C09994026 / invoice 10000

Reason: Intermittent vomiting for 3-4 daysSubjective: EDDU normally, vomiting intermittently after eating for 3-4 days. Approximately 6 days ago ingested baseball leather covering - leather portion not recovered. Vomited this morning with breakfast, no vomiting yesterday. Yesterday breakfast no vomiting. Faeces variable - solid yesterday, puree-like 2 days ago but still formed enough to pick up. No toys ingested - destroys toys but does not eat them. Ran and played normally yesterday for 30 minutes. Well behaved, does not chew inappropriate items.Objective: BARHR/PR/Cardio: pulse normal and synchronous, CV normal, no audible murmurTemp: neMM/CRT/Hydration: pink, moist CRT 1 sec, hydration normalRESP/RR: NAD normal rate and effortGIT/UG: abdomen slightly tense (tense due to handling), comfortableSkin/Ears: NADM/S: NADEyes: NADDental: cleanLymph Nodes: wnlBCS: 5/9Weight: 20kgAssessment: Intermittent vomiting and variable faeces consistency. Suspected partial GI obstruction vs delayed passage of ingested baseball leather (6 days ago). Physical exam unremarkable - BAR, well hydrated, comfortable. Given size (20kg) and intermittent nature of signs, likely slow passage through GI tract rather than complete obstruction.Treatment: None todayPlan: Conservative management - monitor at home. Dispense bland GI diet to support passage. O to monitor for vomiting and fecal output. If vomiting continues or worsens, recommend 3-view abdominal radiographs with light sedation (estimated $450). Follow-up call Monday (public holiday noted). If still vomiting by Tuesday, proceed with radiographs. Expect foreign material to pass within next few days (typically 5 days maximum for ingested material to pass).____________________________INSURANCE HXInitial Assessment > Intermittent vomitingSuspected cause > possible gastro vs FBDate of first clinical signs > 6.3.26Any other conditions / treatments > None    Vital Signs    Weight: 28.3;       

Subjective: Follow up callTried to call O @1.55pm, n/a but did leave a msg to update on progress. BGO called back - Mijo is better today than yesterday. no further v+. O to call for recheck if any further concerns. BG    Vital Signs    

Reason: V+ Not ThemselvesSubjective: At a friends house yesterday with Mijo. Playing outside. Then overnight restless, unsettled, going in and out of Os bed which is very out of character. Usually sleeps all through the night. Vomited this morning once off.  Brought up breakfast. Ate well still though. No diarrhoea. Not drinking as much. No known toxin access.  Not a typical FB eater but would eat food if left laying around. Reg diet: dry kibble.  Brighter today. Objective: BAR HR/PR/Cardio: 112, normokinetic, no obvious murmur or arrhythmiaTemp: 38.7MM/CRT/Hydration: pink, moist <2s RESP: clear, normal bronchovesicular sounds GIT/UG: comfortable with abdominal palpation but occasional lip smaking with cranial abdo palpation. Skin/Ears: Clean coat, well groomed. Ears free from discharge on external exam of the internal pinnae. M/S: ambulating fine Eyes: clean and bright  Dental: Gr0/4  no FB within the hard palate Lymph Nodes: wnl BCS: 5/9Assessment: restlessness, once off vomit, suspect nausea ddx: gastroenteritis, FBO (full vs partial), pancreatitis, dietary indescretion, renal dz, hepatic dz, toxin ingestion, other Treatment: 2ml maropitant injection (10mg/ml) s/c Plan: discussed ddx with O. Evidence of nausea. Discussed maropitant trial. If vomiting through inj then next step abdo xrays to assess for obstruction. O working from home today to monitor closely. Bland diet. Small frequent meals. FUC tomorrow    Vital Signs    Weight: 20;