SANTINO – 35979
Safe - 7-31-2018 Manhattan
SANTINO – 35979
***NEEDS FOLLOW UP VET CARE***
Care Center Location: Manhattan; ZIP Code From: 10459
Intake Type: Agency; Medical Behavior: Blue; Age: 5 months; Sex: Male
Weight: 30 pounds
Vet Notes: 10:20 AM -DVM Intake Exam: Estimated age: ~6months based on PE. Microchip noted on Intake? scanned negative by LVT. MC placed by LVT on intake.
History / Subjective – stray found with injured R TL. Observed Behavior timid, head and ears low. very gentle. Allows all handling. Loose body. Evidence of Cruelty seen – none
Evidence of Trauma seen – R TL lameness Objective: BCS 5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge notedOral Exam: no dental disease PLN: No enlargements notedH/L: NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: intact male. testicles smooth and symmetrical within scrotum MSI: Ambulatory x 3, toe touching lameness of the R TL; crepitus palpated on flexion ofthe R cubital joint. Moderate swelling of the soft tissues. skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate – no signs of neurologic abnormalities Rectal: grossly normal. Assessment:Fracture of the distal R humeral condyles Prognosis: good. Plan: Sedate with 1.3ml hydromorphone and 0.3ml midazolam IM sedation not adequate — gave additional 0.27ml telazol IM. adequate for radiographs. Gave additional 0.15ml telazol IM for robert jones bandage application Rimadyl inj 50mg/ml — give 1ml SQ one time rimadyl 25mg tablet – give 1 tablet PO q24h x 4 days starting 7/28 tramadol 50mg tablet — Give 1.5 tablet PO q12h HW test postponed due to age recommend immediate placement and orthopedic consult. P will need surgical correction SURGERY: Temporary waiver due to injury Radiographic review: complete fracture of the distal humeral condyles.
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