C09998942 / invoice 10000

Reason: Ate GrapeAppointment Notes: Overdue remindersConsultation Time: 20:48History: Winter was seen to eat a single grape at 8pm.Winter is otherwise EDDU normal, no vomiting or diarrhoeaNo current medications or other health concernsNo other pertinent medical historySubjective: BARObjective: Temp 38.6 MM pink and moist CRT <2 seconds HR 148 FP SS RR 28BCS: 5/9  Wt:16.4  kgCV: no murmur or arrhythmia noted, strong and synchronous femoral pulsesRESP: normal BV sounds all quadrants, normal resp effortGIT: comfortable, no focal abnormalities notedU/G: moderate soft urinary bladder palpatedNeuro: appropriate mentation, no ataxia, full neuro exam not performedM/S: no lameness, no limb pain or swelling, full MSK exam not performedInteg: healthy skin and coat, no skin tentOphth: pupils mid range and responsive, no dischargeLNs: small and symmetricalProblem List:- ingestion of a single grapeAssessment: Options Offered to Client:Treatment:Plan:veterinarian or the AEC.    Vital Signs    Weight: 16.4;       

Reason: possible FB ingestionAppointment Notes: Overdue remindersHistory:- Took out to toilet on the front garden in the afternoon and noticed she had something in her mouth but swallowed it while the O tried to wrestle it out of her mouth. O unsure what it was but knew it was hard. Initially thought it was a piece of bark but O had noticed a hard orange sized object in yard earlier in the day which is no longer there- Brought to VRH emergency and vomited undigested food in the waiting room. No diarrhoea - Last eaten at 6 pm (11/05)Subjective:QAR - very affectionate and eager to interact with team membersObjective:Temp: 38.3     MM: pink, moist     CRT < 2 secs      HR: 140 beats/min        FP: strong femoral pulse synchronous with HR    RR: 44 breaths/minBCS:    5/9                Wgt:  13  kg Pain Score (CSU):   1/4CV: NADRESP: NAD          GIT: slightly uncomfortable on cranail abdominal palpation, soft mass palpable which could be undigested food or foreign material but otherwise, no hard masses palpableU/G:  NADNeuro:  NADM/S:  NADInteg:  NADOphth:  ANDLNs: NADAssessment:At this stage, it is difficult to tell definitely know if Winter has indeed swallowed foreign material. Winter appears only slightly uncomfortable on abdominal palpation and there is material sitting in the stomach though this can also easily be undigested food. Further diagnostics are required (e.G. Sedated 3-view abdominal radiographs).Plan:Options presented to O:1. Admit for sedated 3-view abdominal radiographs- O declined this option 2. Monitor at home over the next few hrs with pain relief and present to GP in the morning (12/05) for radiographs. Adv. That Winter should be fasted prior to being sedated for radiographs.- Anti-nausea not given as we do not want to mask the signs of foreign body ingestion- O elected for this option- 200 mg Gabapentin PO BID dispensed- Hx. To be sent off to Waverley Garden Vet    Vital Signs    Weight: 13;       

Reason: Are ToyAppointment Notes: Overdue remindersConsultation Time:22:36History: Winter has presented today after ingestion of part of a plush toy. Owner's are concerned about obstructionNo other concernsSubjective: Bright, Alert and ResponsiveObjective: Temp: dnp  MM: Pink, moist  CRT: <2s  HR: 80  FP: SS RR: 24BCS: 4/9 CV: Regular Rhythm, No audible heart murmursRESP: Normal BV sounds bilaterally, Normal effortGIT: Comfortable on abdominal palpation, No palpable masses or organomegalyU/G: NADNeuro: MADM/S: NADInteg: NADOphth: NADLNs: NADAssessment: Foregin body ingestion, potential for GI obstruction. Induction of emesis reasonableTreatment:Induced emesis with apomorphine 1mg/kg SCPlush toy brought up in vomitusReversed with metoclopramide 0.5mg/kg SCPlan:  Winter can continue with her normal routine minus foregin body ingestion    Vital Signs