C10015490 / invoice 10000

Admitted for sedation and check paw, suspect grass seed
Consent form signed and discussed estimate

SEDATION: 
Bloods: WNL
Pre GA exam: wnl- anxious
Sedation: 0.2mL medetomidine, 0.3mL butorphanol IM; 0.5mL alfaxan as quite painful paw
Reversal: 0.1mL medetomidine IM
Catheter placed: yes LF
no murmur auscultated while under (hard to tell when awake as vocalizing, panting)

PROCEDURE: 
paw shaved: skin very inflamed and bleeding easily, jagged 1cm cut along medial aspect of RF 5th digit- flushed, no pocketing, appears more traumatic than FB, one cruciate suture placed
flamazine applied all over skin
bandage placed

Nails trimmed. 
rectal- lots of stool, soft enough, removed a little

POST-OP/PLAN:
Sedation Recovery:
0.42mL meloxicam
bandage- leave on for 3 days- remove saturday (MC or CFA), and likely keep open as area very moist and unhappy, likely best to keep open with ECOLLAR at all times and maybe chlorhex scrub if needed
must wear ecollar at all times
meloxicam next few days
amoxyclav 7d

SMSd James, asked to call back. O confirms pick up for 5pm

SUBJECTIVE
Reason for visit/main concern: O was away over weekend and then dog was licking at paw and now has turned into big mess. Unsure cause. Does not have grass that could cause grass seed at home. Also has dog next door that barks at - there is a hole that potentially he could have stuck his paw through and been bitten by another dog??
Very dramatic about everything
ALSO NOT DEFAECATED LAST 2 days because can't move around
Drinking. Eating but less. Urinating.
EDUD normally, no CSV, normal level of energy. 
Current medication/supplements: zactin this morning
Current preventatives: ND
Current diet: ND

OBJECTIVE
BAR, vocal and ridiculous over everything - even chest auscultation
mm pink and moist, CRT <2sec
Lymph nodes: normal submandibular, prescapular and popliteal
Cardiac auscultation: NAD, no murmur, no arrhythmia, strong synchronous pulse HR: 120 (hard to auscultate over crying)
Pulmonary auscultation: NAD, normal BV sounds, no resp effort RR: panting
Eyes: NAD
Nose: NAD
Ears: NAD
Mouth: NAD
Dental Grade: 1 - few missing teeth - crown amps exposed?? /4
Abdominal palpation: Crying on palp
Skin: RF paw between digit 3 & 4 all purulent and inflammed, cannot examine
Neuro: NE, normal mentation
Myo-arthro-skeletal: 
Uro-genital: NE
Temperature: NE
BCS: 4/9 

ANALYSIS
Infected paw - FB, DFWs, other

PLAN
Admit for sedate and explore paw
To do comp bloods as due 07/26
To do rectal 
Dental care plan: 
Next point of contact (recall/rv/reminder):
INI RV/after hours emergency centre

LMOM + sent sms CR
Hi Alan, please call The Thornbury Vet Hospital on 03 9480 1333 to settle Harry's & Sophie's gap claim. Thank you, Thornbury Vets.