C10020634 / invoice 10000

REASON: Acute onset facial swelling, suspected allergic reaction.HISTORY:- Presented after being found at home at approximately 6 PM with a very swollen face.- No episodes of vomiting or diarrhoea were observed prior to presentation.- No hypersalivation or drooling has been noted during the hospital stay. The owner reports that drooling can sometimes occur with trazodone administration.- There is a history of eating bees previously with no adverse reaction.- He is an outdoor dog and there are known wasps in the backyard.- He has a history of anxiety, particularly related to veterinary visits.- He can be sensitive to his paws being handled due to a past traumatic incident involving his paw pads.- There are no known food allergies.- There have been no recent changes to the home environment, such as new grass or other new introductions.- Pre-existing conditions: Anxiety related to veterinary visits.- Access to toxins: Potential access to wasps in the backyard.- Current vaccination status: up to date- Current medications: Gabapentin and Trazodone administered prior to arrival for anxiety.TRIAGE:Mentation: QARHR 132Pink MMCRT 2sRR PantingTemp UnableEXAMINATION:Body Condition Score:5/9Pain Scale (0-4):0Cardiovascular: Cardiac auscultation revealed a stable heart rate, which was slightly elevated during examination on the table, likely due to stress. Normal rhythm, pulse pressures normal and synchronous. Mucous membranes were pink and moist.Respiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge. No dyspnoea or other respiratory signs noted.Neurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performed.Musculoskeletal: Ambulating normally, no apparent lameness observed on the right front paw. Full musculoskeletal exam not performed due to patient anxiety.Gastrointestinal:- Oral: NSF- Abdominal: NSF- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: Periorbital angioedema and urticaria noted around the face. No other significant findings.Lymph Nodes: WNL on palpationEyes: NSFDIAGNOSTICS:Nil performed.PROBLEM LIST:1. Angioedema and urticaria secondary to suspected insect envenomation (allergic reaction).2. Anxiety.DIFFERENTIAL DIAGNOSIS:- Allergic reaction (insect bite/sting, contact allergen): Highly suspected given the acute onset of facial swelling. The presence of wasps in the environment makes a wasp sting a primary differential, especially as prior exposure to bees did not cause a reaction.- Other causes of facial swelling are less likely given the presentation.ASSESSMENT:Squid presented for acute facial swelling, consistent with an allergic reaction (angioedema and urticaria). The primary suspicion is an insect bite, likely a wasp, given the history. He received an antihistamine injection on arrival, and the facial swelling has already begun to resolve. Examination was limited due to anxiety but confirmed cardiovascular and respiratory stability. No gastrointestinal or severe systemic signs of anaphylaxis were present. The owner was counselled on the spectrum of allergic reactions, from mild skin signs to more severe systemic signs like vomiting, diarrhoea, and respiratory distress. The possibility of a biphasic reaction, where a secondary response can occur 36-72 hours after the initial event, was discussed. Management has focused on symptomatic care and monitoring. Given his stable condition and improvement, further aggressive medical intervention is not warranted at this stage. He will be discharged for continued monitoring at home.TREATMENT:- NIramine 1.4ml SC- No further medications were administered in hospital.PLAN:- Discharge home for monitoring. Owners advised to monitor closely for the next 2-3 days for any recurrence of swelling or development of new symptoms such as vomiting, diarrhoea, or difficulty breathing. If any of these signs develop, immediate veterinary attention is recommended.- Dispensed Zyrtec (cetirizine) for the owner to administer at home if swelling persists or recurs.- It was discussed that preventing future exposure is challenging given he lives outdoors and has access via a dog door. The possibility of restricting him to a more enclosed area while wasps are prevalent was discussed as a potential management strategy. It is difficult to determine if this was a primary or secondary exposure to a wasp, which can influence the severity of the reaction. Advised to seek immediate veterinary care for any future suspected reactions.- He may be lethargic this evening due to the allergic reaction and the sedative effects of the gabapentin and trazodone.DISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide your pet’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today. Diagnosis: Suspect Hypersensitivity/Allergic ReactionHypersensitivity reactions:Hypersensitivity reactions can vary from facial swelling and raised lumps over the body to severe anaphylaxis causing vomiting, collapse and respiratory difficulty.  Generally the cause of the reaction is unknown but it is most commonly thought to be caused by insect bites or possibly contact with plants.  Facial swelling and skin lumps is the most common form, this is usually managed with anti-histamines in combination sometimes with an anti-inflammatory. Monitoring at home: The swellings should reduce gradually over the next 12 hours, occasionally they can persist for longer and a longer course of anti-histamines and anti-inflammatories are required.  Your pet will need to be reassessed by your primary care veterinarian and they will determine if that is suitableThe anti-histamines can make your pet sleepy over the next 12 hours.Please keep your pet rested until the skin lumps have completely resolved then gradually reintroduce normal activity over the following week.They are fine to be offered food and water as per normalMedications:Cetrizine (Zyrtec) 10mg - not dispensed- Give THREE tablets up to ONCE daily. Anti histmaine. Recheck:Once you pet is discharged home we advise a reassessment with your primary care veterinarian within 48 hours to monitor your pets progress.If your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital. If your pet's condition deteriorates or fails to resolve over the next 24 hours, or they become flat or lethargic, go off their food and water, develop vomiting or diarrhoea, develop breathing difficulty or if you have any concerns please contact our team or your primary care veterinarian immediately. Thank you for trusting us with the care of your pet.    Vital Signs    Weight: 28;