C09987520 / invoice 10000

History:
Eaten a corn cob 15 minutes ago - O saw it happen

Examination:
BAR
Pink MM
Waling ambulatory
very stressed / anxious
Clean skin and coat

Procedure:
Induced vomiting with apomorphine 1 tablet diluted with NaCl 0.9%. 0.9mg/kg dose

Emesis:
Evident corn and chewed up bits of a corn cob
numerous vomits 
Reversed with metoclopramide 0.5mg/kg SC

Plan:
Monitor at home

ABDOMINAL ULTRASOUND
ultrasound by AWO
sedated with medetomidine 4mcg/kg + buprenorphine 0.02mg/kg IV
--> patient appear sedated (sleepy eyes) BUT will consistently jerk body around. needing two nurses to keep Eddy on lateral/ dorsal recumbency

unable to perform a full ultrasound without GA/ very heavy sedation. unable to capture images
Summary of brief scan
- no FF
- gas filled colon was obstructing a good detailed view of the stomach
- stomach is NOT overly distended. no obvious shadowing/ FB noted 
- sections of duodenum and jejunum examined appear normal with no obvious disension

HISTORY
Presented for: Off his food since yesterday, two large volume watery vomits, lethargic, salivating.
Reduced appetite over the last couple of days and off his food for 24h. 
V+ last night ~10pm - very watery bile + yogurt which was fed earlier. Another vomit early this morning also watery bile.
Known scavenger - tends to eat things and vomit them up - has brought up socks before
Diet: fussy eater, grazer on kibble + rolls - Hx of D+ with beef and lamb
Vax and worming UTD.
No known access to toxins.
Goes on daily walks around the park, mostly on lead but still supervised when off leads.

EXAM
QAR - very flat
BCS 5/9
HR = PR = 132
Normal resp effort and BVS
MM pink, CRT~2s, delayed skin tent
EEN - NAD
Teeth - NAD
LNs - NAD
Abdomen - tense on palpation
Temp 37.6

CBC - moderate haemoconcentration and mild neutrophilia 
Biochem - Mild increased ALT 266 (10-125)
Electrolytes - NAD

ASSESSMENT

1. Dehydration ~7%
IVFT 3x maintenance at 53 ml/hr 

2. V+
Maropitant 1mg/kg IV @7:30am
Methadone 0.2 mg/kg IV @11am
Medetomidine 4 ug/kg IV @11am
Alfaxan 1ml IV @11am >> rough recovery thrashing and very noise sensitive >> gave 0.01 mg/kg ACP IV @11:30
Abdominal rads
- Stomach: no distension, pylorus visible and gas-filled >> no gastric outflow obstruction
- Intestinal loops: gas-filled, no dilated loops observed
- Colon: descending is filled with gas and granular mixture, transverse + ascending + caecum are dilated and gas-filled.
Abdominal US

PLAN

COMMUNICATION
STO - updated with findings on rads and ultrasound - no gastric or intestinal obstruction, no obvious FB found on imaging >> will trial feeding him and if he keeps it down and is stable and rehydrated then good to go home and monitor. Otherwise if still not keeping food down will keep overnight for further monitoring in hosp.