C10007089 / invoice 20000

Referring Veterinary Practice: 4 PawsOk to send Hx to rDVM: Yes <In-hospital patient>PRIMARY CONTACT CHECKED: ElizabethESTIMATE GIVEN: $1500-$2000 for overnight CPR:  YESHistory:Referred by 4 PawsToday - Bilious vomit, then food vomit, then liquidy vomitsPreviously had sx for toy FB But no indication today that there has been a potential non-food item ingestionSole catIndoors only. No balcony access. Sometimes darts out onto grass briefly.Advocate.Vaccination overdue.No diarrhoea.Food not touched this AM. Normal for him to graze.Diet: canned meat and biscuitsRescue kitty. Had cat flu.Sedated with buprenorphine, medetomidine and alfaxan for radiographs (mass effect). Became spicy after per Dr Megan.Tx: MaropitantExamine: BAR, very stressedRE WNLChest ausc - no murmurFP S/SIVC in place without extension lineTreatment:Sedated for venipuncture:Butorphanol 0.2 mg/kg + Midazolam 0.2mg/kg IVAlfaxan to effect IVLaboratory: PCV/TP: 30/62CBC: Eos 0.08 lowChem15: all WNLVenous blood gas revealed pH: 7.421, PvCO2: 30.2mmHg, PvO2: 48.1mmHg, ScvO2 : 78.6%, Na: 155mmol/l, K: 3.2mmol/l, Cl: 124mmol/l, Ca: 1.24mmol/l, HCO3-: 20.8mmol/l, BEecf: -4.8mmol/l, AnionGap: 14.4mmol/l, Glu: 4.7mmol/l, Lac: 0.6mmol/Current problems:Acute vomitingAssessment:Bloods unremarkable. Primary GI more likely.Client Discussions: Recommended blood tests in case of extra GI cause.Keen for SpAUS tomorrow.Financial update + Estimate:$1500-$2000 for overnight hospitalisation, supportive care, baseline bloods, +/- point-of-care ultrasoundPlan:IVFT Hartmanns @ maintenanceBuprenorphine 0.02mg/kg IV q8hGabapentin 20mg/kg PO q12h for anxiolysisRemove food at midnightSpAUS tomorrow    Vital Signs    Weight: 3.9;       MMColour: pink;       Temperature: 38.1;       HeartRate: 180;       RespirationRate: 24;       CRT: < 2s;       

Reason: V+ 4 X And Something Abnormal In XraysAppointment Notes: ref from 4 pawsRQHistory: Night 1 hospitalisation for investigation and management of vomitingExamine: BAREating food offered to him - ravenousGrowling when touchedMM pinkObjective: RR 32BT 38.1HR 180Subjective: Urination 0/4Defecation 0/4Drinking n/oEating 2/4Assessment: StableEatingNo further vomitingTreatment: Hartmann's 10ml/hBuprenorphine 0.02mg/kg IV @ 11pm. 7am dose held as IVC out.Plan: As previous    Vital Signs