C10004505 / invoice 10000

Reason: Sedate + torn nail
History:
See prev hx - torn nail RF digit 3

BAR
MM p/m
CRT <2s
HR wnl, no murmur or arrhythmia
RR wnl, clear lung sounds

Sedation: Butorphanol 0.4ml / Medetomidine 0.4ml IV - good level sedation
Reversal: Atipamezole 0.4ml IM

Hair lightly clipped around RF digit 3. 
Ring block around distal toe with lignocaine ~0.5ml total
Nail broken longitudinally all the way to base. Able to remove entire nail in 2 parts. Quick remaining appears quite healthy with bed of granulation tissue forming. 
Nail trimmed back as short as possible. 
Entire toe/quick cleaned thoroughly with dilute betadine. 
Once paw dried, bandage placed - melolin, soffban, conforming bandage, vetwrap, elastoplast
All other nails clipped. 

Treatment:
Continue melox and amoxyclav
E collar if required
Bandage care notes printed

Plan:
Recheck in 2-3 days to remove bandage. May require a second bandage or if looking good can leave open with E collar instead. 

Presented for sore RF paw. 
Been licking alot since wednesday. No other paws. 
Not itchy anywhere, no known preceeding trauma. 
Otherwise fine in himself. EDUF wnl, no V/D. 

Current meds: nil 
Parasite control: UTD 
Vaccination status: UTD 

Mentation: BAR, very good boy 
MM: pink, moist
CRT: <2s 
DS: 1/4
Skin tent: good skin turgor
LN: wnl
L Ears: brown ceruminous discharge, erythemic pinna, erythemic canal, TM intact, yeast like malodour 
R Ear: clear no discharge, no malodour, TM intact 
Eyes: clear, no discharge 
HR: 112, no murmur or arrhythmia auscultated, = synchronous PR
Chest Auscultation: normal BV sounds and resp effort
Abdo Palpation:  tense/ nervous
BCS: 6/9
Temp: not performed 
Rectal Exam: not performed 
Skin: No obvious lesions, good coat 
- R paw : digit II cracked nail all way to base, not easily mobile to pull, fur surrounding wet w saliva, mildly swollen and painful on examination. Rest of nails nad
- Rest of paws nad. 
Joints/Gait: ambulatory, no lameness observed, full MSK not performed  
Urogenital: nad

Treatment in clinic: 
L ear cytology: malassezia pachydermatis ++++
R ear cytology: no infectious organism identified. 

Problem List: 
Torn nail 
- Advised O torn nail, requires sedation to remove. No availability today will have to come back monday. 
- in mean time start pain relief and ABs, On lead walks til removed. Reccommended E.collar, O declined as Rufus gets very agitated w it. O will supervise. O otherwise happy w plan. 

Otitis Externa
- Advised O of L ear infection. Reccommend topical tx for 1 week. Rv in 10d. 

Plan: 
melox 30KG dose SID q5d - extend after monday 
Amox clav 500mg PO BID q7d 
Dermotic - L ear BID q7d 
Admit 0800 on mon for sedate & nail pull. (estimate made but not discussed w O).

Communication: 

Eye is completely back to normal 
no more vomiting
back to his normal self BB