C09983945 / invoice 10000

Reason: EBSECore nurse: edShift time: 1300-2000Pet ICU outstanding at 0500:Pet ICU ongoing 24 hour estimate: Was a financial update given?: Billing notes:nilCURRENT DIAGNOSIS +/- PROBLEM LIST:- Eastern brown snake envenomation (SVDK positive)- Neuromuscular paralysis (improving, ambulatory for short distances)- Dyspnoea/Hypoxaemia (resolved, stable on room air)- Urinary tract infection (on treatment)- Weak gag reflex (resolved, gag present)- Mild regurgitationCLINICAL ASSESSMENT:Continues to improve this afternoon. Now able to walk a few steps unassisted but still tires very easily. Remains off oxygen and is breathing comfortably. Cannot hold a position to urinate independently and lies down to urinate, but has voided the bladder. A single small regurgitation was noted during eating around 6 p.m. Has eaten chicken and is drinking water.Objective findings are: respiratory rate 24 breaths per minute when asleep and 60 when awake. Lung sounds are clear but slightly dull on the right. Mucous membranes are pink and moist. Heart rate is 68 bpm. Blood pressure is 122 mmHg systolic. SpO2 is 96% on room air. Temperature is 38.7 degrees Celsius.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.PROCEDURES:Eyes stained yesterday - negative.Attempt to place a urinary catheter overnight was unsuccessful.TREATMENT:Currently maintained on Hartmann's fluids at 68 ml/hr.Plan is for discharge this evening around 7:30 p.m.Medications:Hartmanns, 68 ml/hr, IVDexmedetomidine, 0.75 ug/kg/hr, IV CRI (discontinued)Maropitant, 1 mg/kg, IV, q24hAmoxyclav, 25 mg/kg, IV (changed to oral)FINANCIAL PLAN AND CONSENTS COMPLETED:The owners have an insurance limit of $20,000 but have expressed a wish to limit spending. Consent for treatment is on file.PERTINENT OWNER UPDATES:- The owner was updated this afternoon at 4 p.m. Advised that Sailor remains quite weak and that it would be recommended for her to stay overnight again. The owner is keen for discharge and confirmed there will be people at home to look after Sailor for the next 24 to 48 hours. The owner will come for discharge at approximately 7:30 p.m. tonight. A DNR (Do Not Resuscitate) order remains in place.    Vital Signs    

Reason: EBSECore nurse: ATShift time: 0500-1300ICU hospitalisation day: 3Brief history:Presented for brown snake envenomation with severe respiratory compromise requiring oxygen therapy. Has been successfully weaned off oxygen. Was previously over-sedated but mobility has improved significantly after sedation was discontinued.Free catch urine last night: rods +++. Overnight update:Successfully weaned off oxygen therapy yesterday afternoon.Has been marginally tachypnoeic with mild increased effort overnight with normal SpO2s.Has been haemodynamically stable, afebrile, and increasingly mobile.Weight 29.5 kg.No regurgitation or vomiting overnight.Urinated a large volume at 6 pm last night, has not urinated overnight.No defecation overnight.NPO up until this morning.Clinical assessment:Mentation: Bright, alert, and responsive. Able to lift head and maintain a sitting posture.Hydration status: normal skin turgor, moist oral mucous membranes.Weight: 29.5 kg.Cardiovascular: Pink moist oral mucous membranes, CRT 1-2 seconds. Regular heart rate and rhythm, no murmur auscultated. Strong, synchronous dorsal pedal pulses. Warm extremities.Respiratory: Mildly increased respiratory effort but normal rate. Normal bronchovesicular sounds bilaterally. No nasal discharge.Gastrointestinal: Abdomen soft and pliable. Urogenital: Bladder moderate but soft. External genitalia unremarkable.Neuromuscular: Able to right, rise, and ambulate briefly, but stiffens and lies down. Moderate gag reflex. Palpebral reflexes intact. Improved ambulation, walked from scales to kennel without rest.Ocular: No ocular discharge.Lymphatic: Peripheral lymph nodes unremarkable.Indwelling lines: Right cephalic venous catheter patent and palpably within normal limits.Diagnostics:Cystocentesis performed this morning.QML urine C&S pending. Problem List:Brown snake envenomationUrine retentionBacteriuriaMild residual tachypnoeaAssessment:Sailor is recovering from brown snake envenomation. She is increasingly mobile. She still has some urine retention. She has evidence of bacteriuria. Suspect community acquired bacteriuria, presence of established infection unclear, elect to treat due to concurrent urine retention. She has mild residual tachypnoea and increased effort, but is breathing room air comfortably and improved overall.Prognosis - fair to good.Treatments:Fluid therapy: Hartmann's at 68 ml/h.Medications:Continue:Maropitant 1 mg/kg IV q24h PRN.Celluvisc OU q4h.Add:Amoxicillin clavulanic acid 400 mg/100 mg (16.9 mg/kg) PO q12h pending urine culture results.Nutrition: Offered a small meatball of SPD this morning, ate well. Offer food and water q4h. Plan:Plan to discharge this afternoon as per discharge instructions.--- 03/03/2026 06:29:53 KN3:LMOM for update on Sailor--- 03/03/2026 07:27:20 KN3:Brad returned callSailor is doing very wellOff sedativesModerate gag - ate a single meatball this morning with good coordinationDiscussed urine - smelly last night, looked at it in house, concerning for UTIGiven single dose a/bsLikely pre-existing/community acquired, unsure if urinary signs but currently has some urine retentionOffered cont a/bs without culture vs cysto & C&S (recommended), E~$250, he approves latter, discussed small risk of injury or vagal response, will give mild sedative and pain med for needle, will call if any complicationsAs long as still eats well throughout today will be able to go home this arvy, will get another update around lunch all being well    Vital Signs    

DISCHARGE INSTRUCTIONSCURRENT DIAGNOSIS +/- PROBLEM LIST:- Eastern brown snake envenomation (SVDK positive)- Neuromuscular paralysis (non-ambulatory) - improving- Dyspnoea/Hypoxaemia - no longer oxygen dependent- Bacteriuria (bacteria in the urinary tract) Sailor presented with severe paralysis affecting her limbs but also her respiratory muscles. She received antivenom and aggressive care, initially also requiring oxygen therapy, but has improved markedly in a short time in hospital. During hospitalisation she required manual bladder expression and her urine was noted to be smelly. In house urinalysis showed signs of a urinary tract infection. A urine sample has been submitted to an external laboratory for culture and susceptibility testing to ensure she receives the correct antibiotic. Sailor is ready to go home but will need special care at home as follows:1. Ensure access to fresh water at all times. 2. Sailor can be fed her usual food but will need close monitoring during feeding times for the next 2-3 days. If Sailor has difficulty swallowing, is hypersalivating, choking, regurgitating or vomiting please take food and water away and seek veterinary advice immediately. 3. Please monitor for signs of deterioration, such as: lethargy, decreased appetite, increased thirst and/or urination, vomiting or diarrhoea, or any other change that concerns you. 4. We expect that Sailor will take 1-2 weeks to return to her usual general strength level. We recommend that she be kept quiet for the next 3 weeks while she recovers. Please avoid walks, rough play or other exertion during this time. She is allowed brief leashed toilet walks multiple times a day.  4. We will call with the results of Sailor's pending urine test in 2-3 days time. Please call if you haven't heard from us with results by Friday. 5. Sailor doesn't need a recheck with her primary care veterinarian unless you have concerns about her recovery. Please call ahead to make an appointment. We are available out of hours and can be reached any time with questions or concerns. Medications:Amoxicillin/clavulanic acid 400mg/100mg tablets: Give one (1) tablet twice by mouth every 12 hours with food until finished. This is an antibiotic. Side effects include gastrointestinal upset. Giving with food helps. Next dose is due this evening with food. Sailor may be going home with a pressure wrap over where her IV catheter was removevd. Please remove it within 20 minutes of leaving the hospital. Thank you for trusting us with Sailor's care. She is a very sweet girl and we wish her a speedy continued recovery. Please don't hesitate to contact us with any questions or concerns. We are available 24 hours a day. Katie Nash BVSc MS DACVECC and the rest of the team at Pet ICU and Animal Emergency Services.    Vital Signs