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Advanced Clinical Nursing Theory > Equine Emergency > Flashcards

Equine Emergency Flashcards

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1
Q

what are the most common emergency surgeries performed in horses?

A

colic
dystocia
trauma
synovial sepsis
fracture repair

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2
Q

what is colic?

A

broad term for abdominal discomfort in horses

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3
Q

what body systems are potentially involved when a horse has colic?

A

GI tract
liver
urinary tract
reproductive organs

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4
Q

what can the colic work up help to identify?

A

body system that is involved

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5
Q

what questions should be asked of the owner of a colicking horse?

A

how long for
severity of signs
when were faeces last passed
breed/age/sex
has this happened before
any management changes recently
geographic location -sand

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6
Q

what questions should you ask the referring vet about a colic case?

A

TPR on initial presentation
and any subsequent
clinical findings so far
medications administered
response to any medications administered
suspected lesion
is surgery an option for the owner
are they insured
horse temperament

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7
Q

what tests may the referring vet have carried out on a colic case already?

A

NG tube
rectal exam

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8
Q

what drugs may be needed for colic assessment?

A

sedation
NSAIDs
buscopan / buscopan compositum

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9
Q

what sedation may be used for a colic case?

A

xylazine
detomidine
butorphanol

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10
Q

what equipment is needed for colic assessment?

A

drugs
clippers
prep solution
catheter
blood tubes
lactate reader
NG tube
rectal gloves and lubricant
fluids (isotonic and hypertonic)
US machine

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11
Q

where will colic workup often take place within the hospital?

A

stocks
if unsafe knockdown box

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12
Q

what essential equipment could go in a grab box if a colic case is moving straight to the knockdown box?

A

IVFT
bloods

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13
Q

what are the stages of a colic workup?

A

focused physical exam
rectal exam
pass NG tube
bloods
AFAST
abdominocentesis

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14
Q

what are the areas of the focused physical exam in a colic workup?

A

demenour
signs of pain
abrasions on face from rolling
TPR
borborygmi
MM
pulses
abdominal distension

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15
Q

what is indicated by purple MM?

A

endotoxaemia which is suggestive of GI rupture

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16
Q

when should TPR be performed if possible?

A

pre- medication

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17
Q

what may be required for rectal exam?

A

sedation
buscopan

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18
Q

why is passage of an NG tube before surgery so crucial?

A

horses unable to vomit
if obstruction present and stomach fills they are at risk of gastric rupture

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19
Q

what patient parameters suggest that gastric decompression should be performed?

A

high HR
significant pain

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20
Q

what does reflux on passage of an NG tube indicate?

A

SI obstruction

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21
Q

what amount of refluxed fluid would suggest a colic is surgical?

A

> 2L

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22
Q

what blood tests should be performed on colic patients?

A

PCV
TP
lactate
haem and biochem if time

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23
Q

what is being assessed dung an AFAST for colic?

A

distention
motility
displacement

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24
Q

what should fluid obtained through abdominocentesis in a colic exam be assessed for?

A

TNCC
TP
lactate

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25
Q

what is the aim of the initial hospital exam?

A

is the colic medical or surgical

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26
Q

what are the findings on clinical exam that would indicate surgical colic?

A

congested MM
CRT >3s
HR >60-80 bpm
poor PQ
uncontrolled pain

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27
Q

what are the findings on rectal exam that would indicate surgical colic?

A

distension or displacement of small or large intestine

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28
Q

what are the findings on NG intubation that would indicate surgical colic?

A

> 2L reflux

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29
Q

what are the findings on ultrasound that would indicate surgical colic?

A

amotile, distended loops of SI

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30
Q

what findings on bloods or abdominocentesis would indicate surgical colic?

A

high lactate

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31
Q

what other conditions may be indicated by amotile distended SI?

A

ileus
enteritis

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32
Q

what must be done if a colic patient is moving to surgery?

A

ensure IVC in place and patent
ensure gastric decompression has ben performed or NG tube is left in
start clipping abdomen if safe
remove shoes if safe

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33
Q

what is the size of clip required for colic surgery?

A

20cm either side of midline over whole ventral abdomen

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34
Q

what equipment is needed for knockdown and prep of colic patients?

A

theatre bed ready for horse in dorsal recumbency
anaesthetic machine and circuit
hoist
clippers
ucath and suture
surgical scrub

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35
Q

how may horses be prepped for colic surgery?

A

may hose first if lots of rolling to remove most gross debris
then use hibi and spirit after

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36
Q

what equipment is needed in theatre for colic surgery?

A

warmed fluids
CMC
surgical kit (2-3)
fresh gowns and gloves
drapes
hose
colon table and dump drum

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37
Q

what are warmed fluids needed for in colic surgery?

A

lavage

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38
Q

what is CMC?

A

carboxymethylcellulose

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39
Q

what is the role of CMC in colic surgery?

A

lubricant to prevent post op adhesions

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40
Q

why are multiple surgical kits needed for colic surgery?

A

need clean kit to close the abdomen and new kit if performing multiple enterotomies

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41
Q

why are fresh gowns and gloves needed for colic surgery?

A

in case of contamination, enterotomy or resection

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42
Q

what is a hose used for in colic surgery?

A

to clear the colon

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43
Q

where is the incision for colic surgery made?

A

ventral midline (~20cm)

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44
Q

what is involved in colic surgery?

A

all GI tract assessed for distension, thickening, viability and displacement

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45
Q

what should happen to any non-viable intestine?

A

resected and anastomosed

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46
Q

what is found within resection kit?

A

buster drapes
doyen bowel clamps
suture material
fluids for lavage

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47
Q

what suture material is likely to be used for anastomosis?

A

PDS 2-0 but check with surgeon

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48
Q

does large intestinal displacement require resection/anastomosis?

A

no

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49
Q

what must be done with LI displacements?

A

contents of pelvic flexure dumped via enterotomy
may use hosepipe to flush out colon

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50
Q

how should the colon table be placed when emptying the pelvic flexure?

A

tilt downwards so that contents run into the dump drum and away from the surgical field

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51
Q

how is the abdomen closed following colic surgery?

A

usually 3 layer closure

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52
Q

what are the 3 layers of the abdomen closed following colic surgery?

A

linea alba
SC tissue
skin

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53
Q

what material is used to close the linea alba?

A

vicryl 0 or 2

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54
Q

what suture material is usually used to close the SC tissue of the abdomen?

A

PDS usually

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55
Q

what suture material is usually used to close the skin of the abdomen?

A

PDS
staples if under time pressure

56
Q

what will be used to dress the abdominal wound following surgery?

A

melolin
lap bandage
adhesive spray

57
Q

what should be done once the patient has moved to recovery following colic surgery?

A

remove ucath
bandage feet is shoes are still on
towel dry as much as possible as will be saturated

58
Q

what should be done following colic surgery once the patient is standing?

A

belly bandage

59
Q

what is involved in the post op care of all surgical colic patients?

A

IVFT
analgesia
antimicrobials
incision monitoring

60
Q

what CRI is commonly used in colic patients post op?

A

lidocaine

61
Q

why is lidocaine so useful for colic patients?

A

reduced risk of ileus compared to opioids
lowers NSAID use

62
Q

when can refeeding start if patients have had large intestinal displacements?

A

gradually refeed once awake and alert (~4 hours post op)

63
Q

when can patients with small intestinal resections/anastomoses be fed?

A

case by case but usually 48 hours post op
then start with small handfuls of nuts and grass

64
Q

what food type should be reintroduced last?

A

hay - likely to irritate wounds

65
Q

what is endotoxaemia?

A

leakage of bacteria from GI tract into bood

66
Q

how is endotoxaemia treated?

A

IVFT
flunixin / polymixin B / hyperimmune plasma

67
Q

what can be caused by endotoxaemia?

A

laminitis

68
Q

why may endotoxaemia lead to laminitis?

A

systemic inflammation causing inflammation of laminae

69
Q

how can incidence of lamintis due to endotoxaemia be reduced?

A

ice boots used preemptively
deep bedding
frog supports

70
Q

how can ileus be prevented post colic surgery?

A

NG intubation regularly for gastric decompression
pro-motility drugs
IVFT
nil by mouth
US monitoring

71
Q

what pro-motility drugs may be used in horses to manage ileus?

A

lidocaine
erythromycin
metoclopromide

72
Q

what is colitis?

A

inflammation of the colon

73
Q

what are the signs of colitis?

A

D+
pyrexia

74
Q

how is colitis treated?

A

IVFT
gastroprotectants (misoprostol and sucralfate)

75
Q

should colitis patients be isolated?

A

yes - shed salmonella

76
Q

how can jugular thrombophlebitis be managed?

A

removal of IVC
anti-inflammatories

77
Q

what does thrombophlebitis lead to?

A

occlusion of vein
inflammation

78
Q

can anti-thrombolytics be used to manage jugular thrombophlebitis?

A

can be used but risk of bleeding from other wounds

79
Q

what are the signs of peritonitis?

A

pyrexia
ileus

80
Q

how is peritonitis diagnosed?

A

abdominocentesis

81
Q

how is peritonitis treated?

A

broad spectrum antibiotics

82
Q

what are the signs of incisional infection?

A

marked oedema
celulitis

83
Q

what is cellulitis?

A

inflammation or infection of SC tissue

84
Q

how is incisional infection managed?

A

swab for culture
encourage drainage
antibiotics if systemically unwell

85
Q

how often should clinical exam be performed following colic surgery?

A

Q2-4 hours

86
Q

what are the key areas of the post colic exam?

A

demenour
borborygmi
faecal output/consistency
appetite
jugular vein
digital pulse
incision checks
ensure not urinating on belly bandage

87
Q

how often should the belly bandage be removed to check the incision?

A

SID

88
Q

what should the jugular vein be checked for?

A

heat
swelling
pain
patency

89
Q

what rate of IVFT is needed for horses?

A

50 ml/kg/day

90
Q

what must be accounted for in post op IVFT?

A

ongoing losses e.g. NG tube reflux

91
Q

what electrolyte is often supplemented in IVFT following colic surgery?

A

K+

92
Q

what is involved in colic surgery aftercare?

A

gradual reduction and analgesia
gradual refeeding

93
Q

when can hay/haylage be reintroduced to the diet?

A

once coping with grass

94
Q

how longs should horses be left on box rest for following colic surgery?

A

4-6 weeks if no incision complications
short walks to grass

95
Q

how long after the end of box rest is paddock rest continued?

A

1 month

96
Q

after paddock rest how long should patients have turn out for before gradually returning to work?

A

1 month

97
Q

for every 10 minutes over 30 mins stage 2 of labour lasts what is the effect on foal mortality?

A

rate increases by 16% every 10 mins over 30 mins

98
Q

what happens during red bag delivery?

A

premature separation of the placenta before the foal is outside the mare and able to breathe

99
Q

when should the placenta separate?

A

only when the foal is able to start breathing in normal delivary

100
Q

what should be seen at the vulva first?

A

amnion - silvery white

101
Q

what is seen at the vulva first in red bag delivery?

A

chorioallantois - deep red

102
Q

what should be done if the chorioallantois (red bag) is seen?

A

ruptured immediately
assisted delivery of foal

103
Q

what is the main risk with red bag delivery?

A

hypoxia

104
Q

what is the incidence of dystocia?

A

1-10% of delivaries

105
Q

what are the reasons for dystocia?

A

foal malposition
foal abnormalities e.g. limb deformities

106
Q

what is the key history that needs to be taken of a mare in dystocia?

A

signalment
time of onset of stage 2
gestation days
assistance attempted? (owner and vet)
pertinent medical treatments and history

107
Q

what should be prepared for if a mare in dystocia is being admitted?

A

assume C-section

108
Q

what should be prepared for if a mare is arriving in dystocia?

A

knockdown box for assisted delivery
anaesthetist for induction
theatre ready for mare in dorsal
foal trolley

109
Q

what should be prepared in the knockdown box for assisted/controlled delivery?

A

warm water
lube
foal ropes
hoist

110
Q

what should be done when the mare arrives at hospital?

A

bandage tail
place IVC
vaginal exam

111
Q

what is assessed through vaginal exam of the mare?

A

whether vaginal delivery is possible or not

112
Q

what should be done if vaginal delivery of the foal is possible?

A

assisted where possible
then controlled

113
Q

how long should assisted delivery be attempted for?

A

5-15 mins
ensure timer is used

114
Q

what is involved in controlled delivery?

A

hoisting of HL to remove pressure on foal from abdominal organs
mare is put under GA

115
Q

what should be happening during assisted and controlled delivery?

A

clipping and prep of abdomen for C-section

116
Q

if vaginal delivery is not possible what can be done?

A

C-section if foal is alive
foetotomy if not
often hard to tell

117
Q

what incision is made for c-section?

A

ventral midline

118
Q

how is a caesarean performed?

A

ventral midline incision
uterine horn located and exteriorised
hysterotomy performed
umbilical cord clamped and cut
foal lifted out and transferred to foal team

119
Q

how long does the hysterotomy incision need to be?

A

35-40cm

120
Q

how many people are needed to lift the foal from the abdomen?

A

two at least as 30-50kg

121
Q

what is the role of the people looking after the mare during the caesarean?

A

2 scrubbed in
circulating nurse
anaesthetist

122
Q

what is involved in the management of the foal once it is delivered by C-section?

A

two people minimum to resuscitate
check if foal is normal or abnormal
O2 needed
IVC placement

123
Q

how should the mare be recovered following c-section?

A

assisted wherever possible

124
Q

what is the mare at increased risk of during recovery?

A

limb fracture

125
Q

why is the mare at increased risk of limb fractures following c-section?

A

low Ca2+ due to milk production
likely exhausted from attempted delivery prior to c-section

126
Q

what is the foal survival rate like for controlled vaginal delivery?

A

87-94%

127
Q

what is the mare survival rate like for c-section?

A

87-89%

128
Q

what is the foal survival rate like for c-section?

A

10-30%

129
Q

what is the management of the mare like post caesarean?

A

similar to post op colic
monitor stage 3
uterine lavage?
mammary glands regularly assessed for mastitis

130
Q

what must be checked about stage 3 of labour?

A

has placenta been passed normally

131
Q

how can the mare be managed if stage 3 has not been completed properly?

A

oxytocin every hour if placenta retained
tied up and left to hang
ensure placenta intact once passed

132
Q

how often should uterine lavage be performed?

A

SID/BID

133
Q

how much fluid should be used for uterine lavage?

A

5-10L isotonic fluid

134
Q

what are the main complications seen with dystocia?

A

reproductive tract trauma (perineal lacerations or uterine rupture)
retained placenta
delayed uterine involution
metritis
peritonitis
uterine prolapse
bladder prolapse
uterine artery haemorrhage

135
Q

how can the mare be monitored for uterine artery haemorrhage?

A

MM colour

136
Q
A

Advanced Clinical Nursing Theory (36 decks)

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