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Y4 EQ - Miscellaneous > Equine iatrogenic emergencies > Flashcards

Equine iatrogenic emergencies Flashcards

1
Q

Define iatrogenic

A

Relating to illness caused by medical (veterinary) examination or treatment

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2
Q

Name some examples of iatrogenic issues

A
  • Nasal haemorrhage during nasogastric intubation / endoscopy
  • Rectal tears during rectal examination
  • Evisceration following castration
  • Adverse drug reaction
  • Anaesthetic death
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3
Q

Describe the legal issues and client management of iatrogenic issues

A
  • There are often recognised risks associated with particular procedures
  • Can be stressful and upsetting for both owner and vet
  • Rarely associated with negligence
  • Owners may question the veterinary surgeons actions
  • Failure to identify and deal with these may lead to a negligence claim
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4
Q

Name the 3 major complications that can occur due to nasogastric intubation

A

Haemorrhage
Oesophageal perforation
Inhalational pneumonia

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5
Q

Describe haemorrhage as a consequence of nasogastric intubation

A
  • Can be alarming to the owner
  • Mention possible complication
  • Leave the horse quietly for 5-10 minutes
  • Haemorrhage will usually stop by this time
  • Do not pack the nasal passages
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6
Q

What are some key tips to avoid nasogastric intubation problems

A

Use an appropriate tube
Ensure the horse is restrained
Pass the tube along the ventral meatus
Never force the tube
Ensure it is placed in the oesophagus/stomach before administering fluids

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7
Q

If haemorrhage continues following nasogastric intubation what should be done?

A

Endoscopy
Clotting profiles

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8
Q

Describe oesophageal perforation as a consequence of nasogastric intubation

A
  • Uncommon
  • Excessive force
  • Secondary to existing problem
  • Suspect if blood on nasogastric tube (in the absence of epistaxis)
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9
Q

How is oesophageal perforation further assessed and treated?

A

Endoscopic assessment of the oesophagus +/- radiography
Full thickness perforations have poor prognosis

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10
Q

How does inhalation pneumonia occur?

A

Inadvertent passage of nasogastric tube into trachea
Always check positioning of the tube

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11
Q

How can you try and prevent rectal tears during a rectal examination?

A
  • Be in a safe position
  • Ensure the horse is restrained
  • Sedate if necessary +/- butylscopolamine
  • Never push against the rectum if the horse strains
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12
Q

When is the risk of rectal tears increased?

A

Arabians
Stallions / colts
Colics
Fractious horses
Using an ultrasound probe

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13
Q

Describe the initial action steps when a rectal tear has occured

A
  • Inform the owner
  • Sedation
  • Butylscopolamine
  • +/- epidural anaesthesia
  • Evaluate rectal mucosa: Lubrication and lidocaine
  • Proctoscopy
  • Determine the location and grade
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14
Q

Describe the grades of rectal tears

A

1 = mucosa and submucosa
2 = muscularis only
3a = mucosa and muscularis (serosa intact)
3b = mucosa and muscularis (tear into mesocolon)
4 = All layers

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15
Q

How are rectal tears managed, based on their grade?

A

Grade 1 and 2 - Medical management
Grades 3 & 4 - Medical / surgical management / euthanasia

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16
Q

List some other Iatrogenic Injuries/Accidents

A

Adverse drug reaction
Anaphylaxis
Intracarotid drug administration
Perivascular injections
Injection site abscess
Iatrogenic synovial sepsis
Broken needles
Catheter accidents
Anaesthetic-related complications

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17
Q

List the golden rules when dealing with trapped/stuck horses

A
  • Trapped horses can be unpredictable: Offering food and keeping a companion nearby may help
  • Be aware of your own and others’ safety: Work from the spine side of the horse if they are lying down
  • Have control of the horse’s head: Place a headcollar
  • Be prepared to sedate / anaesthetise
  • Never release the horse unless it has somewhere safe to go
  • Always plan an exit route for you and others
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18
Q

Describe how to deal with the emergency services in the case of a trapped/stuck horse

A
  • You may be required to sedate / anaesthetise / euthanase
  • Ensure you are properly attired
  • Identify yourself to the person in charge
  • Discuss the plan – human life takes priority. Horse may be asked to be euthanised
  • Some emergency service professionals may not be used to horses
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19
Q

How should a horse be assessed once released

A

Assessment & treatment of:
- Limb fractures
- Wounds
- Head / ocular injuries
- Dehydration / hypothermia
- Acute haemorrhage
- URT / LRT inflammation

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20
Q

Which injuries are most likely to occur due to stable fires?

A

Smoke inhalation – scope?
Skin burns
Corneal ulceration
Hypovolaemia = ‘burn shock’ - Need IV fluids

21
Q

How should horses involved in stable fires be initially assessed?

A

Lukewarm water; remove rugs
Sedation / anxiolytics if required
Administer flunixin
+/- oxygen
IV catheter +/- tracheostomy
Referral / euthanasia may be needed

22
Q

How are burns assessed/classified?

A
  • Extent of burns (rule of 9’s) = Percentage of total body surface area (TBSA)
  • Depth of burns (superficial layers of skin through to involvement of bone, fascia etc.) = 1st – 4th degree
  • Extent of hypovolaemia
23
Q

How should less severe burns be managed?

A

Cool skin
Clip hair
Lavage (0.05% chlorhexidine solution – very dilute)
Water (not oil) based antimicrobial ointment: Silver sulfadiazine

24
Q

What advice should be given to owners when they have a horse with a wound?

A
  • Control haemorrhage: Dressing, Pressure
  • Do not move the horse if it is very lame unless in imminent danger
  • Minor wounds in low-risk areas: telephone advice may be all that is needed
  • More severe cases: tell owners not to apply anything to the wound
25
Q

What first aid may be administered to wounds?

A

Haemorrhage – very sturdy bandage. Wounds may bleed for several hours so need to wait for this to stop before it can be evaluated
Limb stabilisation

26
Q

What history is imperative to obtain when presented with a horse with a wound?

A

Does it have tetanus cover?

27
Q

Describe the clinical exam of a horse with a wound

A

Shock/ other injuries
Assess stance / weightbearing
Vital parameters - Be aware that PCV and Total protein don’t change very quickly when a horse has lost blood – can take 12/24hrs

28
Q

Which parameter can be used instead of PCV and total protein to assess blood loss?

A

Lactate will increase faster so can use this parameter to gather information about blood loss

29
Q

How can a detailed assessment of wounds be carried out

A

+/- sedation
- Assess: Age of wound, Contamination, Location (remember anatomy!) – what structures have been affected?
- Apply sterile gel to the wound – stops hair going into the wound
- Clip and clean the site around it
- Lavage
- Sterile gloves, use finger / sterile probe: Depth and direction, Foreign material, Subcutaneous pockets, Bone / tendon exposure

30
Q

How can wounds be further assessed?

A

Radiography / ultrasonography

31
Q

What factors should be considered when treating wounds

A

Time since injury
Contamination / infection
Tissue defects
Tissue flaps / viability
Patient compliance
Is GA needed

32
Q

Which wounds are ideal for suturing?

A

<8h old - If longer than this you need to warn the owner that the wound is more likely to break down
Healthy tissue
Eyelids, nostrils, lips (full thickness)

33
Q

How can horses be restricted for treating wounds?

A

Twitch / sedation

34
Q

Describe local anaesthesia use in horses with wounds

A

Mepivacaine / lidocaine (not with adrenaline)
Regional nerve block
Ring- / L-block

35
Q

How are wounds treated/stitched up?

A
  • Remove necrotic / non-viable tissue
  • Skin staples: Quick & easy, Tissue cannot be under tension
  • Suturing: Equine skin: 3 - 3.5 metric (2-0 – 0 USP) monofilament e.g. polypropylene. Subcutaneous 3 metric (2-0 USP), absorbable e.g. poliglecaprone
    +/- Stenting to remove tension on sutures
    +/- drain
    +/- dressing and bandaging
36
Q

Describe ongoing management of horses with wounds

A
  • Analgesia / anti-inflammatories
  • Antimicrobials
    +/- tetanus toxoid / tetanus booster
    +/- box rest (beware colic)
  • Timing of suture / staple removal - Usually 10-14 days
  • Dressing / bandage changes - Frequency depends on amount of exudation – ballpark every 2-3 days initially
37
Q

Describe secondary intention healing for wounds

A
  • Sterile hydrogel & non-adherent, absorbent dressing initially
  • Various dressings / topical treatments for ongoing management
  • Bandaging of the distal limb important (+/- splint or cast bandage)
  • Ongoing wound management: Duration, Cost
38
Q

List the possible complications of wounds

A
  • Synovial sepsis / fracture (missed initially)
  • Sequestrum formation
  • Dehiscence: anything being sutured can always break down
  • Foreign material remains in situ
  • Bandage sores
39
Q

Describe sequestrum formation

A

Where cortex of the bone exposed
Acts like a foreign body – leg will not heal/stop draining until that bit of bone is removed

40
Q

Describe the types of skin grafting

A

Pedicle grafts
- Rarely used – inelastic skin
Free grafts
- Usually autografts
- Pinch / punch / tunnel grafts
- Solid or meshed sheets (full / split thickness)
- Meek micrografts

41
Q

Describe the timing of skin grafting

A

Healthy granulating wound bed
Can also be applied to fresh injuries / surgically created defects

42
Q

For a skin graft to be accepted the wound bed must have what requirements?

A
  • Vascularised
  • No necrotic tissue
  • No overt infection
  • No evidence of delayed wound healing: Sequestrum, Foreign body
43
Q

List the indications for skin grafting

A
  • Traumatic injuries
  • Non- / slow-healing granulating wounds
  • Adjunct to management of skin neoplasia
  • Extensive skin burns
  • Deformity-causing scarring
44
Q

Describe preparation of the skin graft donor site

A

Neck
+/- abdomen
Clipped, local anaesthesia
Skin preparation

45
Q

Describe placing skin grafts

A
  • Start at the lowest site (prevents haemorrhage obscuring sites)
  • Make a pocket in the granulation bed - No 15 scalpel blade
  • Tuck grafts into each pocket
  • Non-adhesive dressing, bandage
  • Box rest
  • Change bandage in 5-7 days
46
Q

In which situations would advanced grafting be considered?

A
  • Wound / surgically created defect cannot be closed
  • Secondary intention healing would be prolonged & result in large scar
  • More simple techniques would not provide sufficient cosmetic / functional result
  • Defect too large for more simple techniques
47
Q

Describe full thickness grafting

A

GA / sedation and local anaesthesia
Pectoral region most commonly used (sutured closed)
Insufficient skin to cover a large defect

48
Q

Describe split thickness grafting

A

Can be taken from several sites (ventral thorax / abdomen)
Larger defects can be covered
More specialist equipment and expertise needed

Y4 EQ - Miscellaneous (6 decks)

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