C10014320 / invoice 10000

11/03/2026 History:
- Acute onset haemoptysis this morning, approximately 30-40 minutes prior to presentation
- Three coughing episodes with blood-tinged phlegm, largest episode first followed by two smaller episodes
- Coughing fit lasted approximately one minute total
- One small non-productive cough the night prior
- No vomiting or diarrhoea
- No change in behaviour or energy levels
- No known access to toxins, rat bait, or caustic substances
- History of kennel cough twice last year, presented with persistent coughing and white foam at that time

Physical Exam Findings:
- Temp: Afebrile
- Mentation: Bright, alert
- Behaviour: Normal, swallowing appropriately
- Respiratory: Upper airway discomfort on palpation, cough response elicited with upper airway pressure, lower airway non-reactive, lung sounds clear bilaterally

Assessment:
- Problem list:
1. Upper airway irritation with haemoptysis

Plan:
- Day admission for imaging and blood work
- Three-view neck/airway x-rays under mild sedation
- Red blood cell count panel to assess for clotting abnormalities and infection
- Anti-inflammatory medication to be commenced pending results
- If no improvement or worsening, further workup including upper airway scope to be considered

Communications:
- Discussed differentials including foreign body, mucosal irritation from ingested substance, or toxin exposure
- Discussed that persistent coughing would be more suggestive of foreign body, which is less likely given current presentation
- Discussed insurance gap payment process with Medibank, can submit claim on the spot or pre-approval prior to pick up
- Will contact owner if any abnormalities identified on imaging or blood work


Admit:
CBC - on machine platelets a bit low but blood smear adequate platelets 
Chem -
Amylase 1,753 (500 - 1,500 U/L)
Lipase 5,094 (200 - 1,800 U/L)
Total T4 55 (13 - 51 nmol/L)

Upper airway exam - mucosa normal in upper airway
X3 view chest rads taken - lungs look okay, no FB noted


Plan:
Paracetamol for inflam
If not doing consider upper airway scope