Case Study...

1. Nala : CT Scan

 

CT Scan


2. Diagnostics


CBC

   
Range
NUCLEATED CELLS   9.0   4.5 - 15.0 x 103/µl
---- ----
SEG NEUTROPHILS 62% 5.6   2.6 - 11.0 x 103/µl
LYMPHOCYTES 29% 2.6   1.0 - 4.8 x 103/µl
MONOCYTES 4% 0.4   0.2 - 1.0 x 103/µl
EOSINOPHILS 5% 1.0   0.1 - 1.2 x 103/µl
---- ----
PLASMA PROTEIN   7.1   0.0 - 0.0 g/dl
RBC   7.2   5.5 - 8.5 x 106/µl
HGB   17.5   13.0 - 20.0 g/dl
PCV   49.0   40.0 - 50.0 %
MCV   68.0   62.0 - 73.0 fl
---- ----
MCHC   36.0   33.0 - 36.0 g/dl
RETICULOCYTES 0.4% 28,920   0.0 - 60000.0 #/µl
RETIC: CELL HGB   26.5   22.3 - 27.9 pg
RETIC: MCV   93.0   77.8 - 100.2 fl
RDW   13.3   12.0 - 15.0  
PLATELETS   333.0   200.0 - 500.0 x 103/µl
MPV   13.9   7.5 - 14.6 fl

 

ProTime/APTT

   
Range
PRO TIME 9.0 7.5 - 10.5 seconds
APTT 11.0 10.5 - 16.5 seconds

 

Blood Gas Analysis with Electrolytes

Source: Arterial
Temp: 98.6° F
   
Range
FIO2 100      
BAR PRESSURE 642      
pH 7.275 Low 7.3 - 7.5  
PCO2 39.2 High 24.0 - 39.0 mmHG
PO2 250.0 High 67.0 - 92.0 mmHG
HCO3- 17.6   15.0 - 24.0 mm/L
ABE - 8.3 Low 0 ± 3 mm/L
SO2 (sat) 99.7      
Na+ 144   142.0 - 152.0 mEq/L
K+ 3.6   3.5 - 5.2 mEq/L
IONIZED Ca2+ 1.2   1.2 - 1.5 mm/L
GLUCOSE 92   75.0 - 130.0 mg/dl
LACTATE 2.1 High 0 - 2 mm/L
CHLORIDE 124 High 108 - 120 mEq/L
ANION GAP 7 Low 13.0 - 22.0 mEq/L


 

3.  Glasgow Short Form


A. Look at dog in kennel. Is the dog?

(i)
 POST-OP
On-Site Video
Quiet 0 0

prior to seeing assessor		  
Crying or whimpering 1
Groaning 2
Screaming 3
(ii)
Ignoring any wound or painful area 0 0  
Looking at wound or painful area 1
Licking wound or painful area 2
Rubbing wound or painful area 3
Chewing wound or painful area 4

B. Put lead on dog and lead out of kennel. When the dog walks / rises is it?

(iii)
 POST-OP
On-Site Video
Normal 0 0  
Lame 1
Slow or reluctant 2
Stiff 3
It refuses to move 4

C. If it has a wound or painful area, including abdomen, apply gentle pressure 2 inches around site. Does it?

(iv)
 POST-OP
On-Site Video
Do nothing 0 0  
Look around 1
Flinch 2
Growl or guard area 3
Snap 4
Cry 5

D. Overall. Is the dog?

(v)
 POST-OP
On-Site Video
Happy and content or happy and bouncy 0 0  
Quiet 1
Indifferent or nonresponsive to surroundings 2
Nervous or anxious or fearful 3
Depressed or nonresponsive to stimulation 4

(vi)
 POST-OP
On-Site Video
Comfortable 0 0  
Unsettled 1
Restless 2
Hunched or tense 3
Rigid 4
TOTAL SCORE:   0  


4.  History

Nala was presented to the Oncology Service at Colorado State University's Veterinary Medical Center for surgical excision of a grade III fibrosarcoma located in the right hemimandible.

  • Nala was presented to the referring DVM for moderate discomfort when eating. Nala's dry food had to be moistened and the owner noticed Nala would only chew on the left side of her mouth.
    • The referring DVM diagnosed the grade III fibrosarcoma via incisional biopsy.
  • Prior to surgery at Colorado State University a CT Scan was performed which revealed the following:
    • lysis of a large portion of the body of the right hemimandible
    • a large soft tissue component associated with the mandibular lysis
      • this component was pronounced caudally and was causing lateral compression of the pharynx
    • an enlarged right mandibular lymph node

5.  Medications

Chronic:

  • none known

Perioperative:

  • surgical complications:
    • hypotension
    • blood loss
    • low PCV (patient received one transfusion of canine A+ blood)
  Drug Dose Route Time/Other
Preanesthetic: atropine 0.04 mg/kg SQ 9:45 am
morphine 1 mg/kg
Induction: thiopental 9 mg/kg IV 10:15 am
Intraoperative: isoflurane 0.5 - 2.5% inhaled 10:15 am - 2:55 pm
fentanyl 2 - 20 µg/kg/hr CRI 11:25 am - 2:15 pm
2 ug/kg IV 11:20 am & 12:15, 12:45, 3:00 pm
ketamine 10 - 20 µg/kg/min CRI 11:25 am - 2:45 pm
0.5 mg/kg IV 11:20 am
meloxicam 0.2 mg/kg 1:30 pm
xylazine 0.12 mg/kg 3:00 pm
Postoperative: fentanyl 3 - 4 µg/kg/hr CRI • started at 3 µg/kg/hr
• increased to 4 µg/kg/hr - 2 hrs. post-op
• decreased to 3 µg/kg/hr - 5 hrs. post-op
• increased to 4 µg/kg/hr - 8 hrs. post-op
• decreased to 3 µg/kg/hr - 10 hrs. post-op
• increased to 4 µg/kg/hr - 12 hrs. post-op
• discontinued 17 hrs. post-op
2 µg/kg IV 8 & 12 hrs. post-op
10 mg / 72 hrs. transdermal placed 3 hrs. post-op
ketamine 1 - 2 µg/kg/min CRI • started at 2 µg/kg/min.
• decreased to 1 µg/kg/min. - 14 hrs. post-op
• discontinued 17 hrs. post-op
acepromazine 0.01 mg/kg IV 2, 8, 10 & 12 hrs. post-op
Outpatient: fentanyl 10 mg transdermal remove after 72 hrs.
acepromazine 25 mg PO 1 tablet up to TID as needed for anxiety
meloxicam 1.5 mg/ml draw suspension to 70 lb. mark &
give once daily for 7 days
morphine 30 mg 1 tablet BID for 7 days



6.   Physical Exam

weight: 40.0 kg
T: 102.3° F
P: 120 beats / min.
R: panting
  • Abnormalities noted:
    • firm mass, approximately 4 - 5 cm on lingual and buccal side of right mandible (from premolar to caudal mandible)
    • right & left submandibular lymph nodes enlarged, right larger than left
    • obese

7.  Simple Descriptive Scale


  POST-OP
On-Site Video
0 = No Pain 0  
1 = Mild Pain
2 = Moderate Pain
3 = Severe Pain
4 = Very Severe Pain (Worst Possible Pain)


8.  Visual Analog Scale


POST-OP
On-Site Video
2 mm  

 

9. Pain Assessment Videos

History

Nala was presented to the Oncology Service at Colorado State University's Veterinary Medical Center for surgical excision of a grade III fibrosarcoma located in the right hemimandible.

  • Nala was presented to the referring DVM for moderate discomfort when eating. Nala's dry food had to be moistened and the owner noticed Nala would only chew on the left side of her mouth.
    • The referring DVM diagnosed the grade III fibrosarcoma via incisional biopsy.
  • Prior to surgery at Colorado State University a CT Scan was performed which revealed the following:
    • lysis of a large portion of the body of the right hemimandible
    • a large soft tissue component associated with the mandibular lysis
      • this component was pronounced caudally and was causing lateral compression of the pharynx
    • an enlarged right mandibular lymph node

 

10. Pain Assessment Videos

Medications
Chronic:

  • none known


Perioperative:

     surgical complications:

  • hypotension
  • blood loss
  • low PCV (patient received one transfusion of canine A+ blood)

Preanestheitc: Atropine 0.04 mg/kg and Morphine 1mg/kg both SQ

Induction: Thiopental 9 mg/kg IV

Intraoperative: Isoflurane 0.5 - 2.5 %
 
  Drug Dose Route Time/Other
Preanesthetic: atropine 0.04 mg/kg SQ 9:45 am
morphine 1 mg/kg
Induction: thiopental 9 mg/kg IV 10:15 am
Intraoperative: isoflurane 0.5 - 2.5% inhaled 10:15 am - 2:55 pm
fentanyl 2 - 20 µg/kg/hr CRI 11:25 am - 2:15 pm
2 ug/kg IV 11:20 am & 12:15, 12:45, 3:00 pm
ketamine 10 - 20 µg/kg/min CRI 11:25 am - 2:45 pm
0.5 mg/kg IV 11:20 am
meloxicam 0.2 mg/kg 1:30 pm
xylazine 0.12 mg/kg 3:00 pm
Postoperative: fentanyl 3 - 4 µg/kg/hr CRI • started at 3 µg/kg/hr
• increased to 4 µg/kg/hr - 2 hrs. post-op
• decreased to 3 µg/kg/hr - 5 hrs. post-op
• increased to 4 µg/kg/hr - 8 hrs. post-op
• decreased to 3 µg/kg/hr - 10 hrs. post-op
• increased to 4 µg/kg/hr - 12 hrs. post-op
• discontinued 17 hrs. post-op
2 µg/kg IV 8 & 12 hrs. post-op
10 mg / 72 hrs. transdermal placed 3 hrs. post-op
ketamine 1 - 2 µg/kg/min CRI • started at 2 µg/kg/min.
• decreased to 1 µg/kg/min. - 14 hrs. post-op
• discontinued 17 hrs. post-op
acepromazine 0.01 mg/kg IV 2, 8, 10 & 12 hrs. post-op
Outpatient: fentanyl 10 mg transdermal remove after 72 hrs.
acepromazine 25 mg PO 1 tablet up to TID as needed for anxiety
meloxicam 1.5 mg/ml draw suspension to 70 lb. mark &
give once daily for 7 days
morphine 30 mg 1 tablet BID for 7 days

 

11. Pain Assessment Videos

Physical Exam

weight: 40.0 kg
T: 102.3° F
P: 120 beats / min.
R: panting
  • Abnormalities noted:
    • firm mass, approximately 4 - 5 cm on lingual and buccal side of right mandible (from premolar to caudal mandible)
    • right & left submandibular lymph nodes enlarged, right larger than left
    • obese

 12. Pain Assessment Videos

Nala

Nala was presented to the Oncology Service at Colorado State University 's Veterinary Medical Center for surgical excision of a grade III fibrosarcoma located in the right hemimandible. To view Nala's history, medications, physical exam, CT scan, diagnostics, or to view her postop video, click on the corresponding link.

 

 

File NameDescription / Comment
CSU Acute Pain Scale - Canine Click to read article
CSU Acute Pain Scale - Canine v.2Click to read article
CSU Acute Pain Scale - Feline Click to read Article
CSU Acute Pain Scale - Feline v.2Click to read article
CSU Instructions For Pain Scale Use
CSU Simple Descriptive Pain Scale - Canine Click to read article
Glasgow Composit Pain Scale (short form)Simple form - mainly canine oriented.
Nala postopClick to view movie
Simple Visual Analogue Scale (VAS)Click to read article