KEN – A0813532 aka FRODO – A1076487
Safe - 7-6-2016 Manhattan
SAFE 7/6/16
Manhattan Center
**RETURN**
KEN – A0813532 (aka FRODO – A1076487)
MALE, GRAY TABBY, DOMESTIC SH MIX,2 yrs
STRAY – STRAY WAIT, NO HOLD Reason STRAY
Intake condition INJ SEVERE Intake Date 06/06/2016, From NY 10467, DueOut Date 06/09/2016,
Medical Behavior Evaluation YELLOW
Medical Summary Sex: Male neutered Scan: POSITIVE! 985121002838206 Estimated age: 2-4 years Fleas: No flea dirt. Hx: Found in a park S: Alert, sedated for abscess cleaning O: BAR-H, BCS 5/9, MMs pink and moist, CRT <2 sec EENT: Large fluid pocket on left side of face, extending from just caudal to AS to the mandible. Swelling pushes inward in pt’s mouth and left ear canal. Lots of crusted discharge cranial to and caudal to the abscess. There are two puncture wounds on the left side of the neck, just caudal to the abscess – one about 1 cm dia and one 0.5 cm dia. Mild amt yellow-red-pink thick opaque discharge from the puncture wounds. Moderate serosanguinous discharge from left ear. No discharge OU, nose. Clean teeth. H/L: Pt occasionally hacks as if having difficulty breathing. NSR, NMA. Abd: Soft, no pain on palpation, no masses palpated M/S/I: Amb x4. No skin lesions noted. UG: Male neutered A: Large abscess and likely bite wound near left ear Short-term prognosis: Fair P: Sedate for abscess drainage today. 1088
Weight 7.9
Initial Exam (6/06/16)
Sex: Male neutered
Scan for MC: POSITIVE!
Estimated age: 2-4 years
Fleas: No flea dirt.
Hx: Found in a park
S: Alert, sedated for abscess cleaning
O: BAR-H, BCS 5/9, MMs pink and moist, CRT <2 sec
EENT: Large fluid pocket on left side of face, extending from just caudal to AS to the mandible. Swelling pushes inward in pt’s mouth and left ear canal. Lots of crusted discharge cranial to and caudal to the abscess. There are two puncture wounds on the left side of the neck, just caudal to the abscess – one about 1 cm dia and one 0.5 cm dia. Mild amt yellow-red-pink thick opaque discharge from the puncture wounds. Moderate serosanguinous discharge from left ear.
No discharge OU, nose. Clean teeth.
H/L: Pt occasionally hacks as if having difficulty breathing. NSR, NMA.
Abd: Soft, no pain on palpation, no masses palpated
M/S/I: Amb x4. No skin lesions noted.
UG: Male neutered
A: Large abscess and likely bite wound near left ear
Short-term prognosis: Fair
P: Sedate for abscess drainage today.
Re-Exam (6/06/16)
Large fluid pocket on left side of face, extending from just caudal to AS to the mandible. Swelling pushes inward in pt’s mouth and left ear canal. Lots of crusted discharge cranial to and caudal to the abscess. There are two puncture wounds on the left side of the neck, just caudal to the abscess – one about 1 cm dia and one 0.5 cm dia. Mild amt yellow-red-pink thick opaque discharge from the puncture wounds. Moderate serosanguinous discharge from left ear.
Sedated with 0.08 ml telazol IM and 0.07 dexmedetomidine IM. Intubated with laryngoscope and maintained on isoflurane anesthesia.
Two incisions were made in the abscess – one ventrally and one dorsally. The abscess was drained (large amount of hemorrhagic purulent creamy discharge with a few chunks) and flushed with dilute chlorhexidine solution. A Penrose drain was placed and secured with 3-0 Monocryl.
PLAN: Start Clavamox 1 ml PO BID x10 days and buprenorphine 0.15 ml SQ BID x6 days. Keep in Medical. Monitor daily. Remove drain in 5 days or when drainage stops if sooner.
Re-Exam (6/07/16)
Pt doing very well today! Came to front of cage to say hello when I walked over. There are 3 food bowls in the cage and they are all empty.
Pt allowed minimal palpation of L side of face. Swelling is greatly reduced. There is moderate discharge on the pt’s fur and on the cage floor.
Continue treating and re-assess tomorrow.
Re-Exam (6/08/16)
BARH, good app. drain in place, dc is dry
P: ok to move to holding with regular vc
Re-Exam (6/10/16)
S/O: hx abscessdrain placed 4 days ago
BAR very sweet Hydr wnl eating wet food well
EENT/MS/SK: AU debris visualized, drain not productive but firm swelling base of ear to mandible left face.
expressed hemorrhagic fluid and white viscous material. Flushed w/ Nacl syringes-mildly prductive
Thin, dry coat
ABD: nsf on palpation
Repro/Ur: nsf
H/L: hr wnl nm nsr pink moist mm <2 Lungs: nsf
Lymph: nsf
A: abscess left face
thin
P: move to medical
add warm compresses to tx plan and monitor improvement resolution of abscess
add clindamycin 1 ml po bid to tx
Re-Exam (6/11/16)
S/O: BAR, affectionate, hydrated, no URI signs, NPO overnight so no food in cage. mandibular region on left side is very swollen and has dried exudate on the surface, wounds on base of ear and ventral neck also exudative.
A: abscessed bite wounds
P: NPO today for sedated wound tx +/- drain placement
continue amoxi/clav and clindamycin and buprenorphine
on DOH hold
Re-Exam (6/12/16)
S/O: BAR, 5% dehydrated based on prolonged skin turgor, tachy mm. NPO for sedated treatment today. Area ventral to AS/overlying ventral pinna is firm, swollen with little exudate produced on expression. Enlarged submandiblular ln’s.Dried exudate on fur ventral to swelling AS. BCS 2-3/9 with moderate generalized muscle atrophy. HL WNL.
- Bite wound with communication to AS external ear canal
Thin
Dehydrated
- Sedated wound cleaning/treatment (see details below)
Continue amoxi/clav and clindamycin as previous prescribed
Continue buprenorphine as previously prescribed
Continue warm compress
Wound treatment: Sedated with 0.1 ml telazol IM
Area around ventral AS and lateral left face and neck clipped and cleaned with chlorhex solution. An 18G jelco catheter tip was used to flush incisions in skin (previously made from drain dorsal and ventral on ventral AS swelling as well as cranial/medial AS). Small amount of purulohemorrhagic debris expressed from swelling below ear but palpated more cellulitic. Probing with catheter tip also felt more cellulitic with no overt dead space or abscess cavity. It was noted that upon attempt to express the ventral AS swelling, purulent debris and a blood clot arose from the AS external canal. Probing with q-tips showed overt communication from the vertical external canal into the area of cellulitis on the L lateral face. The material from the ear canal was cleaned. Patient given 100 ml SQ LRS. Patient had a slow recovery.
Re-Exam (6/13/16)
QARH in cage,
app good
wound below AS, marked swelling and irregular in texture, no palpable fluid
A: non healing mass r/o resistant infection versus primary neoplastic
P: needs rescue for culture and sensitivity +- biopsy
Re-Exam (6/14/16)
good app, mass still same as previous
A: non healing mass r/o resistant infection versus primary neoplastic
P: recc rescue for workup v
Re-Exam (6/15/16)
Good appetite, very friendly, allows full exam
Firm swelling on left side of face, small draining tract with purulent/hemorrhagic discharge. Moderate bloody crusts in left ear canal. Pt resistant to cleaning of left ear.
R/O resistant infection and trauma to ear canal.
Prognosis: Good-excellent with treatment.
Rec placement with skull rads +/- CT to definitively diagnose ear/facial pathology and create appropriate treatment plan.
Re-Exam (6/16/16)
Sedated pt with 0.28 ml dexmedetomidine IM and took DV, VD and rostrocaudal skull rads. There is signficant swelling around the left ear canal, and fluid in the canal and in the tympanic bulla. There appears to be a small bone-opacity object in the tissue ventral to the ear canal.
Recommend placement asap with myrinogotomy and culture/sens panel done of fluid from left ear. Failing that, treat conservatively with clindamycin, amoxi/clav, warm compresses, gentle ear cleaning daily.
Re-Exam (6/16/16)
Good appetite
Firm swelling on left side of face. At rest, pt’s left third eyelid is halfway elevated and this eye is half closed.
R/O neurologic involvement in infection of L ear canal and L side of face.
Will sedate for skull rads later today.
Re-Exam (6/17/16)
06/17/16 14:46 QARH, OS enopthalmos, mass on L caudal mandible, seems painful to touch
A: mass r/o poss tooth root abscess
P: continue abx, restart pain medication buprenex SC BID
Re-Exam (6/18/16)
06/18/16
O/ASS: BAR , BSC 3/5, CRT< 2SEC
HR- 160, RR-24, TEM 101.1
H- WNL, L-WNL , TEETH-DENTAL CALCULUS , GIT-WNL, NEURO- WNL, OU – ENOPHTHALMUS , INTUG – MASS ON THE LEFT SIDE OF THE MANDIBLE AND EXTENDED DORSALLY WITH MILD PAIN , LN- ENLARGED RIGHT SUBMANDIBULAR LN , UROGENIT-WNL, AU-WNL
ABDOMINAL RADIOGRAPH – GASE FILLED THE LARGE AND SMALL INTESTINE , FULL UB
DEFF DIAG- CLOSED ABSCESS VS NEOPLASIA VS DENTAL ABSCESS VS OTHERS
Re-Exam (6/19/16)
06/19/16 11:03
BAR, good appetite. Appears comfortable. No v/d/s/c. Euh. Mm pk/moist
BCS 3/9 – prominent spine, generalized muscle wasting
Abdomen distended, doughy – nmp
H/L clear, excessive purring
Swelling at left ventral base of ear that extends caudally. Swelling is fluctuant with fluid texture and firm areas. Swelling is warm to the touch, tender (pt reacts with excess palpation). Some purulent material is expressed into ear canal when applying pressure to swollen areas. Resists ear cleaning but excess crusted exudate accumulates within ear canal.
Prominent right submandibular LN
A:
Suspect abscess vs granuloma. Likely encapsulated with excess cellulitis.
Underweight
Distended abdomen
P: Continue conservative treatment with abs and pain med
if time, consider re-sedation and potential re-attempt to lance/place drain. At least clean ear canals and explore + more throrough oral exam.
Reco transfer ASAP for appropriate work up and treatment
Reco cbc/chem, FeLV/FIV testing
Re-Exam (6/20/16)
06/20/16 11:08 firm mass on L side of head, tender to touch, OS enophthalmos, otherwise BARH and eating very well.
A: mass +- abscess on head
P: needs thorough expore and biopsy of facial mass. pt is stable to go to holding on current treatments and pain management w daily vet checks
06/21/16 12:46 Mass on side of head unchanged, eating well appears BARH, OS enophthalmos
P: CWSC, awaiting transport
6/22/16 17:44
Mass on L side of head below ear – fluctuant, as described. Pt purrs and allows all handling. OS has corneal ulcer – epithelial damage and neovascularization are visible.
Start TAB ophth oint OS BID x7 days, recheck and fluorescein stain in 5 days.
06/23/16 12:57 pt eating, alert, mass and OS unchanged, reported poss ndc but none seen
P: continue monitor, awaiting transport
6/24
S/O: recheck left facial swelling
EENT: OS lat ventral opaque area w/central on cornea, fluorescein dye + (OD neg)
AS white beige fluid in prox ext canalm, AD pruritic and crusted debris ext ear canal
MS/Sk: soft swelling l face extending from ear to caudal aspect of left jaw-aspirate 1.5 viscous white and red black fluid (pus and blood) with 2-3 firm areas within fluid “pocket.”
ABD: nsf on palpation
Repro/Ur: nsf
Lymph: nsf
Neuro: nsf
H/L hr 172 nm nsr pink moist mm <2 lungsL nsf
A: Otitis AU
OS fluorescein+ r/o desmetocele other
Facial swelling r/o abscess 2nd to trauma vs neoplasia
P: cont tx
add warm compresses bid x 5 days
rec rescue for further dx/ts
Px fair to good pending def dx
6/25
S/O: friendly cat who likes belly being rubbed!
urine in litter box, food bowl empty
EENT: pink gums, AS: dark black/red d/c, palpable thyroid nodule
AD: scant debris
M/S: mild to moderate swelling, non painful of left jaw extending to AS
ABN: SNP
H/L: no m/a, lungs clear
LLNN: NSF
A: Otitis
OS fluorescein+ r/o scarring, other
Facial swelling r/o abscess 2nd to trauma vs neoplasia
P: CWSC rec full senior workup- cbc/chem/t4/UA/fecal OPG as general health screen for any geriatric
strongly rec NH placement- needs further dx’s and tx to determine underlying cause of AS and swelling
prognosis- open- depends on what cause is of swelling
Behavior
Reaction to assessor: Ken looks neutral in the cage when approached by the assessor.
Reaction to door opening: Ken remains crouched position on his cage bedding, alert with soft eyes.
Reaction to touch: Ken slowly leans into the assessor’s hand and appreciates petting on the head and body.
Reaction to Being Picked up: Ken becomes antsy then jumps back into the cage.
Placement determination: Average
Ken interacts with the observer, appreciates attention, is easy to handle and tolerates all petting.
This cat is showing behavior appropriate for new or experienced cat parents.
6/7/16
Large abscess and possible bite wound on face. Sedated for treatment. Very good appetite! Came forward for treats, voracious. Allowed pets, ignored me in favor of eating.
6/8/16
Friendly, desperately hungry. Came forward on approach and inhaled offered treats. Moved away from head pets, but did not aggress. Arched into back and shoulder pets.
6/12/16
Super sweet and affectionate. Came to the front on approach and sniffed hand. Leaned and arched into pets, and purred.
6/13/16
Sleepy today, still very friendly. Lay in place, leaned into pets and looked around.
6/14/16
Face still swollen, but seems largely unbothered. Came to the front when door opened, leaned into pets. Very hungry and thirsty.
6/15/16
Still seems very hungry and thirsty, all food and water bowls empty. Came to the front when door opened, ate treats from hand, leaned and arched into pets.
6/16/16
Still very friendly. Came to the front on approach, ate treats from my hand, leaned into pets
ALL LOCATIONS:
For more information on adopting from the NYC AC&C, or to find a rescue to assist, please read the following: http://information.urgentpodr.org/adoption-info-and-list-o…/
If you are local to the Tri-State, New England, and the general Northeast United States area, and you are SERIOUS about adopting or fostering one of the animals at NYC ACC, please read our MUST READ section for instructions, or email [email protected]
Our experienced volunteers will do their best to guide you through the process.
*We highly discourage everyone from trusting strangers that send them Facebook messages, offering help, for it has ended in truly tragic events.*
For more info on behavior codes and ratings, please read here: http://information.urgentpodr.org/acc-placement-status-des…/
For answers to Frequently Asked Questions, please see: http://information.urgentpodr.org/frequently-asked-questio…/
You can call for automated instructions. (212) 788-4000
For more information on adopting from the NYC AC&C, or to find a rescue to assist, please read the following: http://urgentpodr.org/adoption-info-and-list-of-rescues. If you are local to the Tri-State, New England, and the general Northeast United States area, and you are SERIOUS about adopting or fostering one of the animals at NYC ACC, please read our MUST READ section for instructions, or email [email protected]. Our experienced volunteers will do their best to guide you through the process. * We highly discourage everyone from trusting strangers that send them Facebook messages, offering help, for it has ended in truly tragic events.* For more info on behavior codes and ratings, please click here: http://information.urgentpodr.org/acc-placement-status-descriptions. For answers to Frequently Asked Questions, please see: http://information.urgentpodr.org/category/frequently-asked-questions/. You can call (212) 788-4000 for automated instructions.
View all entries in: Safe Cats 2016-07