Equine Emergency Flashcards
what are the most common emergency surgeries performed in horses?
colic
dystocia
trauma
synovial sepsis
fracture repair
what is colic?
broad term for abdominal discomfort in horses
what body systems are potentially involved when a horse has colic?
GI tract
liver
urinary tract
reproductive organs
what can the colic work up help to identify?
body system that is involved
what questions should be asked of the owner of a colicking horse?
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
what questions should you ask the referring vet about a colic case?
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
what tests may the referring vet have carried out on a colic case already?
NG tube
rectal exam
what drugs may be needed for colic assessment?
sedation
NSAIDs
buscopan / buscopan compositum
what sedation may be used for a colic case?
xylazine
detomidine
butorphanol
what equipment is needed for colic assessment?
drugs
clippers
prep solution
catheter
blood tubes
lactate reader
NG tube
rectal gloves and lubricant
fluids (isotonic and hypertonic)
US machine
where will colic workup often take place within the hospital?
stocks
if unsafe knockdown box
what essential equipment could go in a grab box if a colic case is moving straight to the knockdown box?
IVFT
bloods
what are the stages of a colic workup?
focused physical exam
rectal exam
pass NG tube
bloods
AFAST
abdominocentesis
what are the areas of the focused physical exam in a colic workup?
demenour
signs of pain
abrasions on face from rolling
TPR
borborygmi
MM
pulses
abdominal distension
what is indicated by purple MM?
endotoxaemia which is suggestive of GI rupture
when should TPR be performed if possible?
pre- medication
what may be required for rectal exam?
sedation
buscopan
why is passage of an NG tube before surgery so crucial?
horses unable to vomit
if obstruction present and stomach fills they are at risk of gastric rupture
what patient parameters suggest that gastric decompression should be performed?
high HR
significant pain
what does reflux on passage of an NG tube indicate?
SI obstruction
what amount of refluxed fluid would suggest a colic is surgical?
> 2L
what blood tests should be performed on colic patients?
PCV
TP
lactate
haem and biochem if time
what is being assessed dung an AFAST for colic?
distention
motility
displacement
what should fluid obtained through abdominocentesis in a colic exam be assessed for?
TNCC
TP
lactate
what is the aim of the initial hospital exam?
is the colic medical or surgical
what are the findings on clinical exam that would indicate surgical colic?
congested MM
CRT >3s
HR >60-80 bpm
poor PQ
uncontrolled pain
what are the findings on rectal exam that would indicate surgical colic?
distension or displacement of small or large intestine
what are the findings on NG intubation that would indicate surgical colic?
> 2L reflux
what are the findings on ultrasound that would indicate surgical colic?
amotile, distended loops of SI
what findings on bloods or abdominocentesis would indicate surgical colic?
high lactate
what other conditions may be indicated by amotile distended SI?
ileus
enteritis
what must be done if a colic patient is moving to surgery?
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
what is the size of clip required for colic surgery?
20cm either side of midline over whole ventral abdomen
what equipment is needed for knockdown and prep of colic patients?
theatre bed ready for horse in dorsal recumbency
anaesthetic machine and circuit
hoist
clippers
ucath and suture
surgical scrub
how may horses be prepped for colic surgery?
may hose first if lots of rolling to remove most gross debris
then use hibi and spirit after
what equipment is needed in theatre for colic surgery?
warmed fluids
CMC
surgical kit (2-3)
fresh gowns and gloves
drapes
hose
colon table and dump drum
what are warmed fluids needed for in colic surgery?
lavage
what is CMC?
carboxymethylcellulose
what is the role of CMC in colic surgery?
lubricant to prevent post op adhesions
why are multiple surgical kits needed for colic surgery?
need clean kit to close the abdomen and new kit if performing multiple enterotomies
why are fresh gowns and gloves needed for colic surgery?
in case of contamination, enterotomy or resection
what is a hose used for in colic surgery?
to clear the colon
where is the incision for colic surgery made?
ventral midline (~20cm)
what is involved in colic surgery?
all GI tract assessed for distension, thickening, viability and displacement
what should happen to any non-viable intestine?
resected and anastomosed
what is found within resection kit?
buster drapes
doyen bowel clamps
suture material
fluids for lavage
what suture material is likely to be used for anastomosis?
PDS 2-0 but check with surgeon
does large intestinal displacement require resection/anastomosis?
no
what must be done with LI displacements?
contents of pelvic flexure dumped via enterotomy
may use hosepipe to flush out colon
how should the colon table be placed when emptying the pelvic flexure?
tilt downwards so that contents run into the dump drum and away from the surgical field
how is the abdomen closed following colic surgery?
usually 3 layer closure
what are the 3 layers of the abdomen closed following colic surgery?
linea alba
SC tissue
skin
what material is used to close the linea alba?
vicryl 0 or 2
what suture material is usually used to close the SC tissue of the abdomen?
PDS usually
what suture material is usually used to close the skin of the abdomen?
PDS
staples if under time pressure
what will be used to dress the abdominal wound following surgery?
melolin
lap bandage
adhesive spray
what should be done once the patient has moved to recovery following colic surgery?
remove ucath
bandage feet is shoes are still on
towel dry as much as possible as will be saturated
what should be done following colic surgery once the patient is standing?
belly bandage
what is involved in the post op care of all surgical colic patients?
IVFT
analgesia
antimicrobials
incision monitoring
what CRI is commonly used in colic patients post op?
lidocaine
why is lidocaine so useful for colic patients?
reduced risk of ileus compared to opioids
lowers NSAID use
when can refeeding start if patients have had large intestinal displacements?
gradually refeed once awake and alert (~4 hours post op)
when can patients with small intestinal resections/anastomoses be fed?
case by case but usually 48 hours post op
then start with small handfuls of nuts and grass
what food type should be reintroduced last?
hay - likely to irritate wounds
what is endotoxaemia?
leakage of bacteria from GI tract into bood
how is endotoxaemia treated?
IVFT
flunixin / polymixin B / hyperimmune plasma
what can be caused by endotoxaemia?
laminitis
why may endotoxaemia lead to laminitis?
systemic inflammation causing inflammation of laminae
how can incidence of lamintis due to endotoxaemia be reduced?
ice boots used preemptively
deep bedding
frog supports
how can ileus be prevented post colic surgery?
NG intubation regularly for gastric decompression
pro-motility drugs
IVFT
nil by mouth
US monitoring
what pro-motility drugs may be used in horses to manage ileus?
lidocaine
erythromycin
metoclopromide
what is colitis?
inflammation of the colon
what are the signs of colitis?
D+
pyrexia
how is colitis treated?
IVFT
gastroprotectants (misoprostol and sucralfate)
should colitis patients be isolated?
yes - shed salmonella
how can jugular thrombophlebitis be managed?
removal of IVC
anti-inflammatories
what does thrombophlebitis lead to?
occlusion of vein
inflammation
can anti-thrombolytics be used to manage jugular thrombophlebitis?
can be used but risk of bleeding from other wounds
what are the signs of peritonitis?
pyrexia
ileus
how is peritonitis diagnosed?
abdominocentesis
how is peritonitis treated?
broad spectrum antibiotics
what are the signs of incisional infection?
marked oedema
celulitis
what is cellulitis?
inflammation or infection of SC tissue
how is incisional infection managed?
swab for culture
encourage drainage
antibiotics if systemically unwell
how often should clinical exam be performed following colic surgery?
Q2-4 hours
what are the key areas of the post colic exam?
demenour
borborygmi
faecal output/consistency
appetite
jugular vein
digital pulse
incision checks
ensure not urinating on belly bandage
how often should the belly bandage be removed to check the incision?
SID
what should the jugular vein be checked for?
heat
swelling
pain
patency
what rate of IVFT is needed for horses?
50 ml/kg/day
what must be accounted for in post op IVFT?
ongoing losses e.g. NG tube reflux
what electrolyte is often supplemented in IVFT following colic surgery?
K+
what is involved in colic surgery aftercare?
gradual reduction and analgesia
gradual refeeding
when can hay/haylage be reintroduced to the diet?
once coping with grass
how longs should horses be left on box rest for following colic surgery?
4-6 weeks if no incision complications
short walks to grass
how long after the end of box rest is paddock rest continued?
1 month
after paddock rest how long should patients have turn out for before gradually returning to work?
1 month
for every 10 minutes over 30 mins stage 2 of labour lasts what is the effect on foal mortality?
rate increases by 16% every 10 mins over 30 mins
what happens during red bag delivery?
premature separation of the placenta before the foal is outside the mare and able to breathe
when should the placenta separate?
only when the foal is able to start breathing in normal delivary
what should be seen at the vulva first?
amnion - silvery white
what is seen at the vulva first in red bag delivery?
chorioallantois - deep red
what should be done if the chorioallantois (red bag) is seen?
ruptured immediately
assisted delivery of foal
what is the main risk with red bag delivery?
hypoxia
what is the incidence of dystocia?
1-10% of delivaries
what are the reasons for dystocia?
foal malposition
foal abnormalities e.g. limb deformities
what is the key history that needs to be taken of a mare in dystocia?
signalment
time of onset of stage 2
gestation days
assistance attempted? (owner and vet)
pertinent medical treatments and history
what should be prepared for if a mare in dystocia is being admitted?
assume C-section
what should be prepared for if a mare is arriving in dystocia?
knockdown box for assisted delivery
anaesthetist for induction
theatre ready for mare in dorsal
foal trolley
what should be prepared in the knockdown box for assisted/controlled delivery?
warm water
lube
foal ropes
hoist
what should be done when the mare arrives at hospital?
bandage tail
place IVC
vaginal exam
what is assessed through vaginal exam of the mare?
whether vaginal delivery is possible or not
what should be done if vaginal delivery of the foal is possible?
assisted where possible
then controlled
how long should assisted delivery be attempted for?
5-15 mins
ensure timer is used
what is involved in controlled delivery?
hoisting of HL to remove pressure on foal from abdominal organs
mare is put under GA
what should be happening during assisted and controlled delivery?
clipping and prep of abdomen for C-section
if vaginal delivery is not possible what can be done?
C-section if foal is alive
foetotomy if not
often hard to tell
what incision is made for c-section?
ventral midline
how is a caesarean performed?
ventral midline incision
uterine horn located and exteriorised
hysterotomy performed
umbilical cord clamped and cut
foal lifted out and transferred to foal team
how long does the hysterotomy incision need to be?
35-40cm
how many people are needed to lift the foal from the abdomen?
two at least as 30-50kg
what is the role of the people looking after the mare during the caesarean?
2 scrubbed in
circulating nurse
anaesthetist
what is involved in the management of the foal once it is delivered by C-section?
two people minimum to resuscitate
check if foal is normal or abnormal
O2 needed
IVC placement
how should the mare be recovered following c-section?
assisted wherever possible
what is the mare at increased risk of during recovery?
limb fracture
why is the mare at increased risk of limb fractures following c-section?
low Ca2+ due to milk production
likely exhausted from attempted delivery prior to c-section
what is the foal survival rate like for controlled vaginal delivery?
87-94%
what is the mare survival rate like for c-section?
87-89%
what is the foal survival rate like for c-section?
10-30%
what is the management of the mare like post caesarean?
similar to post op colic
monitor stage 3
uterine lavage?
mammary glands regularly assessed for mastitis
what must be checked about stage 3 of labour?
has placenta been passed normally
how can the mare be managed if stage 3 has not been completed properly?
oxytocin every hour if placenta retained
tied up and left to hang
ensure placenta intact once passed
how often should uterine lavage be performed?
SID/BID
how much fluid should be used for uterine lavage?
5-10L isotonic fluid
what are the main complications seen with dystocia?
reproductive tract trauma (perineal lacerations or uterine rupture)
retained placenta
delayed uterine involution
metritis
peritonitis
uterine prolapse
bladder prolapse
uterine artery haemorrhage
how can the mare be monitored for uterine artery haemorrhage?
MM colour
