C09987359 / invoice 10000

Hx: ( from nurse report)  limping since 28/2/26, given NSAIDs / gabapentin , no antibiosis ,  not been wearing cone -  o reports been licking++

CE: 
NWB LF 3rd digit swollen+ dripping serosanguinous / thin purulent fluid  - full thickness wound along lateral aspect of digit necrosed skin and fibrin partially covering wound , deep infected wound exposed deep to this 
puncture draining serosanguinous fluid on palmar aspect of paw at level of MCP joint 
wounds flushed saline and explored with forceps ( not tolerated well so limited ) 
swab taken in case C+S required 

A: 
, deep infection digit - original pathology vs self induced / caused by licking  - FB  vs cellulitis vs osteomyelitis vs fracture 

P: MUST wear cone 24/7 
wash chlorhex, apply neocort 
Clav course once infection controlled  if limited / no response  then swab for C+S +/-xray
Bup 2ml IM on discharge 


STO 2.28pm discussed the above and got Hx from O 
decided to give Bup tonight and manage with paracetamol and gabapentin then add in meloxicam ( stopping previcox ) and add clav 
INI will explore surgically and  xray toe  ( plus MSK series - hips and stifles) plus COHAT as requested all in 1 GA 


- sedation cancelled after meds drawn up, all discarded.

idexx machines not working so bloods were run at Currambine

Reason:  
History: 
limping 24hrs 
Saturday morning started limping 
sore on paw pad when O had a feel 
no known trauma 

NWB lame

E/D/U/D WNL 

BIOP for 3 months 

otherwise well 

Current medications: nil 

Examine: 
Mentation: BAR
Body condition score: 
MM:  PM              CRT: <2
HR:   110             RR: pant
LN: NSF
Temperature: nt

Ocular: NSF
Oral/Dental stage: 2-3
Ears: NSF
Cardiovascular: NSF
Respiratory: NSF
Gastrointestinal: NSF
Integumentary & lumps (measurement, location): NSF 
Musculoskeletal: LFL digit 3 swollen and sore on palpation, interdigital skin on palmar aspect of paw red and irritated 
Urogenital: NSF
Neurological: NSF

Problem List:
LFL digit 3 swollen 
DDx: fracture vs soft tissue 

Assessment: 
discussed Xrays - unable to do them today - will trial pain relief and monitor and ini by tuesday back for xrays 

Treatment: 
227mg previcox SID
600mg gaba BID 

Plan: 
recheck INI

On-going medications required: Y/N (use prescription tab for further supply):

Followup: