C09976097 / invoice 10000

Reason: L3 - Attacked By Larger DogREASON: Presented for assessment following a dog attack.HISTORY:- Attacked by two Rottweilers who bit her head through a gate.- The owner noticed blood from her mouth and on her own shoulder after pulling her away.- Carried home and the owner washed the area.- The owner noted that some front teeth are now missing.- The owner is concerned about the mouth injury and risk of infection.- Pre-existing conditions: No known pre-existing conditions- Access to toxins: No known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavenged.- Current vaccination status: not discussed- Current medications: nil mentionedTRIAGE: HR: 120 RR:  24 Temp:  Not taken Mm:  Pink and moist Crt: 2sMentation: BARPain Scale (0-4):  0.5 EXAMINATION:Body Condition Score: 5/9 Pain Scale (0-4): 0.5 Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: No signs of traumatic brain injury noted on initial assessment. Pupils are responsive to light. Mentation is bright, alert and responsive. Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performedMusculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: Multiple upper incisor teeth are missing. The gums appear intact with no significant pocketing or visible trauma to the hard palate. A full oral examination under sedation would be required for complete assessment of retained roots.- Abdominal: NSF- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: A small, superficial puncture wound is present on the right dorsal aspect of the head and superficial graze ventral of right eye  Lymph Nodes: WNL on palpationEyes: NSFDIAGNOSTICS: Nil performedPROBLEM LIST:1. Dog bite wounds (superficial)2. Traumatic extraction of incisor teeth3. Risk of infectionDIFFERENTIAL DIAGNOSIS:- Dog bite wound infection: High risk given the nature of the injury.- Retained tooth roots: Possible following traumatic avulsion of teeth, requires further investigation.- Traumatic Brain Injury (TBI): Less likely given normal mentation and neurological exam, but requires monitoring.ASSESSMENT:Presented today following an altercation with two other dogs. The primary injuries sustained are superficial, including a minor puncture wound to the head, and the traumatic loss of multiple incisor teeth. The gums and palate appear grossly intact, but the possibility of retained tooth roots cannot be ruled out without dental radiography.A neurological assessment was performed to rule out traumatic brain injury. She is currently bright, alert, and responsive with a normal heart rate and appropriate pupillary light response, making TBI unlikely at this stage. However, the owner has been advised to monitor for any delayed neurological signs.The plan is to manage the wounds to prevent infection and provide pain relief.TREATMENT:- Gabapentin 12mg/kg PO BID - Amoxyclav 15mg/kg PO BID - Meloxicam 0.1mg/kg PO SID  PLAN:- Discharge home with oral medications.- Advised a soft food diet for the next week. Food can be mashed or biscuits can be soaked in warm water. Avoid hard or crunchy foods.- Monitor closely overnight for any changes in mentation, such as becoming dull or unresponsive. Advised to return immediately if any concerns arise.- Recommended a recheck examination with the regular veterinarian on Tuesday to assess wound healing.DISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide your pet’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today. Diagnosis:  Wounds (Trauma/Dog Bite) Treatment Summary: Pippi was in hospital today after a dog fight attack. She has had sustained multiple injuries - eg: multiple upper incisors missing, one small puncture wound on the top right of her head, and one small superficial graze underneath her right eye. Fortunately, she did no exhibit any other signs of traumatic brain injury (TBI). Please monitor her for any change in mentation.   Exercise:Please keep your pet strictly rested for the next 5-7 days then gradually reintroduce normal activity with 10 minute on lead walks only. Wound care and management:- Your pet needs to be kept inside, confined, clean and dry (no bathing or swimming) until the wound has healed completely.  If the wound is not covered with a bandage please check it daily for signs of redness, swelling or discharge.- Any concerns regarding the type of discharge (eg: pus) must be checked as soon as possible with your primary care veterinarian in the daytime or with our team if after hours. Recheck:Please organise a recheck for your pet with your primary care veterinarian in 3 days to assess your pet's improvement.Please discuss dental radiograph and dental procedures with your primary care veterinarian.  Dog fight wounds always have a high potential for wound breakdown due to the significant bruising  and tissue damage sustained from bites. This is not easy to predict, and close monitoring is therefore required. If there is any breakdown or blackening (necrosis) of tissues,  then a repeat surgery may be required which will incur additional fees.  Medications at discharge:Clavulox Drops 15mlGive 2ml TWICE daily by mouth until finished. This is only 3 days worth of antibiotics, please get more from your regular veterinarian if requied. Next dose: As soon as at home Meloxicam Oral Suspension 10mLGive 0.5ml ONCE daily by mouth for next 5 days. ALWAYS with or after a meal. STOP immediately if any vomiting or diarrhoea. Next dose: As soon as at home Gabapentin 100mg CapsulesGive ONE capsule TWICE daily by mouth. May cause sedation. Next dose: As soon as at home  If your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital. If your pet's condition is not improving or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call Perth Vet Emergency.  Thank you for trusting our team with the care of your pet.    Vital Signs