C09988848 / invoice 10000

REASON: Presentation for a ruptured sebaceous cyst on the dorsal neck.HISTORY:- Presented for a large cyst on the neck which ruptured this evening.- There was no known incident or trauma associated with the rupture; it is thought to have burst due to pressure.- The cyst has been present for a few years and has been growing slowly.- There is another large lump of a similar size on the ventral stomach.- These lumps have previously been investigated by the primary care veterinarian, including a FNA and were identified as cysts. The advice was to monitor them, with removal being an elective option.- He was due for a routine appointment for a blood check.- Pre-existing conditions: History of a mast cell tumour on one of his legs which was previously removed. He is described as being very cystic and lumpy. At the end of last year, he had a dental clean and pre-anaesthetic bloods which showed a mildly elevated liver enzyme and a slightly enlarged liver. He has a history of swelling in both back legs, occurring two years in a row, with associated weakness. The cause was never determined but was suspected to be an allergic-type reaction.- 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: nil mentionedTRIAGE:- HR 140- Pink MM- CRT2s- RR Panting- Temp: 37.8°C- BAREXAMINATION:Body Condition Score:6/9Pain Scale (0-4):0.25Cardiovascular: 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/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- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: A large, 5cm x4cm x3cm ruptured cyst is present on the mid dorsal thoracic back. Purulent serosanguinous discharge from area. Multi-compartmentalised sebacoeous cyst with thickened cystic material and serosanguineous purulent discharge.Lymph Nodes: WNL on palpationEyes: NSFDIAGNOSTICS: Nil performed.PROBLEM LIST:1. Ruptured sebaceous cyst on neck2. History of multiple skin/subcutaneous masses3. History of elevated liver enzymes4. History of recurrent hindlimb swelling of unknown aetiologyDIFFERENTIAL DIAGNOSIS:The ruptured mass is consistent with a sebaceous cyst. The fluid-filled nature and pressure build-up leading to rupture are characteristic. Secondary infection is a risk following rupture.ASSESSMENT:Lucca presented for a ruptured sebaceous cyst on his neck. The cyst has reportedly been present for several years. Examination revealed a large, fluid-filled mass with surrounding inflammation, consistent with a ruptured cyst. The primary concern is managing the open wound to prevent secondary infection and to alleviate discomfort caused by the pressure and inflammation. Local anaesthetic was applied to the area and the area gently drained. #15 blade scalpel applied to extend rupture site to facilitate drainage.  Area was clipped an cleaned using dilute betadine. Multi-compartmentalised sebacoeous cyst with thickened cystic material and serosanguineous purulent discharge. The owner was counselled that sebaceous cysts have a capsule and are prone to refilling unless the capsule is surgically excised. Draining is a temporary measure to relieve pressure and protect the surrounding skin. Antibiotics and anti-inflamamtories to go home, reassessment skin with primary caree in 2-3 days. TREATMENT:- Topical local anaesthetic cream applied to the site of the ruptured cyst.- Plan to commence antibiotics and anti-inflammatory medication.- AmoxyClav 500mg BID 5 days- Meloxicam 0.1mg/kg SID 5 daysPLAN:- The cyst will be kept open to allow for drainage over the next few days. Bandaging is difficult due to the location.- The owner should monitor the site for any increased swelling, discharge, or signs of discomfort.- It is recommended to follow up with the primary care veterinarian to discuss ongoing management, including the potential benefits of anti-inflammatory medication for possible underlying arthritis and a plan for surgical excision of the cyst capsule to prevent recurrence.DISCHARGE 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: Lucca presented for a ruptured sebaceous cyst on the back of his neck. Local anaesthetic was applied to the area and the area drained and cleaned thoroughly. There is risk of secondary skinn infection or local skin breakdown (necrosis) given the severity of skin inflammation and infection.Monitor the area closely and represent to the vet in 2- 3 days for reassessment to ensure skin healing. Prevent the area from getting dirty or wet. You can clean the area locally daily with dilute betadine if Lucca allows at home.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 your primary care veterinarian in 2-3 days to assess your pet's improvement unless otherwise advised by your veterinarian.Medications at discharge:Give 1.5ml ONCE daily WITH or AFTER food for 5 days. Stop if any vomiting or diarrhoea. Next due: TonightAmoxyclav 500mgOne (1) tablet twice a day until finishNext due: TonightIf 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. 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    Weight: 24.5;       

Reason: Possible PoisoningHistory: - Owner heard Lucca playing outside ~ 1 hour prior to presentation, and found that he was playing with an empty bottle of brake fluid. - The brake fluid bottle was half full earlier in the day. - Evidence of brake fluid visible on the lawn. - Owner has not noticed any other changes in Lucca's demeanour.- No vomiting or diarrhoea. - He has no other medical history as far as owner is aware. Current Medication/Treatment: None. Objective:Bodyweight: 23.2kgDemeanour: BARTPR: Temp: 38.8C, HR: 108 = Pulses, RR: 24MM Colour: Pink, CRT: <2secCVS: No significant findings on auscultation. Pulses normal.Resp: No significant findings on auscultation. Normal respiratory rate and character at rest.Abdo/ALI: No significant findings. No pain on palpation.MSK: No significant findings. Normal gait.Rectal: No significant findings UG: Small bladder on palpation.L/N: No significant findings EENO: No significant findings. Woods lamp used to assess for fluorescence within oral cavity - none noted. Dental Score: 1/4Integument: No significant findingsNeuro: No cranial or peripheral neurological deficits noted, good gag reflex, no appreciable ataxia. Hydration: No clinical evidence of dehydration Client discussion:Owner(s) consented to diagnostics and treatment as required.Diagnostics:pH (7.35-7.45): 7.39CO2 (35-45)mmol/L: 43O2v (50-70)mmHg: 44Na (145-155)mmol/L: 144K (3.5-5.2) mmol/L: 4.1Cai (1.00-1.4)mmol/L: 1.35Glu (3.7-7.9)mmol/L: 5.7Lactate (<2)mmol/L: 1.4Hct (38-55)%: 49HCO3- (18-24)mmHg: 26BEecf (-4  +2): 1.0The results of a urinalysis were:USG: 1.030Colour: Yellow pH: 7.3Protein: +Blood/Hb: NegKetones: NegBilirubin: NegGlucose: NegWet preparation: No crystals or castsStained preparation: No evidence of bacteruiria or pyuriaInterpretation: No evidence supportive of ethylene glycol poisoning.Problem List:1. Possible brake fluid ingestion - potential ingestion of ethylene glycolAssessment:Given the significant amount of brake fluid noted on the lawn, the lack of clinical or laboratory evidence of ethylene glycol toxicity it is considered unlikely in this case that Lucca ingested enough to cause clinical toxicity. There was no evidence of metabolic acidosis, hypercalcaemia or crystals in the urine to suggest toxicity.Ideally, ethylene glycol serum levels would be measured to rule out toxic levels requiring fomepizole treatment - unfortunately this test was only available in-house and as a result Lucca was treated conservatively overnight and a check of her renal parameters can be performed this morning that will hopefully rule out toxicity and allow for her discaharge home later in the morning.Treatment:1. Emesis - Apomorphine 0.9mg IV.2. Sedation - Acepromazine 0.4mg IV at 2300. - Butorphanol 5mg IV at 2300 and 0200.3. IV Fluids - LRS 115ml/h (total volume ~1000ml overnight).Plan:Transfer to primary care vet in the morning for ongoing fluids and for biochemistry to check renal parameters. If renal parameters are fine this morning and Lucca is still not showing clinical signs than discharge home around lunch time would be appropriate. --- 22/05/2015 13:22:35 PM NAN:Examinations - Resolved -     Vital Signs