visual stimulus
Ears: nad. no debris or inflammation
Nose: nad
Oral Cavity: nad. no gingivitis, calculus/tartar or other oral lesion 
Cardiovascular: Auscultation no murmur detected ,pulse quality normal ,rhythm regular
Respiratory: RE normal , auscultation normal
Abdomen: soft and comfortable
Musculoskeletal: ambulatory all 4 limbs
Neurological: appropriate mentation
Integument: free of ectoparasites or other skin lesions
Peripheral LNs:Normal size, symmetrical
Urogenital: not assessed
Rectal exam: not examined

Assessment/Problem List:
1. Foreign body ingestion (plastic thong)

Treatment:
After vomiting ceased reversed with 0.82ml prevomax

Plan:
Feed 1/2 of normal meal tonight
Monitor for signs of lethargy, vomiting (particularly after food), constipation/soft stool and recheck if these present. Recommend specialist u/s to rule out fb obstruction given tiny nature of fb and material. 
Also discussed endoscopy however I feel that Coco has vomited a decent amount of plastic, all chewed to very small pieces, likely anything remaining will also be chewed to this extent/not much left; to start soft diet to try to coat remaining pieces and defecated - monitor stools for now. 

Will call on Monday to check in.