C09970252 / invoice 10000

Reason
(BEAH consult)

Presenting/Owner's Chief Complaint
Scooby was run over by a horse. He yelped immediately, held up his right front leg, and was observed to have weakness in his hindlimbs.

Consult Nurse
Cass, George

Triage Notes
Patient presented after being trodden on by a horse. Obvious swelling of the right elbow with significant pain on palpation. Bruising noted over the right thorax. Anxious but can ambulate. Gr4/5 toe touching lame on R fore..

History
EDDU normal  
No V+ or D+ No  
Diet:  
Vaccinations:  
Preventatives;  
Worming:  
Heartworm:  
Flea & Tick:  
Current Age: Nearly 13 years  
Current Medications: Cartrophen, Beransa, Gabapentin, and Meloxicam. Last dose of Meloxicam was administered last night for a 37 kg body weight.  
History: Patient was chasing a horse and ran underneath it. The horse trod on him, with contact points on the front leg and back. The owner witnessed the event. Scooby yelped immediately, struggled to get up, and held his right front leg up. He was able to walk up stairs afterwards but showed weakness in his hindlimbs. He has a history of pre-existing arthritis in his hindlimb joints. The patient is also deaf.

Physical Exam
Demeanor: Bright and alert, but anxious.  
Behaviour: Wagging tail intermittently.  
HR: Tachycardic; RR: Increased; T: ; MMC: Pink; CRT: 1 sec ;  
Hydration: Adequate  
BCS: 7/9  
EENT: eyes clear, no evidence of conjunctivitis, no discharge or blephrospasm; no swelling or discharge to the external ear canal, ear pinnae clear; no nasal discharge; A sore was noted in the mouth, reportedly from licking at his joints.  
Cardiac: Tachycardic, no murmurs on auscultation  
Resp: Increased respiratory effort with crackles auscultated. No paradoxical chest movement noted.  
Abdo: comfortable on abdominal palpation, no palpable abnormalities  
Urogenital:  
Integument: no external parasites noted; no erythema or pruritis. A large bruise is present over the right thorax. Multiple subcutaneous lipomas are palpable.  
Neuro: proprioception no abnormalities detected; no significant findings  
Musk: Significant pain and swelling of the right elbow. Left elbow is comparatively less swollen. Pain elicited on spinal palpation of the mid-thoracic region, with a palpable dip over the costochondral junction. Pre-existing arthritis noted in hindlimb joints.  
Ln's: Peripheral lymph nodes within normal limits

Client Communication
Discussed the history of trauma and the physical examination findings. Recommended diagnostics including sedation, radiographs of the chest and limbs, and a possible abdominal ultrasound to rule out internal injuries. Provided an initial estimate of $1150 for these diagnostics. A more comprehensive estimate including full blood work was provided at $2040. The owner consented to all recommended procedures, stating cost was not a concern. The possibility of hospitalisation for ongoing pain management and monitoring was discussed, with an estimated cost of $1600 for the first night.

Laboratory/Imaging
Radiographs and ultrasound were performed.  
Veterinarians interpretation / summary of findings:
-   Chest radiographs: No rib or vertebral fractures identified. The lungs are intact with no evidence of pulmonary contusions or pleural space disease (e.g., pneumothorax).
-   Limb radiographs: Significant bilateral elbow osteoarthritis, left worse than right, with multiple osteophytes and subchondral sclerosis. A suspected subchondral bone cyst was noted in the left ulna. Bilateral tarsal osteoarthritis was also present. No acute fractures were identified.
-   Abdominal radiographs and ultrasound: The spleen was noted to be enlarged but considered within normal limits. No free fluid was detected in the abdomen. The liver and bladder appeared normal.

Assessment/Problem List
-   Acute trauma secondary to being trodden on by a horse.
-   Significant soft tissue injury to the right forelimb and thorax.
-   Right elbow swelling, and pain.
-   Thoracic wall contusion.
-   Severe, chronic, bilateral osteoarthritis of the elbows and tarsi.
-   Suspected subchondral bone cyst of the left ulna.
-   Multiple subcutaneous lipomas.
-   Stress and anxiety in a clinical environment.

Treatment
-   Intravenous catheter placed.
-   Methadone 0.4 mL administered intravenously for analgesia.
-   Sedation administered for diagnostic imaging.

Plan
1.  Discharged home due to significant stress in the hospital environment.
2.  Strict rest is recommended.
3.  Continue current dose of Meloxicam for pain relief.
4.  If patient deteriorates, pain is uncontrolled, or there are any other concerns, then reassess immediately. The owner was advised to return tomorrow (Sunday) if needed.

Treatment Plan Comms
The owner was provided with an estimate of $1150 for sedation and diagnostic imaging (radiographs and ultrasound), and a second estimate of $2040 which included full blood work. The owner consented to proceed. Following the diagnostics, the findings of significant soft tissue injury without fractures or internal bleeding were discussed. The plan to discharge home with pain relief and strict rest was agreed upon, with the understanding that Scooby should return for reassessment if his pain is not well-managed or if any other concerns arise.

Follow Up Notes
Next Visit: Re-examination tomorrow if pain is not controlled or if any other concerns arise.  
Follow-up Call: Owner to call if they have any concerns about Scooby's condition.