C09993102 / invoice 20000

Appointment Notes: O tube placement AME admit client discussion: went through O tube placement and some of the management after. We will go through how to manage it with the O this afternoon and show them how to feed her, give meds etc Rec'd PCV to make sure it has not dropped too much further and proceeding with AFAST to make sure there is no FF. O happy with plan. Plan: O tube placement + AFAST and PCV TGH this afternoon vet consult + nx to go through management and feeding > send home with emaraid Likely r/c CBC in 1 week see if there is an improvement with better nutrition continue pred, denamarin, amoxy clav + add in omeprazole encase there is an upper GI bleed (has had some darker faeces since being on pred) Can go onto gabapentin 50mg PO BID for a few days for pain relief after tube placement likely remove tube in 10-14 days sooner if she starts eating on her own     Vital Signs    Weight: 2.98;       

Reason: therapeutic thoracocentesisObjective: HR: 220, G3 murmur present (not previously audible) RR: 40-50 and increased effort MM: pale pink/almost white ASA 3-4Laboratory: see previous Treatment: Premed: see previous Induction: alfaxalone 10mg/mL 0.2mL IV 4:10pm; then 3x 0.1-0.2mL IV top-upsMaintained O2 2L/min via maskSPO2 94-100%, MAP 67-128, RR 32-36. Stable throughout. Used u/s to guide thoracocentesis using 25G needle + mini volume extension + 3-way tap: multiple small pockets divided by ++ fibrin strands, had to reposition needle multiple times to continue getting flow. Managed to drain ~65mL of fluid. Mild blood contamination (sample appeared to get more blood tinged during the procedure).Also collected abdominocentesis sample from abdomen via u/s guided. GA finished: 4:30pm Recovery: recovered in O2 crib, fairly smooth Laboratory: For pleural space + abdomen: placed fluid in sterile pot + EDTA + prepared airdried slides (spun down and non-spun down). Also placed separate sample for potential FIP testing in EDTA. Plan: Discharge at 7:20pmAt discharge confirm if sending samples to idexx: >> Effusion analysis with cytology (2 sites) ($366)>> +/- FIP testing? (consistent appearance of fluid/fibrin and Alb:glob 0.5) ($244)>> C&S of abdominal effusion ($225) Start on marbofloxacin 12.5mg PO SID for 2 weeks; start omeprazole 5mg PO BID; continue pred and denamarin (marbo and pred are priorities); can continue mirtazapine; stop amoxyclav INI or declining then strongly consider euthanasia Other option is starting remdesivir/anti-viral therapy but may have poor prognosis given already so unwell. Monitor breathing effort/appetite etc at home, consider syringe feeding given have not placed feeding tube today. Ideally repeat PCV in 2-3d time to ensure not dropping further, r/c sooner if deteriorating.FUC tomorrow.  GAP:Reason - HospitalisationCause - UnknownDuration - 01/2026Other concerns - Nil    Vital Signs    

Reason: PCV check and AFAST (prior to O-tube placement) Treatment: required sedation for IV placement and afastButorphanol 10mg/mL 0.15mL IV at 12:50pmPlus alfaxalone 10mg/mL 0.2mL + 0.1mL + 0.1mL After sedation, increased resp effort noted - O2 support via mask 2L/min and elevated chest. Imaging: AFAST > 4/4 abdominal free fluid (anechoic to slightly echogenic): cranial to bladder, between intestinal loops, caudal to spleen, between liver lobes, between liver and diaphragm, dependent> Pleural effusion also present: some fibrin strands presentLaboratory: abdominal effusion SG 5.0g/L Moderately cellular: erythrocytes, macrophages, neutrophils, mesothelial type cells Sparse cocci seen Background proteinaceous cells Glucose =  8.44; lactate = 1.25Laboratory: bloodPCV 15-18% across 4 tubes (ave 16.3%)BG = 6.6mmol/L (ran from EDTA tube, likely some cellular consumption). Lactate = Assessment: 1. Abdominal and pleural effusion present > septic (though glucose/ketones not suggestive) vs liver failure vs PLE vs neoplastic vs inflammatory vs other2. High risk of decompensation - increase resp effort with just mild sedation and stress. Options:Further workup could include sending abdominal + pleural effusion to idexx for cytology and fluid analysis; + C&S. Consider adding second line abx in the meantime Consider draining pleural effusion given risk of resp compromiseConsider going ahead with O-tube placement however high GA risk/risk of poor recovery. Euthanasia reasonable.  Discussion: AME went through above findings, unfortunately prognosis at this stage is quite poor. Went through options of therapeutic drain of chest (went through risks) +/- sending to idexx for cytology and culture and starting on marbo as a last option. Vs taking to SASH through emergency she will likley be admitted for a number of days and need chest drain, feeding tube etc. Can still consider placing O tbe today but high risk she would not survive the GA. Also discussed euth. O elected for therapeutic thoracocentesis, declined sending to idexx at this stage explained we will keep the fluid for now if O changes her mind at d/c. Went through risk of arresting O elected for DNR. estimate still ~$1000 today w/o sending anything away Plan: proceed with therapeutic thoracocentesis confirm at d/c not sending for cytology + culture +/- FIP testing? start on marbo 12.5mg PO SID for 2 weeks, start omeprazole 5mg PO BID, continue pred and denamarin (marbo and pred are priorities). Can continue mirtazapine. Stop amoxy clav INI or declining then strongly consider euthanasia d/c at 7pm If doing well consider r/c CBC in 1 week +/- repeat AFAST     Vital Signs