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Large Animal Surgery > Equine Thorax > Flashcards

Equine Thorax Flashcards

1
Q

What kind of trauma commonly affects the equine thorax?

A

penetrating —> fence posts, branches, HBC

(can’t be managed like in cattle!)

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2
Q

What are the 4 major signs of thoracic trauma in horses?

A
  1. shock - hypovolemic due to blood loss
  2. respiratory distress - shallow breaths, nostril flaring, increased effort and thoracic excursion
  3. hypoventilation - cyanotic MM (muddy purple/grey)
  4. pain - tachycardia, stiff gait (hard to move with FB in thorax)
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3
Q

What is the goal when evaluating thoracic penetrating wounds? What are important diagnostic/prognostic steps?

A

determining extent of injury and ruling out abdominal involvement that can lead to colic

  • PE - thoracic auscultation!
  • blood gas
  • PCV/TP
  • radiographs
  • ultrasound - better for air and fluid buildup
  • wound exploration
  • thoracocentesis
  • thoracoscopy
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4
Q

What is the normal pH, PCO2, and HCO3- in horses?

A

7.35-7.45

35-45 mmHg

22-26 mEq/L

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5
Q

How are pH, PCO2, and HCO3- affected by metabolic acidosis and alkalosis?

A

ACIDOSIS = pH <7.35, decreased HCO3- (<22)

ALKALOSIS = pH >7.45, increased HCO3- (>26)

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6
Q

How are pH, PCO2, and HCO3- affected by respiratory acidosis and alkalosis?

A

ACIDOSIS = pH <7.35, increased PCO2 (>45)

ALKALOSIS = pH >7.45, decreased PCO2 (<35)

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7
Q

What are common causes of metabolic acidosis and alkalosis?

A

ACIDOSIS = diarrhea, lactic acidosis, renal failure

ALKALOSIS = proximal GI obstruction, vomiting

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8
Q

What are common causes of respiratory acidosis and alkalosis?

A

ACIDOSIS = hypoventilation

ALKALOSIS = hyperventilation

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9
Q

Blood gas:

A
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10
Q

A venous blood gas from a horse with thoracic trauma shows the following:

  • pH = 7.2
  • PCO2 = 65 mmHg
  • HCO3- = 25

What is the primary disorder?

A

primary respiratory acidosis

  • low pH
  • increased PCO2
  • normal HCO3- (may have compensation)
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11
Q

What are the 3 major steps in triaging and stabilizing patients with thoracic trauma? What is avoided?

A
  1. treat shock by expanding blood volume with IV fluid support
  2. thoracocentesis for air/fluid
  3. supplemental O2

pulling out the object —> will cause pneumothorax, immediate packing and bandaging is recommended

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12
Q

What are the 4 major steps in wound care in patients with thoracic trauma?

A
  1. pack wound with lap sponge or huck towel
  2. seal wound with loban dressing, rectal sleeve, or saran wrap, and secure with elastikon
  3. stent bandage or tie-over
  4. tetanus toxoid
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13
Q

What are the 3 groups of medications recommended in treating penetrating thoracic wounds?

A
  1. pain control: NSAIDs (Flunixin, Phenylbutazone), opioids (morphine), intercostal nerve blocks
  2. broad-spectrum systemic antibiotics
  3. tetanus toxoid
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14
Q

What antibiotics are recommended when treating thoracic trauma to cover Gram positive, Gram negative, and anaerobic bacteria?

A

G+ - Penicillin, Cephalosporin

G- - Gentamicin

ANAEROBES - Metronidazole

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15
Q

What treatments are recommended for the pleural space in cases of penetrating wounds?

A
  • treat pneumothorax/hemothorax
  • treat thoracic contamination by placing a chest tube and flushing the chest with 5-10 L of LRS or saline SID-BID
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16
Q

What 3 sets of tubes are recommended for cases of pleural effusion or pneumothorax?

A
  1. Jackson Pratt - active (closed suction) drainage
  2. dorsal chest tube for air
  3. ventral chest tube for pleural fluid (Heimlich one way valve attached to keep air out)
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17
Q

What is prognosis of penetrating thoracic trauma?

A

good without abdominal involvement

  • guarded if septic pleuritis is present
18
Q

What is the most common cause of rib fractures in equine patients? What horses are most commonly affected?

A

severe blunt trauma

  • foals
  • neonates that underwent dystocia
19
Q

What are the most common signs of rib fractures? What rarely occurs?

A
  • increased respiratory effort
  • pain (can look like colic)
  • reluctance to move
  • swelling over injury
  • grunting and groaning on palpation
  • crepitus
  • flail chest - multiple ribs broken in two places causes suction upon exhalation = flapping

lung penetration

20
Q

How are rib fractures diagnosed?

A
  • palpation (foals)
  • ultrasonography - sensitive test for fluid, pulmonary contusions, pericardial fluid, # of ribs affected, and degree of fragmentation
  • radiographs
  • CT/MRI
21
Q

What conservative treatment is recommended for rib fractures?

A
  • multimodal pain control
  • restricted exercise
22
Q

When is surgery recommended for rib fractures? What is recommended?

A

foals with axially displaced fractures, multiple fractures, or internal injuries

internal fixation with nylon suture or cable ties or plating, bridging and cerclage

23
Q

What is prognosis of rib fractures like?

A

good to excellent without internal injuries

24
Q

What causes pneumothorax? What are 4 signs?

A

disruption of the thoracic cavity causes a loss of negative pressure due to air entering the pleural space

  1. increased respiratory effort and rate
  2. dyspnea
  3. cyanotic MM
  4. distress
25
What 4 wounds commonly cause pneumothorax?
1. penetrating wounds 2. axillary wounds (SQ emphysema!)* 3. tracheal wounds* 4. esophageal wounds* * = pneumomediastinum
26
What are 4 signs of pneumothorax on radiographs?
1. collapsed lung 2. increased detail in the dorsal lung field 3. lung displaced ventrally and cranially (G) 4. free air between diaphragm and lung (B)
27
What sign is indicative of pneumothorax on ultrasound?
glide sign - normal = visualize pleural surface moving with inspiration and expiration - pneumothorax = no movement, just side to side
28
What 3 treatments are recommended for pneumothorax?
1. seal defect 2. dorsal and caudal thoracocentesis - evacuates air from the thorax with teat cannula and suction or indwelling dorsal chest tube with a Heimlich valve 3. supplemental oxygen
29
What is prognosis of pneumothorax like?
good with uncomplicated cases - poor with traumatic wounds and other confounding factors
30
What are 2 common causes of hemothorax? What are the most common clinical signs?
1. trauma 2. damage to heart and/or pulmonary or intercostal vessels - tachypnea - dyspnea - pale MM - hemorrhagic shock
31
What are 4 ways to diagnose hemothorax?
1. clinical signs 2. auscultation - decreased lung sounds ventrally 3. ultrasound - fluid between body wall and lung looks Starry Night due to increased cellularity of the fluid (hyperechoic) 4. thoracocentesis - teat cannula in the cranioventral
32
What are 4 aspects of conservative treatment for hemothorax?
1. treat underlying cause 2. address blood loss with transfusion 3. pain management 4. systemic antibiotics (blood is a good medium for bacteria!)
33
How is the volume of a blood transfusion calculated?
BW x 0.08 x [(desired PCV - actual PCV)/donor PCV]
34
How is it determined if a hemothorax should be drained?
- dyspneic = YES; aseptic prep, intermittent vs. indwelling - no dyspnea = NO; pressure may be providing hemostasis, pleura can autotransfuse up to 75% of RBCs by 72 hours
35
What is the prognosis of hemothorax like?
fair to good if sepsis does not develop (risk of pleural adhesions) - guarded if sepsis develops
36
What are 3 indications for thoracoscopy?
1. exploration - penetrating wound, neoplasia, diaphragmatic hernia, pleural effusion of unknown origin, assist thoracotomy 2. transection of pleural adhesions 3. guided pulmonary biopsy
37
What are some indications for lung biopsies? What is the best option for technique? What must be performed after?
NOT COMMON - neoplastic or granulomatous masses thoracoscopy-guided must seal lung to prevent closed pneumothorax - Ligasure, laparoscopic staplers, pre-tied ligature
38
What are 3 indications for a thoracotomy and rib resection?
1. refractory pleuropneumonia 2. lung abscess 3. chronic pleural effusion
39
What are 4 purposes of performing a thoracotomy and rib resection?
1. establish drainage 2. removal of infected tissues 3. lavage of affected tissues 4. reduce pleural adhesions
40
How is the horse set up for thoracotomy and rib resection? What are the 3 steps?
standing - horses can tolerate pneumothorax, use U/S to determine proper location 1. crease and opening in the body wall 2. elevate the periosteum 3. use OB wire or oscillating saw to cut into and remove 20-25 cm of ribs

Large Animal Surgery (32 decks)

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