C10007286 / invoice 10000

Reason: Lethargy and rapid breathingSHIFT CHANGE 0600-1600VET: Dr Nerida Warburg BVSc(Hon) EXAM: 0700QARRR=48, normal effortHR=120T=39.0ASSESSMENT:  HIgh normal temp this am. Concern PUOTREATMENT PLAN/Changes to Plan:  Transfer to reg vet for further assess +/- workup O Contacted and Bill update (Y/N): Discharge to owners 0930    Vital Signs    

Reason: Lethargy and rapid breathingSHIFT CHANGE 2400-0700VET:  AKASSESSMENT: See SF for TPRT dec to 39.2 overnight. Unable to find any areas of pain on examination. TREATMENT PLAN.changes to plan:IVFT hartmanns @ 50mL/hrMaropitant 1mg/kg IV q 24hrO Contact required overnight? - NTransfer details/stay on/discharge from AES: O transfer    Vital Signs    

Reason: Lethargy and rapid breathingHISTORY:- Presents for acute onset lethargy and unusual behaviour from approximately 4 pm today.- Owner reports marked lethargy, not getting off chair, not responding to usual stimuli like kids on the trampoline, treats, or toys.- Unusual breathing noted at home, through a closed mouth. Appeared to be struggling to stand up and open eyes.- History of snake bite last year (- Walked approximately 5km on lead today around 3 pm. Owner reports a small (15cm) tiger snake was seen on the walk, which they walked over. Wednesday did not appear to notice or interact with the snake.- No access to beach or swimming in water today.- Owner notes Wednesday can be dramatic and exhibit similar behaviour when anxious (e.g., owners packing a suitcase), but attempts to distract her were unsuccessful today.- has had mast cell tumours removedEXAMINATION:HR: 160Temp: 39.9MM: pinkCRT: <2 secondsMentation: qarPain Scale: 0-1?Hydration status (%): clinically adequateWeight: 34kgBody Condition Score:5/9Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: mild increase lung sounds bilaterally Neurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait normal Musculoskeletal: ambulating normally, no palpable neck, limb or joint pain. Appears to have some mild sensitivity to thoracolumbar palpation. Gastrointestinal: - Oral: normal, no mouth pain, dental score: 1 - Abdominal: no detectable pain on abdominal palpation, normal gut sounds - Rectal: soft faeces on rectal :Integument/Ears: clean furcoat no evidence of otitis. No evidence of bite marks or swelling. Mass that owner is aware  of Lymph Nodes: peripheral lymph nodes normal size/shape & not painfulEyes: clear corneas, nil discharge or blepharospasmASSESSMENT AND PLAN:1. Fever of Unknown Origin (FUO) / Acute Lethargy- Assessment: Presented for acute onset lethargy and pyrexia. The cause is currently undetermined. Thoracic auscultation reveals slightly harsher than normal lung sounds.- Differential diagnoses: Infection, inflammation, immune-mediated process. Atypical snake envenomation is considered less likely but cannot be ruled out due to the sighting of a snake on a walk shortly before clinical signs began.- Recommended diagnostic tests: Recommended initial diagnostics include a full blood count, biochemistry profile, clotting time and muscle enzyme (CK) levels to investigate for systemic inflammation, infection, and help rule out snake envenomation. A chest X-ray is the recommended next step if blood work is unrewarding.- Treatment plan: Plan is to perform blood tests while the owner waits, then make a decision on hospitalisation for ongoing monitoring and supportive care. If she deteriorates, further investigation and treatment will be required.CLIENT COMMUNICATION:- Discussed the sudden onset of signs and the finding of a fever.- Discussed the difficulty in diagnosing fever of unknown origin and the potential need for a step-wise diagnostic approach.- The possibility of snake envenomation was discussed. While the signs are atypical, it remains a differential given the history.- The owner was advised that Wednesday's condition could improve, stay the same, or deteriorate.- Recommended admitting for monitoring and diagnostics, but owner elected to have bloods run while they wait to make a decision about hospitalisation.- An estimate for blood work was provided and accepted. The plan is to run the bloods and then reassess the plan for hospitalisation.Advisd owner that blood work is basically normal. Recommend admit. Owner consented. Unlikely to get xrays done but if so will update, if not will have update in morning. DIAGNOSTICS:Full bloodsNeut slightly high - needs smear to check bandsAlkp  461Pt normalCk normal Blood gas nsf except normal glucose  40/92TREATMENT:Cerenia and fluids @ maintenance. PLAN:- fluid therapy, possible xraysOwner transfer to continue work up (unless dramatic improvement)Recheck joint/thoracolumbar pain sensitivity. .    Vital Signs    Weight: 1;