C10032781 / invoice 10000

Reason: Mars TransferHospitalisation time period: 1500 - 2000HISTORY:Night 2 hospitalisation following laproscopic liver biopsies/o-tube placement for an acute on chronic severe hepatopathy (MARS) Aggressive patient and has required medetomidine/fentanyl CRI sedation - unable to assess otherwise Today has been off medetomidine CRI however remains very sedate on low dose fent CRISee previous history for full details EXAMINATION: @1700:Sedated mentation HR 68, RR 20, Mm unable (muzzle on), Pulses strong and synchronous. Temp unable Pain score-  unable to accurately assess due to sedated mentation Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronous Respiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge Neuro/MSK: sedated mentation, but reactive and twitching when touching his feet. Attempted temp check - growled and turned around quickly. Full neuro/MSK exam not performedInteg: Bandage patch over surgical site strike through - removed this. Surgical site appears clean and dry Abdo: comfortable on palpation however sedated mentation - unable to accurately assess. Normal gut sounds audible. Owner offered SPD chicken (warmed) but he turned his head away (still relatively sedate mentation) PROBLEM LIST: Acute on chronic severe hepatopathy with marked hepatocellular enzyme elevation, hyperbilirubinaemia, and coagulopathy.13/3 laparoscopic liver biopsies and oesophageal feeding tube placement.History of aggression - muzzle to be warn at ALL TIMES. ASSESSMENT: Sedated patient during this hospital period - given on minimal dose fentanyl and medetomidine CRI has been off for the last 12 hours or so, it is likely that there is delayed clearance of the previous medications owing to hepatopathy. Reasonable to discharge home given requirement for ongoing sedation here in hospital, and subsequent cumulative effect as we can see in patient here tonight. Awaiting laparoscopic liver biopsies TREATMENT: 1/ LRS 110ml/hr 2/ Amoxyclav 25mg/kg IV q8h - last dose given @ 19003/ Enrofloxacin 10mg/kg IV q24h - last dose given @ 1900 Turned off fent CRI @ 1700 Dispensed:- Amoxyclav 1000mg PO q8h - Enrofloxacin 450mg PO q24h- Hepatoadvanced large tab  2 PO q24h - Ondansetron 8-6mg PO q8h PLAN: Discharge home tonight at 8pmOwners to contact MARS Monday morning to schedule recheck appt Owners to O-tube feed at home unless eating well - Emeraid only available here, owner to  pick up RC hepatic wet food CLIENT COMMUNICATION:--- 14/03/2026 5:36:12 PM ADC:Hi Tara, Just wanted to touch base about Floyd's plan for tonight. I understand that the plan was to get him home tonight for ongoing care and management (where he does not need to be kept on sedative drugs) - however Floyd is still quite sleepy and drowsy right now (likely from delayed clearance of the previous medications due to his liver condition). I think it would be best if you came down sometime soon ( in the next hour or so) and we can see how he is with you. Please give us a call back to chat further! - Dr Desiree (AES ICU)Spoke to owner when she came down at 7pm. Discussed medications , recheck appt, symptoms to monitor for.Vet nurse went through feeding tube cleaning/use - and I discussed the use of emeraid but to change onto RC hepatic wet food when available.Owner is comfortable to take him home tonight    Vital Signs    

Reason: Mars TransferHOSP PERIOD: 2300-0700Problem List:Acute on chronic severe hepatopathy with marked hepatocellular enzyme elevation, hyperbilirubinaemia, and coagulopathy.13/3 laparoscopic liver biopsies and oesophageal feeding tube placement.History of aggression - muzzle to be warn at ALL TIMES. SUBJECTIVE:Floyd is sedate overnight due to medetomidine CRI - no vitals taken during this period due to aggressive and TPR frequency de-escalation. Distance examination shows patient to be sedate most of shift. When sedation removed patient is standing and seems unsettled. No changes in posture or overt signs of discomfort when standing but sensitive to stimuli (appears anxious). Patient kept sedated for remainder of shift to reduce stress. Diagnostics:Diagnostic results from tests performed 13/3 are pending. ASSESSMENT: Post-operative recovery from laparoscopic liver biopsies and oesophageal feeding tube placement for investigation of acute on chronic severe hepatopathy.Remains sedated but visually stable. Aggression limits a full conscious examination.TREATMENT:Amoxyclav 25 mg/kg IV q8h.Enrofloxacin 10 mg/kg slow IV q24h.Ondansetron 0.4 mg/kg IV q8h.Maintenance LRS IVFT.Fentanyl CRI 2mcg/kg/hr reduced to 1mcg/kg/hr Medetomidine CRI at 1 mcg/kg/hr for sedation.Oesophageal tube feeding to commence q6h at full RER with a gastrointestinal low-fat diet once awake. PLAN:When off sedation patient is alert, able to stand, and appears comfortable but due to patients level of stress has been kept sedated. Goal to remove sedation gain during the day when patient can be discharged into owners care in a swift manner once assessed to reduce time patient is awake and distressed in hospital. No O-tube feeds as patient sedated    Vital Signs    

Reason: Mars TransferHOSP PERIOD: 07:00 - 1500Problem List:Acute on chronic severe hepatopathy with marked hepatocellular enzyme elevation, hyperbilirubinaemia, and coagulopathy.13/3 laparoscopic liver biopsies and oesophageal feeding tube placement.History of aggression - muzzle to be warn at ALL TIMES. Client Communication: SUBJECTIVE:Was disconnected from fluids and CRI on check this morning. Remains sedate and handable - so have left off Medetomidine and just maintained on Fentanyl for now. Have started on 25% RER and 2 hour feeds while sedate to see if tolerating. Diagnostics:Diagnostic results from tests performed 13/3 are pending. ASSESSMENT: Post-operative recovery from laparoscopic liver biopsies and oesophageal feeding tube placement for investigation of acute on chronic severe hepatopathy.Remains sedated but visually stable. TREATMENT:Amoxyclav 25 mg/kg IV q8h.Enrofloxacin 10 mg/kg slow IV q24h.Ondansetron 0.4 mg/kg IV q8h.Maintenance LRS IVFT.Fentanyl CRI 1mcg/kg/hr --> 0.5mcg/kg/hrMedetomidine CRI StoppedOesophageal tube feeding started at 10am @ q2 at 25% RER. Increased to 50% at 3pm feed. If tolerating by end of the day can be discharged at 100% RER. PLAN:Discussed with owners can send home with O-tube management and medications. O wanting to keep here today on fluids and will potentially pick up tonightTo maintain on minimal sedation dependent on patient toleranceManage O-tube feeds    Vital Signs