NEPTUNE – A1106747

MANHATTAN CENTER

NEPTUNE – A1106747

MALE, BLACK / WHITE, DOMESTIC SH MIX,1 yr
STRAY – STRAY WAIT, NO HOLD Reason STRAY
Intake condition INJ SEVERE Intake Date 03/21/2017, From NY 10314, DueOut Date 03/24/2017,
Medical Behavior Evaluation BLUE
Medical Summary DVM Intake Exam Findings History stray Subjective Observed Behavior – allowed handling Evidence of Cruelty seen – n Evidence of Trauma seen – yes Objective Large open wounds on lateral right tarsal and hock; appear infected. consistant with crushing injury no obvious fracture, but severity on injury makes fracture possible. no other wounds seen BCS 5/9 EENT: Eyes clear, ears clean, no nasal discharge noted Oral Exam: clean teeth PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: 2 testes CNS: mentation appropriate – no signs of neurologic abnormalities Assessment severe injury to hock Plan: rads, sedate and treat wound unsure at this point is leg is salvagable prognosis with proper care (poss amputation) is good
Weight 8.3

INTIAL EXAM

3/21

DVM Intake Exam Findings

History stray

Subjective

Observed Behavior – allowed handling

Evidence of Cruelty seen – n

Evidence of Trauma seen – yes

Objective

Large open wounds on lateral right tarsal and hock; appear infected. Consistent with crushing injury

no obvious fracture, but severity on injury makes fracture possible.

no other wounds seen

BCS 5/9

EENT: Eyes clear, ears clean, no nasal discharge noted

Oral Exam: clean teeth

PLN: No enlargements noted

H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic

ABD: Non painful, no masses palpated

U/G: 2 testes

CNS: mentation appropriate – no signs of neurologic abnormalities
Assessment

Severe injury to hock

Plan:

rads, sedate and treat wound

unsure at this point is leg is salvagable

prognosis with proper care (poss amputation) is good

Re Exam:

3/21/17 17:00

S: Some growling but allows handling with towel

O: QAR, decreased skin turgor, estimated 5% dehydrated. BCS 3-4/9, MMs pink

EENT: No discharge OU, AU, nose. Clean teeth.

PLNs: Not enlarged.

H/L: NSR, NMA. Eupnic, quiet lung sounds.

Abd: Soft, no pain on palpation

M/S/I: Right hind leg – multiple areas of degloving and skin falling apart around the hock on both the medial and lateral aspects – SQ and deeper tissues (tendons) are visible beneath. Small amount of debris present in the wounds. Skin of distal right leg is erythematous. Left hind leg – debris and discharge caked onto the medial tarsus.

UG: Male intact, testicles soft and symmetrical.

Sedated with 0.25 ml buprenorphine (0.3 mg/ml) IM and 0.2 ml Dexdomitor IM for closer exam and lateral rad. Did not take AP view due to pt pain.

Flushed RHL wounds with water and clipped some of the fur around the leg. Did not do a full clip due to the skin falling off the leg as I clipped.

A: Severe soft tissue wound to right tarsus

Short-term prognosis: Fair -poor

SURGERY: Temporary waiver for RHL wound.

Bandage application, radiographs, plan overnight.

Markedly swollen, malodorous injury over hock with two islands of full thickness tissue defects on lateral and dorsal aspect of hock and metatarsal region. Hair easily epilates. Dirty and wet hind legs. Patient very painful. Given dexdormitor and buprenex for exam.

Lateral RH (unable to get AP based on patient comfort): Possible irregularity on plantar aspect at level of tarsal bones +/- chip fracture. Will need other view.

Placed a modified soft padded bandage. Applied SSD and nonadherent bandage. Applied thin layer of cast padding (not enough for whole bandage) and then stockinette, cling and vet wrap.

Plan:

1. Ampicillin 22 mg/kg IV TID x 1-2 days, then start clavamox (add in baytril PRN)

2. Simbadol 0.24 mg/kg SQ SID x 5 days

3. Sedate for wound treatment and AP view of limb; consider NH placement; concern that best option would be amputation but can base this on clinical response in next few days.

3/22/17

Hx: Intake with severe open infected wound R tarsus. Wound cleaned and bandage placed. No fx seen on x-ray lateral.

S/O) QAR. 8% dehydrated. MM pk.

EENT: NSF.

CV: HR= 120, nsr, nm. L: clr and eup.

A) Wound

Dehydrated

Low HR – r/o decreased perfusion

P) Place 22 g IV cath LFL. Bolus 50 cc IV LRS over 1/2 hour. Reduced to 60 ml/hr – sx rate.

Sedated with IV telazol.

Removed bandage – marked purulent d/c extending up to inguinal area.

Wounds – 1) Medial tarsus – partially necrotic 3 cm wound with good blood supply.

2) Medial mid tarsus 2 cm wound – less necrotic with some granulation.

3) Dorsal metatarsal – 1.5 cm full wound. All wound are open down to deep tissue.

Moderate laxity and some bone crepitus when moving distal leg medially at tarsus.

Clipped/ cleaned/ flushed/ debrided some and extruded copious amt of pus dorsally. Placed drain from inguinal area to stifle on medical aspect.

Placed bandage – needs to be changed tomorrow.

X-rays: AP tarsus – no fx noted. Chest lateral – NSF. Abd/ pelvis lateral – NSF, no pelvic fx.

A) Deep wounds tarsus and paw. Marked infection extending up leg. Concern about systemic infection possibility.

P) Start IV abs. Amoxicillin 85 mg IV TID (0.85 cc of 100 mg/ ml)

Baytril 18 mg IV SID – slow and dilute.

LRS 20 ml/hr.

Placed e-collar.

Bandage change tomorrow.

Prognosis currently: Guarded- poor.

3/23/17

RECHECK FOR TREATMENT OF HINDLIMB DEGLOVING INJURY

PULLED OUT IV CATHETER OVER NIGHT

PRIOR TO SEDATION PET WAS ALLOWED TO AMBULATE, WILL PUT PRESSURE ON ALL FOUR LIMBS INCLUDING BANDAGED RH, PETS WALKS WITH NO LAMENESS DETECTED

SEDATED WITH :

KETAMINE 0.08 ML

DEXDOMITOR 0.08 ML

BUTORPHANOL 0.01ML SAM E SYRINGE IM

HEAVY LEVEL OF SEDATION, MAINTAINED ON ISO MASK

PE: CLEAR AU, OU

DIRTY FACE

MINIMAL DENTAL DISEASE

H/L; PULSE 132, II/VI BILAT HM, RR 32, NORMAL EFFORT

ABD SOFT NO MASSES

M/S/I; BANDAGEREMOVED FROM RHL, AREAS OF DEGLOVING AT TARSUS, DOWN RO PHALANGES. DEGLOVED REGIONS HAVE HEALTHY GRANULATION TISSUE, AMPLE BLOOD SUPPLY.

CREPITUS AT RIGHT TARSUS, REDUCED ROM , NO INTACT ACHILLES TENDON PALPATED, HAS SCAR TISSUE

MEDIAL ASPECT THIGH PENROSE DRAIN INTACT, DRY, NO ODOR

U/G SCROTAL TESTES, LARGE URINARY BLADDER, EASILY EXPRESSED DURING SEDATION

PLNS WNL

NEURO AS AWAKE PET WAS BARH , GROWLING

CBC:

NEUT 17240

HCT 25.6%

PLT 205,000

CHEM:

ALB 2.1

Ca 7.3

NOSF

A; YOUNG MALE DSH

CHRONIC DEGLOVING INJURY CAUSING TARSAL INSTABILITY RH

ANEMIA R/O BLOOD LOSS, CHRONIC INFECTION

P FLUSHED WOUNDS WHICH AFFECT 40% OF SKIN DISTAL TO AND INCLUDING TARSUS

THREE ON DORSAL ASPECT OF METATASAL, WOUND MARGINS FRESHENED, CLOSED WITH CRUCIATE SUTURE

03/23/17 08:35

Hx: severe chronic wounds to RHL at tarsus, no fx seen on rads, was able to chew out IVC overnight, brief re-exam done in am prior to schedule sedation for bandage change

S: growling but allows exam

O:

~5% dehydrated based on skin turgor

EENT: no discharge from nares or OU

Int: bandage on RHL in place

CV: pale takcy mm, HR 126, difficult to ascult dt growling

Resp: difficult to asucult dt growling, fast short breaths, RR 44

Abd: not palpated

MS: not observed

Neuro: appropriate mentation

A:

chronic wounds

bradycardia

tachypnia

dehydration

P:

CBC

Chem

sedate for bandage change

px: open

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