C10006558 / invoice 10000

Suspected insect bite reactionSubjectivePresenting Concerns:  Brax, a 3-year-old miniature dachshund, presented for an acute onset of a red, sore left hind paw. The owner reported that this occurred suddenly while at the river and suspects an insect bite or sting. The patient was acutely lame and licking the affected paw.  No collapse or vomiting associated with incident. Not currently on any medication.  Historical Conditions:-   History of a previous bee sting with a similar, though less severe, reaction.Lifestyle Risk Factors:-   Frequents the local river.ObjectiveMentation: BAR, but anxious and agitated. Compliant for PE though.2/5 lame in LH and licking at paw throughout consult.Underside of LH paw red, no associated sting found.Noted NEW grade 3 heart murmur.AssessmentAcute paw inflammation and lameness – DDx: Insect bite (e.g., ant), insect sting (e.g., bee), contact irritant. The clinical signs are consistent with an acute hypersensitivity reaction.    Heart murmur – An incidental finding. Further investigation is required to determine the underlying cause and clinical significance. DDx: Degenerative valve disease, congenital defect, physiologic murmur.Treatment:- Niramine (0.5ml) SC- Dexamethasone (0.2ml) SC.- O has e-collar at home for Brax, recommend to put on when gets home and leave on overnight if still wanting to lick at paw.Plan:-   Advised to rest the patient for the next 24 hours and monitor for any worsening of clinical signs.-   Discussed monitoring mucous membrane colour and capillary refill time at home.-   Recommended using an Elizabethan collar if licking becomes excessive to prevent self-trauma and secondary infection.-   Recommended a recheck appointment in 2 weeks to re-evaluate the heart when the patient is not stressed.-   Discussed referral for a cardiac ultrasound to investigate the murmur, including the potential outcomes and management options depending on the findings.-   Instructed the owner on how to monitor the sleeping respiratory rate at home, aiming for a rate of less than 28 breaths per minute. Recommended the Cardalis app to assist with this.    Vital Signs    Weight: 8.7;       MMColour: Pink;       RespirationRate: 20;       HeartRate: 160;       HeadEyes: Normal;       Nose: Normal;       Skin: Abnormal;       Ears: Normal;       Neck: Normal;       LymphNodes: Normal;       Heart: Abnormal;       Lungs: Normal;       Abdomen: Normal;       Demeanour: BAR;       Hydration: Normal;       Gingivitis: 0;       Calculus: 0;       Observation: Normal;       BodyScore: 6;       DentalGrade: 0;       PainScore: 1;       CRT: 1-2;