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Year 4 > Equine Emergencies > Flashcards

Equine Emergencies Flashcards

1
Q

What is meant by ‘iatrogenic’?

A

Caused by vet

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2
Q

Give some examples of iatrogenic injuries in horses

A
  • Nasal haemorrhage during nasogastric intubation/endoscopy
  • Rectal tears during rectal exam
  • Evisceration following castration
  • Adverse drug reaction
  • Anaesthetic death
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3
Q

Give some possible complications from nasogastric intubation

A
  • Haemorrhage (common)
  • Oesophageal perforation (uncommon)
  • Inhalational pneumonia (uncommon)
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4
Q

How can you prevent complications when doing nasogastric intubation?

A
  • Use an appropriately sized stomach tube, lubrication and ensure it is not roughened/damaged
  • Ensure horse is suitably restrained (twitch/sedation if needed)
  • Make sure tube is passed down ventral meatus
  • Never force the tube, ensure it is placed properly within the oesophagus/stomach before administering fluids
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5
Q

What should you do if a haemorrhage occurs when you are passing a nasogastric tube?

A
  • Explain to owner that this is a possible complication
  • Leave horse quietly for 5-10 mins (will spontaneously stop in most cases. Don’t pack nasal passages-horse will snort and make situation worse)
  • Further assessment required if haemorrhage continues (uncommon)-endoscopy, clotting profiles
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6
Q

When may you suspect oesophageal perforation when doing nasogastric intubation?

A

If blood seen on nasogastric tube (where no nasal haemorrhage is evident)

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7
Q

How would you further assess a possible oesophageal perforation?

A

Endoscopic assessment of oesophagus +/- radiography

Full thickness perforations -> poor prognosis

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8
Q

How does iatrogenic inhalational pneumonia occur?

A
  • Inadvertent passage of nasogastric tube into trachea

- Water inhalation (small amounts ok, nut large quantities can result in pulmonary oedema/inhalational pneumonia)

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9
Q

How would you identify an iatrogeenic rectal tear?

A

Blood on rectal sleeve

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10
Q

What should you do if you identify a rectal tear when doing a rectal exam?

A
  • Inform owner
  • Sedate horse
  • Administer butylscopolamine +/- epidural anaesthesia
  • Evaluate the integrity of the rectal mucosa
  • Protoscopy is useful if endoscope is available
  • Determine location and grade of tear
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11
Q

What are the grades of rectal tears?

How would you treat them?

A

Grade 1: mucosa and submucosa (no particular concern, treat medically or not at all)
Grade 2: muscularis (can be treated medically)
Grade 3a: mucosa, submucosa, and muscularis (not midline)
Grade 3b: mucosa. submucosa, and muscularis (midline)
Grade 4: all layers
Grade 3-4 can be treated medically or surgically

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12
Q

How can you medically treat rectal tears?

A

-Broad spectrum antibiotics-penecillin/gentamicin
-Flunixin meglumine 1.1mg/kg IV
-Check tetanus status
+/- epidural anaesthetic an dpacking of rectum

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13
Q

What initial advice would you give to an owner of a horse with a wound?

A
  • Control any profuse haemorrhage by placing a dressing/clean dry material over the site and maintain pressure if possible
  • Don’t move horse if severely lame unless it’s in imminent danger
  • For what sounds like minor cases, phone advice may be all that’s needed
  • For more severe cases, tell owner not to apply anything to wound before you assess it
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14
Q

What should you check when assessing a wound?

A

Horse’s tetanus status

Check for shock

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15
Q

How should you assess a wound?

A

+/- sedate horse

  • Assess age of wound/degree of contamination and its location
  • Apply sterile gel, clip and clean around it
  • Remove gel and lavage the site using sterile polyionic fluids/ 0.05% chlorhexidine/ 0.1% povidone iodine. Make sure pressue of lavage is under 10-15psi (35/60ml syringe and 18/19G needle)
  • Determine depth and direction of wound, presence of foreign material, SC pockets, bone/tendon exposure
  • Is wound near a joint/tendon sheath?
  • Could it involve penetration of thoracic/abdominal organs or other vital areas eg trachea?
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16
Q

Which kinds of wounds should you suture?

A
  • <8 hrs old and have healthy looking tissue at the wound margins
  • Are around the eyelids, nostrils and lips (full thickness)
17
Q

How should you approach suturing wounds?

A

-Suitable restraint (twitch/sedation)
-LA (regional nerve block, ring block)
-Remove necrotic/non-viable tissue
-Skin staples (should not be placed where there is any tension)
-Suturing (+/- stenting)
+/- drain
+/- dressing and bandaging

18
Q

What is secondary intention wound healing?

A

Wound edges cannot be brought together/extensive tissue loss, wound is allowed to granulate

19
Q

How is secondary wound healing carried out?

A
  • Apply sterile hydrogel and non-adherent, absorbent dressing
  • Bandage distal limb +/- splint
  • Ongoing wound management is important (can take a long time)
  • Some wounds may be suitable for tertiary healing (delayed priamry closure) or skin grafting
20
Q

Is horse skin elastic or not?

A

Very inelastic

21
Q

What is tertiary healing (delayed primary closure)?

A

The wound is initially cleaned, debrided and observed, typically 4 or 5 days before closure. The wound is purposely left open but later closed
Examples: healing of wounds by use of tissue grafts

22
Q

What ongoing management shoudl be applied to wounds?

A

-Analgesia/anti-inflammatories (IV meds followed by oral)
-Antimicrobials (IV/IM followed by oral, eg trimethoprim sulphonamides)
+/- tetanus toxoid/tetanus booster
+/- box rest (beware colic)
-Timing of suture/staple removal (usually 10-14 days)
-Frequency of dressing/bandage changes (depends on amount of exudation)

23
Q

Give some possible complications of wound management

A
  • Synovial sepsis/fracture (missed initially)
  • Bone sequestrum formation (where bone cortex is exposed)
  • Wound dehiscence
  • Foreign material remains in situ
  • Bandage sores (eg over hock/carpus)
24
Q

When dealing with a trapped horse, which side of the horse should you work from?

A

Spine side of the horse is safest
Never position yourself where you could get kicked/butted by horse’s head
Ensure you have control of horse’s head (head collar/halter)

25
Q

What should you do after freeing a trapped horse?

A

Full clinical exam

26
Q

Give some common injuries that may occur when a horse is trapped?

A
  • Limb fractures
  • Wounds
  • Head/ocular injuries
  • Dehydration/hypothermia
  • Acute haemorrhage
  • URT/LRT inflammation
27
Q

Which injuries should you consider with stable fires?

A
  • Smoke inhalation
  • Skin burns
  • ‘Burn shock’
28
Q

How should you initially assess a horse that has been in a stable fire?

A

-Stop any burning-cool affected areas with lukewarm water and remove rugs/blankets
-Sedate/anxiolytics if required
-Administer flunixin 1.1mg/kg IV (NSAID)
+/- administer oxygen
-Severe cases: may need catheter placement +/- tracheostomy (URT inflammation, burn shock)
-Referral/euthanasia may need to be considered

29
Q

How should you assess burns?

A
  • Full clinical exam (check for involvement of eyes and other structures eg joints/tendon sheaths)
  • Assess extent of injury
  • Assess depth of burns injury (depth=degree of burn)
  • Determine if referral/euthanasia should be considered
30
Q

How should you treat less severe cases of burns?

A
  • Cool skin with cold water (4oC) for 1 hour
  • Clip hair and lavage with 0.05% chlorhexidine solution
  • Apply a water (NOT oil) based antimicrobial ointment eg silver sulfadiazine
31
Q

When should you not use skin staples?

A

Around sites where there is any tension

Year 4 (51 decks)

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