C10001818 / invoice 10000

Reason: Y - Skin Infecttion, V+ After MedsAppointment Notes: Special payment terms exist, Overdue remindersHISTORY:Current meds:Prophylaxis:Pre-existing conditions:Access to toxins eg. Rodenticide:TRIAGE:HR:RR:Temp:Mm: Crt:Mentation:EXAMINATION:Body Condition Score: Pain Scale (0-4):Hydration status (%):Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):  - Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: no detectable abnormalities Urinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFPROBLEM LIST:DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:DIAGNOSTICS:ASSESSMENT:TREATMENT:PLAN:CLIENT COMMUNICATION:    Vital Signs    

Reason: Y Stung By Insect, V+HISTORY:Presented after developing acute onset of facial swelling and vomiting during a walk with roommate. History of previous bee sting reactions with facial swelling. Owner reports Honey became unsteady on feet, had difficulty walking, and experienced multiple episodes of vomiting. Owner administered antihistamine tablet which Honey initially regurgitated, second dose was successfully administered. Owner noted pale/grey mucous membranes during episode.Current meds: Antihistamine (administered prior to presentation)Prophylaxis: UTDPre-existing conditions: Known hypersensitivity to insect stingsAccess to toxins eg. Rodenticide: noneEXAMINATION:Body Condition Score: 5/9Pain Scale: 0/4Hydration status: hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal mucous membrane colour, no mouth pain, dental score: 2- Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: no detectable abnormalitiesUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFPROBLEM LIST:1. Acute anaphylactic reaction2. History of hypersensitivity to insect stings3. Facial swelling4. Vomiting5. Transient weakness/ataxia6. Reported pale mucous membranes during episodeDIFFERENTIAL DIAGNOSIS/DIAGNOSIS:Anaphylactic reaction secondary to insect stingDIAGNOSTICS:Blood pressure monitoring recommendedASSESSMENT:Presented for suspected anaphylactic reaction following likely insect sting. History of previous similar reactions. Clinical signs included facial swelling, vomiting, and transient weakness. Antihistamine administered by owner prior to presentation. Currently stable on examination with normal mucous membrane colour and cardiovascular parameters.TREATMENT:Maropitant 1mg/kg SC @ 1845PLAN:Monitor blood pressureObserve for recurring signs of anaphylaxisHome into owner's care if stableContinue oral medication (iramine 8mg) PO Q8 for 48 hours.CLIENT COMMUNICATION:Discussed anaphylactic reactions and potential for severe complications including cardiovascular collapse. Advised to seek immediate veterinary attention if similar episodes occur in future. Recommended keeping antihistamines on hand given history of reactions.    Vital Signs    

DISCHARGE NOTES: Suspect Hypersensitivity/Allergic ReactionHypersensitivity reactions:Hypersensitivity reactions can vary from facial swelling and raised lumps over the body to severe anaphylaxis causing vomiting, collapse and respiratory difficulty.  Generally the cause of the reaction is unknown but it is most commonly thought to be caused by insect bites or possibly contact with plants.  Other more serious but not so common causes include snake envenomation and Mast Cell tumours, these generally cause anaphylaxis.  Facial swelling and skin lumps is the most common form, this is usually managed with anti-histamines in combination sometimes with an anti-inflammatory. Monitoring at home: The swellings should reduce gradually over the next 12 hours, occasionally they can persist for longer and a longer course of anti-histamines and anti-inflammatories are required.  Your pet will need to be reassessed by your primary care veterinarian and they will determine if that is suitableThe anti-histamines can make your pet sleepy over the next 12 hours.Please keep your pet rested until the skin lumps have completely resolved then gradually reintroduce normal activity over the following week.They are fine to be offered food and water as per normalRecheck:Once you pet is discharged home we advise a reassessment with your primary care veterinarian within 48 hours to monitor your pets progress. If your pet's condition deteriorates or fails to resolve over the next 24 hours, or they become flat or lethargic, go off their food and water, develop vomiting or diarrhoea, develop breathing difficulty or if you have any concerns please contact our team or your primary care veterinarian immediately.Thank you for trusting us with the care of your pet.    Vital Signs