C09980978 / invoice 10000

Reason: L3 - Breathing Difficulty (ACCWA Patient)Appointment Notes: Overdue remindersCardiopulmonary resuscitation was performed on the patient.Cardiac compressions were started at 100 compressions per minute, in lateral recumbency.An endotracheal tube was placed in the trachea and manual ventilation was commenced using 100% oxygen at a rate of 10 breaths per minute.CPR was performed in 2 minute cycles, between cycles the patient was reassessed for signs of return of spontaneous circulation but with minimal delay between restarting compressions.An IV catheter was placed to gain venous access and to administer medications.Drugs administered Adrenalin at 0.01mg/kg IV and Atropine 0.04mg/kg IV were administered down the endotracheal tube and then later intravenously every 4 minutes.An ECG was performed to assess the electrical activity of the heart and a Doppler ultrasound probe was placed on the cornea to help determine efficacy of cardiac compressions.    Vital Signs    

Reason: L3 - Breathing Difficulty (ACCWA Patient)Appointment Notes: Overdue remindersHISTORY: Jelly presented for possible respiratory difficulty with raspy breathing noted earlier today (CCR reported loud/stertorous breathing when rang earlier but not observed once in clinic). Relevant History:- Diagnosed with large B-cell lymphoma stage 3-4 in May 2025- Completed 16 rounds of therapy followed by two additional rounds of Doxorubicin- Poor response to Doxorubicin with persistent lymph node enlargement- Recent neutropenia requiring treatment change to L-Asparaginase (seen for pyrexia and neutropenia at PVE 2 weeks ago)- First L-asparaginase dose administered 19/02/2026 (assessed by ACCWA)- Due for possible Lomustine dose with ACCWA appointment scheduled ThursdayCurrent problem:- Noted to be limping on Friday (resolved today)- Initially lethargic this afternoon, went for a walk and afterwards seemed to be breathing with increased noise and effort - Raspy breathing noted after medication administration with dip, initially thought maybe related to administration method?- Received increased steroid dose today (1.5 tablets instead of usual 1) plus 1.5 Panadol tablets - seemed to imrpove after this- Normal appetite, noted to have polyuria/polydipsia on steroids but no change today - Normal defecation earlier followed by increased urgency without production - possibly early diarrhoea- Pre-existing conditions: Large B-cell lymphoma stage 3-4, recent neutropenia (Resolved as per last bloodwork)- Access to toxins: No known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavenged- Current vaccination status: not discussed- Current medications: Prednisolone 25mg daily (increased to 1.5 tablets today), Paracetamol as needed*Moderately stressed in clinic today, normally has gaba/traz prior to visits but has not had today TRIAGE:- HR: initially 108-116 bpm (settled to 80-88 bpm once in consult room)- Temp: 38.4°C- Mm: Pink and moist- Crt: 1.5 seconds- Mentation: QAR- Hydration status (%): Hydrated- SPO2 not toleratedEXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronous - initial tachycardia on presentation, resolved once settledRespiratory: Panting with mouth closed (RR ~28-32 breaths/min), intermittent mildly increased inspiratory effort (more obvious when laying down), no increased broncho-vesicular sounds in any quadrant, no audible crackles or increased upper respiratory noise. Neurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performedMusculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: NSF- Abdominal: NSF comfortable on palpation, normal gut sounds- Rectal: Blood-tinged mucoid diarrhoea noted on thermometer, rectal examination not toleratedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: Right submandibular lymph node markedly enlarged, left submandibular lymph node enlarged but less than right, pre-scapular, popliteal and inguinal lymph nodes normal on palpationEyes: NSFDIAGNOSTICS: Nil performedPROBLEM LIST:1. Large B-cell lymphoma stage 3-4 - currently managed by ACCWA, most recent treatment 1.5 weeks ago L-asparaginase 2. Increased RR/pant (28-32 in clinic), mild increased respiratory effort intermittently3. Blood-tinged mucoid diarrhoeaDIFFERENTIAL DIAGNOSIS: 1. Partial response to most recent treatment - due for reevalutation with ACCWA next week & likely next course of treatment 2. Steroid-induced +/- related to increased physical acitivity today vs mediastinal lymphadenopathy (+/- other sternal or upper airway lymph nodes) causing respiratory compromise vs other progression of disease resulting in pleural effusion, other - owner reports improved compared to when first noted3. Medication side effect vs dietary indiscretion vs other ASSESSMENT: Jelly presented for evaluation of raspy breathing noted earlier today. Currently stable on examination with normal temperature and no obvious respiratory distress. Jelly has been noted to have intermittently mildly increaed respiratory effort but is taking treats and eating well during consultation. Unfortunately we were unable to obtain pulse oximetry due to patient intolerance but Jelly does not appear to be oxygen dependent. Her asymmetric submandibular lymphadenopathy is consistent with known lymphoma. She also was noted to have blood-tinged mucoid diarrhoea during temperature assessment, but did not tolerate rectal examination. Discussed potential for mediastinal lymphadenopathy contributing to respiratory signs which would require imaging for evaluation. TFAST could identify pleural effusion, some lung changes, heart disease, possibly large massess, but may not detect internal thoracic lymphadenopathy depending on the severity (Radiographs could provide some insight but CT would likely be modality of choice). Owners declined bloodwork +/- further diagnostic testing +/- hospitalisation at this time given improvement and current stable condition.TREATMENT: Continue prednisolone and paracetamol as previously directed by ACCWA, Pro-kolin 5-6ml BID (Already have at home)PLAN:- Monitor for worsening respiratory signs including louder breathing, panting with open-mouth (has been closed mouth only in clinic), or any other concerns- Keep cool and indoors, limit exercise as seemed to be predisposing factor today - Return immediately if appetite decreases or respiratory signs worsen- Consider tFAST + chest radiographs (or CT imaging if able) if respiratory signs progress- Recheck with ACCWA as soon as possible (available Tuesday after public holiday)- Continue current medications as directedDISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide your pet’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today. Treatment summary: Jelly presented for panting and increased respiratory noise this evening. On examination she was found to be panting but with no audible crackles or harsh lung sounds. She was also found to have diarrhoea with some blood-tinged mucus coming through. She was eating well in consultation and her temperature was normal. Jelly is to follow up with ACCWA on Tuesday, and re-present to PVE if any changes or concerns for bloodwork and imaging of her chest. Exercise:- Please follow the instruction of your veterinarian with regards to reintroduction of exercise.- If no specific instructions have been provided please keep your pet rested for the next 3 days then gradually reintroduce normal activity.Diet:- If your pet has suffered any gastrointestinal upset (vomiting or diarrhoea) please feed your pet bland food with no access to high fat foods or scraps. We recommend either a low fat commercial diet or boiled, skinless chicken with rice. Continue this diet for 3 days and then slowly reintroduce normal food. Recheck:- Please organise a recheck for your pet with ACCWA as soon as possible.Medications at discharge:Please continue your current medications as directed by ACCWA. Pleae give pro kolin 5-6ml TWICE daily.If your pet’s condition is not improving or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call Perth Vet Emergency.  We are open from 6pm until 8am Monday to Friday and 24h over weekends and public holidays. Phone 1300 040 400    Vital Signs    

    Vital Signs