C10006609 / invoice 10000

Appointment Reason: Vomiting, Appointment Notes: vomiting for a day or two? Not eating. Last meal was Saturday night...OMREASON - UnwellHISTORY - First vomit Saturday night, another bigger vomit this morning, but did have a few smaller liquid vomits in between. Stools are soft, not watery, dark in colour. Restless and unsettled. Innappetant. Did eat small piece of dried chicken this morning, but then vomited. Children did give nandos food on saturday before all this started. EXAMINATIONQAR, HR = 100, Temp = 37.6, no skin tent, gums are very dry and slightly pale, RR = 24, abdo palpation - painful cranial abdomen. ASSESSMENTVomitingInnappetantDiarrhoeaRestless/unsettled - painfulPale dry mmPLANAdmit for CP2, PCV, IVFT, medical management (prevomax, pantoprezole, methadone), abdominal ultrasound with jarrad - sedation if needed. $2000 initially. Ongoing costs to be discussed. JJS-Blood taken for CP2. Marked urgent.In house PCV 54. Likely dehydration. 9.30am-Start IV fluids Hartmanns soln 2x maint rate (35ml/ hr).Prevomax 0.65ml ivMethadone 0.2ml ivpantoprzole 8mg iv12.30pm-Formal abdo u/s by Jarrad without sedation-Likely pancreatitis/ gastroenteritis and mild ileus.No evidence of mechanical obstruction.2.30pm- Bloods show haemoconcentration but hypoproteinaemia. Biochem otherwise fairly unremarkable. Likely D+/ protein losses. Will start metro tabsOffered cooked chicken not interested. Syringe fed approx 20ml RC recovery. Took well, then ate recovery from hand. 3:30pm - no longer wanting to eat from hand. Syringe fed another 30ml. Seems brighter than this AM. JJS STO and updated. O said she has a sensitive stomach. Will send home later today with view to RV tomorrow AM. Give another dose of pantoprazole before discharge. 4.30PM- Seems reasonably bright. Had another feed of RC recovery. Approx 1/2 can in total. Gave another 8mg pantoprazole IV. Will remove IV cath and send home with recheck tomorrow.     Vital Signs    Weight: 6.3;       

3pk of simparica added to rewards card. TT     Vital Signs    

REASON - KC Vacc & ProheartHISTORY - Simparica 3pk transferred to card....OMhas been well. O does brush teeth, 2-3 times a week. On simparica trio, tapeworming and proheart - recommended change as per below. EXAMINATIONBAR, heart and lungs sound normal, abdo palpation soft and relaxed, grade 1 tartar, NAD on PE today. ASSESSMENTlow grade dental diseaseTREATMENTPi2 vaccine sc (5264017, exp 01/27)BB vaccine po (5245045B, exp 11/26)0.33ml proheart scSimparica monthlyAll wormer 3 monthlyPLANC5 and proheart due 12 monthsRecommended daily brushing and $525 for prophy dental - no bloods or fluids. Emailed dental handout.     Vital Signs    Weight: 6.5;