C09978208 / invoice 10000

Reason: EBSECore nurse: ZNShift time: 2100-0500Pet ICU outstanding at 0500:Pet ICU ongoing 24 hour estimate: Was a financial update given?: Billing notes:    Vital Signs    

Reason: EBSECore nurse: MS for HONShift time: 1300 - 2100 Billing notes used left over midaz to share with another patientCURRENT DIAGNOSIS +/- PROBLEM LIST:- Eastern brown snake envenomation (SVDK positive)- Neuromuscular paralysis (non-ambulatory)- Dyspnoea/Hypoxaemia (oxygen dependent, weaned off as of 4pm)- Urinary tract infection- Weak gag reflexCLINICAL ASSESSMENT:Condition has improved. Was previously considered for euthanasia due to severity, but is now doing okay. Remains non-ambulatory but can lift her head and wag her tail. A palpebral reflex is present, but the gag reflex remains weak. She self-removed her nasal prongs at 4 PM and has been stable off oxygen since. Respiratory rate at 6 PM was 20 breaths per minute with mild effort. When asleep, respiratory rate is approximately 20, with a slight abdominal component. Lung auscultation reveals dull sounds on the left and slightly increased sounds on the right. Heart rate is 58 bpm, systolic blood pressure 123 mmHg, and SpO2 is 100% on room air.Has been salivating, with some brown staining on the bedding. The bladder was noted to be large and soft but could not be manually expressed. Following administration of midazolam, she voided a large volume of strong-smelling urine. Food has not yet been offered.DIAGNOSTICS:Chest radiographs, Performed by ICU - Left-sided changes noted.Urinalysis, Performed by ICU - Dipstick: leukocytes 1+, pH 6, protein 1+, blood 4+, USG 1.024. Stained sediment examination: copious rod bacteria present.Blood gas, Performed by ICU - Capillary sample, CO2 was 41. A previous gas last night was normal.PROCEDURES:An attempt to place a urinary catheter overnight was unsuccessful; no clipping or prepping was performed.Eyes stained yesterday - negative.TREATMENT:Continues on Hartmann's fluids at 68 ml/hr. Will continue to monitor gag reflex overnight and in the morning. Will monitor for any signs of respiratory deterioration, though she is currently stable. A urinalysis will be performed on the voided sample due to its odour. Based on results, she will be started on antibiotics overnight.Medications:Dexmedetomidine, 0.75 ug/kg/hr, IV CRIMaropitant, 1 mg/kg, IV, q24hMidazolam, 0.2 mg/kg, IV, onceTo start Amoxyclav 25mg/kg IVPENDING DIAGNOSTICS:Nil.CONTINGENCIES:- A DNR (Do Not Resuscitate) order is in place.- Wean sedation if able, consider trazadone 5mg/kg rectally as an option.FINANCIAL PLAN AND CONSENTS COMPLETED:The owners have an insurance limit of $20,000 but have expressed a wish to limit spending. They have been updated on her progress. A bill update has been provided and consent for treatment is on file.PERTINENT OWNER UPDATES:- The owner was updated at 7 PM. They were advised that Sailor has been breathing well off oxygen for the last few hours. They understand that if there are any concerns overnight, they will be contacted; otherwise, the next update will be in the morning. I have advised the owner that we will likely perform a urinalysis and may need to start antibiotics based on the results. There was discussion last night regarding the humane aspects of continuing treatment without mechanical ventilation, which the owners declined due to cost. They understand that recovery can take several days. A DNR resuscitation code is in place, and they are aware humane euthanasia may be required if she deteriorates.    Vital Signs    

Reason: EBSEAppointment Notes: Special payment terms exist, Overdue remindersCore nurse: BDShift time: 0500-1300Billing notes: Billed from 0900- AES transferPet ICU outstanding at 0500:Pet ICU ongoing 24 hour estimate: Was a financial update given?: --- 02/03/2026 07:27:40 KN3:Updated Brad when he calledSailor is still O2 dependent, ventilating ok, keeping quiet with mild sedativesWere unable to pass u-cath without heavy sedation and didn't want to destabilise her so currently getting manual bladder expression with mild sedation and tolerating it wellCurrent outstanding amount $960 with AES, E$2.5-3.5k/24h ongoing and will send through consent forms later this morning, AES will need them to fix up bilHe asked us to send to his email (Brad) as Tahnee is at work, confirmed both email addressesWill send photos, discouraged from visiting due to excitement until she is improved, he just wants whats best for herEncouraged with status so far, will call immediately if deteriorates, next update later today all being wellVenous Blood GasFindings:    Vital Signs