Red Queen Theory

以下摘自 Saga 的病歷 :)

Case Number: XXXXX
Admit Date: Monday, November 27, 2006
Owner: XXXXX
Patient: Saga
Patient ID: 18297-A
Signalment: 4 Yrs. 0 Mos. Male Shorthair, Domestic

rDVM: XXXX Veterinry Hospital

====== Pertinent History ======
Saga is a 4hr intact M DSH referred for ongoing care of hematemesis and hematochezia that started shortly after a rabies vaccine earlier today. His housemate was also noted to have similar but less severe signs. He was represented to his regular veterinarian when vomiting started, where Dex SP 3.2 mg IM, diphenhydramine 8mg IM, IVF, and O2 were given. He progressed to vomiting blood, and arrangements were made to transfer for continued care.

====== Exam Findings and Initial Assessment: ======
Time: 18:18
Temperature: 98 Heart rate: 220 bpm Respiration Rate: 60 bpm
Muscus membrane color: pink Capillary Refill Time: 1-2 s
Attitude: QAR
Body Condition: 3/5
Hydration: est 7% dhdn
Ears, Eyes, Nodes, Throat: nsf
Heart and Lungs: regular, ssp, nma; lungs clear, eupneic
Abdomen: tensing on abdominal palpation
Genitourinary: nsf
Musculoskeletal system: ambulatory
Integument: nsf
Lymph nodes: nsf
Neuro: nsf
Initial Assessment: 1. vomiting blood after vaccination, ddx: severe allergic reaction vs coincidental and open for primary vs secondary gi, consider combination (secondary HGE, ulcer, ITP, etc)

====== Initial Diagnostics ======
Istat: BG 334, K 3.3, pCO2 38.1
PCV/TS: 50%, 5.5

====== Initial Therapy ======
Saga was triaged to the back and continued to have frankly blood vomiting and diarrhea. He was started on plasmalyte A 20 ml/hr after 15ml bolus. Epinephrine 0.05 mg IV, metronidazole 36 mg IV q 12, diphenydramine 7.25 mg IM, and famotidine 1.5 mg IV q 24hr were started. Vomiting continued, with tackycardia and tacky mm noted, and chlorpromazine 1.1 mg was given SQ. More bloody diarrhea and vomit have continued since, and ACT and platelet count will be checked. Saga will be started on HES cri at 10 ml/kg/d, pantoprazole, reglan cri and carafate increased to q 6 hr.

===== Daily Update ======
Saga has not vomited since yesterday at 7pm or had any diarrhea since 8am today. He has been breathing well and has been very vocal in his cage and interactive. He has eaten well and drinking. He can discharged later this afternoon.
===== Presumptive Diagnosis ======
- Vaccine Reaction

===== Medications ======
Metronidazole 250 mg tablet (1/8 tablet by mouth twice daily for five days) 0.62
Carafate 1 g tablet (1/2 tablet as slurry every 6 hrs till gone) 6

===== Recent Medications ======
(這段略過)
===== Discharge Instructions =====
1. If Saga has problems breathing, has bloody stool or bloody vomit, please have him rechecked.
2. Please seriously discuss further rabies vaccines with your regular veterinarian. If he absolutely has to have the vaccine, he will need to be premedicated with steroids and diphenhydramine and then hospitalized for vaccination.

Current Weight: 3.62 kgs
(這段略過, 為感謝言)
===== END ======

順帶一提，我在台灣沒送過貓急診，不過這邊的急診真的是貴的跟人一樣...而且你簽的單上面就會要你打勾，表示你同不同意 "萬一寵物情況惡化，你准許醫生使用任何急救手段，即使這會使你的帳單暴增"(因為一開始就會有預估的價單，你必須先預付一半，而這預估是假設牠情況不再嚴重惡化)。當然你也可以選擇不要勾，只是這樣萬一寵物不活了你也不能怪他們。基本上，我還滿喜歡這種選擇的。對於某些人來說，醫療費真的是無法負荷的話，選擇適度的聽天由命大概也是情可有原的吧...只是我當然是咬牙勾下去了(心裡OS: Saga，你敢不好起來，救活了你回家等著瞧XD....)

有趣的是，我碰到的獸醫院跟急診中心的護士跟醫師，通通是女的耶...不知道是不是因為當動物醫生比較沒有性別問題呢?

P.S. 附上病患近照一張! (剛照的，熱呼呼哦XDDDD)