Equine External Coaptation and Emergencies Flashcards Preview

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Flashcards in Equine External Coaptation and Emergencies Deck (27):
1

Assorted layers of bandaging?

- vet gammgee (padding)
- non adherent wound dressing
- orthopeadic padding
- cohesive bandage tape
- conforming bandage
- adhesive bandage
- white tape

2

What types of limb bandage can be applied to horses?

- lower limb bandange
- foot bandage
- full limb (fore/hind)
> start with lower limb and then add another section higher up, then cover both
- RObert-Jones (fx support before surgery/if sugery not possible)
> multiple layers of thick padding, getting tighter -> provides support

3

How is a lower limb CAST applied?

- minimal orthopeadic padding
- cotton stockingette
- fix cast felt to proximal mrgin
- apply casting tape
- apply heel wedge
+- encorporate Gigli wire (facilitates easy cast removal)

4

What is transfixation casting? Indications?

> transosseal pins cemented in cast
- repaired or conservatively treated distal limb fx that is unstable under axial loading
- fetlock breakdown
- often salvage

5

How can setting time of cast be altered?

- hotter the water, faster it sets

6

What is a large animal external fixator also known as?

Walking cast

7

What Hx must be found out about the Fx patient?

- what happened? How long ago ?
- was the trauma observed?
- has the horse been moved since?
- did it have to be caught after the trauma?
- did the horse lose a lot of blood?
- did the horse sweat excessively?
- has any medication been given?

8

Kit necessities to be prepared for fx

> bandage material
- wound dressing
- conforming gauze
- sheet cotton
- casting tape
- duct tape
> splints
- 2"x4" slats, boards
- light metal rods
- PVC pipes
- Kimzey leg saver splint
> Chemical restraint
- Xylazine
- detomidine
- romifidine
- butorphanol
> Abx
- Procaine Penicillin G
- K-Penicillin
- Gentamicin
> other
- flunixin
- bute
- tetanus toxoid vax
- IV fluids

9

Initial steps to tx of emergency patient?

> take charge
> assess condition
- shock
- blood loss
> localise and assess damage
- tx v euthanasia
> correct immobilisation
- always 1st, before radiographs etc.
> radiographs
> referral

10

Which drugs can be used for chemical restraint inthe mergency situation? Which should not be used?

> A2s
- xylazine 0.2-1.1mg/kg IV
- detomidine 10-25ug/kg IV
- romifidine 0.05mg/kg IV
> A2 + Narcotic
- detomidine
+ Butorphanol 0.020.1mg/kg IV
- never use narcotics alone -> excitement
> AVOID ACP d/t hypotensive effects in the presence of circulating catecholamines

11

Outline initial examination of an injured limb

> visual
- deviation axial/abaxial
- hyperextension
- swelling/haematoma
- open wound
> palaption
- crepitus
- fx fragments
- open wound/moist spot
- stress tests
-> localisation and classification of fx
- incomplete v complete
- simple v comminuted
- closed v open
- articular v non-articular
- tendon/lig disruption?
- status of soft tissue

12

Outline classification of a fracture. LEARN THIS FOR ROTTIONS!!

- closed/open
- incomplete/complete
- simple/comminuted
- articular/nonarticular
- tendon/ligament disruption?
- status of surrounding soft tissues

13

How do the biomechanics of a limb change when fx?

- muscles acting over a fx bone exert different action to what they are intended to do
> eg. digital extensors and flexors in proximal radius -> abduction
> passive action structures counter their action
- suspensory aparatus
- reciprocal apparatus

14

Outline the ideal splint

- neutralises forces
- not too cumbersoe (pendulum effect)
- applicable under difficult circumstances (no GA)
- economical and accessible

15

What are the functional divisions of the equine limb?

1. Coronary band to distal MC / MT
2. Distal MC/MT to distal radius/proximal MT
3. Distal radius/prox MT to elbow/stifle
4. elbow/stile to distal scapula/hip

16

What biomechanical acts on division 1 of the forelimb? What effect does this have clinically and so what are the goals of immobilisation?

> angle of the fetlock
- suspensory apparatus
- flexor tendons
- bending focus over fx site
> counteract bending forces
> axial alignment of dorsal cortices

17

What immobilisation technique would be appropriate for division 1 forelimb fx?

*debatable*
- padded bandage/cast bandage with dorsal splint
- Kimzey leg saver splint
- can keep up on tippytoe but some argue immobilisation of the fetlock in flexion is counterproductive, can result in displacement of a fx that is otherwise stable under axial loading eg. condylar fx 3rd MC/MT, proximal phalanx fx
- rigid external coaptation with limb weight bearing may be better
> avoid excessive padding
- slipping
- pendulum effect

18

What biomechanical acts on division 2 of the forelimb? What effect does this have clinically and so what are the goals of immobilisation? Methods of immobilisation?

- use bones proximal and distal to attach splints bridging fx site
> immobilisation
- RObert Jones bandage (2/3x diameter of limb @ fx site, multiple layers of individually confoming padding)
+ rigid splints up to elbow laterally and caudally

19

What biomechanical acts on division 3 of the forelimb? What effect does this have clinically and so what are the goals of immobilisation? Methods?

- digital extensors and flexors act as abductors of the limb (prox radius)
- inadequate stabilisation with RJB splints up to elbow
> goal of immobilisation
- prevent abduction and soft tissue damage on medial aspect of the limb
> methods
- RJB with extended lateral splint

20

What biomechanical acts on division 4 of the forelimb? What effect does this have clinically and so what are the goals of immobilisation?

- triceps apparatus disabled -> dropped elbow (cannot be flexed for weight bearnig)
- but humerus, radius and ulna (bones affected) are well protected by soft tissue so no need for direct protection
> goal
- splint carpus in extended position to allow for weight bearing and blanace
> method
- padded bandage
- splint caudally orcranially over carpus
- walking may be difficult and foals may be too weak to ambulate
> may not require immobilisation

21

What biomechanical acts on division 1 of the hindlimb? What effect does this have clinically and so what are the goals of immobilisation?

*debatable* as for forelimb - maintain in extension or flexion?
- reciprocal apparatus
- plantar cortices easier aligned
> method
- bandage/cast bandage with plantar splint
- ANGLED Kimzey leg aver splint

22

What biomechanical acts on division 2 of the hindlimb? What effect does this have clinically and so what are the methods of immobilisation?

> angulation of tarsus
- prox tarsus difficult to bandage and splints difficult to apply
> immobilisation
- RJB with spints to tuber calcaneous (lateral and plantar)
- usually less voluminous than forelimb to allow movement!

23

3 main purposes of bandages?

- cover wounds protected by dressing
- prevent swelling/oedema
- immobilisation (+splinting)

24

What biomechanical factor acts on division 3 of the hindlimb? What are the components of this? Effects clinically? Immobilisation technique?

(prox metatarsal to stifle)
> reciprocal apparatus
- peroneus tertius m.
- fllexor digitalis superficialis m.
- gastrocnemius m.
> overriding at fx site instead of hock flexion
+ stifle joint cannot be immobilised
+ muscles laterally over tibia act asabductors
> RJB with extended lateral splint up to coxofemoral joint (wide board splint, light metal [modified Schroeder-Thomas without groin bar]
- prevents lower limb instability
- angulation at tarsus and stifle prevents paplication of cranial or caudal splint

25

How are fx of division 4 of the HL treated? Clinical signs? Prognosis?

(femur and pelvis, stifle to coxofemoral joint)
> non-weight bearing lameness
- limb remains controllable d/t more distal muscle insertions
- impossible to stabilise by external means
- poor prognosis (unstable fx, fx involving acetabulum)

26

See lecture for good summary of tx of each division

> FL
1. dorsal splint
2. RJB caudal and lateral splint
3. RJB with extended lateral splint
4. caudal splint to lock carpus in extension/no immobilisation necessary
> HL
1. plantar splint
2. RJB with plantar and lateral splint
3. RJB with extended lateral splint
4. no immobilisation necessary

27

What are the best ways to transport a fx patient?

> shorten the distance to get to trailer
> use goose neck trailers or large vans
- put sound legs at the FRONT to allow them to compensate for breaking forces
> limit space to allow for leaning
> leave head and neck free
> young foals will travel recumbent