C10012626 / invoice 10000

Reason: Has Been Vomiting For Last WeelAppointment Notes: potentially eaten corn cob-   vomiting on/off for past weekConsultation Time:History: Seen by RTSubjective: Hugo is a 4y4m MN Spoodle presents to the hospital for intermittent vomitingVomiting once every second day about a week ago. Vomitant includes bile initially but noticed a small piece black corn cob 3 days ago and another 2 more yesterday/this morning. O had corn last week but he is quite sure Hugo did not get to it.Appetite is still completely normal. No change in diet. No diarrhea.No change in energy level.O reported that he will have neighbour walking his dog once a week and sometimes there are food waste in the park. Always a scavengerDiet: 50% kibble and 50% Lyka.UTD with parasite prevention - O unsure brand but is a spot on productStarted Zenrelia 1.5mo ago for allergic skin and O reports working wellObjective: Temp 37.9           MM P&M             CRT <2s            HR 124            FP Strong and syncCardio:  No murmur, normal intensity and rhythm. Regularly regular rhythm. Resp: Normal breathing effort. No crackle and wheeze. No BV sound.Abdominal palpation: Soft and pliable Urogenital: clean and no discharge. Integument: Adequate coat quality, clear skin with no obvious abrasion or pruritis. Normal skin turgor.Lymph node: LNs normal in size.MSK: Ambulating comfortably with WBx4.Nervous system: Normal mentationLaboratory:PCV/TP: Blood gas:PH: 7.491 HPCO2: 28.8 LPO2: 50.2 :Lac: 2.1 HUnremarkable otherwiseProblem List:Intermittent vomitingMild hyperlactemiaAssessment: Intermittent vomiting can be caused by numerous causes including GI - dietary vs obstruction vs inflammation vs ulcer vs neoplasia) vs extra GI (inflammatory - pancreatitis, hepatic, peritonitis), metabolic, toxin, drug etcsGiven Hugo presentation, gastric FB is still on the differential list but unable to rule out other dietary related/inflammatory/metabolic etcs cause without further diagnosisOption recommended to O1. Admit for full work up - blood and abdominal U/S2. Admit for blood and abdominal radiograph but advised limitation of xray3. Since Hugo is CV stable, start with blood and manage as out-patient, follow up with RV and revisit tomorrow morning if unable to facilitate imaging with RV. Advised may not be able to perform U/S or radiograph depends on the day.4. Follow up with RVO elected option 3 Treatment:NilPlan:Ring O with blood result and revisit tomorrow morning if still concern or unable to facilitate abdominal U/SRevisit earlier if noticed further vomiting, or any CV signs.    Vital Signs    Weight: 11.3;