C09999149 / invoice 10000

Appointment Notes: Poss snake bite JSPresented QAR, pale, was totally normal then episode of weakness.On pe gums are pale and tacky. Owner hasn't seen a snake but location makes it possible.Ddx include insect bite, Anaphylaxis, snake Plan is bloods to narrow differentials.Actalyte tube looks to have delayed clotting.HISTORYPresenting for: Kallie presented for acute onset vomiting and syncope following a normal afternoon and dinner at home.Lifestyle Risk Factors: Lives at Cameron Park near creek area with red belly black snake presence, lots of logs in backyardEXAMMentation: BARHR: Initially 140, settled to 120 within minutesMM: Very pale (1/2) initially, extremely pale/white noted by owners at time of episodeCardiovascular: Initially slightly thready pulse which returned to normal within minutesBehavioural: Improved considerably throughout visit, appeared normal within 10-15 minutesNeurologic: Episode of apparent syncope at home following vomitingDiagnostics: Biochemistry showed slightly elevated glucose and electrolyte abnormalities. CK normal but at high end of normal range. Coagulation studies not performed in-house due to equipment malfunction.ASSESSMENTSuspected red belly black snake envenomation - Clinical presentation of acute vomiting, syncope, and severe pallor consistent with possible snake bite given environmental exposure Also have wasps in yard and insect bite not excluded,PLANDiagnostics:- Coagulation studies to be performed at referral facility - abnormal results would support red belly black snake bite diagnosis, normal results make envenomation less likelyAdditional Discussion:- Patient to be transferred to Eric for coagulation testing and possible observation- Further management plan dependent on coagulation study results    Vital Signs    Weight: 9;       MMColour: Pale;       HeadEyes: Normal;       Nose: Normal;       Skin: Normal;       MusculoSkeletal: Normal;       Ears: Normal;       Neck: Normal;       LymphNodes: Normal;       Heart: Normal;       Lungs: Normal;       Abdomen: Normal;       RectalGenetalia: Normal;       Demeanour: QAR;       Gingivitis: 0;       Calculus: 1;       Temperature: 38.5;       HeartRate: 120;       BodyScore: 4;       DentalGrade: 0;       CRT: 1-2;