C10005629 / invoice 10000

Reason: Discharge

Owner present:
Discharging vet:

Assessment:

Treatment:

Plan:

Reason: Ear Clean/ Pluck
Presented by: Peir
Admitted by: ET
Relevant History:
head shaking has inproved since taking the pred over the last 2 weeks. no other health concerns today other than right ear

Pre-op exam:
Demeanour: BAR- does not like restraint
HR: 64
RR: panting - stressed
MM's: Pink
CRT: <2sec
Temp: NT
Dental Stage: G0 
BCS: 5/9
Vaccination Status: yes
Microchipped: Y

Laboratory/ Pre-GA Bloodwork: (Prep Profile II / Basic Bloods)
Basic Pre-GA Blood Test:
PCV: 44.97% (Dog: 37-55 Cat: 24-45)
TP: 6.3 g/dL (Dog: 5.6-8.0 Cat: 5.4-7.8)

Assessment:
ASA: stage 1

Pre-med:
Methadone (10mg/ml): 0.50mls, Route: IM, Time: 10.11
medetomidine (2mg/ml): 0.25 mls, Route: IM, Time: 10:11
Sedation comments: 

Induction: Propofol (10mg/ml): 5mls, Route: I/V, Time: 10:50
ET tube size: 9.5 mm, Difficult induction?: N
Catheter size: 20G, Site: left cephalic
Maintenance: Isoflurane
IVFT Type: crystalloid hartmanns, Rate: 115 ml/hr

Anaesthesia comments: 
smooth

Procedure report:
R ear: black debris all the way down. TM ruptured. No foreign body.
L ear: black debris all the way down. Large black clod of discharge against TM. Could not flush out and could not grab with alligators. Unable to confirm if L TM is intact (could see an intact portion of it though). No foreign body.
*Flush both ears repeatedly with Otoflush to remove most of the debris.*

= Bilateral OE, no FB either ear, R TM rupture, L ?TM

Recovery: 
quick and uneventful 

Treatment:
antipamazole: 0.25ml IM @ 11:45am

Take-home Medications:
amoxyclav 500mg  BID for 10 days
script dex/keto/enro 1ml both ears SID 10 days
increase prednisolone back up to -> 20mg SID 5d; to 10mg SID 5d; to 10mg EOD 10d.
Otoflush both ears once daily as well

Plan: 
- Adv. complete course of topical ab's + oral ab's + CCS
- Adv. gauge response
- Adv. referral to WAVES for video otoscopy would be useful at any stage as possible R middle ear disease
- Adv. likely an atopic dog -> may see recurrent ear + skin problems through life

Revisit in 10 days (with VET )

Reason: Patient recheck
Presented by: Pear
History:
- See previous
- R ear is much improved but still not 100% acc. to O
O's assessment:
- Dubious

Examination:
Demeanour: BAR
EARS:
- L ear NAD
- R ear faint odour
- Erythema at cranial aspect of canal entrance
- Unable to examine otoscopically
- Swab taken with difficulty reveals +++ black discharge

Lab:
- No cocci
- Masses of non-nucleated squames

Assessment:
- Not happy with progress here
- Residual inflammation despite topical + oral medication
- Lots on discharge without infection
- Unilateral

Treatment:
- Continue pred 10mg SID 7d then drop to 10mg EOD

Plan:
- Flush with C&S under GA Monday