C09989979 / invoice 10000

Reason: R/VAppointment Notes: Overdue remindersHistory:  aware of where owner is and what they are doing but seems super tired. Stayed sleeping this am rather than following family around in the mornings (had been doing this even the day after Sx). Breathing seems fine. No interest in food now at all and not walking/collapses down if try to make him stand this am. Have seen voluntary movement, walked at 1 sm but seems flatter/worse since then. Walked out to toilet (U) 6pm last night but that's the last time he's known to have toileted. No cough or V. Last known stool Tuesday  pm, not sure yesterday. Last ate chicken yest am ~8am then yest lunchtime had a treat serve of peanut butter, refused ham yesterday afternoon. Not eaten since No meds since saw RA. Yest am had melox (~9am). Put some traz and gaba on food but wouldn't take to o' knowledge, last poss access was 9am yesterday.No meds, drugs, baits, toxin access. Is a scavengerExamine:  flat, depressed/very subdued, just lying on table, held head up initially but then just lying there, eyes closed. Eyes rotated down, pupils small but even, no convincing PLR. Sclera white. RR 16 with mild insp stridor but no abdo effort or exp noise, no cough.Mm palish pink, no pet/ecchy. Moist, CRT<2sec. Lungs clear, HR90 with an NQR sinus arrythmia, generally 4-5 beats, then skips one, then 1-2 beats then skips one. Missed beats seem to be roughly on insp and expiration. Lung sounds clear through the URT stridor. Abdo palp nad, some bruising at castarte sites and to the L of prepuce. PLNs WNLs. T37.6No CPs x4 but have to hold him up to check, has witdrawals. Vol movement see of HLs, FLs and attmpts to right from L lat to sternal when checking oral mm (only made it half way up before collapsing back down to lat). Has anal tone and clenches anus when poke with tip haemostat. When attempt him to stand have to support for him to stay up at all then he just crumples. No ticks felt but brief searchAssessment:  open Dx, signif neuro concerns. Medication reaction? But worsening not improving with time.... Adv owner I am v. concerned, esp as seems to be worsening not improving.No fever but infectious/memngitis/enceph? Vasc? High spinal/brain stem issues, congenital malformations/issues manifesting postGA? Toxicity? Med reaction? Metabolic or cardiac?Plan:  to VRH.    Vital Signs    Weight: 7.32;