C09984004 / invoice 10000

Reason: GDVCore nurse: ATShift time: 0500-1300ICU hospitalisation day: 6Brief history:Nala remains hospitalised for management of ventricular tachyarrhythmias (improved) and aspiration injury (improving) post-GDV surgery. She is in season.02/03/2026PCV/TP - PCV 39%, TP 46 g/L, clear serum.Blood Gas - pH 7.46, PCO2 28, BE -3.9, AG 11, Na 142, K 3.8, Cl 115, iCa 1.27, HCT 33, BG 5.7, lactate 1.3. Mild respiratory alkalosis with a mild concurrent metabolic acidosis.Overnight update:Nala had a stable night. She has been intermittently eating small amounts of chicken, rice and boiled egg brought in by the owner. Urinating small volumes regularly. Oxygen supplementation was discontinued earlier this morning. Temperature 39.3C at 10pm. Oxygen saturations have been 89-95% off oxygen. She has a normal respiratory rate but mildly increased effort. She was transitioned to oral medications. Potassium supplementation was discontinued.Clinical assessment:Mentation: QAR, laterally to sternally recumbent.Hydration status: Normal skin turgor.Cardiovascular: Regular heart rate and rhythm, murmur auscultated. Strong, synchronous dorsal pedal pulses. Pink, moist mucous membranes, CRT 1 second.Respiratory: Mildly increased respiratory rate and effort. Normal bronchovesicular sounds bilaterally.Urogenital: Vulva is oedematous, but has reduced since yestereday. Haemorrhagic discharge is ongoing. Neuromuscular: Normal mentation and gait. Ocular: No ocular discharge.Nasal: No nasal discharge.Lymphatic: Peripheral lymph nodes unremarkable.Rectal examination: Not performed. Integument: Bandage removed from coeliotomy site. It is clean and dry with one small area of skin eversion.Indwelling lines: Left cephalic intravenous catheter palpably within normal limits. Left nasal oxygen line in situ (not in use).Diagnostics:NilTreatments:Fluid therapy: Hartmann's at 79 ml/hMedications:Sotalol 2.2 mg/kg PO q12h.Maropitant 1 mg/kg IV q24h.Enrofloxacin 12.9 mg/kg PO q24h (consider de-escalation as day 5). Amoxicillin-clavulanic acid 21.5 mg/kg PO q12h.Plan:Reduce fluids to sub-maintenance rates provided she continues to eat well and her breathing improves.Discharge is an option for this evening or tomorrow.Communication:The owner is reluctant for her to be discharged until her breathing has normalised. She lives 30 minutes from an emergency hospital. Owners will visit at 19:30 this evening to decide whether to take her home or keep her in overnight.--- 03/03/2026 07:52:57 KN3:Updated MeganNala eating intermittentlyBreathing improved overall, trialling off O2She will visit shortlyUpdated Megan in personOff O2, still mildly tachypnoeic, markedly improved overallAte well for herShe'll visit again this evening (~7.45), they'll consider taking her home if significantly better otherwise 30min from emergency care and would rather leave her longer if any  concernsPaid additional deposit to cover gap over next 24h.    Vital Signs    

DISCHARGE NOTESASSESSMENT:Gastric Dilation-Volvulus (GDV)GDV refers to a life-threatening condition where the stomach expands with gas and twists, causing an obstruction. This condition is often associated with your pet eating a meal, followed by strenuous exercise. This is most likely to occur in large, deep chested breeds such as German shepherds, Great danes and Standard poodles. Clinical signs will include restlessness, increased breathing rate, drooling, retching or vomiting. They will also have a painful belly, which you may notice slowly enlarge and they may also collapse. This condition requires immediate stabilisation to treat the shock which includes rehydration with intravenous fluids, decompression of the stomach and pain relief, followed by surgery as soon as possible. The surgery will untwist the stomach and the stomach will be attached to the body wall to minimise recurrence. Sometimes the spleen’s blood flow can be affected and it may also need to be removed. Once through surgery your pet will spend several days in hospital recovering until they are able to go home. Prognosis is dependent on several factors, however if treatment is sought promptly and surgery is uncomplicated 80% of dogs can make it home.      Aspiration PneumoniaAspiration pneumonia is a condition where your pet has inhaled stomach contents into their lungs. This causes significant inflammation and infection on the lungs. Due to the inflammation, excessive fluid and mucous accumulates within the lower airway and causes difficulty breathing. Dogs that have developed aspiration pneumonia will likely have a history of either recent surgery, vomiting, underlying medical condition such as tick paralysis or neurological problems. Clinical signs will include breathing difficulty, swallowing difficulty, coughing, high temperature, discharge from nostrils and once more advanced bluish tinge to gums, rapid breathing and exercise intolerance. Aspiration pneumonia can quickly become a life-threatening condition. Aggressive supportive treatment is essential and this includes oxygen support, intravenous antibiotics, intravenous fluid therapy and symptomatic treatment. If the disease progresses and your pet is unable to maintain appropriate breathing on their own, life support may be needed to assist your pet whilst the lungs are able to heal. This involves placing your pet under anaesthetic and having a machine breath for them. Your pet will kept asleep until their lung function improves, at which time they will be slowly woken up off the anaesthetic. Prognosis is greatly varied and depends on severity on presentation, response to treatment and amount of lung tissue involved.  DIAGNOSTICS AND MANAGEMENT:PCV/TP and blood gas to assess acid-base and electrolyte status and guide fluid therapy Complete Blood CountBiochemical analysis to assess organ functionDecompression of the stomach Radiographs to diagnose GDV and monitor aspiration pneumoniaStabilisation prior to surgery General anaesthetic to repair stomach Intravenous fluid therapy AnalgesiaSPECIFIC HOME CARE INSTRUCTIONSPost Surgery Instructions:1. No running, jumping, playing or strenuous activity for 10 days until the sutures have been removed 2. Ensure your pet does not lick at the surgical site; an Elizabethan collar may be needed to ensure they can’t get to their sutures3. Keep your pet indoors and short lead walks to the toilet only 4. Keep your pet dry and as clean as possible for 10 days after surgery – this includes no baths, swimming or rolling on wet grass.  Exercise:In order to facilitate your pets recovery, strict confinement is recommended until the stitches are removed. This includes no running, no stairs, no jumping and lead walks to the toilet. It will likely take some time for your pet to return to their normal activity levels. Walks should be slowly introduced and gradually increased once your pet is feeling better. Diet:To decrease the likelihood of further aspiration, feed chunks of cooked meat or tinned food shaped into meatballs, meals should be fed more often rather than larger meals once a day. This helps the passage down the throat and decreases the likelihood of ending up in the lungs. Medications:Enrofloxacin 150mg - AntibioticGive 3 tablets ONCE daily - due at nightAmoxyclav 500mg - AntibioticGive ONE and HALF tablets TWICE dailySotalol 80mg - Heart medicationGive ONE tablet TWICE dailyRecheck ECG in two weeks before discontinuing medicationTrazodone 100mgGive TWO tablets every 8-12 hours for sedation/anxiety - May not be needed once at home.What to look for at home:1. Check the surgical site twice daily – look for any redness discharge or opening of the site. If any of these are noted or your pet is lethargic, inappetant or otherwise unwell re-check with Animal Emergency Services or your regular veterinarian as soon as possible. 2. Re-check with your regular veterinarian in 3 days to track progress. 3. Sutures out with your regular veterinarian in 7 days.  4. Recheck ECG in two weeks before discontinuing Sotalol medicationIf your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital. Thank you for trusting Pet ICU with the care of Nala.    Vital Signs    

Reason: GDVCore nurse: EDShift time: 1300-1800Billing notes: nilCURRENT DIAGNOSIS +/- PROBLEM LIST:Post-operative Gastric Dilatation-Volvulus (GDV)Aspiration pneumonia (left lung) - resolvedPost-operative cardiac arrhythmias - resolvingOestrusCLINICAL ASSESSMENT:Nala is bright, alert, and responsive. She remains off oxygen and is stable, with an SpO2 of 100%. She is eating well, consuming chicken, chicken SBD, and her own food. No regurgitation or vomiting has been observed. She tires easily upon returning from walks but is otherwise stable and comfortable at rest.Urinary continence has improved; she is no longer overflowing and is able to hold her urine, urinating on walks. The surgical wounds are being tolerated well. She remains in oestrus, with a reported increase in bleeding, although her vulva appears less oedematous. The owner noted her oestrus cycle began approximately two weeks ago and that her seasons are typically prolonged. Temperature was 39.3°C last night.TREATMENT:Nala was weaned off oxygen supplementation as of 03:00 this morning. She is no longer receiving potassium supplementation. She is stable and comfortable. The plan is for discharge this evening. Discharge medications have been prepared and explained to the owner.Medications:Sotalol, OralMaropitant, IVEnrofloxacin, OralAmoxicillin/clavulanic acid, OralPENDING DIAGNOSTICS:ECG monitoring to be performed in two weeks, prior to considering weaning sotalol.FINANCIAL PLAN AND CONSENTS COMPLETED:The owner has settled the outstanding balance. Additional funds were added to the account, and insurance benefits are being applied.PERTINENT OWNER UPDATES:- The owner was contacted at 16:00 on 03/03/2026 to discuss Nala's progress. The owner is keen to take Nala home this evening and will collect her between 17:30 and 18:00 for discharge.- The owner's main concern had been the 30-minute distance to the nearest emergency facility, but she is now comfortable with discharge given Nala's stability.- Discharge instructions and medications have been discussed with the owner. A follow-up appointment in two weeks for ECG monitoring before weaning sotalol has been arranged. The owner expressed sincere gratitude for the care provided to Nala.    Vital Signs