C10006974 / invoice 10000

Reason: Respiratory DistressConsultation Time: 1930History:Has been having a wet cough this afternoon and breathing has been gradually becoming more labouredHas been EDDU normally priorNo V+ or D+ recentlyIndoor mostly due to ageNo changes in environment (ie dust, fumes)Has been gradually eating less for a few monthsDiet: normally has meat but has been eating less of it therefore O has been feeding boiled chicken- no bonesCurrently on:- Frusemide PO BID- Vetmedin PO BIDNo recent changes to dosesNo access to rodenticideSubjective: BARObjective: Temp: Not takenBCS: 4/9     Wt: 4kg Pain Score (CSU): 0/4MM: Muddy, tacky   CRT: <2   NIBP: 167/122 (130)HR: 180      FP: Strong, synchronous      RR: 64CV: Grade V/VI heart murmur audible; no arrhythmias auscultated       RESP: Mildly increased effort, crackles audible in all lung fields       GIT: Soft and pliable on palpation, no abnormalities detectedU/G: Bladder not palpableNeuro: Normal mentation & posture; no ataxia; menace & palpebral reflexes normal; PLRs intact direct & consensualM/S: Ambulatory on all four limbs, no lamenessInteg: Hair coat clean & full; skin – no masses, lesions or erythema presentOphth: Pupils equal and visible, no discharge notedLNs: No peripheral lymphadenopathy appreciatedProblem List: DyspneaCrackles on auscultationKnown heart diseaseHx of syncope and LSCHFAssessment:Most likely LSCHF given the presenting symptoms and history. Oxygen dependant and requires IV diuretics.Ideal to repeat echocardiogram.Options offered to Clients:1) Admit for diagnostics, IV medications, supportive care, and monitoring2) Humane euthanasiaO elected option 2 to prevent any further suffering.Treatment:Oxygen via humidicribButorphanol 0.2mg/kg IMFrusemide 2mg/kg IMSedation with Propofol IV titrated to effectEuthanasia with Pentobarbitone 5ml IVPLAN:O elected PRIVATE CREMATION.    Vital Signs