EMERGENCY - Equine Emergency

Question 1

In regards to the alimentary system, what is classified as an emergency in horses?

Answer 1

Colic
Abdominal trauma

Question 2

In regards to the respiratory system, what is classified as an emergency in horses?

Answer 2

Dyspnoea
Thoracic trauma

Question 3

In regards to the cardiovascular system, what is classified as an emergency in horses?

Answer 3

Severe haemorrhage

Question 4

In regards to the neurological system, what is classified as an emergency in horses?

Answer 4

Spinal or cranial fracture

Question 5

In regards to special senses, what is classified as an emergency in horses?

Answer 5

Corneal laceration

Question 6

In regards to the musculoskeletal system, what is classified as an emergency in horses?

Answer 6

Fractures
Tendon and ligament injuries
Wounds
Myopathies

Question 7

In regards to the reproductive system, what is classified as an emergency in horses?

Answer 7

Dystocia
Red bag delivery

Question 8

How do you prepare for an equine emergency?

Answer 8

Know phones numbers of your colleagues, referral practices and disposal contact
Check your car to make sure you have the equipment you need

Question 9

How should you triage over the phone for an equine emergency?

Answer 9

1. Determine if this is really an emergency
2. Gather signalment information
3. Gather a history
4. Provide the client with guidance whilst they wait for you to arrive

Question 10

What are the main steps involved in triage for an equine emergency?

Answer 10

1. Identify the stability of the animal
2. Identify your patient using their passport, determine signalement and take a history
3. Identify and treat injuries that are immediately life threatening and identify which injuries could be exacerbated by moving the animal
4. Thorough clinical exam
5. Make a differential diagnosis list and plan your treatment and management

Question 11

What guidance should you provide a client with a colicing horse or horse with coke whilst they wait for you to arrive?

Answer 11

Remove all food from the area (for both choke and colic) and if the colic is violent stay away from the horse and don’t risk human safety

Question 12

What guidance should you provide a client with a horse with a penetrating hoof injury whilst they wait for you to arrive?

Answer 12

Tell the client not to remove the penetrating object if it is deeply penetrated, however, if the penetration is superficial it may be beneficial to remove it to prevent further trauma if the horse pushes it further in etc.

Question 13

What guidance should you provide a client with an actively bleeding horse whilst they wait for you to arrive?

Answer 13

Apply pressure to the wound if safe to do so and do not remove the pressure

Question 14

What do the ABCD principles stand for in equine emergencies?

Answer 14

Airway
Breathing
Circulation
Drugs

Question 15

What should you do if a horse has an upper airway obstruction?

Answer 15

Emergency tracheostomy

Question 16

How do you carry out an equine emergency tracheostomy?

Answer 16

1. Surgically scrub and administer lidocaine at the upper third of the trachea (if there is time)
2. Carry out a midline vertical incision at the upper third of the neck
3. Divide the stenothyrohyoideus muscles overlying the trachea
4. Stab incision through the annular ligament between the tracheal rings and extend this inision to either side big enough to allow for the placement of the tracheostomy tube
5. Secure the tracheostomy tube to the neck

Question 17

What is the circulating blood volume of a horse?

Answer 17

80 - 100ml/kg

Question 18

When will a horse begin to decompensate due to haemorrhage?

Answer 18

A horse will begin to decompensate due to haemorrhage if they suffer from approximately 30% acute blood loss

Question 19

List five clinical signs of significant haemorrhage in horses

Answer 19

Tachycardia
Tachypnoea
Hyperpnoea
Pale/white mucous membranes
CRT more than 2 seconds

Question 20

What should you do if a horse has severed an artery?

Answer 20

Clamp the artery but be careful of nerves as they often sit very close to arteries

Question 21

What is the ceiling dose of sedatives?

Answer 21

The ceiling dose of sedatives is where you reach a dose where increasing the dose of a sedative no longer increases the intensity of the sedation, instead it just increases the duration of sedation

Question 22

When in an equine emergency can it be useful to use xylazine as a sedative?

Answer 22

Xylazine is good to allow you to assess a fractious colic as it can be administered IM and has a short duration of action so you can carry out a safer clinical exam and then reassess the animal when the sedation wears off. If horses colic through xylazine, this suggests vert painful colic

Try to get a heart rate before administering the xylazine

Question 23

What should you be aware of if using detomidine to sedate a fractious colic?

Answer 23

Detomidine is a more potent analgesic than xylazine and this can mask escalating pain which could indicate a worsening colic and alter your treatment plan. Ideally you should only use detomidine for horses with severe and unrelenting colic pain

Question 24

What is the ideal route of administration for sedatives in horses?

Answer 24

Intravenous (IV) administration

Question 25

Which side affects of α2 agonists should be aware of in horses?

Answer 25

Transient hypertension followed by hypo- or normotension Bradycardia Mild to moderate respiratory depression Worsen upper airway obstruction Tachypnoea in pyrexic horses Reduces gastrointestinal motility Sweating Diuresis Hyperglycaemia

Question 26

How do α2 agonists worsen upper airway obstructions in horses?

Answer 26

α2 agonists cause muscle relaxation which can exacerbate pre-existing airway obstruction

Question 27

Why should you not offer horses food until they are fully awake following sedation?

Answer 27

Horses that are not fully awake following sedation as they are at risk of oesophageal choke

Question 28

Which opioid is commonly used in combination with α2 adrenoreceptor agonists in horses?

Answer 28

Butorphanol

Question 29

Why is butorphanol commonly used in combination with α2 adrenoreceptor agonists in horses?

Answer 29

Butorphanol has a significant potentiating effect on the sedative and analgesic effects of α2 adrenoreceptor agonists

Question 30

How should you generally administer sedatives to horses?

Answer 30

Generally you administer and top up sedative drugs via an IV bolus

Question 31

How should you administer sedative drugs for longer procedures?

Answer 31

Administer an IV loading dose followed by continuous infusion

Question 32

How do you prepare a horse for referral?

Answer 32

Talk to the referral centre for advice Organise transport to the referral hospital Support the horse *(bandage/immobilise, analgesia, indwelling NG tube etc.)* Provide owners with directions and phone numbers

Question 33

What is the criteria for humane destruction of a horse?

Answer 33

The decision to advise an owner to destroy a horse on humane grounds must be the responsibility of the attending veterinary surgeon, based on his or her assessment of the clinical signs at the time of examination, regardless of whether or not the horse is insured. The veterinary surgeon's primary responsibility is the welfare of the animal

Question 34

How should you approach euthanasia in horses?

Answer 34

Communicate with your owner Ask about All Risks Mortality Insurance Get a second opinion

Question 35

What does All Risks Mortality Insurance cover?

Answer 35

All Risks Mortality Insurance will compensate if the insured horse sustains an injury or manifests an illness or disease that is so severe as to warrant immediate destruction to relieve incurable and excessive pain and that no other options of treatment are available to that horse at that time

Question 36

Which drug should you use for euthanasia in horses?

Answer 36

Somulose

Question 37

How should you administer somulose?

Answer 37

Place an IV catheter and administer the drug over 10-15 seconds

Question 38

What dose should you use for somulose?

Answer 38

1ml/10kg

Question 39

(T/F) Somulose is very unsafe for humans

Answer 39

TRUE. Somulose can be very dangerous if absorbed through your skin or mucosa