C09990380 / invoice 10000

Presenting for: Aural haematoma

HISTORY
- Noticed swelling on ear 3 days ago. 
- O has not seen much shaking head or scratching at ears. 
- EDDU normal. No V+ or D+. No coughing or sneezing

EXAMINATION
Mentation: BAR, anxious - limited exam
FAS score: 4/5
HR = 120 bpm, no heart murmur or arrhythmia detected on ausc  
Resp rate = WNLs, Normal resp effort and clear BVS, no crackles and wheezes 
Throat: no tracheal pinch
Eyes: clear and bright corneas, no discharge
Ears, Both ears: small amount waxy, brown discharge. R ear: large, circular, firm, fixed mass on R pinna
Nose: clear, no discharge
LNs: Submandibular NAD
MSK: ambulatory x4, no obvious lameness
Integument: healthy, well kept coat
BCS: 6/9

EAR CYTOLOGY
R ear: + rods, +++ cocci, + yeast 
L ear: ++ cocci, + yeast

ASSESSMENT & PLAN
1. Bilateral otitis externa and R aural haematoma (R > L)

COMMUNICATION
As above. 

Second Opinion:


Below is an update for Lily Staesk, who is recovering well following a median sternotomy with partial lung lobectomies to treat a recurrent spontaneous pneumothorax. The owner reports that Lily has been doing well since surgery and has no concerns.

Examination findings:
At today’s examination, Lily is breathing well and thoracic auscultation is normal The incision has healed well.

Treatment:
The staples were removed. Blood was collected for a heartworm test (negative).

Assessment: Surgery has resolved the immediate urgency regarding recurrent pneumothorax however histopathology did identity some other lung changes, as well as the bulla formation, that indicated some underlying lung disease. Dr Labuc from the medicine department was consulted and recommended a heartworm test (negative) and to consider electrocardiography to rule out right sided heart disease which could result in pulmonary hypertension.

Plan:
I have recommended a return to normal exercise and to monitor for any breathing difficulty. An echocardiogram to investigate right sided heart dieae/pulmonary hypertension can also be considered.

Thank you for this referral. Please contact the clinic if you have any further questions regarding this case, or any other surgical cases, on the number below or for after-hours surgical emergencies on 03 9379 0700.

Kind regards,


Dr. Simon T. Kudnig BVSc, MVS, MS, FACVSc, Dip.ACVS <br>
Specialist in Small Animal Surgery <br>
ACVS Founding Fellow of Surgical Oncology <br>

R and L lateral and DV view chest taken - significant pneumothorax RHS.
Sedated 0.3ml acp/0.6ml butorphanol.
Instill lignocaine into intercostal space 8-9.
Sterile prep of area already clipped.
Aspirated approx 2.5L air.
Post rads confirm significant improvement but still some pneumotharox caudally. 
Nasal oxygen tube placed - maintaining Spo2>95%.
Recommend transfer to emergency when awake for CT.