C10020097 / invoice 20000

Reason: Tail Between Legs/shaking PADDY mORGAN VET OVERNIGHT  overnight Appointment Notes: Special payment terms exist, Overdue remindersPJM 8pm to 6amSuspected dog fight with owners younger dog. One full thickness penetrating wound on rhs. One superficial laceration. Mild oedema. Client comms: PJM spoke with Kelly at 1:25 am. Said that the wounds did not appear to need drains and that pain management and antibiotics might surffice. Explained that dog wounds are crushing injuries and that they might break down in the next few days and surgery might then be necessary.FM morning vetTeal  ready to be discharged, he seems comfortableHad Penetrating wound on the right proximal shoulder and 1 on the mid right shoulder no discharge, no extensive bruising and skin necrosis but will advise the owner it can happen in the next few days since it is crushing injuryWill be sending home with Meloxicam 1.5mg 1ml SID for 5-7 days since Kidney Values normalAmoxicillin Clavulanic acid 200mg/kg already prepared  with instruction 1.5tab BID for 7 days    Vital Signs    Weight: 15.2;       

Presented and seen by Dr  KS  @  11:23pmRegular Vet: KSPresenting Problem: Bloated and shakingHistory:Owner was out and found her stressed at home owner believes is bloated and shaking / trembling.  Owner arrived home at 5:10pm.  Otherwise EDDU normal this AM.Any current medications: NOneAny access to potential toxins?: NoAny known conditions: None knownPreventatives up to date? May be due from last weekExamination Findings:General demeanour:  BAR, stressed, anxiousTemperature: 39.1Cardiovascular: HR 140, hard to hear over shaking and trembling Respiratory: PANTINGOral exam: mm-injected, crt <1sAbdomen: soft and comfortablePeripheral LNs: WNLEyes/Ears: WNLIntegument:  puncture on right shoulder seen an additional puncture further dorsally was also locatedMusculoskeletal: hard to assess deeper structuresGait: appears normalNeurological: WNLRectal exam: not performedUrogenital:Body Condition Score: 5-6/9Initial Assessment:Dog fightClient Communication:Advised i think the wounds may need surgical drains as some blood appears to be pocketing under the mobile skin.  Offered to stabilise / monitor in hospital and discharge for surgery with RV in AMLaboratory:PCV/tpMild elevation ALT, 145, AST 53 (muscle damage?)Current problems: -  dog fight wound-  injected mm, inc HR ddx - stress/ anxiety / pain-  mild biochemical hepatopathyTreatment:-  commence antibiotics: 200mg x 1.5 amoxyclav BID-  methadone 0,2mg/kg -  IVFT @ maintenance -  place drains / surgical explore - owner happy to do here overnight if needed otherwise would prefer to wait until AM Daily update emailed to referring vet: YES/NOFinancial update provided to owner: YES/ NO    Vital Signs