ECC Case diary

1. Rachael Lang
1006190l

2.  Signalment: 8 week old, male entire, Italian Greyhound purchased
2 weeks ago
 History: Vomited twice and diarrhoea twice throughout day.
Quieter in demeanour, inappetent and not drinking.
 Clinical exam: HR 180, pale mm, pulses narrow, RR 36, T 38.1, no
skin tent, quiet mentation.
 Diagnostics:
 PCV/TS: 35/50
 Blood gas and electrolytes: WNL
 Haematology: degenerate left shift with a monocytosis
 Faecal smear: mixed bacterial population and occasional WBC
(normal)
 Parvo Antigen test: negative
 Fast scan: no free fluid or distended small intestine loops
 Faecal sample for c&s not sent off as resolved

3.  Differentials: Dietary indiscretion, parvo virus, bacterial
enteritis, foreign body ingestion, parasites
 Treatment:
 Admit for IVFT Hartmanns 10ml/kg bolus then 40ml/hr
 Buprenorphine 0.01mg/kg q 8
 Metronidazole 10mg/kg IV q12 then oral tablets for 5 days
 Protexin Probiotic
 Outcome:
 Following day he was stable and eating chicken without any
vomiting or diarrhoea. No abnormalities found on clinical
exam.
 Discharged with a 5 day course of oral metronidazole and
protexin probiotic.
 Informed to come back if any further gastrointestinal signs
occurred

4.  Signalment: 9 month old female entire Kelpie cross
 Reason for presentation: Hit by car going at 40-
50km/he about 1.5 hrs ago.
 Clinical exam: Very dull mentation, HR 140, white
mucous membranes, CRT 3s, pulses short and
shallow, painful on gentle abdominal palpation,
T:38.1
 Stabilisation:
 Free flow oxygen by mask
 IVFT: Hartmanns 800ml/hr bolus for fifteen minutes then
reassessed and decreased to 200ml/hr
 Pain relief: Methadone 0.01mg/kg (twice)
 Abdominal wrap to reduce venous bleeding

5.  Diagnostics:
 Fast scan:
 Abdomen: Large volume of free fluid around bladder (ddx:
uroabdomen vs haemoabdomen).
 Splenic mass on repeat fast scan. Thorax: no FF
 Abdominocentesis: Frank blood in abdomen; PCV/TP of fluid:
51/46
 BP: systolic 120
 SpO2: 91%
 Urine: grossly normal
 ECG: right bundle block, intermittent VPC’s and transient runs of
V-tach
 Bloods:
 PCT/TP: 41/46 (decreased after fluid therapy to 21/29
 Blood Gas and lytes: metabolic acidosis (SBEc:-6
) with no respiratory compensation. Lactate high due to hypoperfusion
injury. Glucose high due to stress

6. Treatment:
 Packed red cells transfusion (after cross matching) as Olive’s PCV/TP
dropped to 21/29 and she became tachycardic. Post transfusion her
mucous membranes became more pale pink than white, her HR dropped
to 120 and her pulses were much better
 IVFT which was tapered based on her clinical signs down eventually to
maintenance 2 days after presentation
 Pain relief:
 2mg methadone was given for first two days.
 Tramadol was used instead of methadone after day 2 as she did not seem to painful
and responded well to the first trial of tramadol
 Other medications:
 Maropitant as Olive was hypersalivating and seemed nauseous after methadone
Outcome:
Olive went home on 50mg Tramadol TID after her PCV had increased and her
clinical parameters returned to normal. The amount of free fluid in her
abdomen decreased due to reabsorption.

7.  Signalment: 4 year old MN outdoor DSH
 History: Owner saw cat in fight yesterday and today he
seems dull, lethargic, in-appetant and not himself.
 Clinical exam: HR 200, mm pink and moist, CRT 1s, pulses
normal, Temp: 39.6, R 20, normal auscultation, Abdo
palpation normal, integument had several cat scratches and
after searching a cat bite which was inflamed and painful
was identified on the left hind leg, orthopaedic and neuro
exams normal.
 Diagnostics: Searched whole body for cat bites as history of
being in fight. Shaved cat in area where sore and located bite
 Treatment:
 Amoxycillin and clavulonic acid injection and 5 day course PO
 0.06mg Buprenorphine subcut and 5 days sublingual
Buprenorphine

8.  Signalment: 4 year old female entire Chow Chow
 History: Season started 4 weeks ago (usually lasts 2 weeks),
bleeding throughout but had decreased in past week till today
when increased again. Drinking twice as much as normal.
Reduced appetite for 2 weeks and today completely inappitant.
Lost 4kg in weight in 2 weeks. Vomited twice last night. Ate bone
two weeks ago and not been right since.
 Diagnostics:
 Clinical exam: HR 160, Pulses tall and narrow, distended abdomen, Caudal
abdominal pain, very flat mentation, T 40.6, panting
 Abdominal Ultrasound – 2 large fluid filled uterine horns visible but no
flocculent material
 Abdominal rads to rule out FB refused by owner
 Full bloods: refused by owner (suspect neutrophilia or neutropaenia also
potentially azotaemia)
 PCV/TP 37/110
 Glucose 3.3mmol/l (indicates likely septic)
 Lactate 2.2, Cl 127, SBE -11 (metabolic acidosis)
 Rectal exam: tachy mucosa, normal faeces
 Vaginal exam: no free flowing discharge, smear of vaginal mucous showed
no WBCs

9.  Ddx: Pyometra – closed or open but not currently
discharging or foreign body
 Stabilisation
 IVFT LRS Bolus of 60ml/kg/hr for 15 minutes
 Treatment: Advised spaying but refused due to financial
concerns so stabilised as much as possible. Plan to take to
GP vets in morning. Advised against medical management
as presented so sick. Warned of risks of deterioration, sepsis
and uterine rupture.
 IV Ticarcillin 40mg/kg q 6
 IV Buprenorphine 0.01mg/kg q 8
 IVFT LRS post bolus of 5ml/kg/hr spiked with 2.5% glucose as
heart rate decreased to 130 but only lasted 20 minutes before
coming back up
 Outcome: Temp reduced overnight to 38.6, panting all night
and taken to GP vets at 8am.

10.  Signalment: 2 SBT, 10 yr and 13 yrs MN
 History: Owner found both dogs near chocolate bar (200g plain
milk chocolate – 40mg/kg if one dog ate it – toxic GI dose) which
they had stolen. Didn’t know if both or which dog had eaten it.
Both had no seizures, vomiting or diarrhoea. Healthy otherwise.
 CS: Dog 1 HR 104, Dog 2 HR 132. Rest of clinical exam as WNL
 Dog 2 was checked for oesophageal pain on palpation due to FB
and none was noted and no S/C emphysema. Suggested should
radiograph to check for gas leaving oesophagus if FB caused a
perforation
 Treatment:
 Induce emesis with ½ tablet conjunctival apomorphine
 Dog 2: V++ straight away, no chocolate but plastic sharp FB produced!
 Dog 1: No V, gave another ¼ tablet, waited 10 minutes: no V so gave 0.13mg
IV apomorphine: V++ immediately with lots of choclate. Once stopped V gave
Metocloprimide to prevent further emesis.

11.  Signalment: 11 month old ME German Shepard Dog
 History: No GDV history, on treatment for ear and skin problems. Was
fed at 8am then taken for a two hour run with ball. When came back had
a drink and then lay away himself which is not normal. After one hour
was salivating and not himself – taken to his own vets.
 GP: painful abdomen, rads showed very dilated GDV. Referred.
 Cex: T 38.5, HR 132, pulses short, R 20, mm pink and CRT <2, normal
abdominal palpation (suspect may have untwisted as so stable)
 Warned owners that if had been GDV since 10am (now 3pm) may be too
much necrosis of stomach wall or spleen and of post op ileus.
 Diagnostics:
 Repeat rads –Right lateral abdominal radiograph shows pylorus
remains displaced dorsally. Distension of stomach has much reduced
however.
 Blood gas and Lytes: metabolic acidosis. Lactate 2.3(would expect
higher if dilation was big and causing hypoperfusion),
Hypercalcaemia: ionised Ca: 1.42
 BP and ecg: showed no abnormalities before, during or after surgery

12.  Stabilisation:
 IVFT:340ml LRS bolus over 30 mins (640ml/hr)
 IVFT: post bolus IVFT at twice M for 24 hours till eating and
drinking well with no clinical signs
 Pain relief: 3mg Methadone q6. Switched to 60mg IV Tramadol
TID after 24 hours
 Treatment:
GA and midline laparotomy from xiphoid to parpreputial area.
Remove falciform ligament. Omentum visible as first tissue on entering
abdomen.Stomach only 90o torsion and pylorus easily reduced to correct
position. Systematic abdominal exploration reveals no abnormal
findings. Spleen normal and strong pulse in splenic artery. Stomach wall
viable and short gastric vessels intact. No evidence of haemoabdoen.
Stomach dilated. Orogastric Stomach tube passed easily and cardia
palpated and no torsion present. All other abdominal organs visualised
and palapated and are within normal limits.
Incisional gastropexy performed right abdominal wall with 2/0
Monoplus.
Abdomen lavaged with 1 litre of warmed saline and all fluid suctioned
out prior to closure.
Midline closure with 2/0 Monplus (simple continuous), 3/ Monosyn for
teo latyer SC simple continuous stures and 3/0 nylon simple continuous
suture for skin.
 Outcome: Monitored on ecg for 24 hours with methadone pain relief and
then buprenorphine, kept on IVFT at 2xM overnight. Discharged two
days when eating and drinking well.

13.  Signalment: 13 year old FN spotted mist cat
 History: Diagnosed with Diabetes four months ago and been treated with 1IU of
Glargine BID until 2 weeks ago when increased to 4IU of Glargine BID as BG on
dipsticks and curves have been consistently high. Owner reports been more lethargic
recently. Owner returned home today and found cat curled up, unresponsive and to
have urinated in bed so brought straight here. Most recent dipstick showed no glucouria
 Cex: T 33.6, HR 220, R 12, mm pale pink, CRT 2S, pulses tall and narrow, minimally
responsive, marked mydriasis, mucoid diarrhoea
 Differentials: Diabetic remission or insulin overdose
 Diagnostics:
 Glucometer BG 1.1mmol/l
 Electrolytes: glucose= 0.9mmol/l, sodium= 156 mmol/L, potassium= 3.4mmol/L, chloride 124
mmol/L
 Stabilisation:
 IVC placed
 0.5ml/kg IV 50%glucose given diluted in 10ml 0.9% Saline (responded very fast)
 Feed asap (ravenous)
 BG monitored every hour, dropped again 3 hours later to 2.6mmol/l so gave another 50% glucose
bolus IV (0.5ml/kg)
 Outcome:
 Overnight if BG > 11 gave 1IU Glargine, if BG >15 gave 2IU Units Glargine, none if <11mmol/l
 Transferred to medicine and started on 2IU Glargine BID

14.  Signalment: 2 year old ME SBT who lives backing onto river and woods.
 History: Owner was with him in garden and he was fine, went back 15 minutes
later and he was staggering and bleeding from his tongue. On car ride to vets
(15 minutes) he stopped breathing
 Cex: No cardiovascular or respiratory function on arrival. Blue mm. Urine
pigmented. Tongue bleeding continuously. T 37.2
 Diagnostics:
 Urine sample – pigmented urine caused by snake bites classically
 Bloods:
 APPT >300s (off scale), PT 64s (11-17 ref)
 PCV/TP 52/60
 Lactate 9.4 (0.6-2.5), Glucose 16 (4.2-6.6)
 Blood Gases: SBEc -11.5 (metabolic acidosis) and Pco2 71 (Respiratory acidosis). pH 7.023
(7.35-7.44)
 Treatment:
 Closed CPR and flow by Oxygen, rhythm returned on ecg after 2 minutes of chest
compressions , mm went pink, HR 189, pulses palpable but not breathing on his own.
 IV line placed
 10ml/kg LRS Bolus
 Outcome: owners opted for euthanasia because estimate of $5000-$10000 dollars
was too expensive for them. This was for the snake bite detection kits,
antivenom vials and mechanical ventilation.

15.  Signalment: 3 year old ME GSD, very aggressive towards even
owner
 History: Found this afternoon with blood coming from his
right forelimb so owners brought here. No idea how he cut
himself. Not limping and BAR. Very aggressive especially
towards men.
 Cex: HR 88, mm pink, CRT not performed as muzzled, pulses
good, panting and lunging so lungs auscultation not accessed,
T after sedation 38.4, large laceration full thickness through
skin approximately 3.5cm in length distal to the accessory
carpal pad on the right forelimb. Increase in bleeding when
stressed.
 Treatment:
 Premed: butorphanol and medetomidine. Induction: Alfaxone.
Maintained: ISO. Fluids: LRS at 10ml/kg/hr. Antibiotics: Amoxyclav.
Painrelief: Buprenorphine
 Wound clipped (sterile lubricant in wound), cleaned, examined, flushed
with 150ml 0.9% NaCl.
 Wound closed with absorbable sutures: 2 layers deep in wound,
intradermal layer and one layer of interrupted skin sutures

16.  Signalment: 10 year old MN Jack Russel
 History: Healthy otherwise but tonight got into a fight with owners other dog over dinner
and was bitten ½ hour before presentation. Lost significant amounts of blood.
 Cex: pale mm, HR 176, R 24, T 35.7 (In shock), jugular hanging out of neck (see photo)
 Diagnostics: PCV 14. TS 30. MAP 39! US to get for pneumo/haemothorax: -ve, glide sign
present.
 Treatment:
 Premed: methadone 0.2mg/kg
 Antibiotics: Ticarcillin as very likely bacteraemia.
 Induction: Alfaxone 10mg
 IVFT: 1200ml/hr bolus first ten mins. MAP increased to 64 but only lasted for 10
minutes. Repeat boluses of 100ml.
 Blood transfusion: started slow at 1.2ml/hr then increased to 100ml/hr and fluids
running at 50ml/hr
 Surgery:
 Clamped off Jugular cranial end which was visible. Caudal end not visible.
 Ligated jugular 6 times to be sure
 Flushed with 200ml 0.9% Saline
 Placed penrose drain and close s/c then skin with very loose sutures as
contaminated wound
 Outcome:
 Transferred to GP for continued monitoring and supportive care

17.  Signalment: 14 year old FN DSH
 History: owner returned from work to find her lying immobile with her pupils dilated.
She was bitten by a snake before and showed the same signs so owners brought her
straight to the ECC.
 Cex: collapsed, HR 204 - intermittent gallop sounds mm pink, CRT 1.5s, T36.9, R 32 -
Paradoxical abdominal movement, non ambulatory tetraparesis, alert but LMN
weakness causing minimal responsiveness, bilateral mydriasis, absent PLR.
 Diagnostics:
 Urine: pigmented and on Snake detection kit strong positive (blue) for tiger envenomation
 Bloods:
 PCV/TP 38/74
 Blood gas & Lyes:
 Treatment:
 Premed: chloramphenimine
 2 vials of tiger/brown antivenom (diluted in 40ml 0.9% saline IV)
 Methadone 0.8mg IV q4hr
 Lacrilube eyes q2hr
 Outcome: Treated in ICU for 4 days as developed colitis and did not eat for 4 days - had
an O tube placed. Case still active when we left

18.  Signalment: 9 month old MN Cockapoo
 History: No problems until 1 hour before presentation when he started to
vomit small volumes of his evening meal and continued to vomit 10 x in
that hour (progressively more watery vomit). Still drinking, ate normally
that evening, no known toxins. Reguarly chews up his toys. No diarrhoea
and healthy otherwise.
 Ddx: GI: Foreign body, intussusseption, entrapment, gastritis,
gastroenteritis. Extra GI: pancreatitis, liver, renal, central problem
 Cex: QAR, HR 140, T38.3, mm pink, CRT 1.5s.
 Abdo palp: cranial abdomen tense and stomach very full, pain on
palpation of cranial abdomen – deep palpation not possible.
 Diagnostics:
 PCV/TP 55/70
 Electrolytes: all WNL except K 3.4 (3.6-4.6)
 Radiology Rlateral and VD (diazepam and butorphanol for sedation) : gastric
dilation/distension with obvious foreign material, SI looks wnl. VD overexposed
and poor detail but very good serosal detail on lateral
 Fast scan: obvious FB shadowing in stomach, large amount flocculant swirling fluid
in stomach, SI wnl
 Treatment:
 IVFT: 5ml/kg/hr LRS
 Offered surgery but as Pluto clinically very stable owners opted for surgery in the
morning
 Transferred to GP that morning
 Outcome: In GP in morning he had repeat rads taken and his stomach was
much less distended. He stopped vomiting by early morning and was
trialled on food the next day. He kept this down well, was monitored for 24
hours and discharged.

19. 
Signalment: 7 year old entire male GSD
 History: recent onset of retching and struggling to
breathe and so advised to come down to the ECC in
case of GDV. Owner mentioned a kong has gone
missing too.
 Cex: HR 164, mm injected, distressed, resp 40 and
very loud, T 39.6, on opening of mouth the red kong
was seen in the oropharynx which luckily had a hole
in the middle through which he was breathing.
 Treatment: induced with Alfaxone and manually
manipulated with forceps and spoons to removed
the ball as fast as possible! Injection of
dexamethasone to decrease inflammation.
 Outcome: Monitored for a few hours for any
respiratory distress but very luckily went home on
meloxicam to prevent inflammation later that night

20.  Signalment: 7 year odl MN Cocker
 History: Travelled to NSW one month ago in a campervan which he now plays in in
the back garden. Owner noticed a tick on his Left eye last night and removed it asap.
He did not show any signs of being ill until the owner returned from work the
following afternoon and heard immediately that his bark had changed and he was
weak in his hind limbs. He was coughing and out of breath when excited. His eye
was also swollen where the tick was and dropping. She took him straight to the vets
who referred him to ECC. Owner brought tick to ECC.
 Cex: HR 140, Pink mm, CRT 1s, pulses normal, T 38.4, Resp: panting and coughing,
choaking occasionally, left eye dropping and unable to blink.
 Diagnostics:
 Examined tick and confirmed its middle legs were lighter than the caudal and
cranial legs and the legs were all cranial on the tick – Ixodes Holocyclus
(Australian Paralysis tick)
 BP: 181/133
 Blood gas: all WNL, PCV/TP: 46/66
 Full body clip and tick search – including orifices
 Ecg monitored constantly
 Treatment :
 1ml/kg tick antiserum given slowly over ½ hour by syringe driver.
 Full body tick bath with pyrethrin shampoo
 Outcome: recovered well and went home the next day when breathing returned to
normal

21.  Signalment: 13 year old FE SBT
 History: in past 5 hours has ingested an unknown amount of Snail Bait. The owners
other dog also ingested snail bait and was at another vets having seizures. The ref vets
had suggested to the owner to give soda crystals (1 or 2) to the owners dog to make it
vomit but he had given two full handfuls. After the first handful the dog had vomited
up a lot of metaldehyde and he gave another handful. This handful had not caused
much vomiting so it was presumed there was around a handful of soda crystals still in
the dogs stomach (given 1 hour ago).
 Cex: Muscle trembling but T 38.7, HR 180, mm injected, CRT 1s, pulses short and
narrow, panting. Able to stand but falling into sternal.
 Diag:
 Fast Scan: no abdominal FF so hopeful soda crystals had not yet perforated the stomach.
 Bloods: PCV/TP 50/75, all electrolytes and blood gas WNL
 Treatments:
 Induce emesis: Apomorphine IV and subcut – two doses given and no V+ produced
 Metoclopramide and Ondansatron to prevent emesis for induction (after 40 mins)
 Gastric Lavage: Induced with Alfaxone, maintained on iso. Produced small amount of blue-green
tinged liquid
 Enema x2: large amount of thick blue-green paste like material consistant with metaldehyde and
some blood flakes
 Giafen small amount given to stop muscles tremors
 Metronidazole to prevent GIT infection
 Plan to start charcoal in am

22.  Signalment: 7 week old minlop, 0.78kg
 Hx: owner noticed today when he went to spray water over
the rabbits to cool them down that when all the rabbits
scattered this one did not move. All of the rabbits are kept
in a shaded aviary in the back garden, they were seperated
from their dam 4 days previous to presentation. They are
fed pellets and hay but owner not sure how much this
rabbit would have had as they are all together.
 Cex: HR 280, T 38.9, R 176, CRT <1, mm pink, Pulses strong,
GIT: no sounds heard on auscultation but faecal pellets
palpable, head tilt and very floppy
 Diagnostics: BG 9.1mmol/l
 Dx: Presumed floppy bunny syndrome
 Tx:
 Subcut 40ml 0.9% NaCl
 Panacur: 20mg/kg
 Meloxicam: 5kg mark
 Critical care mix 5ml syringed every 2 hours
 Owners offered to bring rabbit in for hospital care but declined
 Outcome: Owners returned 2 hours later with rabbit unable
to get it to eat and PTS