PAUL – A1106270
Safe - 3-18-2017 Manhattan
SAFE 3/18/17 Super Sweet Orange tabby boy Paul looking for a cozy home to recover in @MACC
PAUL IS NOT FEELING WELL AND NEEDS RESCUE!
PAUL – A1106270
MALE, ORG TABBY, DOMESTIC SH MIX,2 yrs
STRAY – STRAYAVAI, NO HOLD Reason STRAY
Intake condition ILLNESS Intake Date 03/15/2017, From NY 11233, DueOut Date 03/18/2017,
Friendly, allows handling, started to eat when food put in front of him
Epiphora, mild conjunctivitis OU, moderate brown debris AU, mucoid bilateral nasal discharge
OP 2/4 ddz & gingivitis
H/L reg, no obvious murmur, lungs clear/eupenic, no active coughing or sneezing
MSK amb x 4
Integ large burn wound on neck, mostly unhealthy scabs but small area clean granulation tissue, minimal discharge, seems comfortable, slightly unkempt coat
UG m/i, smooth & symmetrical testes
Neuro alert and appropriate
A: URI-nasal discharge and conjunctivitis
Wound on neck-looks unhealthy
Suspect ear mites with secondary otitis externa
P: Anesthetize, clip and clean and debride wound on neck-very unhealty, cannot wait to be treated
Pull PCR Swab while under anesthesia
Recommend convenia 8 mg/kg SQ-not given yet
Recommend ivermectin 0.1 mL SQ-not given yet
Start doxycycline 0.8 mL PO SID x 14 days
Start erythromycin both eyes BID x 14 days
Start tresaderm BID x 14 days
+/- add on baytril depending on how wound looking over next couple days
Keep in medical for monitoring, may needed cleaning of wound daily
Hx: Neck wound, URI
S: Quiet, allows handling
O: QAR, BCS 5/9, MMs pink and moist
EENT: Moderate purulent nasal discharge, mild mucoid ocular discharge. Moderate black granular discharge AU. Moderate gingivitis.
H/L: NSR, NMA. Referred upper resp sounds, but quiet quiet lung sounds.
Abd: Soft, no pain on palpation, no masses palpated
M/S/I: Amb x4. Large partial-thickness wound on left side of neck, about 8 cm long and 2-3 cm wide. Significant debris or dried dead skin is crusted all over the wound and a large piece of this dead skin is sticking out of the middle of the wound.
UG: Male intact, testicles soft and symmetrical.
Sedated with 0.1 ml buprenorphine, 0.06 ml Dexdomitor and 0.34 ml ketamine mixed together and given IM in one syringe. Pt vomited post-sedation.
The neck wound was clipped and cleaned with chlorhexidine scrub, then debrided and flushed with sterile saline. 10-20% of the crusts were firmly adhered and therefore not removed. A good granulation tissue bed was visible underneath the crusting, with minimal purulent discharge. The wound was bandaged with SSD and Telfa, held in place by a cotton stockinette.
Both ears were cleaned and Tresaderm was applied to the left ear. The right ear bled heavily with gentle cleaning so Tresaderm administration was skipped.
A full body exam was performed and one digit pad on each hind foot was found to be scabbed with purulent hemorrhagic discharge. The pads were cleaned with chlorhexidine scrub but left unbandaged.
Pt was given 0.3 ml Cerenia SQ and reversed with 0.1 ml Antisedan.
2. Large neck wound – possibly burn
3. Small abscesses on each hind foot
4. Likely ear mites
Short-term prognosis: Good
SURGERY: Okay for neuter!
1. Give Tresaderm AU BID x10 days – but monitor Tresaderm, if it is getting in the neck wound then we should discontinue it and give ivermectin 0.1 ml SQ (repeat in 14 days) instead
2. Yesterday’s News litter only while paw pads are healing
3. Amoxiclav 45.7 mg/ml 1 ml PO BID x10 days
4. Daily bandage changes for neck wound – ensure wound is kept moist to expedite healing
5. Continue doxycycline and erythromycin ophth oint
S/O: BAR, VERY FRIENDLY, purring and head butting
EENT: moderate gingivitis, pink gums, dried mucopurulent d/c around nares, AD- moderate dark debris, audibly congested
UROGEN: MI, both testicles descended
M/S: amb x4, BCS 4/9
H/L: purring, but eupneic, no m/a asculted purring, (couldn’t fully ascult cardiac sounds) lungs clear
SKIN: bandage covering skin wound- purulent d/c visible
P: con’t with supportive care
add on nebulization
changed bandage- cleaned with chlorhexidine solution under pus there’s healthy tissue
Possibly attacked by dog? Appears to have burn-like wounds on neck, URI, loose stool. Very sick, but still friendly. Lay in place on approach, soft eyes and body. Leaned into pets, rolled over on to side, and purred.
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View all entries in: Safe Cats 2017-03