C10000678 / invoice 10000

Reason: Y Torn Stitches OTB MYHISTORY:Sarmi presented for evaluation of a sutured laceration on the left forelimb. The initial injury was a laceration under the left carpal pad, sustained at an oval from an unknown sharp object. The wound was described as having extended deeper than the initial split. It was cleaned and sutured by their regular veterinarian today, who reportedly enlarged the wound slightly for thorough cleaning. The recent bleeding occurred after Sarmi jumped off a bed and landed on the affected paw.Current meds: noneProphylaxis: UTD vacc and FTWPre-existing conditions: noneAccess to toxins eg. Rodenticide: noneTRIAGE:HR: 120 bpmRR: 60 breaths/minTemp: 38.8°CMm: pinkCrt: <2 secondsMentation: BAREXAMINATION:Body Condition Score: 4/9Pain Scale (0-4): 0/4Hydration status (%): EuhydratedCardiovascular: cardiac ausculation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, full neuro exam not performedMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain- Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears:- Left forelimb: a 2-3 cm laceration with sutures is present underneath the carpal pad. The bandage was blood-soaked upon presentation. The sutures are intact, and there is no active bleeding from the surgical site. The area was cleaned.Lymph Nodes: NSFEyes: NSFPROBLEM LIST:- Post-operative haemorrhage from a sutured left carpal pad laceration.DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Haemorrhage secondary to straining of the sutured wound, likely due to jumping from a height. Suture dehiscence was ruled out on examination.DIAGNOSTICS:None.ASSESSMENT:Sarmi presented for bleeding from a sutured laceration on the left carpal pad. The bleeding event occurred after Sarmi jumped off a bed. On examination, the sutures are fully intact, and there is no evidence of suture breakdown. The haemorrhage is likely due to strain on the highly vascular tissue of the carpal pad from the impact of landing. The wound is not actively bleeding after cleaning and application of a pressure bandage. Sarmi is otherwise clinically well.TREATMENT:The blood-soaked bandage was removed. The surgical site was thoroughly cleaned with dilute chlorhexidine solution. A new bandage was applied to the left forelimb.PLAN:Home into owner's care.A waterproof "booty bag" made from a fluid bag was provided to the owner to place over the bandage when Sarmi is outside in wet conditions to keep the dressing dry.The owner was advised to restrict activity, particularly jumping, to prevent re-straining the wound and causing further bleeding. Movement will continue to irritate the area.CLIENT COMMUNICATION:Discussed the likely cause of the bleeding as being due to straining the wound from jumping, rather than a failure of the sutures. Advised that the sutures look good and the wound has stopped bleeding. Instructed the owner on how to use the provided waterproof cover to protect the bandage. Advised the owner that they are welcome to return for a recheck at no additional consultation fee within the next 24 hours if the bleeding recurs.    Vital Signs