C10006452 / invoice 10000

Reason: Inappetant. Pale GumsConsultation time: 16:00  History:Presenting problem: - yesterday seemed normal, bright EDDU fine, today quieter than normal, did not want to eat meal, reluctantly ate small bits when hand fed, and did not want to go on walk and gums seemed very pale at home- did have 1 x vomit 3/3 then fine, - last 1-2 months slowing down quite a bit and reluctant to go on some walks (starts for about 15 m then stops)- no Hx trauma, did start meloxicam 2 weeks ago, vomited on initial dose reduced to 1/2 dose (1ml of meloxicam liquid PRN - not every day only when thinks needed- Has suspected partial cruciate tear over xmas 2025. Been getting OA and stiff recently - owner did mention abdomen looked fuller/ broader a few weeks ago, then settled - poos brown, no obvious access top poisons/ medicines etc  Examine:  Demeanour - QART:  37.8     HR: 80      RR: 24    mm: pale pink    CRT:1-2Weight:18.5  kg       BCS: 5 /9Cardiovascular - can hear heart through chest wall both sides, pulses weak, HR 80-110 in triage, ecg normal with occasional spiked QRS, no arrythmia, no tamponade or electrical alternansBP 110/65, 130/72Respiratory - clear all fields, soft breaths, no obvious dull spots, SPO2 97% room air, tachypnoeic with handling but no distress, seems shallowGastrointestinal - no noted abdominomegaly or pain, can deep palpate reasonably well when standingUrogenital -  small bladder palpatedMusculoskeletal - ambulatory here, not assessed other than that, was carried in but did walk down and pull on lead for owner pickupIntegument - no real abnormalities seenNeuro - quiet but reactive and arousable Eyes - NADLymph nodes -    perhaps slighlty larger left prescap lymph nodes but none other Laboratory:PCV/TP: 22/44(Dog: PCV 37-55%, TS 55-75g/L)Blood gases/electrolytes (Sample: venous/arterial):K+ 3.3, glu 6.3, lactate 3.3Haematology:RBC 3.32, HCT 18.6, HGB 7.1, MCV 56, MCHC 38.2, RDW 22.5, Neutrophil11.65Blood smear exam: no real polychromasia seen, marked anisocytosis, no spherocytes noted, occasional mature neutrophil feathered edge, Saline agglutination negative, no rouleaux or agglutination in smearNo basophilic stippling, however on routine staining does look like a few RBC phpf dark stained pigment inclusion - damage/ stain contamination?, parasites? Biochemistry: UREA 10.6, TP 49, ALB 21, CHOL 2.67 Coagulation timePT: 11 (dog: 12-19s, )APTT: 67 (dog: 75-105s) Interpretation: marked anaemia with hypoproteinaemiaImaging:AFAST: no free fluid, no obvious mass or organomeglalyTFAST: free fluid - seem pericardial - first time scanned seemed about 1-1.5cm wide easily seen RHS, second time checked queried pleural effusion?Problem list:Marked anaemia with hypoproteinaemiaSuspected pericardial effusion/ +/- pleural effusionLethargyInappetanceAssessment:Today it seems like there has been recent whole blood loss most likley into a cavity as GIT has been normal. Strongly recommended advanced imaging and transfer to VRH for possible medicine workup. Daisy is not showing any signs of meeting transfusion triggers, no signs tamponade adn is stable for transfer. Client communication:Aware of extended costsTreatment: 1. Hartmans 5ml/kg bolus over 15 mins then 3ml/kg/hr prior to transfer Owners taken to VRH for transfer, email Hx and images    Vital Signs    Weight: 18.5;