Species: dog
Breed: Lagotto Romagnolo
Sex: f, neutered
Weight: 21 kg
Birth date: 2014-01-01 00:00:00
Primary diagnosis: Lung contusions, Monteggia fracture with multifragmentary ulna left & transverse fracture processus styloideus
Situation: pre surgery
Medical history: The dog was hit by a car 3 days ago. On the 31.05 at 13h30 Betty was hit by a car while walking without a lead. She was hit on the left side. Betty then went to the private vet. They did an X-ray and initial stabilisation. It showed a Monteggia fracture on the front left and lung contusions/blood clots. She was given Medetomidien and Methadone, as well as Synulox (AmoxiClav). During the x-ray, Betty began to bleed from the nose and was intubated. Blood was also leaking from the tube. A ‘bleeding stopper’ was administered. During sedation, a wound was treated on the front left side. There was a degloving injury over the carpus and a cut over the phalanges on the left. It was not clear whether there was a direct connection to the fracture or not. She was then referred to us. She was stabilized with O2, first methadon amd then fentanyl & Ketamin, tramexamic acid, maropitant, ondansetron and fluid boli. The day after the bandage was changed and the dog got a urinary catheter. They also did a local block because of the pain and they started sedation with Dexmedetomidin CRI. This CRI was stopped after a day, they also stopped the Ketamin CRI. X-rays report (03.06): Monteggia fracture with multifragmentary ulna; Transverse fracture processus styloideus; Diffuse soft tissue swelling of the entire antebrachium; Suspected distal avulsion fracture of the palmar sesamoid, first digit; Periarticular mineral opacity, medial aspect of the radiocarpal joint; Chronic osteoarthritis accesory carpal bone.
Medication: Before & after surgery: MCP CRI 2 mg/kg/d, Fentanyl CRI 2.5 mcg/kg/h, Maropitant 1 mg/kg IV SID, Ondansetron 0.3 mg/kg IV TID, Ampicillin 30 mg/kg IV TID, Meloxicam 0.1 mg/kg iv SID (initial 0.2 mg/kg 01.06.), Trazodone 5 mg/kg po TID, Omeprazol 1 mg/kg IV BID, Paracetamol 10 mg/kg IV TID. 04.06: Paracetamol & Omeprazol & Meloxicam & Maropitant & Ondansetron & Ampicillin & Trazodone same as 03.06, Gabapentin 10 mg/kg PO TID, Mirtazapin 0.7 mg/kg PO SID, Methadon 0.2 mg/kg IV q4h. 05.06: Paracetamol & Meloxicam & Ondansetron & Ampicillin & Trazodone & Gapapentin same as 04.06, Buprenorphine 0.023 mg/kg IV/SC TID (Omeprazol, Maropitant, Mirtazapin & Methadon stopped).
Anesthesia: Intervention on 03.06.2024: X-Rays, Radius/Ulna fracutre fixation. Premedication at 10:20: Dexmedetomidin 0.01 mg/kg PO. Induction: Fentanyl 0.002 mg/kg IV, Midazolam 0.1 mg/kg IV, Propofol 2.4 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: 4x Bolus Fentanyl 0.002 IV, IV Infusion Fentanyl, IV Infusion Ketamin, Local anaesthesia plexus brachialis ropivacain 2.1 ml. Antibiotics: Ampicillin/Sulbactam 30 mg/kg IV. Complications: saturation dropped but Anaesthesia duration was already >6h, postoperative x-raxys were postponed and the dog stayed on O2 high flow overnight. Intervention duration: 240 min. Anaesthesia duration: 420 min.
Pain type: acute, inflammatory, orthopedic, visceral, somatic
Pain origin: thorax, front legs
Pain duration: 24 hours to 7 days
Estimated pain severity: 50