C10003771 / invoice 10000

Hx sent to SASH alex IG

Hx: Watery diarrhoea for 24 hours, mostly blood. Hasnt eaten yesterday or today. Very unhappy. Vomited yesterday. Drinking a bit. Thinks urinating. Normal diet: hills sensitive stomach/skin. Always had skin issues. Not really had gut issues except when fed human scraps.  Had a slightly cooked large beef bone on Friday. No pieces chewed off. 

S: QAR, BCS 6/9
O: Temp 38.5, HR=PR=164, pulses a bit thready, lungs clear, mm pale pink and tacky, crt 1-2s, both eyes moderate mucoid discharge and scleral hyperaemia, ears ok, abdo palp mild diffuse SI thickening but fairly comfortable, skin areas w lichenfication and scabbing, fresh blood on rectal exam.
A: HGE - likely related to bone ingestion
P: PCV 43%
Discussed referral to SASH vs mgmt as outpatient. 
Feed v small amts bland food today. Ensure is drinking. 
Will trial conservative approach and INI, will take to SASH Alexandria

Prevomax 1ml SC 11am 
Buprenorphine 0.5ml IM 11am
Prokolin 3ml BID - given first dose in consult

Discussed signs of deterioration to look out for which would trigger visit to SASH. O happy w plan. 
Will need STT at later stage when feeling well again. 

Hx: 
OR doing well. EDDU normally. 
Pain relief daily 

Extraction sites healing well 

Plan: 
Final ck 1 week 
Stop metacam 
Cont soft food