Extended patient care report for a patient in anaphylactic shock

The patient presented to the practice in a semi-collapsed condition, the owner reported this happened suddenly while the dog was out walking. On examination it became clear the patient was in shock but the cause was unknown.

Species: Canine

Breed: Labrador

Age: 1 year

Sex: Female (neutered)

Weight: 27 kg

The patient was triaged by assessing the major body systems.

Heart rate was 140 beats/minute (normal 60–140 beats/minute) with weak peripheral pulses, heart sounded muffled. Mean blood pressure (MAP) 81 mmHg (normal 60–85 mmHg). Mucous membranes were pale pink/muddy coloured in appearance with a capillary refill time of 2 seconds (normal 1–2 seconds). Patient was hyperthermic with a temperature of 39.5°C (normal 38.3–39.2°C).

The patient had an increased respiratory effort with a rate of 36 breaths/minute (normal 10–30 breaths/minute). Oxygen saturation was measured with a pulse oximeter as 99% (normal 95%).

Patient was dull with obtunded mentation, unable to ambulate and was hypersalivating.

Blood was taken for biochemistry, haematology and electrolytes: platelet count was low (anaphylaxis causes platelet aggregation), all other parameters were within normal limits. Blood gases were not taken as the practice lacks this facility. An intravenous catheter was placed, Hartmann's solution was administered intravenously at a rate of 270 ml/hour; the patient's response was assessed every 10 minutes. A FAST Scan (focused assessment with sonography for trauma) showed the heart appeared normal, no free fluid was seen, and minor pulmonary oedema was present. The patient's clinical signs continued to deteriorate in the imaging suite: heart rate increased to 160 beats/minute, MAP dropped to 48 mmHg, respiratory effort and rate increased, temperature decreased to 38.8°C, chest continued to sound muffled and it was difficult to auscultate the heart, pulses were still poor, and the patient appeared weaker. While the light was off the patient had developed generalised urticaria which was only noted when the light was turned on. Chlorphenamine (10 mg/kg) and dexamethasone (0.5 mg/kg) were administered intravenously. The patient's clinical signs quickly began to improve, and once stabilised she was transferred to the general ward and monitored every 2 hours. The patient was discharged 4 hours after the initial incident.