Equine emergency and ICU

Question 1

Differences between teflon and polyurethane catheter

Answer 1

PU is less thrombogenic so can stay in for longer; up to a week or more even if over the wire

Teflon = max 24 hours; more memory and more thrombogenic

Question 2

What is an over the wire catheter

Answer 2

Where a wire is placed into the veil and then whole catheter and giving set is threaded over the wilre; then pull wire out
This causes the least trauma to the tip of the catheter so is the least thrombogenic

Question 3

What type of surgery has higher risk of thrombophlebitis; so may choose over the wire catheters for this

Answer 3

Colic

Question 4

Why might we placed superglue between the catheter and giving set screw

Answer 4

If these come apart, air could get sucked in and cause an air embolus which can be fatal

Question 5

What should we do to maintian a catheter

Answer 5

Palpate for heat/swelling
Flush every 4-6 hours with hep saline + before and after medications
Can pul back to feel resistance
Ultrasound scanning

+ must check that the giving set and catheter remain tightly attached

Question 6

What are signs of air embolus

Answer 6

Dullness, pyrexia, neuro signs, death

Question 7

What is. apotential sequelae of thrombophlebitis from catheter

Answer 7

Septic process somewhere else e.g bacterial endocaditis

Question 8

Why must we never use the other jugular once one has been affected by thrombophlebitis

Answer 8

If this one also gets affected; bilateral thrombophlebitis can stop venous drainage from head causign asphyxiation and death

Question 9

What vein could we put a catheter in if there is thrombophlebitis of one jugular

Answer 9

Lateral thoracic
Cephalic (foal)

Question 10

How to deal with thrombophlebitis from catheter

Answer 10

Remove it and place pressure on vein for 5 mins
Culture the tip
NSAIDs
Anti-coagulants if not already on them
Only give antimicrobials if persistently pyrexic

Question 11

When must we take care with interpreting plasma lactate; what about creatintne as markers of dehydratino

Answer 11

Lactate; with liver disease
Creatinine; with kidney disese

Question 12

What must we remember with handling of samples for lactate measurement

Answer 12

Place in heparin tube
MEasure within 5 mins !

Question 13

What would be described as a mild, moderate or severe % dehydration

Answer 13

Mild = 5-8%
Moderate = 8-10
Severe = 10-12% dehydration

Question 14

What things could lead to loss of water frmo the circulatio n

Answer 14

Lack of fluid intake
Bowel hypersecretion in colitis
Fluid loss to reflux
Diarrhoea

Question 15

Signs of haemorrhagic shoc

Answer 15

Marked hypovolaemia meands tachycardia and tachypnoea
Male MMs
Long CRT
Sweating
Depression, weakness

Lactate conc increases
Only small volume of concentrated urine since poor renal perfusino; see pre-renal azotaemia

Question 16

4 main mechanisms of shock

Answer 16

Hypovolaemic
Cardiogenic
Obstructive
Distributive/vasodilatory

Question 17

What do we see on U/S with haemoabdomen

Answer 17

Hyperechoic smokey swirls in abdominal effusion

Question 18

What should we remember to do if we see elevated creatinine in a dull, vaguely unwell horse

Answer 18

Check for internal haemorrhage

Question 19

What is permissive hypotensive fluid resuscitation

Answer 19

When we consciously underperfuse patients with uncontrolled haemorrhage in haemorrhagic shock
- Due to risk of aggressive fluid therapy popping off an unstable clot

Question 20

What should we use/avoid in uncontrolled haemorrhage and shock

Answer 20

Avoid alpha2 sedation because it causes a transient hypertensive phase wich could pop off the clot

Use tranexamic acid as a clot stabiliser
Avoid aggressive fluid therapy

Question 21

What % of blood volume loss can horses tolerate wihtout showing signs

Answer 21

15%
(up to 30% if ver slow onset so can compensate)

Question 22

What do we use to decide if a patient needs a transfusion

Answer 22

Clinical parameters rather than PCV/PP

Question 23

What individuals would we want as a blood donor

Answer 23

Geldings (since females who have had a foal may have alloantibodies)
Not TBs (since these more likely to have Aa or Qa blood type which can get transufsion reactions)

Question 24

WHat blood volume can we take from a donor

Answer 24

20% blood volume
- Volume is 8% of BW
- So multiple BW by 0.016

Question 25

what is key in the set up for giving blood

Answer 25

Giving set must have an in line filter

Question 26

What clot stabiliser is good to use in internal haemorrhage case

Answer 26

Tranexamic acid

Question 27

What shoud we suspect if there is a lack of response of a seemlingly uncomplicated hypovolaemia to the calculated fluid replacement volumes

Answer 27

There may be distributive shock going on at same time due to endotoxaemia

Question 28

What things can lead to distributive shock

Answer 28

Anything where gut wall compromised because this contains lots of free endotoxin
Septic conditions e.g endometritis

Question 29

Signs of distributive/hypovolaemic shock

Answer 29

Tachycardia/tachypnoea
Weak peripheral pulses
Pyrexis
Discoloured MMs due to congetsion
INCREASED CRT
Decreased borygmi (blood preferntially shunted away from guts_
Sweating

Question 30

What is maintenance fluid rate in horse

Answer 30

2-3ml/kg/hr

Question 31

What fluid might we use in a hyperkalaemic pateitn

Answer 31

0.9% saline (because Hartmann’s contains K+ so ocntraindicated)

e.g in renal failure, bladder rupture in neonate

Question 32

How much/how fast to give fluids n shock

Answer 32

Go for 10-20L bolus then reassess clinical parameters

Question 33

What fluid do we use in shock resuscitation

Answer 33

Hartmann’s because it is only thing that comes in 5L bags and need to give 10-20L bolus
–> Can supplement with KCl to make it isotonic

Question 34

When can we give enteral rather than IV fluids

Answer 34

In mild uncomplicated hypovolaemia
NOT in moderate/severe shock as the intestines will not be well perfused enough to absorb this

Start 1L/hr; can increase to 2L/hr if well tolerated

Question 35

How can we prevent laminitis in endotoxaemia case

Answer 35

Cryotherapy of distal limbs
Biosponge
NSAIDs
Deep bed of shavings
Solar support
(could do lidocaine but expensive)

Question 36

What is the definition of hyperlipaemia

Answer 36

Triglycerides >5.6mmol/L

Question 37

How much does 1L of hyperimmune plasma increase foal IgG by

Answer 37

2g/L

Question 38

How much hyperimmune plasma do foals with FPT need

Answer 38

Those with 0-4g/L already nmay need 2L
Those with 2-4 may just need 1

Must recheck later because a septic foal will use these up rapidly

Question 39

What might we need to give a foal that is starting to show a reaction to plasma transfusion

Answer 39

Dexamethasone +/- adrenaline