C10015916 / invoice 10000

Reason: JM/WC 2Appointment Notes: Special payment terms existProcedure: A high quarter (forequarter) right forelimb amputation GA protocol:1- IV methadone 0.3mg/kg once2- IV medetomidine 5mcg/kg once3- IV alfaxalone - titrate to effect4- An E-tube was inserted to secure the airway5- Maintained with oxygen and isoflurane  1- Hair coat was carefully clipped, skin was ascetically prepped for surgery2- Patient moved to OR3- Four quadrant drapes were used to isolate the surgical site4- Skin incision was made from cranial lateral aspect, distal medial aspect and caudal lateral aspect5- Ligature was used to carefully separate the muscles from dorsal aspect of the scapular, TO BE CONTINUED    Vital Signs    

History: Humeral fracture - in for revisionExamination: Refer to smartflow for TPRWalked and fed.Fasted from 0200Assessment: StableOwner Communication:Nil overnightTreatment: Nil meds overnightPlan:-> Sx Wed AM    Vital Signs    

History: Revision surgery on 15.12.26, humeral fracture, ESF. Using the operated limb less than last time seen. It has improved over the last week. Using the limb around 60% of the time.Current medications: noneExamination:General condition:     BCS X /9Mentation: NormalOral Cavity: NormalEyes: NormalEars: NormalLymph nodes: normalIntegument: NormalAbdominal Palpation: NormalGIT: normalUrinary tract: normalCardiovascular:  Pulse normal, Auscultation: NormalRespiratory: Normal   Neurological:  NormalMusculoskeletal: marked right fore lmb lameness (6/10)Assessment: non-union, right humerus. Owner Communication: Discussed rads today and options for non-union; revision with grafting, amputation ($800)Sedation: Med/torbRads: no activyt Plan: Preadmission drugs dispensed. _____________________________________________________________________________________________________________________SURGICAL ADMIT INFORMATION: Estimate: $200 for rads +- sxSurgery or Procedure : Imaging required: Area, x-ray, CT, MRIAnimal information:   - Behaviour: Calm, Boisterous, Anxious, Aggressive   - Relevant Comorbidities:  Pre-Operative information:   - ASA Grade:   - Blood tests required: Clip 10, PCV/TPP, otherAnaesthesia/analgesia;   - Premed protocol: med/meth, midaz/meth, other   - Induction: Propofol, Alfaxan,    - Local blocks / other  (optional); Epidural, nerve blocks, local anaesthesia- Surgical details;   - Surgical instruments - non standard (optional):   - Patient position (optional):- Post operative rehab    Yes / No Additional communication for admission form (optional):    Vital Signs