C10018973 / invoice 10000

HISTORY:Was playing in a dam yesterday and sustained an unknown foot injury. Owner heard a yelp and Max was lame on the left forelimb afterwards. Max was seen by his primary care veterinarian today who attempted to flush the wound but a thorough examination of the wound was not able to be performed due to the pain. He prescribed amoxyclav and meloxicam for the wound. Owner presented Max to ECC today over concerns that the swelling was worsening and he has now stopped eating today. Current meds: amoxyclav, meloxicamPre-existing conditions: noneAccess to toxins: None SUBJECTIVE:- BAROBJECTIVE:Temp: 39.0           MM: pink             CRT: <2            HR: 104            FP: normokinetic and synchronous             RR: pantingBCS:    4/9                Wgt:   29.7 kg  CV: no cardiac murmur, normal rhythmRESP: clear lung sounds bilaterally, normal effort, costoabdominal pattern, no nasal dischargeGIT: soft and pliable, no obvious pain/discomfort even on firm palpation, no abdominal distensionU/G: no abnormalities detectedNeuro: mentation appropriate, full exam not performedM/S: left forelimb weight bearing lame, moderate generalised swelling of antebrachiumOphth: clear, no ocular discharge or other abnormalitiesInteg: 2-3cm deep open wound to interdigital area between P4 and P5 of left forelimb, no obvious foreign material observed, not actively bleeding until lickedLNs: no peripheral lymphadenopathyRectal: normal yellow to brown faeces, normal consistency, no diarrhoea/blood/melena ASSESSMENT: - cardiovascularly stable- interdigital wound on left forelimb with current swelling and lameness of affected limbTREATMENT:  Sedation:- methadone @ 0.3 mg/kg IM + medetomidine @ 15 mcg --> poor sedation, IV placed and alfaxan IV given to effect for sedation- wound flushed and cleaned with dilute chlorhexDispensed:- gabapentin @ 400 mg PO q12- paracetamol @ 375 mg PO q12 PLAN:- plan to manage as open wound given high pressure area, primary closure unlikely to be achieved- bandaging may be considered to prevent Max from splaying toes and reopening wound, will require daily bandage change is proceeding with this- recommended recheck with primary care veterinarian tomorrow for reassessment  CLIENT COMMUNICATION:Discussed the nature of the wound and that it is not suitable for suturing at this point in time, best to allow it to heal via second intention. Advised that the appearance may worsen before improving. Instructed to monitor for purulent discharge. The importance of strict E-collar use was emphasised. Advised that anorexia is likely due to pain and should resolve with augmented analgesia. Advised to return for a revisit if anorexia persists for another 1-2 days. Discussed management options, including the pros and cons of bandaging versus leaving the wound open to air. A surgical opinion has been sought due to the difficult location of the wound.    Vital Signs    Weight: 29.7;