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ACVN - EQUINE NURSING > Equine Emergency Surgery and Perioperative Care > Flashcards

Equine Emergency Surgery and Perioperative Care Flashcards

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1
Q

what are the most common emergency surgeries?

A
  • Colic
  • Dystocia
  • Trauma
  • Synovial sepsis
  • Fracture repair
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2
Q

what is colic?

A

abdominal discomfort

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3
Q

what body systems are involved in colic?

A

– Liver
– Urinary tract
– Reproductive organs

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4
Q

how would you take a history for a colic patient from the owner?

A
  • How long has the horse been colicking for?
  • Severity of signs shown so far?
  • When were faeces last passed?
  • Breed/age/sex
  • Has this happened before?
  • Any management changes?
    – Stabling / turnout
    – Worming
    – Geographical region
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5
Q

how would you take a history from a colic horse who came from a referring vet?

A
  • TPR on initial presentation
  • clinical findings so far
  • medications administered?
  • is surgery an option for owner? insurance? financial concerns?
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6
Q

what is needed for a colic assessment?

A
  • Drugs
    – Sedation (xylazine, detomidine and butorphanol)
    – NSAIDs (flunixin)
    – Buscopan / Buscopan compositum
  • Clippers
  • Sterile prep solution (Chlorhexidine and surgical spirit)
  • Catheter (12g or 14g long-stay catheters)
  • Blood tubes
  • Lactate reader
  • Nasogastric tube
  • Rectal gloves and lubricant
  • Fluids (Isotonic and hypertonic)
  • Ultrasound machine
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7
Q

what are you focusing on durig a physical exam of a colic horse?

A
  • Demeanor, signs of pain, abrasions
  • TPR
  • GI borborygmi (gut sounds)
  • Cardiovascular status (Mucous
    membranes, pulses)
  • Abdominal distension
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8
Q

what bloods would you do for a colic horse?

A

PCV, TP, lactate

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9
Q

what procedure might you do for a colic horse?

A

Abdominocentesis

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10
Q

what should you do to prepare a colic horse for surgery?

A
  • Ensure an IVC is present and patent
  • Ensure the stomach has been decompressed (or an NGT is left in) Start clipping the abdomen if safe
    – 20cm either side of midline, over the whole ventral abdomen
  • Remove shoes if safe
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11
Q

how would you prep theatre for a colic horse who has just been sedated?

A
  • Theatre bed – ready to receive horse in dorsal recumbency
  • Anaesthetic machine and circuit
  • Hoist – ready and working by knockdown
  • Clippers (x2)
  • Urinary catheter (Suture)
  • Surgical scrub
    –Hose, hibi swabs, spirit swabs
    –If the horse has been rolling ++, it will take a while
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12
Q

how wold you prep theatre after the colic horse has been prepped and is coming into theatre?

A
  • Warmed fluids
  • Carboxymethylcellulose (CMC)
  • Surgical kit (x2)
  • Fresh gloves +/- gowns in case of contamination /enterotomy/ resection
  • Drapes (lots)
  • Hose
  • Colon table and dump drum
    –(Colon contents may need to be emptied)
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13
Q

what is included in a resection kit?

A
  • Buster drapes
  • Doyen clamps (atraumatic bowel clamps)
  • Suture material
  • Fluids for lavage
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14
Q

what dressings would you use for a horse that has had colic surgery?

A

–Melolin
–Lap bandage as stent
–Adhesive spray

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15
Q

what should you do once the colic horse has been moved to recovery?

A

–Remove urinary catheter
–Bandage feet if shoes still on
–Towel dry as much as possible (will be saturated due to scrub/lavage during surgery

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16
Q

what post-op care should you provide to the colic horse?

A

– IVFT +/- Lidocaine CRI
– Analgesia
– Antimicrobials
– Incision care

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17
Q

what post-op complications can arise after colic surgery?

A
  • endotoxaemia
  • ileus
  • colitis
  • jugular thrombophelbitis
  • peritonitis
  • incisional infection
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18
Q

What should you do if a horse gets endotoxaemia?

A

– IVFT
– Flunixin +/- Polymixin B +/- hyperimmune plasma
– Can cause laminitis so ice boots pre-emptively + deep bed +/- frog supports

19
Q

what should you do if a horse gets ileus?

A

– Nasogastric intubation regularly – gastric decompression
– Pro motility drugs – lidocaine, erythromycin, metoclopramide
– IV fluids
– Nil by mouth
– Monitor by ultrasound

20
Q

what should you do if a horse gets colitis?

A

–IVFT!
–Isolation?
–Gastroprotectants e.g. misoprostol and sucralfate

21
Q

what should you do if a horse gets jugular thrombophlebitis?

A

–Remove catheter
–Local anti-inflammatory treatment
–Consider anti-thrombolytics?

22
Q

what should you do if a horse gets peritonitis?

A

– Diagnosed by abdominocentesis
– Broad spectrum antimicrobials (pen,
gent, metronidazole)

23
Q

what should you do if a horse gets incisional infection?

A

– Antimicrobials if the horse is systemically
unwell
– Swab for culture and sensitivity before
encouraging drainage

24
Q

what post-op monitoring should you do after colic surgery?

A
  • Demeanour
  • GIT 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 a belly bandage
25
Q

what IVFT should you privde?

A

IV crystalloids

26
Q

What rate should you provide IVFT ?

A

–Maintenance 50ml/kg/24hr
- 500kg horse = 25 litres
–Address dehydration and ongoing losses e.g. reflux

27
Q

what aftercare should you provide after colic surgery?

A
  • Gradual reduction of analgesia
  • Gradual refeeding
    –Hay/Haylage once coping with grass
  • Box rest 4-6 weeks (if no complications with the incision)
    – walks to grass
    –Grass and short fibres
  • Paddock rest 1 month
  • Turn out 1 month
  • Then gradual return to previous work
28
Q

what is red bag delivery?

A

premature separation of the placenta

29
Q

what does the placenta provide?

A

oxygen to the foal

30
Q

where does amnion usually appear?

A

at the vulva with a silvery white appearance

31
Q

what appears at the vulva first?

A

chorioallantois

32
Q

what must you do with the choriollantois?

A

rutpure this first before delivering the foal

33
Q

what causes dystocia?

A

malposition of the foal but occasionally foal deformities

34
Q

what should you prepare for a caesarean?

A

– Preparation of knockdown box
- Warm water, lots of lube, foal ropes
- Hoist ready in case of controlled delivery
– Preparation of induction
- Anaesthetist present
– Preparation of theatre
- Dorsal recumbency
- Foal trolley

35
Q

what can be done if vaginal delivery is not possible?

A

c-section if alive, foetotomy if foal is dead

36
Q

what is the role of the “team mare” during delivery of a dystocia foal?

A

– Two people scrubbed in
– One person running the room
– One anaesthetist

37
Q

what is the role of the “team foal” during delivery of a dystocia foal?

A

– Two people minimum to resuscitate foal
– Is the foal normal /abnormal?
– Will likely need oxygen supplementation, IVC placement, umbilicus
management etc.

38
Q

how would you recover the mare after c-section?

A

Assisted whenever possible
–Increased risk of limb fractures
–Mare is likely exhausted from attempted
delivery prior to C-section

39
Q

what is the survival rate for foals born via controlled vaginal delivery?

A

87-94%

40
Q

what is the survival rate for foals born via caecarean section?

A

10-30%

41
Q

what is the survival rate for the mare who has had a caesarean?

A

87-89%

42
Q

what post-op care should you provide to the mare after dystocia delivery?

A

– Oxytocin every hour if placenta retained
– Check placenta intact
- Uterine lavage
– SID/BID?
– 5-10 litres Isotonic fluid

43
Q

what are the complications that can arise after dystocia?

A

-Reproductive tract trauma
– Perineal lacerations
– Uterine rupture
- Retained placenta
- Delayed uterine involution
- Metritis
- Peritonitis
- Uterine prolapse
- Bladder prolapse
- Arterial haemorrhage

44
Q

what is metritis?

A

inflammation of all uterine layers

ACVN - EQUINE NURSING (3 decks)

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