C09995533 / invoice 10000

Reason: Recheck Torn Nail MlaHistory: Recheck torn nail - remove bandage todayDoing well not needing ecollar On metacamExamination: BAR, very excitable and wrigglyNo lameness,comfortableRF- Able to remove bandage- toes look good no swellings, exposed quick (5th nail) looks clean but still oozing bloodAttempted to re-bandage but unable as so wriggly. Os happy to sedate.Treatment:Butorphanol 0.3ml + medetomidine 0.7ml IM. Good level sed achievedCleaned with dilute chlorhex + rebandage with swab, sofban, conforming, vetrap, elastoplast to secure Reversal 0.7ml atipamezole IM Assessment: Torn nail - clean, no evidence of infection, still oozing bloodPlan:Rv 3 days for bx change - may be able to stop bandanging if bleeding stopped Traz/gaba dispensed for next visit to hopefully avoid full sedationCont metacamKeep bandage clean + dryNo abs indicated at this stage    Vital Signs    

Reason: Pulled Nail OffAppointment Notes: called last night but wanted to come in this morning. Apparently can be reactive so be carefull???History:Running around playing fetch, torn RF lateral nailO using diluted chlorhexidine to clean, bandaged just in caseNo lamenessIs licking a bit Fasted this AM Examination:Lovely excitable dog. Good with people.COAT/SKIN: good EYES/EARS: clearMOUTH/TEETH: permanent dentition, nadHEART: 120LUNGS: clear - is panting ABDOMEN/DIGESTIVE/URINARY: n/pCNS/MUSCULOSKELETAL: normal ambulation. RF 5th toenail partially torn and sticking out laterally. Toe itself non swollen or painful on palpation. No mobility to nail. PERIPHERAL LYMPH NODES: submandibular wnlWEIGHT/DIET: Body Condition Score: 5/9REPRODUCTIVE: nadAssessment:Torn nail- RF 5th toePartially tornDiscussed options- sedate and remove nail now vs ecollar and allow to heal on its own, as it may. O opted for former optionTreatment:Medetomidine 0.75ml + butorphanol 0.3ml IM @9am Removed torn nail + rest of nail where possibleBandaged Atipamezole 0.75ml IM Plan:  - start metacam SID from today- bandage removal/recheck 3d    Vital Signs    Weight: 29.1;       

Wasted sedation medications as per prev visit- unable to add on to visit as has been used for insurance claim    Vital Signs