C10027146 / invoice 10000

Reason: Stage 1 Dental And Chest X-Rays GSTreatment:Anaesthesia:Pre-med: 0.4ml methadone and 0.13ml medetomidine given IV @ 12:35pm RB Induction: with 0.5ml alfaxan given slow IV @ 12:36pm RB Maintenance: with isoflurane @ 2% and oxygen @ 1.2L/min Reversal: 0.13ml atipamezole given IM @ 12:43pm BS IVFT: Hartmann's 66ml/hr during surgery, reduced to 33ml/hr post-op in recovery ET tube: 7.0mm cuffed Radiology: Site: Neck/throat/thoraxType of View: L and R lateral, VDFindings: VHS 10.75, VLAS 2.5, mild dorsal deviation of the trachea, mild narrowing of the trachea at the thoracic inlet. Mild to moderate bronchitis. No obvious FBs or masses, diaphragm intact. No FBs visible on intubation prior to dental scale and polish. Mildly elongated soft palate. Differential diagnosis:Cardiomegaly with left atrial enlargementVLAS 2.5-2.8 can suggest progression to stage B2Bronchitis vs tracheobronchomalacia vs other Obesity Collapsing trachea?Treatment:Full mouth dental radiographs taken. No extractions necessary.Teeth missing (1):408 General scale and polish of remaining teeth. Nails too short to clip. Routine recovery.No post-op meds given.Plan:Ongoing dental care at home. Options for next steps for cardiomegaly, worsening cough:1. Internal med referral, fluoroscopy to assess trachea, repeat echo 2. Trial pimobendan and monitor response 3. Trial doxycycline given bronchitis?Further weight loss needed, going in right direction, down 800g since last visit. Continue decreased intake.    Vital Signs    Weight: 13.2;       MMColour: pink;       Temperature: 38.2;       HeartRate: 108;       BodyScore: 8;       RespirationRate: pant;       CRT: <1s;