Foal Nursing Flashcards
How do we carry out a clinical exam on a recumbent foal?
Every 4-6hrs Thoracic auscultation, HR, RR MMs Palpation - joints, umbilicus Temperature - 37.5-39 degrees C
What other considerations should we have for nursing recumbent foals?
Sternal - support, bean bag Intra-nasal oxygen Keep clean, warm, dry IV catheter care Pressor support Urinary catheter care Hydration status
How do we feed a foal that is able to suck?
Mare is best
No mare - feed milk/milk replacer from bowl
RISK aspiration pneumonia if bottle feed
How do we feed a foal that is unable to suck?
Indwelling naso-gastric tube - X-ray to check position, feed by gravity
5% glucose spiked isotonic fluids short-term
Parenteral nutrition long-term
Monitor glucose, may need insulin SC or CRI
What blood tests should we carry out on a foal?
IgG SNAP ELISA PCV, TP Glucose White cells Creatinine Blood gas, electrolytes Lactate Culture
How do we make sure the foal has the right antibodies before foaling?
Vaccinations - influenza, EHV, rotavirus, tetanus
Last tetanus 4-6 weeks before foaling
Move mare to foaling environment 6 weeks before
What is an ideal foaling box setup?
5m x 5m Good ventilation Disinfected Warm, sheltered Bedding e.g. straw/shavings
On what timeframe do we expect the newborn foal to breathe, stand etc.?
1st breath within 30secs Attempt to stand - up by 30mins-1hr Drink colostrum by 1-3hrs Pass meconium Urinate
Why does respiratory arrest in equine neonates most commonly occur?
Premature placental separation Early severance or twisting of the umbilical cord Dystocia Airway obstruction by foetal membranes Failure to spontaneously breathe
What are some causes for cardio-pulmonary arrest in equine neonates not associated with birth?
Primary lung disease Sepsis Hypovolaemia Metabolic acidosis Hyperkalaemia Hypoglycaemia Hypothermia
When would be choose to stimulate a foal rather than begin resuscitation?
HR < 60bpm / irregular Slow/irregular respiration In lateral, some muscle tone On nasal mucosal stimulation, grimace THEN stimulate and provide intranasal oxygen
When would we attempt neonatal resuscitation?
HR/respiration undetectable
Muscle tone limp/absent
Unresponsive to nasal mucosal stimulation
How do we ventilate a foal during resuscitation?
Clear airway
Place naso-/ET tube (can do this whilst foal in birth canal)
Ambu-bag to tube if possible (if not, then mouth to tube / ambu-bag to mask / mouth to nose)
Short, infrequent breaths - 10 breaths/min
When do we attempt CPR in a foal?
Reassess 30 seconds after starting ventilation
If heart beat absent, less than 40bpm or less than 50bpm and not increasing
How do we do chest compressions in a foal?
Knee parallel to spine
Hands on top of each other
Caudal to triceps at highest point of thorax
Shoulders above hands so can use bodyweight
Optimal chest compression - push hard!
Ideally 1 person to compress and 1 to ventilate - no pauses
Compression to ventilation ratio 15:1
Compressions 100-120 per minute
What is failure of passive transfer (FPT)?
All antibodies received from colostrum, should suck within 1-2hrs
Gut ‘open’ for 24hrs, in that time allows in not just antibodies but bacteria
Partial FPT 400-800mg/dl
Total FPT < 400mg/dl
Normal > 800mg/dl
FPT massive risk for sepsis
How can we test for failure of passive transfer?
SNAP ELISA
Easy, cheap, done in the stable
How do we treat failure of passive transfer?
Hyperimmune plasma transfusion Defrost slowly Blood giving set (filter) Start slow (risk transfusion reaction) 1L over about 1hr Re-test after each bag
What are the clinical signs of sepsis?
Pyrexia, depression, recumbency, injected MMs
May have joint effusion +/- lameness
May be totally unresponsive
How can we test for sepsis?
Blood culture - white cell count, SAA, SNAP test, creatinine USG Glucose Lactate Culture from umbilicus? Joint sample for cytology and culture?
How can we treat sepsis?
Broad spectrum antibiotics Plasma - even if no failure of passive transfer? Joint lavage Remove umbilicus? Intensive care - nursing recumbent foal
Describe seizures in foals.
Generalised convulsions / subtle signs Many causes Correct primary cause if possible Maintain airway, admin oxygen Anticonvulsant therapy - diazepam vs midazolam
What is dummy foal syndrome?
AKA hypoxic ischaemic encephalopathy / perinatal asphyxia syndrome
Hypoxia at birth/in vivo
Brain and other organ damage
What are some clinical signs of dummy foal?
Slow to swallow Not sucking Not following mare Ataxic Forgetting to breathe Seizure
How can we treat dummy foal?
Nursing
Maintain cerebral perfusion - careful IV fluid support
Correct metabolic imbalances
Parenteral nutrition/slow enteral feeding
Squeeze?
Define prematurity, dysmaturity and postmaturity.
Prematurity < 320 days usually require vet attention, 280 days unlikely to survive
Dysmaturity = look premature despite normal or often longer gestation
Postmaturity = long gestation, normal size but emaciated
Define prematurity, dysmaturity and postmaturity.
Prematurity < 320 days usually require vet attention, 280 days unlikely to survive
Dysmaturity = look premature despite normal or often longer gestation
Postmaturity = long gestation, normal size but emaciated
Define prematurity, dysmaturity and postmaturity.
Prematurity < 320 days usually require vet attention, 280 days unlikely to survive
Dysmaturity = look premature despite normal or often longer gestation
Postmaturity = long gestation, normal size but emaciated
What are the clinical signs of pre-/dysmaturity?
Smaller than expected Silky short hair Floppy ears Domed head Weak Abnormal RR (low or high) GI/Respiratory organs immature Musculoskeletal - incomplete ossification of carpal/tarsal bones
Describe tendon laxity in foals.
Flexor tendons/ligaments
May be premature/dysmature/postmature
Complication from bandage/cast/splint
How can we manage tendon laxity?
Usually resolve after a few days
Box-rest - limit bedding
Walk on firm ground 5m 3x a day
Bandage heels for protection
Describe tendon contracture in foals.
Unknown cause - positioning in uterus?
Can be acquired when older
Varying severity, number of limbs
Varying prognosis but usually fair to good
How can we manage tendon contracture?
Physiotherapy Walk on hard ground Oxytetracycline (1x a day for 3 days) To extensions Splint / half limb / full limb cast Check ligament desmotomy Tenotomy
How can we manage meconium retention in foals?
Soapy water/phosphate enema Acetylcysteine retention enema (breaks down mucus) Analgesia - Buscopan Surgery - rare IgG SNAP test
What are the clinical signs and treatments for a ruptured bladder in foals?
2-3 days old Colic, distended abdomen Ultrasound, peritoneal sample High K - bradycardia Medical emergency! Saline 0.9% at 250ml/hr/50kg, drain abdomen, surgery
Describe neonatal isoerythrolysis (NIE).
Foal erythrocyte antigen not recognised by mare
Mare sensitised to that erythrocyte antigen
Foal drinks colostrum
Antibodies attack foal’s red cells
What are the clinical signs of neonatal isoerythrolysis?
Anaemia
Icterus
Weakness
How do we manage neonatal isoerythrolysis?
Transfusion at PCV < 12%
Withdraw colostrum
Prevent future foals from drinking mare’s colostrum
Or blood type dam and sire
How can we diagnose pneumonia in foals?
Radiography Trans-tracheal wash (cytology and culture) Antibiotics Oxygen Sternal
How can a foal become infected with Rhodococcus equi?
Environment (dust)
Nose-to-nose contact with infected foals
Dam (faeces)
What are some clinical signs of Rhodococcus equi?
Clinical signs not usually until at least 6 weeks old Can vary, difficult to interpret Pneumonia Septic/immune-mediated joint effusion Diarrhoea
What diagnostic tests can we run for Rhodococcus equi?
Thoracic radiograph - abscesses
Tracheal wash - cytology, culture and sensitivity
Joint fluid sample if effusion
Very high white cell count and fibrinogen
How can we treat Rhodococcus equi in foals?
Clarithromycin plus rifampicin
Beware fatal diarrhoea in adult i.e. dam!!
Discuss with owner - precautions
Treat until radiographically normal, blood normal (~6 weeks)
Joint lavage if appropriate
How can we prevent Rhodococcus equi infection?
Environment
Hyperimmune plasma
NOT antibiotics at birth
