Intelligent SOAP notes, live transcription, & more.

Buddy, a 10 year 5-month-old Male Neutered German Shepherd Mix presented on emergency for seizures. Acute onset of seizures. Owners were out of town x 10 days, and returned to him having a seizure. The first seizure was focal facial seizure. Has had pet sitter checking on him twice daily while gone. No change in home environment, no toxin exposure. No prev medical hx, owners haven't noticed any neurologic changes reflecting back. Exam at admission to ICU (about 2 hours after presentation) - QAR with fairly normal to slightly sedate mentation. CN intact. PLR present, no menace. Suspect blind/central blind - will head press in corners in exam room. Making wide circles to the right in room, though would occasionally turn other direction. Roaming in room, bumping into walls and head press in corner. Knuckling and mild to moderately ataxic. CBC - HCT 44%, PLT 320K, WBC 17K and neutrophillic, Chem/lytes - NSF, BG 122, lytes normal Buddy is a geriatric (10-year-old) male neutered German Shepherd Mix presenting for acute onset cluster seizures, with focal facial onset and progression to generalized seizures. Clinical course is notable for post-ictal dullness, persistent non-ambulatory status, circling, ataxia, suspected central blindness, and head pressing. Neurologic deficits are asymmetric and suggest a forebrain (prosencephalic) lesion. No prior neurologic history, no known toxin exposure, and initial diagnostics (CBC/Chemistry) were unremarkable. Diagnostics: 1. Advanced neuroimaging (MRI preferred, CT as alternative): - To evaluate for intracranial structural disease (neoplasia, CVA, inflammation). 2. CSF analysis: - If imaging supports non-neoplastic/inflammatory disease; to assess for infectious/inflammatory processes. 3. Infectious disease titers (as indicated by CSF findings/region): - If infectious etiology suspected on CSF. Supportive care and treatment: 1. Continue anticonvulsant therapy: - Maintain phenobarbital; consider adding a second agent (levetiracetam) if seizures recur or side effects are excessive. 2. Monitor and correct hydration status: - Initiate IV fluid therapy to address 5% dehydration and support perfusion. 3. Monitor neurologic status and mental state closely: - Serial neurologic exams to track progression or improvement; monitor for further seizures. Client communication: - Discuss prognosis and further steps dependent on neurologic progression and diagnostic findings. - Advise family of guarded prognosis due to age, severity, and current non-ambulatory/blind status. Re-evaluation: - Reassess after additional imaging/diagnostics to refine diagnosis and adjust therapy accordingly. 1/15/2025, 5:52:12 AM EJM

DVM: "Tell me more about the vomiting—how often?" Owner: "Twice yesterday, none today." DVM: "Any changes in water intake or urination?" Owner: "Drinking a bit less. Normal urination." DVM: "We'll run a CBC/chem and get abdominal imaging today."

Increased WBC may indicate inflammation, infection, immune-mediated disease, or tissue necrosis. It can also suggest neoplasia or stress-induced leukocytosis due to conditions like hyperadrenocorticism or administration of exogenous steroids. Low RBC counts often point to blood loss, hemolysis, or inadequate production due to bone marrow suppression or chronic diseases. It can also indicate immune-mediated hemolytic anemia. Low hematocrit generally indicates anemia, which could be due to blood loss, hemolysis, or bone marrow suppression. Additional evaluations may be necessary to identify the underlying cause of decreased red cell mass. Low platelet counts can result from decreased production in the bone marrow, increased consumption due to conditions like DIC, or immune-mediated destruction. Thorough investigation into potential causes, including history of drugs or bone marrow disease, is recommended. The patient exhibits complex hematological abnormalities that necessitate further diagnostics. Given the high WBC and low RBC, hematocrit, and platelet levels, the differentials may include infections, immune-mediated diseases, chronic inflammation, or neoplasia. Diagnostic imaging and serologic testing should be considered to address the etiology of these findings, along with a review of the patient's medication history and possible exposure to infectious agents.

A plasma transfusion is indicated in specific situations related to coagulation factor deficiencies or clinical conditions requiring supplementation of these factors. Here are the main indications based on veterinary practices: Plasma transfusions are indicated when there is a significant coagulopathy, which could be due to conditions such as anticoagulant rodenticide poisoning. In such cases, the administration of fresh frozen plasma (FFP) can help to restore coagulation factors urgently. When performing surgeries in patients with known bleeding disorders or when prior tests indicate potential coagulopathies, a plasma transfusion may be necessary to prevent excessive bleeding during the procedure. While plasma transfusion can offer proteins and factors, the effectiveness in treating hypoproteinaemia is limited, as very large volumes would be needed to correct albumin deficiency. Other therapies might be more appropriate in these cases. Conditions like von Willebrand’s disease or hemophilia A may warrant specific plasma products (like cryoprecipitate) that concentrate crucial clotting factors. In cases of acute hemorrhage accompanied by coagulopathy, both plasma and red blood cell components may need to be replaced; fresh whole blood can provide both components. Administer plasma intravenously at a cautious rate, typically starting at about 10–20 mL/kg over a period of 4 hours, adjusting based on the patient's response and clinical signs. Monitoring of the patient for adverse reactions is crucial, including parameters like temperature, heart rate, and any signs of allergic reactions. While plasma transfusions can be life-saving, they should be administered judiciously based on clinical signs, underlying conditions, and specific patient needs. Boag (2018). BSAVA Manual of Canine and Feline Emergency and Critical Care (3rd Edition), Tilley (2021). Blackwell's Five-Minute Veterinary Consult - Canine and Feline (7th Edition), Thrall (2022). Veterinary Hematology Clinical Chemistry and Cytology (3rd Edition).