C09999112 / invoice 10000

Reason: L2 Resp Distress, Open Mouth BreathingAppointment Notes: Overdue remindersREASON: Re-presentation for congestive heart failure.HISTORY:- Presented for assessment of respiratory distress.- History of congestive heart failure, diagnosed in January 2026 at this facility.Was hospitalized for 2-3 days and had her airways suctioned with intubation and was ventilated for 20-30 minutes afterwards. She also had thoracocentesis and 20mls of fluid was removed RHS.There are radiographs that hazve been sent to BITRAD for interpretation and the thoracic fluid was sent for cytology.- An echocardiogram was reportedly performed Animalius.- Owner reports weight loss since last visit; .- The owner reports that the current presentation is less severe than the initial presentation in January.- Last dose of Frusemide was administered at approximately 9 pm last night.- Pre-existing conditions: Congestive heart failure.- 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:  - Furosemide liquid, 0.8ml PO BID. The dose was recently reduced from 10 units and prior to this from 12 units by the primary care veterinarian.  - Clopidogrel.TRIAGE:- RR: 60 breaths/min -Open mouth breathing - Cyanotic- wet sounding respiratory noises audible form a distance and gagging- Mentation: QAREXAMINATION: not fully performed.Placed in OXygen immediately and treated without any real examination to try and avoid stressBody Condition Score: 5/9Pain Scale (0-4): 4/4 Cardiovascular: Respiratory: Increased respiratory rate and effort noted. Abdominal effort with little chest compliance. Open mouth breathing cyanotic and gaggingNeurological: 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: not fully examined- Abdominal: NSF- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Tachypnoea/Dyspnoea2. History of congestive heart failureDIFFERENTIAL DIAGNOSIS:- Cardiogenic pulmonary oedema (congestive heart failure) is the primary differential given the history and clinical signs.- Other considerations include primary respiratory disease or neoplasia (e.g., feline asthma, pneumonia) or other causes of respiratory distress.DIAGNOSTICS:Nil performedASSESSMENT:Piggy, a 12-year-old female neutered Domestic Medium Hair cat, presented for recurrence of clinical signs consistent with congestive heart failure. A diagnosis of heart failure was made in January 2026. The current medication regimen includes furosemide and clopidogrel. The furosemide dose was recently reduced by the primary care veterinarian, which may have contributed to this decompensation, but the decompensation was imminent. On presentation, the cat was tachypnoeic with an increased respiratory effort. Initial stabilisation with intramuscular diuretics and an anxiolytic was planned. The owner consented to initial treatment and adamant that she wanted a repeat of the treatment previously performed a month agoTREATMENT:- Furosemide IM administered.  10mg at 4.30am and then 5mg at 6.20am- Butorphanol IM administered for anxiolysis. 1mg at 4.30amPLAN:- Transfer to TAHMU for ongoing treatment and management of congestive heart failure.- Provide oxygen therapy as required for transport- Continue parenteral diuretic therapy and monitor respiratory rate and effort.- Once stabilised, transition back to oral medications, likely at an adjusted dose.- Contact primary care veterinarian to discuss short-term management plan with guarded prognosis.- The owner was waiting to get a follow up echo to compare the heart changes.    Vital Signs