C10004255 / invoice 10000

Reason: DFWAppointment Notes: Overdue remindersHistory: DFWsAnaesthesia: Premed: meth 0.6ml + dexd (15) 0.5ml SC 11.40am CCV Rpt meth (0.2) 0.32ml IV 3.12 CCVRpt meth (0.2) 0.32ml IV 6.27pm CCVAlfaxalone 3ml IV 3pm CCV Hartmanns 5ml/kg/hThen stayed on Hartmanns 5ml/kg/h throughout ETT 8mm cuffed Laboratory: ER noticed discoloured urine during procedureCollected expressed sample - dark brownPigmenturia Suspect myoglobinuria due to rhabdo EPOC relatively unremarkableGlu - negKet - negBil - negBlo - ++++Ph - 7.5Pro - ++++Uro - normUSG - 1.024Sediment: no RBCs, no crystalsSurgery:All wounds were clipped and cleaned and flushed and treated w flamazine Wounds: L side of tongue and other oral contusionsRU I1 fractures but no pulp exposureL shoulder 3x punctures with subcut emphysema2x dewclaws torn to the laminaeHL nails all scuffed to quicksBilateral axillae both punctured with pocketing L elbow puncture L cheek 1x puncture + bruisingL pinna scratch R shoulder 2x puncturesDorsal neck laceration Above R eye R muzzle scratch R ear tiny scratch Generalised contusions and subcut emphysema 1. Both axillary punctures were slightly extended as well as pocketing was tacked internally with 2-0 monosyn simples and then left open for drainage and mobile area2. Under chinL shoulder puncture connected to L elbow puncture Opened up to facilitate closing of dead space Tacked w 2-0 monosyn tacking suturesSubcut 2-0 monosyn Cruciates 2-0 optilene 3. R shoulder puncture opened up to facilitate closing of dead space Tacked w 2-0 monosyn tacking suturesSubcut 2-0 monosyn Cruciates 2-0 optilene 4.Dorsal neck laceration opened up along pocketing  to facilitate closing of dead space Tacked w 2-0 monosyn tacking suturesSubcut 2-0 monosyn Cruciates 2-0 optilene Bandaged both forepaws to treat dewclaw avulsionsAssessment: Multiple DFWs Largely contaminatedRhabodmyolysis Hospital:Slightly vocal recoveryMetacam 0.7ml SC once normothermic Plan:Bandage off 3 days Metacam 3-5 days Panadol as long as neededGaba as long as needed Amoxyclav 2 weeksChlorhex/flamazine/savlon as needed Check dipstick after 3 days - if pigmenturia (visual or dipstick) remains, stop metacamIf still sore after metacam, panadol and gaba consider adding in codeine/temgesic or at worst fentanyl patch E-collarSuture/staple removal in 2 weeks    Vital Signs    Weight: 16;       HeartRate: 120;       CRT: <2;       MMColour: p+t;       BodyScore: 3/5;