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Module 14 > Equine Wounds: Sorting Simple from Serious > Flashcards

Equine Wounds: Sorting Simple from Serious Flashcards

1
Q

what is the difference between a simple vs. serious wound

A

simple: no threat to life, will not be life changing, wont cause permanent lameness. A wound that heals within expected timeframe & not associated with significant complications (surgical wound that heals by 1st intention)
serious: life threatening or potentially life changing (healing delayed &/or associated with complications)

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2
Q

what is the triage of the patient

A

initial evaluation of patient

threat to life or life changing, immediate action required to prevent serious consequences –> 1st aid

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3
Q

what is the stepwise approach (6)

A
  1. triage: initial evaluation
  2. exam
  3. further investigation: radiography, ultrasonography, synovial fluid analysis
  4. diagnosis
  5. treatment
  6. monitoring & treatment of complications
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4
Q

what does the initial triage of the horse include

A
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5
Q

what are the red flags for the must not miss diagnoses (6)

A
  1. respiratory obstruction
  2. pneumothorax
  3. hemorrhage
  4. septic synovitis
  5. fracture
  6. tendon transection
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6
Q

what can cause respiratory obstruction

A

wounds associated with swelling which obstructs the resp tract

nares, nasopharynx, larynx, trachea

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7
Q

what are the signs of respiratory obstruction

A
  1. resp distress with loud inspiratory noise
  2. increased inspiratory effort, flared nostrils, cyanosis, may collapse
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8
Q

how can you locate where the respiratory obstruction is occuring

A

endoscopy can confirm site of obstruction but prioritize temporary tracheostomy if obstruction is severe

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9
Q

how can respiratory obstruction be treated

A
  1. temporary tracheostomy
  2. wound management
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10
Q

what type of wound can cause a pneumothorax

A

penetrating thoracic wall injury

small axillary wound or tracheal perforation (air tracks along tissue planes into pleural cavity)

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11
Q

what is the difference between unilateral or bilateral pneumothorax

A

it can be unilateral or bilateral depending on whether the mediastinum is incomplete or complete

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12
Q

what is a tension pneumothorax

A

air enters the pleural cavity but cannot leave –> more severe signs

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13
Q

what are the signs of pneumothorax (5)

A
  1. respiratory distress without loud resp noise
  2. increased resp rate, flared nostrils, cyanosis, may collapse
  3. subcut emphysema over thorax
  4. auscultation no movement of air dorsally
  5. confirm by radiography/ultrasonography or diagnostic aspiration of air
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14
Q

how is pneumothorax treated (2)

A
  1. prevent air from entering the pleural cavity (cover wound with occlusive dressing)
  2. remove air from pleural cavity (aspirate at 13ic, indwelling drain may be necessary), nasal O2
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15
Q

what is the volume of blood a horse can lose before decompensation occurs

A

~30% –> 11-12 litres

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16
Q

how do you assess signs of hemorrhage

A
  1. signs of hypovolemic shock
  2. anemia
  3. PCV <0.2L/L (20%)
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17
Q

how do you intervene with hemorrhages

A
  1. reduce loss - pressure bandage, tourniquet to allow vessels to be clamped/ligated
  2. restore circulating volume
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18
Q

how many litres of blood does a horse have

A

7-8% of their body weight

ex. 500kg = 35-40 litres

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19
Q

what is septic synovitis

A

infection within a a synovial structure

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20
Q

what structure is prone to septic synovitis

A

digital flexor tendon sheath because distal limb and superficial location

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21
Q

what are the signs of septic synovitis (2)

A
  1. rapidly developing severe lameness (4-5/5)
  2. analysis of sample, pressure test/contrast radiography to confirm penetration
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22
Q

what is a tendon/ligament transection

A

may be partial or complete

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23
Q

where is tendon/ligament transection most commonly

A

distal limb

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24
Q

what tendon is prone to damage on the dorsal surface of the distal limb

A

extensor tendon

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25
Q

what tendon and ligament is prone to damage on the palmar/plantar surface of the distal limb

A

flexor tendon(s) +/- suspensory ligament (potential for concurrent digital flexor tendon sheath penetration)

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26
Q

what are the signs of tendon/ligament transection

A

altered posutre/function if complete transection (severe lameness and altered posture and limb function)

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27
Q

how would you confirm tendon/ligament transection

A

wound exploration may be more helpful than ultrasonography because of the tissue defect there will not be good contact and lots of gas

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28
Q

which tendon/ligament is damaged in each of these presentations

A
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29
Q

what are the signs of a fracture

A

sudden onset 4-5/5 lameness unless small unicortical fragment only, unless affected bone not involved in weight bearing

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30
Q

what are unstable limb fractures

A

crepitus, abnormal angulation/shortening of limb

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31
Q

how would you find more information regarding a fracture

A
  1. probing/exploring wound
  2. radiography (ultrasonography small fragments)
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32
Q

what would the medical history of a horse with respiratory obstruction be (3)

A
  1. patient distressed
  2. markedly increased resp effort
  3. inspiratory noise (if incomplete obstruction)
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33
Q

what would the inspection, clinical exam of a horse with respiratory obstruction be (2)

A
  1. absent or reduced airflow at nostrils
  2. little or no airflow audible on auscultation of trachea and lungs
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34
Q

what would medical history be of a horse with pneumothorax (2)

A
  1. chest wall wound
  2. rapid breathing
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35
Q

what would inspection and clinical exam be of a horse with pneumothorax (4)

A
  1. deep thoracic wound
  2. increased resp rate, shallow
  3. may be cyanotic
  4. no airflow audible on auscultation of dorsal lung fields (one or both sounds)
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36
Q

what would medical history be of a horse with hemorrhage (2)

A
  1. active bleeding
  2. large volume of blood pooled on ground
37
Q

what would inspection and clinical exam be of a horse with hemorrhage (2)

A
  1. signs of shock: increased HR, weak pulse, pale MM, cold extrematies
  2. increased RR
38
Q

what would the medical history of a horse with septic synovitis be

A
  1. rapid onset severe lameness after wound sustained
39
Q

what would the inspection and clinical exam of a horse with septic synovitis be (2)

A
  1. 4-5/5 lameness
  2. wound in vicinity of synovial structure
40
Q

what would the medical history of a horse with tendon/ligament transected (2)

A
  1. sudden onset severe lameness associated with trauma
  2. abnormal posture (if weight bears) or altered foot placement
41
Q

what would the inspection and clinical exam of a horse with tendon/ligament transected (3)

A
  1. variable lameness depending on tendon or ligament
  2. may knuckle over on fetlock when walking –> extensor tendon transection
  3. wound overlying tendon or ligament
42
Q

what would be the medical history of a horse with a limb fracture be

A
  1. sudden onset lameness associated with trauma (but incident may not be seen)
43
Q

what would be the clinical exam and inspection of a horse with a limb fracture be (2)

A
  1. 4-5/5 lameness
  2. may be crepitus, altered limb angulation or shortening if fracture unstable
44
Q

how do you examine the wound

A
45
Q

what are ways to physically restrain so you can examine the wound

A
  1. halter
  2. expertise of handler
  3. need for head protection?
46
Q

how can you chemically restrain the hrose if you need to examine a wound

A
  1. a2 agonist and opioid

usually detomidine/romifidine + butorphanol IV

47
Q

how do you prepare to examine the wound

A
  1. clip surrounding skin
  2. aseptic preparation of skin
  3. flush wound with sterile saline
48
Q

how do you probe a wound

A
  1. sterile gloved finger
  2. blunt metal probe
49
Q

what are you looking for when you probe a wound (5)

A
  1. depth
  2. involvement of underlying structures
  3. underminded skin
  4. foreign bodies
  5. bone fragment
50
Q

what are you looking for when you probe a wound with a blunt metal probe

A

narrow tracts

can radiograph in situ

51
Q

what are the steps to treating a wound (9)

A
  1. clean
  2. debride
  3. do you need antimicrobials and/or NSAIDs?
  4. suture?
  5. protect wound - bandage
  6. immobilization of wound?
  7. give owner instructions
  8. tetanus vaccine
  9. complications
52
Q

how do you clean a wound

A

flush with high pressure lavage

53
Q

how do you debride a wound

A

if heavily contaminated or devitalized tissue

54
Q

what do you need to debride a wound

A

local analgesia

sedation

55
Q

what do you need to be careful of when debriding a wound in the distal limb

A

be sparing with skin

56
Q

what do you need to consider when deciding whether or not to suture the wound

A

is it 1st intention or 2nd intention healing

if suturing - how will tension and dead space be managed

57
Q

what do you need to consider when bandaging the wound

A

which contact layer to use

if immobilization is needed

58
Q

what factors affect wound healing

A
59
Q

what would an acute wound tissue look like in a simple wound

A

skin, subcut tissue, muscle (not transected)

60
Q

what trauma would cause an acute simple wound

A

minimal, ex. incised wound

61
Q

what contamination would be in an acute simple wound

A

minor

62
Q

what infection would be in a chronic simple wound

A

absent

63
Q

how would a simple chronic wound heal

A

1st inention or by 2nd intention with minimal granulation tissue

64
Q

would there be scarring in a simple chronic wound

A

minimal

65
Q

what would the tissues be in an acute serious wound

A

involvement of deeper structures (bone, penetration of synovial cavity, tendon/ligament transected)

66
Q

what type of trauma would there be in a acute serious wound

A
  1. laceration
  2. major blunt trauma
  3. wire wrapped around limb

tissue viability may be affected, possible distal limb ischemia

67
Q

would there be tissue contamination in an acute serious wound

A

extensive foreign material within wound

may be difficult to remove

68
Q

would there be infection in a chronic serious wound

A

present, organisns may be highly resistant

69
Q

how would a chronic serious wound heal

A

exuberant granulation tissue

70
Q

would there be scarring in a chronic serious wound

A

may result in significant scarry

may affects aesthetics and/or function (eyelid)

71
Q

when is suturing appropriate

A

when you are sure the wound won’t break down and you can manage dead space –> drainage is key

72
Q

if the wound has no/minimal contamination (after cleaning & debridement) what antibiotic would you use

A

1st line: potentiated sulphonamide

alternative: oxytetracycline, doxycycline

73
Q

if the wound has contaminated, deep wound, deeper structures, questionable tissue viability what antibiotic would you use

A

1st line: penicilin + gentamicin

alt: oxytetracycline, doxycycline

consider local administration (IV regional perfusion, or intra-synovial for synovial sepsis)

74
Q

what antibiotics would you use for an infected wound

A

1st line: culture if possible

also consider foreign body, sequestrum, necrotic soft tissue? poor drainage?

75
Q

what are the 3 layers in a bandage and their functions

A

primary or contact layer: creates moisture, absorbs exudate, gas permeable

secondary layer: absorbs & protects, immobilization if multiple cotton wool layers compressed (robert jones bandage)

tertiary layer: secures & protects other layers

76
Q

when is immobilization indicated

A
  1. high tensions at skin margin
  2. second intention healing
77
Q

how would you bandage the proximal limb, neck, trunk

A

adhesive dressing materials or use suture loops and umbilical tape to tie on dressing

78
Q

when is radiography useful

A
  1. fracture
  2. radiodense foreign object (grit)
  3. in situ probe useful to visualize end of narrow tract
79
Q

when is ultrasonography useful

A
  1. soft tissue injury, fractures (especially small fragments)
  2. all types of foreign bodies (wood, grit, metal)
  3. wound tracts can be visualized
80
Q

when is synovial fluid analysis useful

A
  1. septic synovitis: gross appearance, lab analysis
  2. bacteriology
81
Q

what are the 3 areas of the foot that are danger areas when there is a penetration and why

A
  1. middle 1/3 of frog
  2. angle of sole
  3. angle of sole

deep penetration may involve digital flexor tendon, navicular bursa or digital flexor tendon sheath

82
Q

what can go wrong with wound healing and what shouldnt you do

A

horse remains very painful/lame or becomes more painful/lame –> don’t just give more NSAIDs

83
Q

what should you consider when a wound isn’t healing (4)

A
  1. infection: foreign body, sequestrum, necrotic tissue
  2. wound breakdown if closed
  3. exuberant granulation tissue - 2nd intention healing
  4. pressure (bandage) sores
84
Q

why is “proud flesh” not good

A

inhibits epithelialization and wound contraction

85
Q

what is proud flesh

A

exuberant granulation tissue

86
Q

when is proud flesh common

A

common in distal limb wounds healing by second intention

87
Q

what is exuberant granulation tissue stimulated by (3)

A

persistent low grade inflammation

  1. infection, foreign bodies, necrotic tissue
  2. inappropriate treatment
  3. movement
88
Q

how can you treat proud flesh

A

excise it and try to immobilize the limb

intermittent application of steroid

skin grafting –> island grafting

Module 14 (29 decks)

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