C09983524 / invoice 10000

Reason: L3 Ref GP Post Op Sx TPLOHISTORY:Onyx had a right TPLO surgery performed at GP today.From initial incision, he was noted to be oozing blood excessively.Pre-anaesthetic bloods were unemarkable including platelet count which was normal on smear.PT/APTT was performed when oozing was noted whcih was within normal limits.Elected to proceed with surgery. No major surgical concerns, didn't hit popliteal artery/vein.After wakeup, noted the leg swelled up with haematoma quite dramatically.Had to administer propofol to examine further due to patient temperament, ended up needing intubation due to lots of soft-tissue in airways (bully breed).No petechiae seen at any point, good gum colour.PCV 43 post-op. PCV 35 TS 50 at time of discharge 6pm.pressure bandaged prior to sending here.Has not had surgery before (not castrated).Current meds: Carprofen, paracetamol. Gabapentin, clonidinePre-existing conditions: Skin allergies.Access to toxins eg: no access to rodenticide.EXAMINATION:Body Condition Score: 6.5/9Pain Scale (0-4): 2/4Hydration status (%): EuhydratedCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: Toe touching lame on the operated leg. Moderate swelling around the surgery site (proximal tibia, distal femur) descending down to hock. Not that much bruising. Very minimal strike-through on primapore bandage over incision. Minimal pain on palpation.Gastrointestinal:- Oral: normal. No petachia. Pink moist.- Abdominal: no detectable pain on abdominal palpation, normal gut soundsUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFPROBLEM LIST:1. Swollen leg post-TPLO2. Excessive bleeding.DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Von-willebrands, hyperfibrinolysis, thrombocytopathia, poor surgical haemostasis (unlikely), other.DIAGNOSTICS:> Baseline BloodsPCV: 46TP: 66Serum: ClearBlood Gas Analysis Results - source: VenousFindings: NoneInterpretation: Unremarkable.Buccal Mucosal Bleeding Time: Very slight ooze at 3 minutes 30 second, completely stopped by 4 minutes -> Normal result. Did appear to bleed excessively at the start compared to other BMBT I have performed but still stopped within a normal period of time.> Repeated Bloods at 5amPCV:36TP:60Serum:clearASSESSMENT:Onyx presented with concerns of excessive bleeding during and post-op after his TPLO today despite normal coagulation parameters and platelet counts. His PCV appeared to drop at GP, but upon recheck upon arrival at PVE it was higher than initially at GP (46). Unsure of the relevance whether there was errors in testing here or at GP, but unlikely to increase so dramatically - this will be retested later in his hospital visit as there are no concerns of anaemia based on examination and vital signs upon arrival. Buccal mucosal bleeding time was at the upper end of normal clotting around 3:30-4 minutes. Given lack of transfusion triggers and normal PCV at present, no indication for plasma or blood transfusion but will continue to monitor PCV. Leg was pressure wrapped and recheked a few hours later and the wound had bled very minimally although the swelling still remains. Onyx is toe-touching in his leg and appears comfortable despite being immediately post-op, so the swelling does not seem to be impacting his comfort.If further coagulation testing is required he may need to go to TAHMU for ROTEM testing but this does not appear necessary at this stage.TREATMENT (Fluid Therapy & Medications refer to Smartflow):5% dehydration IV fluids (for blood loss).20mg/kg Tranexamic Acid slow IV every 8 hours.Paracetamol IVGabapentin 600mg POPLAN:Monitor PCV for signs of anaemia.Monitor leg swelling.Transfer back to GP or home in the morning depending on recovery.    Vital Signs