C09985480 / invoice 10000

Reason: Allergic Reaction?TIME: 1930VET: Dr Megan MartinsHISTORY:Was sniffing in raspberry bushes this evening then suddenly had a swollen face. Was licking front legs, laid on bed for about an hour seeming lethargic. Muzzle swelling improving since being in reception, and energy levels increasing. Possibly some hives visible on front legs. No v+/d+ or collapse. No dyspnoea. No visible wounds. No hx hypersensitivity reactions. Otherwise well. No snakes sited. Current meds: nilProphylaxis: UTDPre-existing conditions: nilAccess to toxins eg. Rodenticide: nilTRIAGE:HR: 100RR: pantTemp: 38.5Mm: PM Crt: <2sMentation: BARPain Scale (0-4): 0Hydration status (%): euhydratedEXAMINATION:Body Condition Score: 6/9Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):  1- Abdominal: no detectable pain on abdominal palpation, normal gut soundsUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: Mild muzzle swelling (markedly reduced from photo owner provided), no visible stingers, lesions, bruising.Lymph Nodes: peripheral lymph nodes normalEyes: NSF, PLRs normal, pupils moderate and symmetricalPROBLEM LIST:- muzzle swelling acute onset, now resolving- pruritus FLs acute onset, now resolving- lethargy acute onset, now resolvingDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Hypersensitivity reaction (suspect bee sting, wasp, ant etc.)TREATMENT:Chlorpheniramine 2mL SCPLAN:Monitor for signs of anaphylaxis at home and revisit if any concernsCan give 5mg loratadine PO in AM if muzzle swelling or pruritus ongoingMonitor for ongoing muzzle swelling which could indicate secondary infection to insect sting/biteCLIENT COMMUNICATION:Typical presentation for hypersensitivity to insect envenomation, with low concern for anaphylaxis (discussed signs of anaphylactic shock, biphasic reaction risk). Low concern for snake envenomation. Offered admission for blood testing (CK, AST, coags) and monitoring for signs of snake envenomation or anaphylaxis - O declined. O comfortable monitoring at home and revisiting if any deterioration. Emailed handout RE hypersensitivity and anaphylaxis.    Vital Signs    Weight: 42;