Case Report – Trauma

This week I’m going to share a brief case report. It’s one of the more unusual things I’ve had to deal with in my career. This case wasn’t a patient of Pet Authority.

Any time that a vet shares information with another vet, there’s a basic format that we try to follow to convey the medical information in a clear, concise, consistent way. This is how:

Signalment: This is the age, sex, and breed of the patient.
Presenting complaint: The reason the patient is at the hospital. Also called the ‘primary complaint.’
History: A more detailed summary of medical history that may apply, including current medications.
Diagnostics: Results of testing performed.
Ruleouts/Diagnosis: Our best assessment of the patient’s problem at that point in time.
Plan: What we are going to do to treat.

So, for this case, I’ll provide the case summary, including a photo of the initial problem. This is an injury/trauma case, so the picture is potentially a little gross. There is a little blood. It’s not a huge wound or a broken bone or anything that graphic. The case summary will give you an idea of what we’re looking at. If you want to see the photo, you can click on the link to see it.

Signalment: 3 year-old male, neutered mixed breed dog that weighs about 45 pounds.
Presenting complaint: A stick is jammed into the left rear leg.
History: Has been healthy up to this point. No vaccination history, not on heartworm prevention or parasite control. Was outside running in the woods without supervision by the owner. Came home with a wound. Owner can see the entry and almost-exit point of where the stick impaled the dog’s left rear leg. Patient is in stable condition, no sign of shock.
Diagnostics: Heartworm test (negative), small serum chemistry and CBC (results within normal limits), radiographs/x-rays (no fractured bones).
Ruleouts: Impaled on a stick. Needs to be surgically removed.
Plan: Anesthetize the patient. Incise the skin over the exit point of the wound and pull the fragment of the stick out. Debride all damaged tissue and remove wood fragments. Flush wounds copiously with antiseptic/saline solution. Oral antibiotics and pain medication. Strict rest for 2 weeks. Repeat bloodwork in 7 days to assess white blood cell count. Recheck patient in 10-14 days, sooner if any problems develop with appetite/attitude.

The photo of the dog’s leg at the time of presentation is here. The stick is broken just under the skin at the insertion point, so there were actually 2 fragments to remove.

Case Outcome: This patient underwent surgery to have the stick and fragments of wood removed. I was able to get everything out without damaging the major artery that runs down the thigh (femoral artery). I wasn’t sure if this dog would do well because there could have been fragments of wood stuck into the muscle that would have been incredibly hard to find and remove. Luckily, it seems that I did in fact get all of the splinters out. The dog had a few days of swelling in the leg, but that rapidly resolved and he was in good shape just 2 weeks later. The owners never came back to the hospital after that, so I’m not sure what the longterm outcome was.

Upcoming blog topics: Staff biographies, Open House Schedule, Radiograph (x-ray) Interpretations, Chocolate Toxicity.

Thanks for Reading!

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3 Comments

Filed under practice, strange cases

3 responses to “Case Report – Trauma

  1. Chris

    Scary picture! So glad you were able to remove the stick without further injury to the dog πŸ™‚ Too bad his people didn’t feel the need to protect him from heart worm and bugs.

  2. Yup, alive after a near-death trauma, and then at risk of something that’s cheap and easy to prevent. The area I was working in was right on the edge of a fairly poor community. Many of the pets I saw there were “Rabies Only” clients. It was challenging to even try to explain to those clients why these things are important. Many of them would say things like: “I’ve had many dogs and none of ’em died from heartworm.” It’s been my experience that no amount of data will dissuade people who are that set in their ways. I did what they would let me do. At least nobody was sick from rabies! πŸ™‚

  3. Chris

    Yeah, it’s tough to win an argument against that kind of mentality. Let’s hope they see the light before they do lose a dog to heart worm. That’s a hard lesson to learn…especially for the dog!

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