C10017305 / invoice 20000

Reason: Vomiting/Rule Out GIFBORecord is In/CompleteSupervisor: Dr Ainsley SuttonReason: Vomiting and inappetanceHospital Day: 2ICU DAYTIME SOAP day shiftExamination: Subjective: QAR, with mild painful abdomen that is diffusely tense on palpation. Has eaten overnight and kept down his food.Passed 7-8 dense faecal nuggets on his morning walk, and had one regurgitation. He has not had anymore vomits. His ptyalism has continued since last night, including when due for buprenorphine.Objective: Temperature: 38.6CVS: MMs pink, CRT 2 sec. HR 110, no murmur or arrhythmia auscultated.Respiratory: RR panting with normal effort, normal b/v sounds bilaterally.Abdomen: eating chicken, tense on palpation, can palpate deeply, two small regurgitations containing bile and one piece of chicken, Passed 7-8 dense faecal nuggets on his morning walk, no diarrhoeaGenito-Urinary: NSF, urination +++, grossly yellow in appearanceM/Skeletal: NSF, ambulatory, no lameness, no crepitus or palpable lesionsNeurological: NSF, normal mentation,  ambulatory x4, no ataxia or paresis, full neuro exam not performed Eyes/Ears: NSFIntegument: No diarrhoea smears, sebaceous adenoma cyst on caudal dorsumLN's: WNLBWT: 13.2 kgNutrition: boiled chicken -> ate well this morning however reduced appetite in afternoonFluid therapy: LRS @ maintenance - 40 mL/kg/hr, discontinued @1300 as euhydratedAFAST:Small amount of hyperechoic material in stomach, stomach otherwise small and fluid filled. Rescanned and hyperechoic material was no longer present in stomach,No FFAssessment: Ptyalism and regurgitation ddx: oesophagitis vs mild ileus vs pancreatitis vs iatrogenic/drug-inducedPainful abdomen ddx: primary GIT (dietary indiscretion - bone ingestion, intermittent pyloric outflow obstruction less likely) vs extra GIT (pancreatitis) vs behavioural (nervous demeanour in hospital)Treatment:Buprenorphine: 0.02 mg/kg IV q 8 hr as requiredOndansetron: 0.58 mg/kg (8mg) TM q 8 hr Metoclopramide: 0.5 mg/kg IV q 8 hr Maropitant: 1 mg/kg IV q 24 hrLRS discontinued  @1300Plan: Continue to treat with supportive care and monitor in hospital. If keeping food down and nausea improved, then discharge this PM with anti-nausea medication.Reassessment:Demeanour: BARMM: pinkCRT: 2 secHR: 96RR: 24, normal effortAbdominal pain has resolved. Ptyalism has reduced. Ate some boiled chicken pieces this morning.Alfie continues to have no vomits, however, did regurgitate one small piece of chicken on his afternoon walk.Plan:To discharge this PM with supportive care for home trial. O to monitor for regurgitation. If regurgitation does not improve, or if Alfie begins vomiting or not eating again, then further investigation with imaging may be required (abdominal ultrasound +/- gastroscopy).Medication to go home with:Ondansetron: 0.58 mg/kg (8mg) TM q 8 hr for 3 daysMetoclopramide: 0.36 mg/kg (5mg) PO q 8 hr for 3 daysClient Communication: Update 1 (start of shift)- Vet Name: KHX- Client Name: Simon- Time: 10:45 am- Medical update: Patient is stable. Defaecated faecal balls containing bone material that were seen on rads. Ate overnight, but not this AM. No vomits since admission, however did regurgitate on walk this AM. Hypersalivation has continued from last night - added extra anti-nausea to help control this. Plan to discharge tonight if he can eat, keep food down, and hypersalivation reduces.Update 2 (end of shift)- Vet Name: KHX- Client Name: Simon- Time: 3:30 pm- Medical update: Patient has improved. Did eat chicken this morning. Hypersalivation has reduced, and no longer uncomfortable in the abdomen. Did have one regurgitation (small piece of chicken) on his afternoon walk. Ongoing regurgitation may be due to oesophagitis associated with vomiting, small degree of ileus, or unlikely, a stomach outflow obstruction. Added another medication that acts as anti-nausea and prokinetic to assist with this. Happy to discharge this afternoon for home trial - anti-nausea medications and monitoring of regurgitation. If regurgitation does not improve, vomiting returns, or he becomes inappetant again, then an abdominal ultrasound may be required for further investigation. O happy with this plan.Daily update emailed to referring vet : YES. Time:    Vital Signs    Weight: 13.7;       

Reason: Vomiting/Rule Out GIFBORecord is CompleteReason: Hospital day: 1ICU SOAP per 12 hours (overnight shift)Examination: Subjective: QAR, mildly tense and painful in abdomen.Eaten shortly after handover (6hrs prior to repeat rad (was charted before approved and signed)).Subjectively less painful through the nightDeveloped hypersalivation early in AM (suspect secondary to buprenorphine and/or sedation, less likely primary GIT nausea.Objective: Temperature: T:39.1 (increased?)CVS: HR: 100bpm, no murmur, SSFP, MM pk, moist, CRT 2s.Respiratory: RR: panting, normal effort, normal BVS on ausc.Abdomen: Mild tense, not overtly painful, no nauseous signs elicited.Genito-Urinary: NSF, urination+M/Skeletal: NSF, no pain/crepitus/lameness appeciable.Neurological: NSFEyes/Ears: NSfIntegument: Clean coat, no D+LN's:  WNLNutrition: Fed 1/2 can GI (RC) ->eaten all happily.Fluid therapy: IVFT: completed rehydration 3% (95ml/hr) -> now at maintenance 40ml/hr.Repeat radiography:Adeqaute serosal detailBone fragments appear to have moved into colon. Ready to defecate.No gas pattern appreciable.Food in stomach (fed earlier) - normal gastric axis.Bladder moderate sizeAll other organs (spleen, liver, kidneys, MSK, skeletal structure) appear as normal.Caudal aspects of lung fields appear as normalAssessment: Acute vomiting, inappetanceNo evident foreign body obstruction on repeat radiography.Ptyalism (ongoing/re-commenced): iatrogenic/drug induced vs primary GIT vs other (ie pancreas)Feces in rectum with bone fragments.Plan:Ongoing supportive careConsider enema/lubricant flushConsider repeat rads if ongoing nausea (vs aUS)    Vital Signs    Weight: 13.7;