C09991840 / invoice 20000

Reason: Got Into Asthma Inhaler - Rapid HR SBAssessment: heart rate now 120, ECG normal, lung sounds clear. Has eaten overnight, bright and comfortable, walking well.Laboratory: electrolytes normalised. K+ 4.7 (3.3-4.9)Plan: no medication this morning- will continue to monitor heart rate until this afternoon and if still ok will be able to go home without ongoing medicationSC 2.30pm: HR 120, ECG trace normalSo no ongoing medication required- ok to go homeNurse notes- 8amDemeanour- QarHeart Rate- 120Pulse quality - Normal Resp rate - 28Lung sounds - ClearTemperature - 38.8Mm - Pink Crt - 1-2 secsAssess pain management - Comfy    Vital Signs    Weight: 16.6;       Temperature: 38.8;       HeartRate: 120;       

History: O found the inhaler chewed on - Contained Ventaline (over the counter - unsure of specific brand). Presented 3pmO could feel an increased heart rateNot himself - has laid down a couple of timesModerate increase to effort and rate of breathing Moderate trembling No seizures or neuro signs Hasnt collapsed Current Medications and Doses:NILExamine:     Demeanour: DAL, very out of character for this dogResp:     Eyes:n    Ears:n    MM pink, CRT 1-2s    Skin/Coat:n    Cardiovascular: HR 210. Very tachycardic, no murmurs heard, rythm sounds ok    Abdominal:n    Musculoskeletal: DAL- poss mildly ataxic    BCS: 5/9Laboratory:  hypokalaemia 3.0, mild hyperglycaemia, remainder of biochem and CBC okDifferential Diagnosis:  ventolin toxicityPuncture and ingestion of contents of Ventolin inhalerThis is a beta agonist so makes HR rate increaseSo use a beta blocker eg atenolol to reduce hr if needed dose rate 3.3-24.9mg/kg bid (this dog 0.7-5ml bid)Consider lignocaine infusion if not respondingCheck bloods as often become hypokalaemic or hyperglycaemicIVF, hospitalisation.Assessment: : ECG: tachycardia, QRS complexes tight and ok most likely sinus tachycardia or supraventricular tachycardia. Pulse fast with normal amplitude. Lung sounds ok. Treatment: atenolol initial dose 2.5ml orally, add K+ 30mmol to 1L htz (=35mmol/l), run at 5ml/kg/hPlan:Intensive care to Monitor tachycardia, ECG and response to tx with chem 8 this eveningOver the course of the afternoon HR gradually reduced to 180 then 160Chem 8 at 5.30pm: K+ stable but still low at 3.0: add another vial of K+ to the IVF, reduce rate to 3ml/kg/hPlan: stay overnight. Needs a vet check late tonight to check heart progress to see if more medication is required. HISTORYPresenting for: Mr Wilson presented for ingestion of contents from an inhaler/puffer found at 3PM todayCurrent Meds: Flea, tick and worm preventatives up to dateEXAMMentation: Lethargic, uncomfortable, restlessCardiovascular: HR elevated/racingRespiratory: Increased respiratory effort and rate since ingestionThroat: Throat palpated during examinationASSESSMENTBronchodilator toxicity - Patient ingested contents of inhaler containing bronchodilator medication, causing tachycardia and increased respiratory effort with lethargyPLANDiagnostics:- ECG to be performed to monitor cardiac rhythm and rateAdditional Discussion:- Bronchodilators can cause toxicity when ingested in excessive amounts, leading to cardiovascular and respiratory signs- Patient to be monitored closely for progression of clinical signsClient Comms:- Will call client in a couple of hours with update on patient's conditionPlan:  update: at 8pm-8:30pm dog is QAR (brihgt but sulky) HR 154bpm, RR 40bpm, T 38.4. Spoke with dr. Suz and given 1.8ml atenolol PO tonight. Dog is otherwise stable and IVF patent at 45ml/hr IV (with potassium CRI in fluids)    Vital Signs    Weight: 16.6;