Intensive Care of Colic Horses

Question 1

Therapeutic goal

Answer 1

Treatment of primary disease

Treat the already developed compllications and prevent any further

Supportive therapy of individual body systems

Question 2

Principles

Answer 2

Much easier in hospitals! where there is the equipment, experience and continuous supervision

Acute abdomen is most freq

Personnel:

• Emergency and critical care specialist
• Int med specialist
• Anaesth specialist
• Surgeon
  
  • Tenchnicians and nurses

Question 3

Basic equipment in ICU

Answer 3

Fluid admin

ECG

Centrifuge

Refractometer

Glucose and lactate meter

Urinalysis strips

Microscope

US- with Doppler

O2 tank and regulator

Isolation units (biosecurity)

Question 4

Intermediate level equiment of ICU

Answer 4

Blood gas and electrolyte analyser

CBC analyser

Coag profile testing

Direct and indirect BP

IV fluid pumps

Sling and hoists

Question 5

Advanced equipment for ICU

Answer 5

Pulse oximeter

Mechanical vent

Colloid osmometer

Capnograph

Continuous ECG

Syringe infusion pumps

Question 6

What are the basic procedures

Answer 6

Monitoring: phys parameters, imaging and lab tests

Fluids: crystalloids, colloids, plasma, blood

Analgesia

Sedation

Question 7

Emergency drugs

Answer 7

NSAIDS

• Flunixin meglumine
• Phenylbut
• Suxibuzone
• Ketoprofen, meloxicam, metamizole

Opiods: morph and but

Ketamine (CRI): conc infusion at low dose

Question 8

Emergency drugs: sedatives

Answer 8

Alpha 2: detomidine, xylazine and romifidine

Question 9

Dobutamine

Answer 9

GA of bad colic- when BP is low because +inotrop

IV

Question 10

Doxapram

Answer 10

Resp stim

IV or topical under tongue

Question 11

Epi

Answer 11

Anaphylaxis: IV, IM, SC or intrthecal

Asystole: IV

Question 12

Glycopyrrolate

Answer 12

BronchoD or bradycard: IV, IM, SC

Question 13

Lidocaine

Answer 13

Postop after SI surgeries

SI ileus: loading dose then in CRI

Arrhythmia: bolus then CRI

*bad colic can cause arrhythmia

Question 14

Definition of shock

Answer 14

Insufficient blood flow to the tissues, as a result of circ problems

1. blood loss internally or externally
2. plasma loss: transudation or exudation
3. loss of fluids and electrolytes: colic or races

Question 15

What are the stages of shock

Answer 15

Compensated

Decompensated

Irreversible

Question 16

Compensated stage of shock

Answer 16

Vital organs maintained

incr BP

Activation of compensatory mechanisms

Question 17

Decompensated stage of shock

Answer 17

The comp mechanisms are unable to deliver sufficient O2 to the tissues

Microvasc tissue perfusion is disturbed

Cell function decreasing

Question 18

Irreversible stage of shock

Answer 18

Severe organ dysfunction

MODS, MOFS

Question 19

Consequences of hypovol shock

Answer 19

Decr IV vol (decr BP)

Hypotonia

Decr CO

VasoC

Contration of spleen- pumps RBC’s into circ- this could incr PCV

Decr intestinal secretion

Organ dysfunction

VasoD on periph in the decomp state

Question 20

Distributive shock

Answer 20

Abnormal peroph blood distrib

1. vasogenic or neurogenic: acute trauma or anaphylaxis
2. Septic/toxic: neonatal foals septicaemia, endotox

leads to SIRS!!!!

Question 21

Endotoxaemic cause of distributive shock

Answer 21

Ileus

Acute colitis

Prox enteritis

Peritonitis

Pleuritis

Pneumonia

*the first 3 show colic signs

Question 22

Clinical signs of shock

Answer 22

Decr skin turgor

Cold extremities

Variable colour of mm- depends on type of shock e.g toxic=purple rim

CRT delayed

Tachypnoea

Tachycard

Weak pulse

Question 23

Clinical signs of shock: blood parameters

Answer 23

The ones that INCREASE!:

1. Ht
2. TPP
3. Albumin
4. Lactate
5. Creatinine and urea

++ leucopenia and neutropenia

Question 24

Treatment of shock

Answer 24

Restore CIRC

Treat the cause

Treat the metabolic disorders

Question 25

Vascular access: catheters

Answer 25

Polyethylene and polypropylene: highly thrombogenic Teflon: less thrombogenic \*\*Polyurethane: much less thrombogenic Silastic: the least

Question 26

Fluid therapy: crystalloids: LRS

Answer 26

matches physio ion conc!!

Question 27

Fluid therapy: crystalloids: ringers soln

Answer 27

Higher Na and Cl

Question 28

Fluid therapy: crystalloids: physio saline

Answer 28

for hyponatraemia! when Na\<125mmol/L

Question 29

Fluid therapy: crystalloids Hypertonic saline

Answer 29

This is 7-7.5% NaCl Max dose: 4ml/kg Used when rapid decrease of PCV!! should be followed by isotonic e.g LRS

Question 30

Fluid therapy: crystalloids: Hypotonic NaCl soln

Answer 30

this is 0.45% soln Only for maint!! Should not be used for rapid fluid expansion- will cause haemolysis

Question 31

Fluid therapy: Plasma expanders

Answer 31

Use when TPP is very low: \<40g/L and cannot be measured by a refractometer or osmometer 1. Dextrans=macromolecules, therefore can cause allergic reaction and have a short half lief 2. Hydroxyethyl starch (HES): keeps oncotic P higher for longer, prolongs clotting times, longer half life. Max dose: 10ml/kg of 6% soln

Question 32

Fluid therapy Equine plasma

Answer 32

Cheap if in house but v expensive if it has to be purchased Long half life Risk of infectious diseases Allergic reactions/incompatibilities

Question 33

Fluid therapy: whole blood

Answer 33

For hematopoietic diseases When Ht is\<15% or in hypixaemia Incompatibility: Qa and Aa antigens Inf diseases

Question 34

Oral fluid therapy

Answer 34

Via NG tube Only for mild deficits, horse can tolerate well when there is no reflux or obstruction For every 21L of water: 1. 10g NaCl 2. 15g NaHCO3 3. 75g KCl 4. 60g K2HPO4 Ca should be given separately because it ppts!!

Question 35

NG tubing

Answer 35

is NB at the beginning of colic Gastric decompression especially for acute gastric dilation or reflux

Question 36

Caecal trocarisation

Answer 36

R paralumbar fossa Release of gas To give AB's Complications: peritonitis and abscesses

Question 37

Transrectal trocarisation of the large colon

Answer 37

Only when surgery not an option (The large colon is so full of gas that it is impairing breathing) Puncture of the large colon through the rectum 16-12G (is that meant to be 21?) or stylet of IV catheter IV giving set Sedation Buscopan Ext P on abd wall Complications:: bleeding, or tear of the Rectum or large colon