Iatrogenic Injuries and Emergencies

Question 1

How should you drag a horse?

Answer 1

From spine side
Backwards
Protect eyes

Question 2

What is a sign of smoke inhalation? How do you diagnose this?

Answer 2

Smoke/black around nostrils

Endoscope

Question 3

How do you treat non-severe burns?

Answer 3

Cool skin with cool water, clip hair and lavage with very dilute chlorohexidine

Question 4

What is a good indicator of blood loss?

Answer 4

Lactate

PCV takes 24 hours to change

Question 5

What should tissue be in order to be able to close the wound by suturing?

Answer 5

< 8 hours old and healthy tissue

Or wounds where anatomical alignment/accuracy is essential (lips, eyes, nostrils)

Question 6

When should staples NOT be used?

Answer 6

If there is tension around the wound

If anatomical accuracy/alignment is essential

Question 7

When is secondary intention healing indicated?

Answer 7

Tissue > 8 hours old
Or no way to close skin defect
Or significant contamination

Question 8

What is sequestrum formation?

What is the treatment?

Answer 8

When the cortex of the bone is exposed
Results in
Won’t heal, despite antimicrobials
Surgical intervention (e.g. curette out) needed

Question 9

What are two causes of drainage tracts?

Answer 9

Sequestrum formation

Foreign material in wound

Question 10

What 3 things must the wound bed be in order for a skin graft to be accepted?

Answer 10

1. Vascularised
2. Free of infection
3. Free of necrotic tissue

Question 11

What 3 things are important to assess when assessing limb injuries?

Answer 11

1. Is the animal in shock (tachycardia, hypovolaemia)
2. Weight-bearing
3. Amount of blood loss

Question 12

What is a common oral antimicrobial used in management of wounds?
What class of drugs should it NEVER be used concurrently with, and why?

Answer 12

Trimethoprim sulphonamide
Alpha 2 agonists
Fatal arrhythmias

Question 13

When are sutures/staples typically removed?

Answer 13

10-14 days later

Question 14

Which 2 type of skin grafts can be done under standing sedation and local anaesthetic?

Answer 14

Pinch/punch grafts

Full thickness grafts

Question 15

What type of skin grafts are most likely to be accepted?

Answer 15

Modified Meek Micrografts

Question 16

What type of skin grafts can cover large defects?

Answer 16

Split thickness grafts

Modified Meek Micrografts

Question 17

What are 3 complications of Nasogastric Intubation?

Answer 17

1. Haemorrhage (common)
2. Oesophageal perforation
3. Inhalational pneumonia

Question 18

How can you prevent nasogastric intubation complications?

Answer 18

Ensure stomach tube is well lubricated, not roughened/damaged, correct size
Ensure passed down ventral meatus
Suitable restraint (twitch/sedation)
Never force the tube
Ensure properly placed before administering fluids

Question 19

How can you tell if oesophageal perforation due to nasogastric intubation has occurred?
What is the prognosis

Answer 19

Blood on tube but no nasal haemorrhage
Very poor prognosis if full thickness laceration
Investigate using endoscopy and radiography

Question 20

What can accidental water inhalation cause?

Answer 20

Inhalational pneumonia

Pulmonary oedema

Question 21

What is severe lipoid pneumonia associated with?

Answer 21

Inhalation of liquid paraffin

Question 22

What groups of horses are at increased risk of rectal tears following rectal examination?

Answer 22

Arabs
Stallions/colts
Colic
Fractious

Question 23

What do you do if a rectal tear occurs?

Answer 23

Sedate the horse
Butylscopolamine
\+/- epidural anaesthesia
Endoscopy/proctoscopy to assess grade and location
Refer