C09987642 / invoice 10000

Reason: Ate Chocolate Coated BiscuitPatient History-       Vomiting > 4 times in 24 hour period or Vomiting > 24h?-       Contents, volume, and colour of vomitus-       Ingestion of chew toys or foreign material? Dietary indiscretion? Recent treat or bone?-       Appetite?-       Activity levels?-       Regurgitation vs vomiting?-       Stool frequency / consistency-       Medications Examination: -       Hydration status: -       MM / CRT -       Hypersalivating?-       Abdominal pain or bloating?-       Stool consistency on rectal examAssessment: Acute vomiting may be infectious (Viral, parasitic, bacterial), inflammatory (eg Dietary indiscretion, pancreatitis), or obstructive (eg foreign body, neoplasia etc). Vomiting may also result from extra-gastrointestinal disease, including anaphylaxis, renal, liver, or neurologic disease. Diagnostic plan: 1.     Pancreatic Profile + CRP; this helps to rule out extraGIT causes of vomiting, and predicts urgency of further diagnostics. 2.     Urine for USG (free catch)3.     POCUS then upgrade to specialist if needed – check for gall bladder wall oedema and free fluid4.     Faecal float (for eggs) and wet prep (for parasites)5.     Radiographs (3 view abdomen + lateral chest) 6.     Specialist ultrasound if extraGIT disease or obstruction suspected. OR IF ABOVE DECLINED; 1.     Maropitant 1mg/kg, if vomiting persists as outpatient above diagnostics will be required. 2.     Follow up call scheduled within 24 hours, recommend testing if vomiting has persisted.  Treatment plan: 1.     Maropitant 1mg/kg SC / IV2.     Replacement + maintenance IV fluid therapy; Hartmanns or Plasmalyte, K supplementation likely required. 3.     Small frequent low residue meals – boiled chicken or I/D. 4.     Omeprazole or Esomeprazole 1mg/kg BID only if haematemesis present.    Vital Signs    Weight: 4.7;