Iatrogenic injuries Flashcards
To avoid haemorrhage when placing an NG tube, where. should the tube be placed?
VENTRAL meatus
Ventral = very good, middle = malicious
What should you do if a horse starts bleeding after passing an NG tube?
Leave the horse quiet for 5-10 minutes, most stop on their own
(If not - endoscopy, check for ethmoid haematoma, check clotting profiles)
Oesophageal perforation when passing an NG tube is uncommon, but is linked to some conditions. What condition is this linked to?
Oesophageal diverticulum
or excessive force
What imaging should be done to investigate oesophageal perforation?
Radiography
Endoscopy
When should you suspect oesophageal perforation?
If blood seen on NG tube but no evidence of blood from nose
What is the prognosis for a full thickness oesophageal perforation?
Poor
Another iatrogenic injury associated with passing an NG tube is inhalational pneumonia after passing the tube into the trachea. How does the prognosis vary depending on whether water or liquid paraffin is inhaled?
Water - small amounts ok, larger amounts may cause oedema or inhalation pneumonia
Liquid paraffin - worse prognosis, can be fatal
What horses are at higher risk of a rectal tear?
Stallions/colts
Arabs
Fractious horses
Horses with colic
What medical management should be given to INVESTIGATE if you suspect a rectal tear?
Sedate
Give buscopan/butylscopolamine
+/- epidural
How do you investigate a rectal tear?
Find on endoscope or manually
Assess location and thickness
What is the grading system for rectal tears?
Grade 1 - mucosa/submucosa only
Grade 2 - muscularis layer only
Grade 3a- mucosa, submucosa and muscularis (not midline)
Grade 3b - mucosa, submucosa and muscularis (midline and extending into mesorectum/peritoneal tissue
Grade 4 - all layers (mucosa, submucosa, muscularis, serosa)
What is the medical treatment for a rectal tear?
NSAIDs = Flunixin (anti-endotoxic)
Broadspectrum antimicrobials - penicillin, gentamicin
Tetanus vaccine
+/- epidural and packing to prevent faeces sticking to tear
Should you pack a nose if you suspect NG haemorrhage?
No- snorting disturbs clot
What is the surgical treatment for rectal tears?
Placement of rectal liner
Direct suturing (if accessible)
Temporary diverting colostomy
What grades of rectal tear should be medically managed? What about surgically?
Grade 1 and 2 - medical
Grade 3 and 4 - surgical (although can do medical, or euthanasia)
