C10016740 / invoice 10000

Rm#2 - Cons: Attacked by Kelpie dog around 3.45pm. Puncture wounds around neck. C.O 
was out for walks on lead
kelpie ran out of house and bit Dex on 
scratched O 
no current meds

HISTORY:
Seen at Greencross vets earlier today and advised to come here for urgent bloods and hospitalisation 
Softer stools this morning around 5am , then was fine
Started to V+ an hr  5 times. First one was water, then brown and last one was blood
Around lunch time was laying down and not wanting to walk
No change in diet.
Last night dropped some onion. Can eat anything from the floor. This morning gave dental tx and ate it and did not V+ it up. Ate a little bit of kibble this morning.
Seems quite bright but shaking the car, panting.
Drinking a little bit of water.
No other concerns at home. DUDE NAD. Diet: dry and wet pm. worm/flea: UTD , NGS
2 days ago. TW UTD
Still eating today 
Known scavenger, will eat things in garden 
No rat bait on property 
O showed photo of D+ - very liquid bloody tinged fluid with fleshy looking material 

EXAM:
Very BAR, walking around consult, curious, barking 
HR 100, RR 20
Chest clear
MMs pink, 1-2 secs
Abdo soft and comfortable on palpation
Temp 38.0. Blood tinged faeces on thermometer 
Hydration normal 

BLOODS:
Mild haemoconcetration 
Rest of results NSF

ASSESSMENT:
Hemorrhagic diarrhea
Vomiting 

PLAN:
Currently clinically stable and eating/drinking normally 
Options discussed with O:
1. Manage as outpatient with anti nausea, prokolin and paracetamol 
2. Further diagnostics before making decision - abdo x-rays/ultrasound as outpatient
3. Admit for monitoring and start supportive care if deteriorating throughout the night  
All options equally good but have different disadvantages. Extra stress from hospilisation may lead to inappetance and worsening of signs. 
O elected to take home at this stage but will bring back if get worse overnight - for example, stops eating, hemorrhagic D+ worsens, vomiting continues etc. 
Feed bland food - chicken and rice 

MEDICATION:
Maropitant 1mg/kg SC 
Paracetamol 0.25 tablet BID
Prokolin 3ml PO BID