C10001273 / invoice 10000

Reason: Screamed Several Times, Found On Carpet Inside HouseHistory: Harvey is a known cardiac patient - has seen cardiologist and confirmed progressive cardiac enlargement on serial echocardiography. Currently on pimobendan 2.5mg PO BID.Has been coughing frequently - not seen to be productive but with lick and swallow like fluid has come up.Generally bright, eating OK (often off food in the mornings), no V+ or D+.Had a normal day today, played with the other dog as usual. Refused breakfast but ate dinner.Was humping his toys this evening (nightly routine for Harvey!) when he began screaming - Os ran in to find him on his side, rigid and screaming, then defecated when he was picked up.No known access to toxins.Examination: T 36.4, HR 120 G2-3/6 HM, RR 50 mild increase in effort which worsened with time to marked increased inspiratory effort, harsh lung sounds all fields, mentally dull/collapsed but responsive Cyanotic, CRT > 2 secThready femoral pulses SAP 125SpO2 varied 70-99% (improved with well fitted oxygen mask)Abdomen soft and comfortableNon ambulatory, unable to assess neuro responses One eye presentECG showed sinus tachycardiaLaboratory: EPOC: Metabolic acidosis with marked hyperlactataemia (14+), hyperglycaemia (19+)Assessment: Problem List:1. Shock (suspect cardiogenic) - collapse, poor pulses, tachycardia, dull, hypothermia2. Screaming/rigid collapse episode ddx cardiac syncope, seizure, painful episode3. Heart murmur, known cardiac enlargement4. Marked hyperglycaemia (secondary to shock vs underlying dz - DM etc)Harvey has presented in likely cardiogenic shock with poor perfusion and marked hyperlactataemia. Heart murmur, cyanosis and history of known progressive cardiac enlargement combined with visualised syncope episode indicate cardiac failure as a likely cause. He is critically ill and at risk of arrest. Intensive care vs euthanasia are the only viable options at this stage. Prognosis is guarded to poor.Offered option 1. Admit for oxygen therapy, medication, further bloods, xrays, U/S with view to try to stabilise and seek cardiologist opinion ASAP (may pass away despite treatment) vs 2. Euthanasia.O elected euth as the kindest option.Treatment: STAT FORM SIGNED ON ARRIVAL, initial CPR code greenOxygen via maskIVC placedButorphanol 0.05mg/kg IV Active warmingEuthanasia:Alfaxan 1mL IVPentobarbitone 6mL IV with Os presentHarvey passed away peacefullyConsent has been given by the client to proceed with this treatment  -  YesPlan:Os present for euthanasia.ELected cremation - will contact us tomorrow with decision on company.    Vital Signs