C09974942 / invoice 20000

Appointment Notes: was at EVA last time might have a broken leg needs to get x-rays done Subjective: Was doing zoomies in the rain yesterday then suddenly ran into the owner and suddenly started to yelp. Has been randomly yelping all night long.  More ginger on the RHL but still weightbearing. Not wanting to move around too much. Quieter. Not himself.  Sad boy. Hasn't gone to the toilet (urination or defecation) for the last 17 hours.  Staying in his bed.  Went to EVA yesterday around 430pm.  Male O unsure too much of tx. They said they gave an opioid injection and was given oral meloxicam at 10pm.  No vomiting.  Eating well dinner. Not offered breakfast this morning.  Reg vet: glenelg vets.   Objective: BAR  HR/PR/Cardio: 124, normokinetic, no obvious murmur or arrhythmia   Temp:   38.4MM/CRT/Hydration: pink, moist <2s   RESP: clear, normal bronchovesicular sounds   GIT/UG: comfortable with abdominal palpation, unremarkable. No large palpable bladder. No evidence of constipation. Skin/Ears: Clean coat, well groomed. Ears free from discharge on external exam of the internal pinnae.   M/S: Gr2/5 RHL Lameness, no toe touching, still weight bearing, increased tremoring of the RHL.  Comf with ROM of the digits and around metatarsal region, along with long bone palpation. No cranial drawer or tibial thrust of the R stifle. Good extension of the R hip, similar to the L, no obvious dislocation. Comf with spinal palpation, good ROM of the head and neck, comf around the ribs, good tail tone.   ** did randomly yelp once when in consult, he was sitting down quite still** Not wanting to move around too much, had to carry out to the yard and still not wanting to move around.  Sat down on the lawn. Eyes: clean and bright  Dental: mix of adult + deciduous. No TMJ pain    Lymph Nodes: wnl   BCS:6/9  Assessment:  Mild discomfort with weightbearing on the RHL with intermittent yelping at home ddx: panosteitis, HOD, Partial CCLR, s/t injury, hairline F#, subluxation, other Discussed with O that Eddie isnt giving much away on physical exam.  Not too reactive with palpation. Unlikely to have broken leg, would expect him to be much more painful. Not doing the classic toe touching stance for cruciate rupture. Discussed other ddx with O including s/t injury, "growing pains", or changes with growth plates (HOD). Spoke with female O OTP in consult too. Discussed further w/u with imaging (xray of the spine, HLs + abdo too to check bladder size, colon for faeces etc).  Rcc'd PAS + CRP too. Estimate provided (on file). Alternatively offered conservative management with rest and nsaids (dispensed from EVA) but O would like to pursue imaging to ensure we arent missing anything obvious. Aware GA required for xrays.  Consented to admit for the day.   Treatment: Nil for now. Plan: Proceed with PAS + CRP and xrays today.  O aware if NSF then continue strict rest and pain relief at home.      Vital Signs    Weight: 27;       

Reason: EUA + xrays Objective: See previous entry Laboratory: PAS + CRP WNL except mild lymphocytosis. Treatment: Premed with 0.81ml methadone (10mg/ml) + 0.08ml medetomidine i/v @ 11:09am Induction with 5ml propofol i/v @ 11:13am  Intubated with cuffed ETT 8.5mm and maintained on iso 2% in O2 1L/minThorough examination all over under GA.  No TMJ pain. Fractured 504, pulp exposure but no swelling or discharge. Adult canine erupting rostrally to this.  L ear: unable to examine down to to the horizontal canal, appears occluded (unsure if conformational vs stenotic but minimal inflammation), no discharge. R ear: more patent and able to see down to the TM. Intact. Ceruminous discharge down the canal. On cytology: Scant Malassezia within the L ear, Marked Malassezia R  ear (no cocci).  Paws: no evidence of trauma to paw pads, no broken nails, no FB or bee stinger.  AGs: Small, fairly empty. Repeat MSK: no cranial drawer or tibial thrust of the R stifle. Negative Ortolani manoeuvre.  No palpable rib fractures.  Good ROM of all FL and HLs joints.  Imaging: 1 > View: R lateral thorax  Factors: 16cm 68kvp 7.5mas Quality:PLACE2 > View: R lateral stifle Factors: 6cm 60kvp 1.8mas Quality: PLACE3 > View: VD hips + pelvis Factors: 12cm 70kvp 3.2mas Quality: PLACE4 > View: L lateral stifle Factors:  6cm 60kvp 1.8mas Quality: PLACE5 > View: L tarsus CaCr Factors:  6cm 60kvp 1.8mas Quality: PLACE6 > View: DV thorax Factors:  18cm 68kvp 5mas Quality: PLACE7> View: R lateral thorax Factors:  18cm 68kvp 7.5as Quality: PLACE8> View: R lateral abdomen Factors:  18cm 68kvp 7.5as Quality: PLACEFindings Normal:Findings Abnormal:Conclusions:Recommendation:Anaesthesia finishedexpressed bladder. 250ml urine emptied. Evacuated rectum from faeces digitally as far as possible.  Normal well formed stools. RecoveryPain reliefPlan: Continue pain relief in case of S/T injury. Strict rest at home.   Consider CT INI.  Paracetamol 275mg PO BID  in addition to meloxicam (dispensed from EVA). Tx ear infection. Recheck ears in 10-14d.     Vital Signs