C10003586 / invoice 10000

REASON: Acute onset lameness following twisting injury during walkHISTORY: Acute onset lameness following twisting injury whilst chasing something during walk- Appeared to twist leg with possible dislocation observed according to owner- Immediate pain response and vocalisation when hip is extended on right side- Non-weight bearing on affected limb- 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: 140- RR: sniffing- Temp: 37.7- Mm: pink- Crt: <2s- Mentation: BAR- Pain Scale (0-4): 2/4- Hydration status (%): euvolemicEXAMINATION:Body Condition Score: Pain Scale (0-4): 1/4 at rest 3/4 when manipulating right hipCardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Neurologically no significant findings, no cranial nerve deficiet. Right hindlimb CP deficiet but all others WNL, full neurological exam not performedMusculoskeletal: Stands with right hindlimb tucked underneath and across body at odd angle. Stifle palpation tolerated well without pain response. Allows foot to be pulled to ground but reluctant to move once positioned. Significant pain response when attempting hip manipulation especially in extensionGastrointestinal:- Oral: NSF- Abdominal: NSF- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFDIAGNOSTICS: Blood Gas Analysis Results - source:Findings:Interpretation:> Radiology : Digital radiography was performed.Views: Lateral and VD, multiples of pelvisThoracic: Extra thoracic structures: No significant findings.Diaphragm: No evidence of herniation and diaphragm appears intact.Pleural space: No evidence of pleural space disease.Large airways: No significant findings.Pulmonary: No significant findings. No evidence of interstitial or alveolar lung pattern.Cardiac: No significant findings. No evidence of cardiomegaly.Oesophageal: Normal location and no evidence of foreign material.Musculoskeletal: cranio-dorsal luxation of right femur, replaced once, however luxated soon after during positioningPROBLEM LIST:1. Acute lameness right hind limb2. Right hip luxation DIFFERENTIAL DIAGNOSIS: Hip luxation versus hip luxation with acetabular injury or fracture secondary to traumaASSESSMENT: Valentine presented with acute onset lameness following twisting injury during walk. Clinical examination reveals significant pain response when attempting hip manipulation whilst stifle examination was well tolerated. Based on examination findings and mechanism of injury, hip dislocation was suspected rather than cruciate ligament injury. Hip dislocation less common injury pattern unless traumatic. Rapid reduction within one hour of dislocation provides best chance of successful reduction and preventing re-dislocation. Anaesthesia and radiographs confirmed definitive diagnosis of hip luxation. However, after reduction, the hip quickly luxated again.Due to failure of reduction, surgical intervention was recommended via referral with board-certified orthopaedic surgeon. Owners aware of costs and willing to crate at home with mild oral sedation and pain relief while awaiting referral. Owners aware of long term rehabilitation likely post surgery. TREATMENT: Methadone 0.3mg/kg IM (total vol 0.28ml) Maropitant 1mg/kg IV (total vol 0.93ml) Midazolam 0.2mg/kg IV (total vol 0.37ml) Meloxicam 0.2mg/kg loading dose SC (total vol 0.37ml)Anaesthetic Report. - Induced with propofol slow IV to effect. - Intubated with an appropriately sized ET tube and the cuff inflated. - Maintained on isoflurane at 1-2% - Anaesthetic monitoring of heart rate, ECG, blood pressure, core temperature, EtCO2 and SpO2 was performed.- MAP was maintained >70mmHg intra-op.- Smooth, uncomplicated anaesthetic recovery.Non Surgical procedure: Right hip reduction PLAN:- Referral arranged to WAVES, TAHMU and Vet surg - sent home with trazadone and gabapentin to start later today, oral nsaids to continue tomorrow- provided acetominophen dose as rescue analgesia - owners have crate at home to ensure Valentine has strict rest until surgical consult- if deteriorates or otherwise becomes unwell to recheck here sooner or with primary care vet ------------------------------------------------------------------------------------------------------------------------------------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. DIAGNOSS: Hip dislocation   The hip is made up of a ball and socket joint. There are many ligaments that hold the hip in place, as does the surrounding muscle. A dislocated hip occurs when the ball part of the joint comes out of the socket, and the ligaments and muscles are torn and stretched. Blunt trauma such as being hit by a car commonly causes this type of injury. This is extremely painful and require immediate veterinary care. X-rays have been taken to confirm the dislocation, and see if there are any other additional fractures or concerns. In order to repair a hip dislocation surgery is usually required, in cats this is usually a procedure called a ‘Femoral Head Excision’.  Some pets will have a shallow socket (acetabulum) or have underlying diseases such as arthritis and in these cases a total hip replacement may be indicated.  A referral will be sent to WAVES surgery, The animal Hospital at Murdoch surgery and internally to Vetsurg. Please fast Valentine in the morning in case she can be seen tomorrow. Exercise: To facilitate your pets recovery, it is very important that your pet has strict confinement including no running, jumping and only short lead walks to the toilet. If possible they should be kept in a crate or small pen until their surgery. The surgeon will then advise you of ongoing aftercare instructions.Medications at discharge: Meloxicam Oral Suspension 30mLGive 0.6ml by mouth once daily. Give with a small meal. If any vomit or diarrhoea or off food stop medication and call clinic. Next due 9/3/26 PMGabapentin 300mg Capsules Give One (1) tablet twice a day. Can give once daily if too sedateTrazodone Tabs 50mg BOVAGive One (1) tablet twice daily. Can be given once daily if too sedatePanadol 500mg A Quarter (1/4) of a tablet up to 3x daily (every 8 hours). ensure no xylotil. Recheck:Please organise a recheck with your primary care vet if you have any concerns while awaiting the referral or if you believe Valentine's pain is not well managed.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    Weight: 9.3;       MMColour: Pink;       Temperature: 37.5;       HeartRate: 140;       PainScore: 2;       CRT: < 2 sec;