C10010992 / invoice 10000

Reason:  UnwellSubjective: Walk-inComplex caseIncreased vomiting over the last 4-5 daysWas OK and playing yesterday with another dogWoke up this AM very lethargic, no energy, shiveringLaboured breathingVomited overnight, seems congestedIs a frequent vomiter, has an oesophageal disease and gets upright feeding and special care around eatingNo interest in food this morning, not interested in toiletingNo diarrhoea recently.O did give Billie liquified food last night - usually does not get this but was disinterested in food Examine:QAREyes NADEars NADOral; MMs pale pink CRT <2sLNNs WNLCardiac: HR 80, no murmursResp: increased abdominal respiratory effort and rate. Rattling/crackling lung sounds esp on R on auscult. SPO2 93% on room airAbdomen NADInteg NADMSK NETemp 38.2Assessment: Has CMT neuropathy - laryngeal paralysis and oesophageal disease, high risk of aspiration pneumoniaPlan: Got O consent for stat chest X-rays X Ray: Lateral R and V/D views of chest taken - no overt consolidation or pleural diseasePlan: Still not 100% sure what's happening with Billie - aspiration pneumonia is of concern given her history but without fever or lung consolidation can't be surePropose we admit Billie, keep her comfy on oxygen and run bloods while waiting until DE can do a TFAST to rule out pneumoniaO happy with plan.Treatment: Placed in ICU with ecollar set up for oxygen - not tolerating nasal prongs or maskLaboratory: Bloods: NSF inhouse, mild hyperglycaemia and borderline anaemia, WBCs WNLTFAST:- nil pleural or pericardial effusion- numerous B-lines (>10) observed both hemithoraxes particularly mid to cranial chest- +ve glide sign bilateral- LA/Ao ratio <1.5 and LA does not appear dilatedAssessment: TFAST consistent with aspiration pneumonia - likely an early caseContact by Phone: Spoke to O - have sent off bloods for CRP and to check on other parameters esp white cell countConcern for Billie is how she will progress - aspiration pneumonia can get worse before it improvesStart Billie on IV ABx and fluids, and continue O2 therapyRecommend transfer to AEC this evening for ongoing monitoring and care as concern for sudden crash for Billie's caseLonger term might be worth reviewing with specialist to discuss prevention but let's get Billie past this for nowAEC has advised $2500-2800 for 12h overnight depending on need for TFASTs and oxygen; 1500-2000 for subs 12 hours depending on if we transfer or notO happy with plan for now; discharge to transfer at 1645Treatment: Amoxil 20mg/kg IV at 1100Fluids at 20ml/h (maintenance)SPO2 around 90% on room air so keep on O2Laboratory: CRP 21 - moderate elevation consistent with inflammationLipase and amylase elevated - potentially mild gastro concurrent but is not consistent with resp signsMild anaemia and lack of inflammation confirmedDBA SM: SPO2 98% on room air and reasonably comfortable Transfer to AEC for overnight monitoring recommended    Vital Signs    Weight: 7.2;