Plan of Action:

First, we would perform a thorough physical exam with bloodwork and urinalysis 
by cystocentesis. Because Ramon was hit by a car, it is quite possible that he 
has other traumatic injuries besides fractures in his hindlimbs. Dogs that are 
hit by cars commonly experience traumatic myocarditis, ruptured spleen, ruptured 
bladder, and diaphragmatic hernia. Due to this, it is important that RamonŐs 
abdomen be carefully palpated to see if there are any painful areas or if an 
intact bladder can be felt. His heart and lungs should be auscultated carefully 
to check for normal sounds.

After the physical exam, we will radiograph RamonŐs chest, abdomen, both 
hindlimbs, and pelvis. We will take both VD and Lateral Views. If possible, this 
should be done under sedation or with proper analgesia for sufficient muscle 
relaxation and to prevent Ramon from further injuring himself. This will also 
alleviate pain as RamonŐs limbs are manipulated thus offering a more pleasant 
experience.

If, after the physical exam and radiographic interpretation, RamonŐs urinary 
tract integrity seems impaired, radiographic contrast studies will be performed 
to test for ruptured bladder.

If any cardiac abnormalities are noted, an ECG will be run to test for 
arrythmias.

Also, if indicated, ultrasound of abdominal viscera and the heart will be done 
to check for normal function and morphology.

Finally, if still needed after radiographs and physical exam, we will perform an 
orthopedic exam under sedation provided that Ramon is stable 
enough. We would use Propofol so that he will recover quickly and he can be 
dosed to effect. This exam would help to further isolate any soft tissue damage 
that might not be seen on radiographs or to detect problems in the joints.

As Ramon undergoes these diagnostic tests and is treated, his urine output will 
be closely monitored to ensure urinary tract health. His status will also be 
monitored closely to make sure he is stable and serial ECGs can be run if 
cardiac disease or arrhythmias are detected. As veterinarians, we will make sure 
to examine and treat the whole patient to ensure RamonŐs quick return to health!