Patient of the Week: Lily Johnson

Lily Johnson was referred to the VRA emergency department on January 25th after being attacked by a larger dog on a walk. The owner was able to pick her up, however, the offending dog jumped up and snatched her away from the owner. A neighbor was fortunately able to help get the owner and Lily back to their house safely. Lily was taken to a nearby veterinarian and was stabilized with pain medicine, antibiotics and fluid support. Chest x-rays were taken and revealed multiple rib fractures and pneumothorax (free air in the chest). Lily was referred to us for further aggressive care and possible surgery.



On presentation at VRA, Lily was diagnosed with a flail chest, which means that multiple ribs in a row were broken. Lily was in shock and was having a very difficult time breathing. She immediately received flow-by oxygen, pain medicine and aggressive fluid resuscitation. The left side of Lily’s chest was shaved and identified two small puncture wounds. A temporary bandage was placed over the defects and after Lily was more stable, x-rays were repeated. The chest x-rays revealed open fractures of her left ribs #5-10, a pneumothorax, a collapsed lung lobe, areas of lung bleeding/bruising, and subcutaneous emphysema. The free air in Lily’s chest had to be removed by thoracocentesis (procedure where a needle in instructed into the chest to remove any abnormal air or fluid) multiple times, revealing that there was a constant leak of air from damaged lung lobes and Lily needed to go to immediate emergency surgery.

Surgery revealed that even though the surface wounds were small, Lily had a leaking lung lobe and multiple defects to her ribs. Her left caudal lung lobe was removed and the defects between her ribs were fixed. It is not uncommon for wounds that appear small in nature to reveal severe damage to underlying tissue and organs. A chest tube was placed on the left side of Lily’s chest which allowed us to remove any free fluid or air. Lily had a moderate to marked amount of bleeding during surgery and she was anemic post-operatively. Fortunately, Lily did not need any blood transfusions and recovered from anesthesia and surgery remarkable well. She had multiple episodes of hypoxemia (abnormally low levels of oxygen content in the body) and was placed in an oxygen cage overnight. Lily stayed in our ICU department for 3 nights on a variety of pain medication, antibiotics, intravenous fluids, anti-nausea medication and was monitored closely. Lily was discharged Tuesday, January 27th as she was eating well and comfortable on oral medication with recommendations to recheck chest x-rays in 5 days.

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