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Module 14 > Equine Emergencies: Recognition & Basic Steps > Flashcards

Equine Emergencies: Recognition & Basic Steps Flashcards

1
Q

what is the definition of emergency

A

a serious unexpected and often dangerous situation requiring immediate action

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2
Q

what are the body systems that can include emergencies

A
  1. alimentary and liver
  2. respiratory
  3. cardiovascular, spleen, blood
  4. nervous system
  5. special senses
  6. urinary system
  7. musculoskeletal
  8. integumentary
  9. reproductive
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3
Q

what are emergencies in the alimentary and liver

A

colic (1 in 10), abdominal trauma (eventration)

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4
Q

what are urgent incidents in the alimentary and liver (4)

A
  1. choke (esophageal obstruction)
  2. colic (potentially)
  3. poisons/toxins
  4. concentrate overload
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5
Q

what are respiratory emergencies (2)

A
  1. dyspnea (obstruction)
  2. thoracic trauma (open thorax)
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6
Q

what are cardiovascular, spleen and blood emergencies (3)

A
  1. severe hemorrhage
  2. wound
  3. guttoral pouch mycosis
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7
Q

what are nervous system emergencies

A
  1. trauma/fracture of cranium or spinal
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8
Q

what are urgencies in the nervous system (3)

A
  1. tetanus
  2. pharyngeal paralysis
  3. vestibular syndromes
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9
Q

what are special senses emergencies

A
  1. corneal laceration
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10
Q

what are special senses urgencies

A
  1. closed eye
  2. uveitis
  3. corneal ulceration
  4. eyelid laceration
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11
Q

what are urinary system urgencies (2)

A
  1. obstruction to urine outflow
  2. trauma to penis
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12
Q

what are musculoskeletal emergencies (4)

A
  1. fractures
  2. some tendon and ligament injuries
  3. wounds (laceration or puncture)
  4. atypical myopathy
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13
Q

what are musculoskeletal urgencies (5)

A
  1. wounds (laceration or penetration)
  2. synovial contamination
  3. foot penetration
  4. myopathy
  5. laminitis
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14
Q

what are integumentary urgencies (2)

A
  1. wounds
  2. burns
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15
Q

what are reproductive emergencies (2)

A
  1. dystocia
  2. red bag delivery
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16
Q

what are reproductive urgencies (2)

A
  1. retained placenta
  2. foal not sucking
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17
Q

how can you prepare for an emergency

A
  1. support: have all the phone numbers (colleagues/team, info/contacts)
  2. facilities: in house, referral options, transport contacts, disposal options
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18
Q

what equipment should be prepared for an emergency (4)

A
  1. restraint
  2. drugs: sedation, anesthesia, analgesia
  3. equipment: stomach tubes, funnel, rectal gloves, lube, clippers, flash light, scrub, bandages, suture, surgical kit, splints, IV fluids, catheters, sterile gloves, farrier and dental equipment
  4. euthanasia: somulose
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19
Q

how do you triage and prioritize emergencies

A

on the phone

  1. history & signalment
  2. guidance while they wait
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20
Q

what guidance could you give an owner while they wait for a vet

A
  1. remove all food from a choke/colic
  2. don’t remove if nail in foot
  3. bleeding wound apply pressure and don’t remove
  4. red bag delivery –> talk through won’t make it in time
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21
Q

what questions should you ask to triage at the scene (4)

A
  1. is this really an emergency?
  2. are there humans at risk?
  3. clinical exam - patent airway? vital parameters TPR, hemorrhage?
  4. prioritize one animal over another?
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22
Q

what are the ABCD

A

A: establish an airway

B: breathing for patient

C: circulation (chest compressions, right lateral recumbency –> knees in adults and hands in foals)

D: drugs

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23
Q

what can cause upper airway obstruction (3)

A
  1. severe trauma/swelling/edema of head/nasal passages
  2. pharyngeal obstruction (severe strangles, Streptococcus equi)
  3. severe laryngeal obstruciton: laryngeal swelling/edema, bilateral laryngeal paralysis (traumatic, hepatic encephalopathy, primary neurological, idiopathic)
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24
Q

how do you treat upper resp obstruction

A

bypass the upper resp tract –> emergency tracheostomy

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25
Q

how is an emergency tracheostomy performed (4)

A
  1. usually upper third trachea: 3rd-5th tracheal ring
  2. midline verticle incision: divide muscles (sternothyrohyoideus) overlying trachea
  3. stab incision through annular ligament between two rings: extend either side big enough to allow placement of tracheostomy tube
  4. secure to neck
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26
Q

what is the circulating blood volume of a horse

A

7-8% of body weight

500kg = 35-40 litres

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27
Q

what volume of blood can horses lose before they decompensate

A

~30%

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28
Q

what are the clinical signs of hemorrhage

A
  1. increased resp rate
  2. pale mucous membranes
  3. high heart rate
  4. poor perfusion
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29
Q

what are external causes of hemorrhage

A
  1. wound
  2. guttural pouch mycosis
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30
Q

what are internal causes of hemorrhage

A

abdominal/thoracic: broad ligament hematoma in mares post-parturition

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31
Q

what are the clinical signs of significant blood loss (3)

A
  1. tachycardia
  2. tachypnea & hyperpnea indicative of significant hypovolemia and hypoexmia
  3. mucous membrane colour depends on severity of loss (pale/white)
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32
Q

what should be included in your clinical exam (6)

A
  1. is the animal viable?
  2. respiratory, CV, musculoskeletal (evidence of poor peripheral perfusion, dehydration, sepsis, endotoxemia), organ systems
  3. shock, exhaustion, trauma
  4. injuries that are immediately life threatening (open body cavity)
  5. what injuries will be exacerbated by moving/rescue/extraction (stabilization)
  6. history
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33
Q

what are the reasons for sedation

A
  1. human safety
  2. animal safety
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34
Q

when would chemical sedation be used

A

any procedure: assess risks - how can they be mitigated? (environment or handler? other restraint? PPE?)

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35
Q

before you sedate what should you do first

A
  1. clinical exam: focus on CV system due to side effects
  2. quite environment: avoid excitement, minimize stimulation
  3. choice of sedation and dose and route
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36
Q

what factors determine what sedation should be used

A
  1. age, breed and temperament
  2. clinical findings
  3. procedure to be performed (duration, expected pain level)
  4. previous sedation history
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37
Q

what is the duty of care when administering sedation

A

to horse, owner, farrier even for sedate to clip

horse is still dangerous

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38
Q

how are alpha-2 adrenoreceptor agonists as sedatives

A

reliable, dose-dependent

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39
Q

what are alpha-2 adrenoreceptor agonists usually combined with and why

A

opioid to decrease the likelihood of being kicked but doesn’t eliminate it

ex. butorphanol

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40
Q

do alpha-2 agonists provide analgesia

A

yes

visceral (for colic) and somatic

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41
Q

do alpha-2 adrenoreceptor agonists cause muscle relaxation

A

yes

may assist in treatment of choke

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42
Q

what else are alpha-2 adrenoreceptor agonists used for

A

anesthesia as pre-medication

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43
Q

what are licensed alpha-2 agonists in the UK

A
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44
Q

how long does xylazine IV last

A

20-30 mins

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45
Q

how long is the onset of action of xylazine IM

A

15-20 min

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46
Q

what are the disadvantages of xylazine

A

not as reliable, shorter duration and more expensive

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47
Q

what is xylazine useful for

A

assessment of fractious colic on its own

permits exam and allows reassessment of pain at end of this time, allows full assessment before use longer acting analgesia

obtain heart rate before administer

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48
Q

what is the duration of detomidine

A

45-60 mins IV

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49
Q

what routes can detomidine be used

A

IV

IM (30 min onset)

oral transmucosal gel

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50
Q

when is detomidine used

A

routine work

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51
Q

what is detomidine combined with typically

A

butorphanol

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52
Q

how does detomidine compare with romifidine (4)

A
  1. romifidine with butorphanol “plants” feet to ground better
  2. greater muscle relaxation: greater instability and ataxia
  3. greater sedation at lower dose range
  4. greater analgesia
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53
Q

can detomidine be used with colic

A

use with care, usually on its own

potent analgesic (10x xylazine) with longer duration

reserve for horses with severe, unrelenting pain (can mask escalating pain)

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54
Q

what is the duration of romifidine

A

60-120 mins IV

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55
Q

when is romifidine used

A

routine work in combo with butorphanol

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56
Q

can romifidine be used for colic

A

yes but not particularly useful

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57
Q

what is the route of choice for alpha-2 agonists

A

IV

58
Q

what is the onset of action following IV of alpha-2 agonists

A

2-5 mins

allow time to take effect

59
Q

what is the “ceiling effect”

A

further increasing dose increases duration but has no effect on intensity

improve intensity using a combo with opioid

60
Q

what are minor side effects/disadvantages of alpha-2 agonists (5)

A
  1. hyperglycemia
  2. diuresis
  3. sweating
  4. decreases in PCV and total protein
  5. no food until awake - esophageal choke
61
Q

why do alpha 2 agonists cause diuresis

A

not clear why

low renal threshold for glucose and produces glucosuria

alpha 2 receptors on renal tubules antagonize ADH

62
Q

how do alpha 2 agonists cause sweating

A

vasodilation, increased blood supply to skin

63
Q

what are important side effects of alpha 2 agonists (5)

A
  1. bradycardia
  2. arrhythmogenicity
  3. reduce GI motility (and secretions)
  4. upper airway obstructions
  5. care in pyrexic horses –> can induce tachypnea
64
Q

how do alpha 2 agonists cause bradycardia

A

reduce cardiac output and respiratory depressants (care in foals)

interpretation of colics –> heart rate

65
Q

how do alpha 2 agonists reduce GI motility (and secretions)

A

impair assessment of colic

repeated doses or CRI –> can cause colic (large colon impactions)

66
Q

how can alpha 2 agonists cause upper airway obstructions

A

muscle relaxation can exacerbate pre-existing obstructions

impairs endoscopic assessment of upper respiratory tract

67
Q

why do you need to take care in pyrexic horses when giving alpha 2 agonists

A

can induce tachypnea and can be antipyretic

68
Q

what can be used to reverse a2 agonists

A

a2 antagonist –> atipamezole

69
Q

what opiods can be used for sedation

A

butorphanol is licensed for use in horses

70
Q

when does butorphanol cause sedation

A

in combo with alpha2 agonist

71
Q

what kind of analgesia does butorphanol provide

A

relatively poor, has claim for visceral analgesia

72
Q

what are the side effects of butorphanol (2)

A
  1. reduces SI activity but minimal effect on pelvic flexure
  2. CV and resp depression
73
Q

what are the sedation protocols

A

alpha 2 agonist (sedation & analgesia) + opioids (augments sedation & analgesia)

ex. detomidine and butorphanol

romifidine and butorphanol

common to mix in same syringe

74
Q

what is the dose of sedation dependent on

A

size, age, temperament, procedure and excitement

heavy breeds more easily sedated than a fractious arab

keep stimulation to a minimum

75
Q

what is an example dosage for heavy sedation of standing castration

A
  1. 9ml/100kg romifidine and 0.2ml/100kg butorphanol
  2. 1ml/100kg detomidine and 0.25ml/100kg butorphanol
76
Q

what is an example dosage for mild to moderate sedation of a calm pony for a dental exam

A

total volume: 0.2ml detomidine and 0.3ml butorphanol

total volume: 1ml romifidine and 0.5ml butorphanol

77
Q

what is a top up dose of sedatives

A

typically 1/4 to1/3 of initial dose

78
Q

when would CRI of sedatives be used and how would you do this

A
  1. prolonged procedure

place catheter and add loading dose (detomidine and butorphanol)

ex. add detomidine to 500ml bag 0.9% NaCl and start set rate for 5-10 mins then slow and titrate to effect

79
Q

how would you sedate a difficult horse

A

IM alpha 2 agonist or remote injection using length of tubing

dart gun?

80
Q

what routes of ACP are used

A

IV

IM

oral gel

81
Q

what are the effects of ACP

A

anti-anxiety (sedation but no analgesia)

82
Q

what is the duration of ACP

A

4-6 hours

83
Q

when is ACB used on its own

A

to calm an anxious, but cooperative horse (clipping)

not good enough for invasive procedures/difficult horses

84
Q

what else is ACP used for

A
  1. premedication for anesthesia
  2. difficult horse prior to sedation with alpha 2 agonist and butorphanol
  3. sometimes used in combo with a2 agonist and butorphanol to aid exam of a gelding penis
85
Q

when is ACP contraindicated

A

breeding stallions –> priapism and paraphimosis (rare)

86
Q

what is the approach in assessing wounds

A

anatomy: bone, soft tissues, synovial

87
Q

how do you plan treatment of musculoskeletal injuries

A
  1. functional and cosmetic
  2. management at home
  3. management at your clinic
  4. cost
88
Q

when would musculoskeletal injuries be referred

A

extensive

synovial structure

fracture

89
Q

what are steps to do before musculoskeletal injury referral (6)

A
  1. plan a good referral: once assessed wound talk to referral hospital, first aid and preapre horse for transport
  2. bandage plus/minus splint: stabilization is key
  3. immobilization is essential: for fractures, many wounds, foot injuries, radial paralysis
  4. prophylactic antimicrobials
  5. analgesia
  6. tetanus
90
Q

what are uses for antimicrobials

A
  1. existing infection
  2. prophylactic use or pending the above
91
Q

how do you select which antimicrobial to use (7)

A
  1. does it need it?
  2. what bacteria are likely to be involved?
  3. select drug that will reach effective concentrations at site of interest
  4. pharmacodynamics: mode of action against bacteria - are bacteria of interest susceptible?
  5. pharmacokinetics: dose, route, frequency - maintain effective concentration at site of interest for duration
  6. effective in local environment?
  7. adverse reactions/toxicities? licensed?
92
Q

what are the main options of analgesia used in the horse (7)

A
  1. NSAIDs
  2. alpha 2 adrenoreceptor agonists
  3. opioids
  4. paracetamol
  5. lidocaine infusions
  6. ketamine including infusion
  7. gabapentin
93
Q

what are the classical signs of colic

A
  1. pawing
  2. flank watching
  3. rolling
  4. distressed
  5. increased resp rate
  6. sweating
  7. odd stance
  8. dull demeanour
  9. not eating
94
Q

what is central to colic management

A

analgesia

95
Q

where are most colics located

A

GI tract

96
Q

what types of colic will have an impact on CV and resp systems

A

strangulating obstruction of SI that causes ischemia

97
Q

what are other types of colic (8)

A
  1. urogenital,
  2. liver
  3. spleen
  4. ovulation
  5. uterine torsion
  6. dystocia
  7. broad ligament hematoma
  8. calculi (renal, urethral, cystci, urethral)
98
Q

what other things can look like colic (8)

A
  1. laminitis
  2. peritonitis
  3. myopathy
  4. esophageal disease including primary choke
  5. neurological
  6. pneumonia/pleuropneumonia
  7. cardiovascular
  8. pyrexia of unknown origin
99
Q

what are further diagnostic tests of colic (7)

A
  1. rectal exam
  2. nasogastric intubation
  3. response to analgesia
  4. blood analysis
  5. abdominocentesis
  6. ultrasonography
  7. exploratory laparotomy
100
Q

what are the classifications of colic

A
  1. spasmodic
  2. impactive
  3. flatulent/tympanic
  4. obstructive
  5. non-strangulating infarction
  6. enteritis
  7. idiopathic
101
Q

what are the types of obstructions

A
  1. mechanical
  2. paralytic ileus
102
Q

what are the two types of mechanical obstruction and name some examples of them

A
  1. simple obstruction: intraluminal; mural; extraluminal
  2. strangulating obstruction: internal and external hernias, pedunculated lipomas, intussusception, volvulus, fibrous bands and adhesions, arterial thrombosis
103
Q

what are primary and secondary paralytic ileus

A

primary: gass sickness
secondary: post-operative, anterior enteritis, peritonitis

104
Q

what is a simple large intestinal obstruction (6)

A
  1. congenital abnormalities
  2. impaction
  3. intraluminal concentrations
  4. foreign bodies
  5. displacement of large colon
  6. strictures
105
Q

what are examples of large intestinal strangulating obstruction (4)

A
  1. volvulus
  2. intussusception
  3. pedunculated lipoma (small colon)
  4. vascular disease
106
Q

where is the NG tube placed

A

via ventral meatus

warn the owner it can cause nosebleed

107
Q

what are the diagnostics of NG tube

A

>2 litres reflux –> SI obstruction

OR

tube can’t be placed –> choke

108
Q

how is an NG therapeutic and for treatment

A
  1. short term for SI obstruction to prevent gastric rupture
  2. analgesia - dilated stomach is painful
  3. admin of fluid or medication
109
Q

what analgesics can be administered for colic

A
  1. NSAIDs: phenylbutazone, funixin meglumine, ketoprofen, meloxicam
  2. alpha-2 agonists: xylazine, detomidine (care 10x potency), romifidine (least analgesia)
  3. opioids: butorphanol (relatively poor analgesia, duration ~1.5 hours) or pethidine (rarely used), morphine, buprenorphine (duration ~8-12 hours)
  4. antispasmodics: anticholinergic not true analgesia –> buscopan or buscopan compositum (butylscopolamine and metamizole)
110
Q

how do NSAIDs provide analgesia

A

inhibit COX enzymes preventing prostaglandin synthesis –> peripheral effect, COX 1 and COX 2

111
Q

what are possible adverse effects of NSAIDs

A
  1. nephrotoxicity
  2. right dorsal colitis - more significant morbidity in the horse
  3. gastric ulceration
112
Q

what analgesia does phenylbutazone provide

A

moderate analgesia

113
Q

what is the duration of bute

A

short action ~ 2 hours

114
Q

what is bute not licensed for

A

colic or visceral pain

115
Q

what analgeisa does meloxicam provide

A

moderate similar to phenylbutazone

116
Q

what COX selectivity does meloxicam have

A

COX 2 > COX 1 (selective)

117
Q

what is ketoprofen licensed for

A

alleviation of visceral pain

118
Q

what is the most potent NSAID

A

flunixin meglumine

119
Q

how long does fluniximin meglumine last

A

long duration of 6-8 hours

120
Q

what other effect does flunixin meglumine have

A

ant-endotoxic effect

121
Q

why do you need to take care when administering flunixin meglumine

A

potent analgesic so could mask deterioration in colic

122
Q

when should you use flunixin meglumine

A

definitive diagnosis

prior to referral

123
Q

what considerations should you make when you are coming up with treatment and management plan

A
  1. don’t need a diagnosis
  2. can you do it?
  3. do you need additional resources?
  4. best treatment option?
  5. referral?
  6. is the client on board?
124
Q

what are the owner factors when referring a patient (6)

A
  1. clear communication
  2. offer options
  3. finance: insurance
  4. referral an option?
  5. what was/is this horse expected to do
  6. emotional attachment
125
Q

what considerations need to be made when referring (4)

A
  1. ask for advice from referrel centre
  2. transport to centre?
  3. support for horse: bandage, immobilization, analgesia, refulx - travel with NG tube, foals need their mares
  4. support for owner: directions, contact numbers
126
Q

how should you communicate euthanasia

A

“take” owner with you

127
Q

what methods are there for euthanasia

A
  1. somulose
  2. pentobarbitone (Euthatal)
  3. free bullet
128
Q

what is the criteria for humane desctruction

A

responsibility is on the vet based on their assessment of the clinical signs at time of exam, regardless of whether or not the horse is insured

the vet’s primary responsibility is to ensure the welfare of the horse

129
Q

what are some examples for criteria for immediate destruction (7)

A
  1. catastrophic injury
  2. open fractures
  3. gross and unstable comminuted fracture
  4. proximal long bone fracture
  5. axial skeleton/cranium fracture
  6. sustained recumbency (>24 hours)
  7. owner request
130
Q

what should you discuss with the owner before euthanasia

A
  1. empathy
  2. insurance
  3. what will happen during and just after
  4. disposal and possible post-mortem, mane, tail, shoes
131
Q

what should you consider about location during euthanasia (3)

A
  1. privacy and noise
  2. surface and hazards
  3. extraction for disposal
132
Q

what can go wrong during euthanasia

A
  1. spare bottle of somulose etc
  2. catheter could come out
  3. bystanders?
133
Q

what is somulose

A

quinalbarbitone and cinchocaine combo

134
Q

what does somulose cause

A

CNS depression and cardiac conduction depression

135
Q

how is somulose administered

A

IV jugular cathete, secured

136
Q

what gives optimal results with somulose

A

alpha 2 sedation prior to euthanasia

137
Q

what is the dose of somulose

A

1ml/10kg over 10-15 seconds

138
Q

what is somulose classified as

A

schedule 2 controlled drug

kept in register, locked container

139
Q

what are the safety considerations with somulose

A

absorbed through skin or mucosa –> avoid self injection

140
Q

what are the steps to euthanize using somulose

A
  1. inject over 10-15 seconds
  2. take horse off owner/handler and they step away behind you
  3. firm downward pressure on head (apply pressure on shoulder and guide horse down)
  4. horse recumbent: ensure everyone stays out of kicking zone
141
Q

what should occur within 5 mins of somulose administration

A

agonal breathing, other reflexes, no heartbeat, lack of corneal reflex, pupils dilated and fixed

142
Q

how are horses injected with somulose disposed of

A

fallen stock

cremation

burial on own land but there are some resitrictions

Module 14 (29 decks)

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