Species: dog
Breed: German Sheperd
Sex: f, neutered
Weight: 32.7 kg
Birth date: 2015-05-31 00:00:00
Primary diagnosis: Hit by car with hemoabdomen and possible lung contusions
Situation: emergency initial
Medical history: The dog was presented to our cinic on 03.12.2024. Gina is a farm dog and is allowed to run around freely at home. At around 11 am the day of presentation, a car reversed and hit her. Gina was then able to get up and walk a little. At the private vet she didn't really walk any more, but just stood up with her front legs. She was very painful on the thorax and pelvis. The vet gave her an infusion and methadone and sent her straight to us. Since the accident, the owners did not see her urinate or defecate. She didn't eat or drink anything. She has had slight osteoarthritis in her hind limbs for some time and is given Cosequin daily. An abscess was removed from her left hindlimb in autumn. The day of presentation x-rays of the thorax were taken --> x-rays report (03.12): Mild right lung intersitial pattern; Mild microcardia, small lung vessels, thin heart silouhete; Questionable minimal pneumothorax lateralised on the right; Mild incidental spondylosis --> The interstitial pattern is might be associated with poor ventilation or represent mild degree of lung contusion or bleeding due to the trauma; The small lung vessels and thin cardiac silouhete is compatible with hypovolemia/shock. On 03.12 the dog also needed a blood transfusion. On 04.12 x-rays of the pelvis and both right and left tarsus were taken --> x-rays report (04.12): Multifocal spondylosis deformans lumbar spine and chronic intervertebral disc disease; Degenerative lumbosacral transistion with signs of stenosis; Possible mild left intertarsal arthrosis; Reduced caudal abdominal and retroperitoneal detail --> Findings of the lumbar spine suggest multifocal degenerative disc degeneration with or without multifocal disc disease and lumbosacral stenosis; If clinically indicated, MRI is suggested; Left intertarsal arthrosis, if real, is considered degenerative, but an anatomical variant should be considered; Loss of abdominal detail compatible with known traumatic hemoabdomen. The dog's clinical state improved over the following days and she was released on 06.12.2024.
Medication: Before presentation (at 11:20): Methadon 0.2 mg/kg IV. Before observation 1: Ondansetron 0.3 mg/kg IV. Before observation 2: Methadon 0.2 mg/kg IV. Before observation 3: Maropitant 1 mg/kg IV, Tranexamic acid, 10 mg/kg IV, Fentanyl 0.003 mg/kg IV then Fentanyl CRI 2 µg/kg/h. In the night of 03-04.12: blood transfusion, Ketamin CRI started around 02 and then stopped around 3, Fentanyl CRI from 2 µg/kg/h to 5 µg/kg/h (around 01) to 2 µg/kg/h (around 04), Ondansetron 0.3 mg/kg IV at 19 and 00, Tranexamic acid 10 mg/kg IV at 00. 04.12 (only Metamizol (and Fentanyl CRI) given before observation 4): Fentanyl CRI 2 µg/kg/h IV stopped at 11, Maropitant 1 mg/kg IV SID, Ondansetron 0.3 mg/kg IV TID, Tranexamic acid 10 mg/kg IV TID, Metamizol 30 mg/kg IV TID (started at 06), Meloxicam 0.2 mg/kg IV SID started at 13, Methadon 0.3 mg/kg IV at 11 then from 13 0.2 mg/kg IV q4h, Gabapentin 6 mg/kg PO TID started at 17. 05.12 (nothing given before observation 5): Meloxicam 0.1 mg/kg IV SID, Methadon 0.2 mg/kg IV / Buprenorphin 0.02 mg/kg IV, Maropitant 1 mg/kg IV SID, Tranexamic acid 10 mg/kg IV TID, Gabapentin 6 mg/kg PO TID.
Pain type: acute, nociceptive, inflammatory, orthopedic, visceral, somatic
Pain origin: back, pelvis, thorax, abdomen
Pain duration: Less than 24 hours
Estimated pain severity: 72