C10032908 / invoice 10000

Reason: Open Mouth BreathingAppointment Notes: Overdue remindersHospital Time Period: 14/3/26 1800-0600 History:Admitted for ongoing mgmt of CHF vs aspiration pneumoniaAdmitted @1800 13/03, see prev records for more detail.Subjective: DAR Objective:Temp:    not performed        MM:  pink, tacky            CRT:  1.5s           HR:  182           SSFP              RR: 36BCS:    7/9                Wgt:    5.7kg Pain Score (CSU):   0/4CV:  no murmurs or arrhythmias but difficult to auscultate over mild crackles and purring, BP 120/81 (92) RESP:  mild crackles biltaterally, slightly increased respiratory effort, SpO2 98% in oxygen GIT: soft and comfortable, no focal splintingU/G: single large urination produced in litter tray, NADNeuro: appropriate mentation, full neuro exam not performedM/S: NADInteg: NADOphth: NADLNs: WNL IMAGINGTFAST: coalescing B-lines cranioventral lung fields, no pleural or pericardial effusion, glide sign present. Problem List:Respiratory distress Assessment: Improved from when first admitted but not improving as quickly as expected, although RR and RE more normal, SpO2 still dropping rapidly when oxygen cage opened and FiO2 drops down to 21%. Treatment:Flowby O2 @FiO2 50%Frusemide 4mg/kg IV initially -> 2mg/kg IV q2-4 hours -> 1mg/kg/hr CRI Butorphanol 0.1mg/kg PRNCefazolin 22mg/kg IV slow q8hr Potassium gluconate 78mg PO q12h  Own medications as per label:Pimobendan 1.25mg PO BID Rivaroxaban 2.5mg PO SIDClopidogrel 1 pump TD SID Plan: As prev- Continue supportive care until RR and RE normalise, then consider room air trialConsider further imaging when more stable including echocardiogram and/or chest radiographsClient Communication:STO @ 8pm - O keen on keeping in hospital, despite earlier conversations with JL on prognosis, feels that he just needs more time, does agree that he has improved since presentation although slowly. Mentioned that if our hospital refuses to continue treatment for Skye, will pursue it with LSAH. Explained that we are happy to continue treatment for Skye, but it is important to be realistic about our expectations with his long term prognosis, reiterated that heart disease is progressive and can only be managed, not cured, even if we are able to get him home from this episode it is likely that he will get another episode of CHF and in possibly the near future. Explained that whilst we can add in more medications etc, they also do come with side effects eg kidney injury, and at some point the CHF could become refractory to medications. Discussed referral to cardiologist if possible. O also asked about performing a thoracocentesis, mentioned no indication at this stage as no pleural effusion, O happy with answer. O explained that she is hoping for another miracle. Est another 1500-1800 for the next 12 hour period.14/03/2026 22:55:22 RLL:~945pm was noted to be in an abnormal position in litter box and was vocalising continuously Bilateral HL paresis, cold peripherals, absent femoral pulses in both HLs > suspect second FATE eventMethadone 0.3mg/kg IV administeredOwners called (Mary and her mother) and update relayed - arrived shortly to visit SkyeAgain discussed above prognosis, especially with the new onset of FATE, prognosis has worsened. Can attempt treatment to get him through this but slim chance and will be suffering until that point with no guarantee that he will get better. Mary was understanding and consented to euthanasia, although Mary's mother had a harder time understanding and consenting to the euthanasia as not primarily english speaking. Propofol and lethobarb administered IV via cephalic vein; CPA confirmed on thoracic auscultation. Home burial.    Vital Signs