C10030735 / invoice 10000

Post op call - No answer LVM (KLC)

sedate -aural hematoma
(4) Sx Points

Admitted by ( RF) 
Ask and check details on admission form ( Y) Completed and submitted ( ) 
Primary Contact (Y ) 
Gap Only ( N)
Adv pre ga bloods-declined 
Fasted ( y) Diet for today (owner brought in food ) 
Medication (None ) 
Concerns ( Bilateral otitis and RIGHT ear aural haematoma) 
Extra Treatment (None ) 
Animal details checked and completed (Y )
Pre-Op TPR Done ( T=38.2 heart=110 bpm reg,lungs clear) 


Strongly advised surgical  correction under ga,declined wish to sedate and drain aware likley recurrence

Supervising vet: Dr Rory Finch

Pre-ga blood tests:Declined
Placed i/v catheter 

sedated with  Butorphanol 0.2mg/kg (0.25mls), Medetomidine 10mcg/kg (0.12mls). Top-up sedation with microdose Alfaxone for cannula placement.
 

 
Monitoring-HR,RR,Core temp,BP,SPO2 and anaesthetic depth constantly monitored by a veterinary anaestheitc nurse usign multi-parameter monitor.,pulse oximetryap alert breathing monitor and manual blood pressure reading.Good uneventfull GA.No hypotension detected throughout sedation
 


The procedure was performed under sedation. Drained aural haematoma using an 18-gauge needle-16 mls serosanguinous fluid drained Inserted Larson's T cannula drainage device.

Bilateral stenotic ear canals, mild erythema. Ear cytology L and R performed - 2+ yeast on both samples. Initial ear clean with Otoflush, residual wax removed.
 

Netra instilled in both ears.
Clipped nails,
Uneventfull recovery from sedation in a heated recovery cage
I/V fluids reduced post operatively to twice maintennace
 
PLAN:
Discharge with recheck in 1 week or sooner if aural haematoma is reforming. Owner is aware the ideal option is GA and surgical repair but wishes to try conservative management first.Was clear on admit for this
If no reformation and drainage cannula stay in place then review weekly for 3 weeks remove cannula at  week 3 and repeat ear cytology then and otoscope exam to ensure otits resolved.If will not tolerate removal cannula unsedated then potentially may need to sedate

possible aural haematoma
Person (Danielle) 
Insurance (bow wow - gap only )
Reminders ()
Preventatives (utd)

HISTORY:
The owner presented Raven for an acute swelling of her ear pinna, which was observed this morning.The owner reported that Raven has been itching the affected ear more than usual recently.
Raven has a history of generalised pruritus. She frequently licks her paws, a behaviour that has been present for a few months. There are also reports of intermittent lumps on her skin. The owner bathes her approximately once monthly with a medicated shampoo, which is reported to improve her skin condition. There are small patches of alopecia and potentially lichenified skin observed.

Diet: Raven was recently transitioned to a grain-free diet approximately one week ago. The owner believes this has helped resolve some lumps that were present on her sides.
Current meds: Medicated shampoo is used approximately once per month.
Prophylaxis: The owner administers a tick, flea, and mite prevention tablet (NexGard) monthly, with the most recent dose given a few weeks ago.
Pre-existing conditions: History of generalised pruritus and skin lumps.
Access to toxins e.g. Rodenticide: nil known

EXAMINATION:
Body Condition Score: 5/9*
Pain Scale (0-4): 0/4
Hydration status (%): euhydrated
Cardiovascular: HR 120, cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronous
Respiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge, no coughing or sneezing
Neurological: neurologically no significant findings
Musculoskeletal: ambulating normally x4, no palpable neck, spine, limb or joint pain
Gastrointestinal:
- Oral: NSF, no mouth pain, dental score: 0/4
- Abdominal: comfortable on palpation, no obvious foreign body or mass effect, no significant distension
- Rectal: not performed
Urinary: NSF*
Reproductive (incl ext. genitalia): NSF
Integument/Ears: A large, aural haematoma is present on the right ear pinna. There are multiple small papules and areas of alopecia on the body. The hair coat appears thin in some areas.
Lymph Nodes: Peripheral lymph nodes NSF on palpation
Eyes: NSF

PROBLEM LIST:
- Aural haematoma
- Pruritus (affecting ears and paws)
- Dermatological changes (papules, alopecia, thinning hair coat)
- Suspected underlying allergic skin disease (e.g., atopic dermatitis)

DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:
- Aural haematoma secondary to self-trauma from pruritus.
- Underlying allergic skin disease (e.g. atopic dermatitis, food allergy) causing pruritus.
- Otitis externa.

DIAGNOSTIC/MANAGEMENT PLAN:
A full otoscopic examination and cytology to investigate for an underlying ear infection.
The primary plan is to sedate Raven to manage the aural haematoma. This will involve draining the haematoma with a large-bore needle or a scalpel blade incision.
Further management options were discussed, including surgical correction involving drainage and suturing to prevent recurrence and the formation of a "cauliflower ear". This procedure would be performed under a general anaesthetic and would likely be scheduled for the following day. An Elizabethan collar and potentially a head bandage or snood would be required post-procedure to prevent further self-trauma.

DIAGNOSTICS:
- Attempt aspiration conscious - unsuccessful, need sedation/GA
- Otoscopic examination and ear cytology - can perform when sedated 

ASSESSMENT:
Raven has presented with an acute aural haematoma, which is very likely secondary to self-trauma from head shaking and scratching. The history of chronic pruritus, paw licking, and other skin changes is highly suggestive of an underlying allergic skin disease, such as atopic dermatitis, which is common in her breed. The immediate priority is to address the haematoma, while investigation and management of the underlying skin condition will be crucial for long-term control and to prevent recurrence.

TREATMENT:
The proposed immediate treatment is sedation to allow for drainage of the aural haematoma. Attempts were made to drain the haematoma today conscious as owner does not have time to sedate - unsuccessful. 
A decision was made to proceed with sedation/GA tomorrow to drain the haematoma 

PLAN:
- Admit tomorrow to hospital for either sedation or GA + drain + ear exam
- Perform otoscopic examination and ear cytology while sedated.
- The owner was advised that there is a high likelihood of the haematoma refilling without surgical intervention.
- Discussed booking for a general anaesthetic and surgical repair tomorrow if initial drainage is unsuccessful or if it refills.
- An estimate for sedation and for a full general anaesthetic with surgical repair will be provided.
- Long-term management will require addressing the underlying pruritus, which may involve referral to a veterinary dermatologist.

CLIENT COMMUNICATION:
The nature of an aural haematoma was explained to the owner, including the link to trauma from scratching and the potential for "cauliflower ear" to develop from scar tissue if not managed appropriately.
The following treatment options were discussed in detail:
1.  Sedation and needle aspiration of the haematoma today. The high probability of recurrence and potential for oozing from the site were explained.
2.  A general anaesthetic for surgical correction, involving drainage and placement of sutures to tack the cartilage, which is the ideal treatment to prevent recurrence. This could be scheduled for tomorrow.
The importance of identifying and managing the underlying cause of the itchiness, likely an allergic skin condition, was emphasised. The need for an otoscopic examination was also explained.