C10004657 / invoice 10000

Reason: L2 - CON4/HOSP Med Pt, Known Tumor, Increased RRAppointment Notes: Overdue remindersPresenting Problem:Respiratory distress.History:Darcy presented for acute respiratory distress. He has a known mediastinal mass and is currently on furosemide and pimobendin for management of a heart murmur. Owner reported no known toxin exposure and no previous similar acute episode. Prior to this event, eating and drinking had been normal. No recent vomiting or diarrhoea reported.Clinical examination:Temperature: 40.3°CCardiovascular: HR 250, murmur present, mm cynotic, BP systolic >250 on presentationRespiratory: dyspnoeic on presentation, Abdomen: AFAST suspicious for encapsulated free fluid around the spleen, concerning for capsular bleedingUrinary: NSFPeripheral LNs: NSFEyes/Ears: NSFIntegument: generalized muscle tremors notedOral exam: not performed prior to intubationMusculoskeletal: generalized tremoring presentGait: not assessed due to severity of presentationNeurological: mentation depressed/stressed secondary to respiratory distress, generalized tremors presentRectal exam: DNPTFAST: bilateral severe B-lines presentAFAST: suspicious encapsulated free fluid around the spleenLaboratory result:Blood glucose: 7.6 mmol/LLactate: 5.8 mmol/LTreatment:Butorphanol 0.2 mg/kg given on presentationDiazepam 0.64 mL givenFurosemide 2 mg/kg givenDue to ongoing tremors and severe respiratory compromise, owner consented to sedation and intubationPropofol given IV for inductionIntubated with size 6.5 endotracheal tubeAssessment:Severe respiratory distressKnown mediastinal massKnown heart diseaseSevere pulmonary change on TFAST with bilateral B-linesGeneralized muscle tremors with hypothermiaSuspicious encapsulated fluid surrounding the spleen, concerning for haemorrhageGrave prognosisPlan:Discussed possible ongoing stabilisation and further workup including continued sedation, thoracic radiographs, and sampling of abdominal fluidGiven grave prognosis and overall findings, owner elected humane euthanasiaProcedure:Propofol 7 mL IV givenPentobarbital 5 mL IV givenCPA confirmed on cardiac auscultationClient communication:Discussed Darcy’s critical condition with owner, including severe respiratory compromise, abnormal thoracic ultrasound findings, and concern for concurrent splenic pathology with abdominal fluid. Discussed options of continued stabilisation and further diagnostics versus humane euthanasia. Owner elected humane euthanasia based on grave prognosis. Private cremation selected.    Vital Signs