If there were concerns about haemorrhage, monitoring the patient ' s blood pressure through the night would have allowed any trends to be noted and acted upon. Had the patient been haemorrhaging, it is likely there would have been a spike in the heart and respiratory rates due to the body ' s compensatory mechanisms [ 4 ].
Naturally, there was a concern that the patient could have sustained further trauma from the impact with the vehicle, which could have led to raised intracranial pressure( ICP), haematoma development, bladder rupture, pneumothorax and diaphragmatic hernia. However, the patient ' s owner reported that he did not lose consciousness during or after the collision and was not crushed underneath the car.
Raised ICP should be taken into account when deciding on treatment plans, as certain drugs may be contraindicated. Signs of raised ICP include hypertension with associated bradycardia( known as the Cushing ' s reflex), ataxia, circling, seizures, nystagmus and non-responsive pupils [ 9 ]; this is a nonexhaustive list.
Figure 1. Right lateral radiographic view of the distal humeral fracture.
Neurological assessment is important to identify any signs of rising ICP and allow early intervention. Head trauma in dogs may be self-limiting but can also result in significant traumatic brain injury and even death, with reported mortality rates ranging from 18 % to 24 % [ 10 ].
The patient had both thoracic and limb radiographs taken, to assess and definitively diagnose the fractured humerus. Figures 1 and 2 show lateral and dorsoventral views of the distal humeral fracture, respectively, and Figure 3 shows a right lateral thoracic view taken at the primary care practice.
Figure 2. Dorsoventral radiographic view of the distal humeral fracture.
Two point-of-care ultrasound examinations were performed, thoracic( T-POCUS) and abdominal( A-POCUS). The T-POCUS identified a number of B-lines present, which are to be expected in a normal canine patient. These are a‘ lung surface phenomenon’ and can be isolated, few and narrow in healthy patients; however, if they are broad-based or numerous, they can be of clinical concern [ 11 ]. There were no obvious causes for concern, such as signs of contusions or haemorrhage, and no evidence of free fluid in or around the pleural space [ 11 ].
The A-POCUS showed some debris in the patient ' s bladder; however, this was not of concern as he was having no trouble passing urine and the urine was not discoloured. The debris was initially thought to be blood clots in the patient ' s bladder but, given the lack of discoloration of his urine throughout his stay in the hospital, this was reviewed and considered not to be of clinical concern. There was no free fluid noted in the abdomen and no sign of haemorrhage or contusions.
Figure 3. Right lateral thoracic radiograph, showing the distal humeral fracture.
The ultrasound scans were repeated after a minimum of 6 – 12 hours to ensure no complications had developed
40 Veterinary Nursing Journal