Equine Flashcards
what are the 2 broad categories of equine orthopaedic surgery?
elective or emergency
what are the most common elective orthopaedic surgeries?
arthroscopy/tenoscopy
angular limb deformities
soft tissue surgery
why might elective arthroscopy/tenoscopy be carried out?
OCD lesions
tendon sheath disease
what are the elective soft tissue orthopaedic surgeries?
neurectomy/fasciotomy
desmotomy e.g. palmar annular ligament
why might an emergency arthroscopy/tenoscopy be performed?
synovial sepsis
intra-articular fracture repair
what emergency orthopaedic surgeries may be performed?
arthroscopy/tenoscopy
fracture repair
+/- sequestrum removal
what technique is used to treat osteochondritis dissecans?
elective arthroscopy
what is OCD?
osteochondritis dissecans
developments defects in cartilage and bone - results in chip fragments in the joint
what is the aim of arthroscopy for OCD?
stop further degeneration to the joint
what is synovial sepsis?
bacterial infection leading to septic arthritis
what is the treatment for synovial sepsis?
arthroscopy for extensive flushing of the joint
systemic abs
what is a sequestrum?
a ‘foreign body’ of necrotic bone which detaches due to trauma resulting in damage to the periosteum
why does a sequestrum require removal?
it is seen as a ‘foreign body’ - often infected
what signs might indicate presence of a sequestrum?
non-healing wounds and draining tracts
how is sequestrum treated?
removal of sequestrum and any active involucrum (bed of bone surrounding the region)
which horses are typically affected by angular limb deformities?
foals
which direction can angular limb deformities occur?
laterally or medially
why might angular limb deformities develop?
different factors - nutrition, incomplete ossification, tendon/ligament laxity
what surgical techniques are performed for angular limb deformities?
growth arresting techniques e.g. transphyseal screw, plating
growth accelerating techniques e.g. periosteal transection
what are the difficulties with post-op management of angular limb deformities?
issues surrounding age - not used to be stabled, handling etc.
what are the difficulties with performing fracture repairs in horses?
size - stress on repair
athletes - repair requires great strength
recovery from GA - flight animals
Lack of tissue on distal limb - potential contamination
cost - up to £6000
how do elective orthopaedic equine patients typically present?
should be otherwise healthy
likely going to be weight bearing on all 4 limbs
what might happen to the elective orthopaedic patient on presentation for surgery?
check vaccination status
may require additional imaging prior - radiographs, U/S
patient prep - pre-op exam, IV catheter, clip site while conscious if tolerant
how should we manage arrival of the emergency orthopaedic patient?
clinical exam - esp CVS stability, treat injury like fracture
sedation?
IV catheter placement
wound care
what sedation agents might be used to emergency patients on presentation?
a2 agonist (e.g. detomidine/ranitidine) and butorphanol
what equipment should prepared for wound care on an emergency patient?
clippers
clorhexidine, swabs
warm water
sterile isotonic fluids
needles/syringes
what medication might be required for an emergency orthopaedic patient?
antimicrobials
tetanus antitoxin
analgesia
check whether any of these have been given prior to referral
what imaging might be required prior to emergency orthopaedic surgery?
radiographs
u/s (musculoskeletal probe - linear)
what are the goals of fracture stabilisation?
stabilise the fracture
reduce discomfort and distress
minimise further trauma to bone ends, soft tissues and vasculature
prevent further contamination
why should care be taken when padding a splint bandage?
padding should be layered but too much padding allows movement of bone fragments or slippage of the splint
can stabilisation damage the limb further?
good stabilisation should not inflict additional damage to the limb
which part of the limb may be splinted?
distal parts - not proximally
why are the distal limbs splinted?
to prevent knuckling
what is a Kimsey splint?
purpose-built distal limb splint
what might a Kimsey splint be used for?
pastern and metacarpal fractures in racehorses
how is a robert jones bandage applied?
many layers of cotton, each held in place and tightened by elastic gauze
each layer is applied more tightly than the previous one
what should a robert jones bandage sound like when flicked?
a watermelon
what is the nurse’s role during ortho surgery?
scrub nurse - run table/anticipate next step during procedure
circulating
what are the general requirements for preparation of theatre for an ortho case?
clippers
antibacterial preparations
fluids
medications
urinary catheter
shoe removal?
anaesthetic machine, circuit etc.
what is the process of patient prep for ortho surgeries?
remove shoes?
cover feet and tail
clip hair - preferable outside operating theatre
two scrubs - first to clean and second to disinfect
how wide should the surgical clip be for ortho procedures?
10-15cm away from surgical site
what is the advantage of chlorhexidine usage?
good residual activity - binds to protein in skin
low toxicity
why shouldn’t chlorhexidine be used on mucous membranes?
can be toxic for fibroblasts
why are iodine compounds rarely used for ortho surgery prep?
stains, radiopaque, smells
only free iodine is bactericidal
how should povidone iodine be prepared for skin prep?
no free iodine unless diluted or combined with detergent
what is the advantage of using povidone iodine for surgical skin prep?
low toxicity
what is the disadvantage of using povidone iodine for surgical skin prep?
it is inactivated in the presence of organic debris
what can be used to improve the efficacy of povidone iodine?
synergistic effect with alcohol
why shouldn’t alcohol be used alone for surgical skin prep?
only effective against bacteria
inactivated by organic debris
no residual activity
what are the specific theatre considerations for ortho surgery?
patient position
instruments required
imaging equipment - radiography PPE, arthroscopy tower
post-op bandagin/casting materials
why do horses require lots of cushioning/padding during surgery?
prone to myopathies and neuropathies
what are the surgeon considerations in terms of patient positioning for ortho surgery?
comfort
accessibility of the surgical site
number of surgical sites - some conditions occur bilaterally
how can we aid the comfort of the surgeon/patient during ortho surgery?
support stands, ropes, padding, cushions, fluid bags
what are the recovery options for the patient post-surgery?
unassisted
rope recovery
sling recovery
pool recovery
what are risks with pool recovery?
infection risk
pulmonary oedema
what are the general considerations for post-op care after ortho surgery?
analgesia and antimicrobials
monitor parameters - TRP WNL
reasonable faecal output/consistency
reasonable appetite
IV catheter required/removed?
bandage care
why should we monitor pain levels closely post ortho op?
consider whether the pain is appropriate for the surgery performed - indicative of possible complications
why is it important to monitor faecal output after ortho surgery?
impactions common - especially if gone from pasture to stable/box rest
why should care be taken if leaving an IV catheter in post-op?
care if hay nets/bars - good table management important
what is involved in post-op care for synovial sepsis?
antimicrobials
repeated synoviocentesis
wound management
what types of antimicrobials might be given for synovial sepsis?
systemic
intrasynovial
intravenous regional perfusion (IVRP)
how is intravenous regional perfusion antimicrobial therapy performed?
tourniquet is placed proximally and high dose abs are injected distally
why might repeated synoviocentesis be performed after synovial sepsis?
monitoring WBC, TP, serum amyloid A
checking whether a second lavage is required
what are some post-op complications of orthopaedic surgery?
post-op infections
incision breakdown
unacceptable post-op pain
bandage sores
supporting limb laminitis
large intestinal impaction
how the risk of supporting limb laminitis be reduced after ortho surgery?
frog support, deep bedding, rubber matting in stable
what makes bandage complications more likely to occur?
horse sweating/hot
horse moving around a lot
poor application
incorrect tension
why is it important to monitor regularly for bandage complications?
severe lesions can develop in quite a short period of time
how can we monitor for cast complications?
twice daily
sudden or gradual changes in comfort
fever
discharge or staining
wear on sole
cast breakage
heat
flies sitting in one spot in summer
bad smell
what are the possible complications of fracture fixation?
post-op infection
breakage of implants/implant failure
further fracture of limb
why should post-op infection be avoided after ortho surgery?
causes unstable fixation
results in pain and reduced healing
what equipment is required for fracture fixation?
general kit and drapes
drill
plates and screws
bone reduction forceps
fracture kit (4.5 and 5.5)
plate bender
what additional instruments might be required for ortho/fracture fixation?
mathieu retractor
hohmann retractor
gelpi retractor
Weitlaner retractor
bruns curette
ferris smith rongeurs
what equipment is required for arthroscopy?
camera and screen
synovial resector
fluid line and pump
trocars and cannula
scope and light cable
how long does stage 1 of foaling last?
30-60mins
what happens during stage 1 of foaling?
cervix relaxation and uterine contractions
ends with water breaking (rupture of chorioallantois)
how long does stage 2 of foaling last?
5-30 mins
what happens during stage 2 of foaling?
delivery of foal
if this is delayed, needs assistance
how long does stage 3 of foaling last?
2-3hours
what occurs during stage 3 of foaling?
placenta expelled
if this is delayed, needs assistance
how long should it take a foal to stand after birth?
within 1 hour
how long should it take a foal to suckle after birth?
within 2 hours - may take some time to find udder
how long should it take for a foal to pass meconium after birth?
should pass within 3 hours
how long should it take for a foal to pass urine after birth?
8-12 hours - colts tend to be on faster side
how do foals sleep?
lying down, legs extended
what is indicated by a foal sleeping curled up?
indication that something might not be right
what should the resting heart rate of a foal be post-partum?
50-80bpm
what may be heard on auscultation of a foal immediately post-partum?
audible crackles - this is normal
what other respiratory signs might a foal have immediately post-partum?
mild nasal discharge - not concerning as long as starting to become more normal by 2-3 hours post-birth
what is the normal heart rate of a foal up to 7 days old?
HR 80-100bpm
what is the normal resp rate of a foal up to 7 days old?
30-40brpm
what is the normal temperature of a foal up to 7 days old?
37.5-39.5 C
what is the normal mm colour of a foal up to 7 days old?
pink and moist
what is the normal blood pressure of a foal up to 7 days old?
> 70mmHg MAP
how much colostrum do foals require?
about 1L in the first 12 hours
how much milk do foals require per day?
will drink 20-30% bodyweight in milk/day
how many calories do foals require?
100-160 kcal/kg/day
why is colostrum important for foals?
contains antibodies from the mare’s blood, which are absorbed by the foals gut in the first 12-24 hours of life (passive transfer)
what can go wrong with the foal during development/birth?
trauma during birth - rib fractures
congenital abnormalities
acquired abnormalities e.g. patient urachus
failure of passive transfer
what congenital abnormalities might develop in foals?
cleft palate
microphthalmia
limb deformities
what is the main sign of a cleft palate?
milk at nostrils when suckling
why does failure of passive transfer occur?
foal unable to drink enough
or
due to quality/quantity of mare colostrum
why does sepsis usually occur in foals?
failure of passive transfer
or
local infection which has spread systemically
what is sepsis?
inflammatory response to systemic bacterial infection
what are the clinical signs of sepsis?
pyrexia
petechiae
injected mms
dull/flat/unresponsive
recumbency
what other clinical signs may occur in foals due to sepsis?
uveitis
synovial sepsis (lameness/swollen joints)
diarrhoea
pneumonia
umbilical infection
what is one of the major parameters indicating sepsis in foals?
hypotension
how does neonatal isoerythrolysis occur?
mare produces antibodies against the foals RBCS - foal absorbs the colostrum and the foals RBCs are broken down by these antibodies
why does neonatal isoerythrolysis occur?
mare has antibodies because she has come into contact with the blood cells before - commonly happens due to previous foal with same sire
what are the signs of neonatal isoerythrolysis?
anaemia, icterus, weakness
how is neonatal isoerythrolysis treated?
cannot be treated directly - may require blood transfusion and supportive care until can generate own blood cells
what are the other names for neonatal maladujstment syndrome?
hypoxaemic ischaemic encephalopathy
perinatal asphyxia syndrome
dummy foal
what is the clinical presentation of neonatal maladujstment syndrome?
very variable -
poor suck relfex
failure to nurse - hyperaesthesia - obtundation/coma
neurological signs
when might signs of neonatal maladujstment syndrome appear?
may be abnormal from birth or may ‘crash’ at 24-48 hours
what technique may help with neonatal maladujstment syndrome?
‘foal squeeze’ - pressure on thoracic cavity - helps in around 20% of cases but unsure why
what is the cause of neonatal maladujstment syndrome?
cause unknown
when is a foal considered premature?
<320 days gestation
when is a foal considered dysmature?
normal gestation duration but appear premature
what is the appearance of a dysmature foal?
silky coat, floppy ears, domed head
what other physical signs do dysmature foals have?
other organs may be immature as well as the musculoskeletal system
incomplete ossification of cuboidal bones
how can dysmaturity be diagnosed?
x-ray carpal/tarsal joints - last to mature in utero, joints will be abnormal for rest of life if born underdeveloped
why might a foal have a ruptured bladder?
trauma within birthing canal
physical manipulation by humans around the abdomen
when do clinical signs of a ruptured bladder begin to present?
at a few days old
what are the clinical signs of a ruptured bladder?
colic
abdominal distension
why is a ruptured bladder life-threatening?
due to electrolyte abnormalities, especially hyperkalaemia
increased potassium, low sodium, low chloride
how can we avoid inducing bladder rupture in foals?
never lift/move a foal from their abdomen - use stifles/forelimbs
what are the clinical signs of meconium impaction?
straining to defecate
mild colic
how can we reduce risk of meconium impaction?
phosphate enemas
is meconium impaction an emergency?
not usually an emergency, but may get referred for IVFT/management
what are the roles of the NICU nurse?
patient care - responsible for all foals needs, don’t forget mare!
staying organised
keep foal unit clean and stocked
communication
what are the general nursing care considerations for NICU foals?
maintain sternal recumbency - prone to atelectasis
assist to stand every 2 hours
weigh foal daily (unless recumbent)
careful examination - attention to detail important
why should the NICU foal be turned every 2 hours?
important to prevent decubitus ulcers developing
what should be involved in a NICU examination?
demeanour compared to last check
all systems - nose to tail approach
treatments - infusions, oxygen
nutrition
urine/faecal output
how often should we examine a sick foal?
minimum every 4 hours, more often is very unwell/declining
why/where should we check the mucous membranes in NICU foals?
good indicator of systemic health
check multiple locations - buccal muscosa, conjunctiva, ear pinnae, coronary bands
what are the normal cardiac parameters for NICU foals?
normal HR = 80-100bpm
strong pulses
warm extremities
why are sick foals reliant on a stable heart rate?
they cannot increase their stroke volume
(HR = CO x SV)
why do sick foals have poor heart rate compensation?
due to immature sympathetic nervous system
why do sick foals develop murmurs?
due to adaptation of foetal circulation to life ex-utero - should go by 4 days old
what if a murmur does not disappear in a foal by 4 days old?
suspect congenital defect or endocarditis due to septic process
how do we monitor function of the respiratory system in sick foals?
rate (30-40brpm) and rhythm, effort
louder bronchial sounds than adult
no wheezes/dullness/crackles after first few hours of life
nasal discharge?
rib fractures?
what else can we monitor in sick foals which goods a good indication of respiration?
blood gas analysis - oxygenation
why should we monitor the eyes in sick foals?
good indicator of systemic state
how do the eyes show dehydration?
sunken, entropion
how do the eyes show sepsis?
injected
hypopyon (fibrin and pus accumulation within anterior chamber of eye)
uveitis
how do the eyes show trauma?
injected
swollen eyelids
why are sick foals prone to developing corneal ulcers?
foals have reduced corneal sensitivity - ulcer formation may be less obvious
what flexural deformities might develop in sick foals?
flexor/tendon laxity
contracture
why might sick foals show signs of colic?
meconium impaction
ileus - will not tolerate enteral nutrition
why might foals develop diarrhoea?
often secondary to sepsis if very young
can acquire infection diarrhoea
what can be used to care for the umbilicus in young foals?
0.5% hibitane
how often should umbilicus care be carried out?
twice daily hibitane dip if otherwise WNL
QID if patent urachus
how can we provide support for the mare after birth?
TPR twice daily
check mares perineum
ensure adequate milk
encourage mare-foal bond
check placenta has been passed
why are over-the-wire IV catheters preferred in horses?
less thrombogenic - polyurethane
what is the disadvantage of over-the-wire IV catheters?
technically more difficult to place, requires 3 people
what should be considered for catheter maintenance in horses?
check patency and vein integrity every 4 hours
care when administering drugs - sedimentation
extra vigilance when on parenteral nutrition
how can we avoid drug sedimentation in IV catheters?
flush drug through adequately after administration of the next
can venous samples be taken from an over-the-wire catheter?
yes
which test can test for failure of passive transfer?
IgG SNAP test
what are the appropriate IgG levels in a foal?
> 8.0g/L
what can be done if the foal is <24hrs old with low IgG levels?
can supplement with colostrum via NG tube
what can be done if the foal is >24hrs old with low IgG levels?
indicates failure of passive transfer - requires plasma transfusion
where should an arterial blood gas sample be taken from?
lateral metatarsal artery
what are the normal PaO2 values in a horse?
80-110 mmHg
what are the normal PaCO2 values in a horse?
40-48mmHg
how can recumbency affect blood gas?
lateral recumbency can reduce PaO2 by up to 30mmHg
why might we obtain a venous blood gas sample?
to assess electrolytes
why should we monitor glucose in sick foals?
hypoglycaemia common
likely have poor glycogen/fat reserves
how can we combat hypoglycaemia in foals?
fluids supplemented with dextrose - monitor closely to ensure not too much
why do we monitor lactate in foals?
good measurement of tissue perfusion
what are normal lactate levels in foals?
<3-4mmol/L in neonates
<2mmol/L by 3 days old
why might a foal have increased lactate levels?
insufficient oxygen supply to tissues - could be hypovolaemia, hypoxaemia, sepsis
what does an increased lactate level mean for a sick foal?
worse prognosis
what fluids should be used for fluid resuscitation in foals?
Hartmanns solution (warm)
what solution can be used for ongoing fluid therapy in a sick foal?
Hartmanns + 5% dextrose
what rate should be used for ongoing fluid therapy for foals?
3-5ml/kg/hr
what else do we need to consider with fluid therapy in foals?
foals cannot tolerate high sodium concentrations in fluids - risk of subcut oedema
need to supplement potassium if not nursing
where is a good place to take a NIBP measurement on a foal?
tail cuff
how should you take an NIBP measurement on a foal?
tail cuff - ensure correct way round, try not to stimulate foal during placement
take an average of 3 readings
what value is considered hypotension in the foal?
MAP <70mmHg
how does sepsis cause hypotension?
suppresses myocardial contractility (reduced stroke volume)
inappropriate widespread vasodilation
can hypotension caused by sepsis be treated with fluid therapy?
no - reduced cardiac contractility means the heart will not efficiently pump it round the body
what medications can be used to treat hypotension caused by sepsis?
inotropes - increase force of cardiac contractions
vasopressors - constrict blood vessels
what should the urine output of a foal be?
> 50-70% of fluid input OR >2ml/kg/hr
how concentrated should foal urine be?
initially hypersthenuric, then quickly becomes hyposthenuric
USG <1.008
how is intranasal oxygen given to the foal?
tubing inserted into nostril up to level of medial canthus of eye
taped to tongue depressor and run along the face
tubing runs through hole in neck wrap before connecting to oxygen
how is intranasal oxygen made less cold/drying?
run through a humidifier filled with sterile water
what flow rate should intranasal oxygen be started at?
5L/min then adjust accordingly
what is involved in management of intranasal oxygen administration?
clean tubes daily and change at EOD
what are the possible complications of intranasal oxygen administration?
nasal irritation
rhinitis
airway drying
what is the advantage of nebulisation?
aids secretion removal
how can nebulisation be made more effective?
manual coupage of the chest
what can be administered via nebulisation?
sterile saline
bronchodilators
abs
are foals commonly ventilated?
no, if requiring ventilation, foal is likely very sick and very unlikely to make it past that point
what can result from prolonged seizure activity?
increased cerebral oxygen demand and neurone damage
what is first line treatment/management of seizures?
5mg diazepam IV - can be repeated
what can be done if seizure activity continues despite diazepam?
midazolam CRI
phenobarbital
levetiracetam
how much nutrition do sick foals require?
approx 10ml/kg every 2 hours
how can nutrition be delivered to a sick foal?
do not bottle feed - aspiration risk
NG tube - if healthy enough to receive enteral nutrition
TPN - short-term prevention of negative energy balance
how often can a phosphate enema be giveN/
max twice in 24 hours
what different types of enema are available for foals?
phosphate enema (fleet)
soapy water (200ml)
acetylcysteine retention enema
how does an acetylcysteine retention enema work?
dissolves the meconium
usually requires sedation
what are the most common emergency surgeries (non-ortho)?
colic
dystocia
trauma
what is colic?
a broad term for abdominal discomfort in horses
what body systems are involved in colic?
GI tract
urinary tract
reproductiv organs
liver
how can we identify the body systems causing symptoms of colic?
performing a colic work-up
what history should be obtained from the owner when performing a colic work-up?
how long was it been colicking for?
severity of signs shown so far
when were faeces last passed
breed/age/sex
previous occurrences of colic
any management changes e.g. stabling/turnout, worming, geographical region
what information should be obtained from the referring vet during a colic work-up?
TPR on initial examination/subsequent exams
clinical findings so far (inc rectal/NGT findings)
any medications administered
suspected lesion based on exam
whether or not surgery is an option for the owner/insurance info
what equipment is needed for a colic assessment?
drugs
clippers and sterile prep solution
catheter
blood tubes
lactate reader
NG tube
rectal gloves and lubricant
fluids (isotonic and hypertonic)
u/s machine
what drug should be prepared for a colic assessment?
sedation (xylazine/detomidine/butorphanol)
NSAIDS (flunixin)
buscopan/buscopan compositum
where is a colic workup usually done?
usually in stocks for restraint
sometimes unsafe to do so will move to knockdown box
what is involved in the physical examination during a colic work-up?
demeanour, signs of pain, abrasions
TPR
GI borborygmi
CVS status (mm, pulses)
abdominal distension
rectal exam - may req sedation + buscopan
how is buscopan useful during a rectal examination?
relaxes the anal sphincter
when might we pass a NG tube during a colic work-up?
for gastric decompression - if high HR or significant pain
what is indicated by the presence of reflux on NG intubation?
small intestinal obstruction
how much reflux provides an indication that surgery may be required?
> 2L
what bloods are useful during a colic work-up?
minimum database for colic
PCV, TP, lactate
what imaging is useful during a colic work-up?
abdo u/s - FAST scan
abdominocentesis (aseptic prep) - TNCC, TP, lactate
what can we check for during abdo u/s for colic work-up?
colon displacement
free fluid/oedema
what is the aim of the initial colic work-up?
determine whether the case is surgical or medical
what findings of the clinical exam indicate colic surgery?
congested mms, CRT >3s, HR >60-80bpm, poor pulse quality
uncontrollable pain
what findings of the rectal exam indicate colic surgery?
distension or displacement of the small or large intestine
what findings of the abdo u/s indicate colic surgery?
amotile, distended loops of small intestine
what biochemistry findings indicate colic surgery?
high lactate in blood or peritoneal fluid
what are the considerations for moving a colic horse to surgery?
ensure IVC present and patent
ensure stomach has been decompressed
begin clipping abdomen (if safe)
remove shoes (if safe)
how big should the clip for colic surgery be?
20cm either side of the midline, over the whole ventral abdomen
how should the theatre itself be prepared for colic surgery?
theatre bed - ready to receive horse in dorsal
anaesthetic machine and circuit
hoist - ready and working by knockdown
what equipment should be prepared for colic surgery?
hose, clippers and surgical scrub
urinary catheter
warmed fluids
surgical kit x2
fresh gloves + gowns in case of contamination/enterotomy/resection
drapes (lots)
colon table and dump drum
carboxymethylcellulose
what is a colon table/dump drum?
extra table attached to main table, dump drum to collect intestinal contents
what is involved in colic surgery?
ventral midline incision (>20cm long)
all GUT is assessed for distension, thickening, viability, displacement
any non-viable intestine must be resected and anastomosed
what equipment is required for intestinal resection?
buster drapes
doyen clamps (atraumatic)
suture material
fluids for lavage
what happens to large intestinal displacements?
no dot require resection/anastomosis
why do the contents of the pelvic flexure need to be removed before fixing lesions?
due to the weight of the contents
how are the content of the pelvic flexure removed?
via enterotomy - colon table should be tilted down so contents run into the dump drum/away from the surgical field
what 3 layers of the abdomen must be closed after colic surgery?
linea alba
subcut tissue
skin
what suture materials should be used to closed the abdomen after colic surgery?
linea alba - vicryl 0 or 2
subcut tissues - usually PDS
skin - usually PDS (occasionally staples)
what dressing materials can be used for the wound after colic surgery?
melolin
lap bandage as stent
adhesive spray
why should surgeons avoid placing staples after colic surgery?
some poor person will have to remove them from a horse
what should happen in the immediate post-op/recovery phase after colic surgery?
remove urinary catheter
bandage feet if shoes still on (to avoid trauma)
towel dry as much as possible (will be saturated due to scrub/lavage during surgery
belly bandage once standing
what should be involved in post-op care for all colic cases?
IVFT +/- lidocaine CRI
analgesia
antimicrobials
incision care
what analgesia will likely be given post-op after colic surgery?
NSAIDs despite GI risk - opioids are generally avoided because horse are already such a high risk for ileus
when should refeeding begin after large intestinal displacements?
can gradually refeed once awake and alert
when should refeeding begin after small intestinal resections/anastomosis?
no food for 48 hours usually - must weigh up incision breakdown vs ileus
what should refeeding start with after colic surgery?
small amounts of fibre nuts +/- handfuls of grass
what are some of the possible post -op complications after colic surgery?
endotoxaemia
ileus
colitis
jugular thrombophlebitis
peritonitis
incisional infection
what is endotoxaemia?
endotoxins leaked into blood from gut
how can endotoxaemia be treated?
IVFT
flunixin +/- polymixin B +/- hyperimmune plasma
what can develop as a result of endotoxaemia? how can we prevent it?
laminitis - ice boots pre-emptively, deep bed, frog supports
how can we treat ileus as a result of colic surgery?
NG intubation regularly - decompression
IVFT
nil by mouth
pro-motility drugs - lidocaine, erythromycin, metoclopramide
monitor by u/s
what are the main signs of colitis after colic surgery?
usually become pyrexic and develop marked diarrhoea
how can colitis be treated?
IVFT
isolation? (will shed salmonella)
gastroprotectants e.g. misoprostol, sucralfate
how can jugular thrombophlebitis be treated?
remove catheter
local anti-inflammatory treatment
consider anti-thrombolytics
how can peritonitis be diagnosed?
abdominocentesis
how can peritonitis be treated?
broad spectrum antimicrobials
what type of incisional complications can occur after colic surgery?
infection
often develop marked oedema/cellulitis
how can incisional infection be treated?
antimicrobials if horse is systemically unwell
swab for culture and sensitivity before encouraging drainage
how often should a patient be monitored post-colic surgery?
complete clinical exam every 2-4 hours
what should be involved in post-op monitoring after colic surgery?
demeanour
GIR borborygmi, faecal output/consistency, appetite
jugular vein (heat/swelling/pain/patency)
feet (comfort and digital pulses)
incision (oedema, discharge)
ensure geldings are not urinating on belly bandage
what fluid rate should a horse be on after colic surgery?
maintenance - 50ml/kg/hour
assess dehydration and ongoing losses e.g. reflux
what should long-term aftercare/management look like after colic surgery?
gradual refeeding and reduction of analgesia
box rest 4-6 weeks, walks to grass
paddock rest 1 month
turn out 1 month
then gradual return to previous work
how does time affect foal mortality during birth?
rate increases by 16% for every 10 mins > 30 mins
what is a red bag delivery?
premature separation of the placenta
what usually appears first at the vulva during foaling?
amnion - silvery white appearance
what appears at the vulva during a red bag delivery?
chorioallantois - deep red colour
what should happen if a red bag delivery is noticed?
chorioallantois must be ruptured immediately and assisted delivery of the foal should be performed
what is the main reason for dystocia during foaling?
usually foal malposition
occasionally due to foal abnormalities e.g. limb deformities
what is the key history that should be obtained for dystocia during foaling?
signalment
time of onset of stage II
gestation days
assistance attempted?
pertinent medical treatments and history
what should we prepare if there is a dystocia case arriving?
preparation of knockdown box - warm water, lube, foal ropes, hoist
preparation for induction - anaesthetist present
preparation of theatre - dorsal recumbency
prep for where foal will be resuscitated
what are the options for dystocia if a vaginal delivery is not possible?
c-section if foal is alive
foetotomy if foal is dead
what are the options for dystocia if a vaginal delivery might be possible?
assisted birth if possible
controlled if assisted not productive after 5-15 mins - clip and prep abdomen in case needs c-section
what is involved in equine caesarean?
ventral midline incision
uterine horn located and exteriorised
hysterotomy incision (35-40cm) - allow for feet and hocks
umbilical cord clamped and transected
foal lifted out and transferred to separate team
how many nurses should be involved in care of the mare during c-section?
2 people scrubbed in
one circulating
one anaesthetist
how many nurses should be involved in care of the foal after c-section?
2 min people to resuscitate foal
will likely need oxygen supplementations, IVC placement, umbilicus management
how should the mar be recovered after c-section?
assisted whenever possible - increased risk of limb fractures, likely exhausted due to delivery attempts prior to c-section
what is the survival rate of controlled vaginal delivery?
87-94%
what are the survival rates of the foal and mare with c-section?
mare - 87-89%
foal 10-30%
what are the specific post-op care considerations after c-section?
similar to colic
check for normal passing of placenta
uterine lavage
regular examination of mammary glands/teats
what if the placenta is retained?
oxytocin every hour
how is uterine lavage performed?
SID/BID?
5-10 litres isotonic fluid
why must the mammary glands/teats be examined regularly?
check for development of toxic mastitis
what are some of the complications of dystocia?
reproductie tract trauma - perineal lacerations, uterine rupture
retained placenta
delayed uterine involution
metritis and peritonitis
uterine/bladder prolapse
arterial haemorrhage (uterine artery)
