Iatrogenic injury

Question 1

what does iatrogenic mean?

Answer 1

illness caused by medical examination or treatment

Question 2

what is critical to ensuring legal issues don’t come up associated with iatrogenic injury?

Answer 2

communication and informing owner of risks/complications

Question 3

what are some complications associated with nasogastric intubation?

Answer 3

haemorrhage
oesophageal perforation
inhalation pneumonia

Question 4

how can the risk of complications associated with nasogastric intubation be minimised?

Answer 4

use appropriate tube
ensure restraint
pass tube along ventral meatus
never force the tube
ensure correct position before administering fluid

Question 5

what should be done if a horse starts haemorrhaging when placing a nasogastric tube?

Answer 5

leave quietly for 5-10 minutes
(do not pack nasal passage - blood builds up!!)

Question 6

what can make you suspect an oesophageal perforation when placing a nasogastric tube?

Answer 6

blood on tube in the absence of epistaxis

Question 7

what is required if an oesophageal perforation due to nasogastric tube placement is suspected?

Answer 7

further investigation - endoscope, radiography…

Question 8

when is inhalation pneumonia considered a severe problem from nasogastric tube placement?

Answer 8

large quantities of water
liquid parafin in lungs

Question 9

what factors increase the risk of rectal tears from rectal examination?

Answer 9

arabians
stallions/colts
colics
fractious horses
ultrasound probes

Question 10

what are the initial actions taken when a rectal tear from rectal examination is suspected? (blood on glove)

Answer 10

inform owner
sedate and butylscopolamine
evaluate rectal mucosa (local and lube)
determine location and grade (deepness)

Question 11

what is a grade 1 rectal tear?

Answer 11

mucosa and submucosa torn

Question 12

what is a grade 2 rectal tear?

Answer 12

only muscularis only (may not see blood)

Question 13

what is a grade 3a rectal tear?

Answer 13

mucosa and muscularis (serosa intact) - no communication with abdomen

Question 14

what is a grade 3b rectal tear?

Answer 14

mucosa and muscularis (torn into mesorectum)

Question 15

what is a grade 4 rectal tear?

Answer 15

all layers torn

Question 16

what grade rectal tears can be managed medically?

Answer 16

1 and 2 (offer referral)

Question 17

what drugs are administered to rectal tear cases?

Answer 17

broad spectrum antimicrobials (penicillin/gentamicin)
flunixin meglumine
tetanus??

Question 18

what are the options for treating rectal tears?

Answer 18

direct suture (difficult to access)
rectal liner placement (sleeve covers tear)
temporary diverting colostomy

Question 19

what is the most common adverse drug reaction?

Answer 19

penicillin

Question 20

what are the main injuries to consider in cases of stable fires?

Answer 20

smoke inhalation
skin burns
corneal ulceration
hypovolaemia (burn shock)

Question 21

what are the initial actions when dealing with a horses in a stable fire?

Answer 21

remove rugs and apply lukewarm water
sedation/anxiolytic
flunixin
possible oxygen and tracheostomy
(euthanasia)

Question 22

what initial advice would be given to an owner with a horse that has a wound?

Answer 22

control haemorrhage using dressing/pressure
don’t move horse if lame (unless in danger)

Question 23

what is a key point that should be found out about a horses history when they present with a wound?

Answer 23

tetanus status

Question 24

how long can packed cell volume and total volume take to change in a haemorrhaging horses?

Answer 24

12-24 hours possibly (lactate will go up faster)

Question 25

what should be assessed about a wound on a horse?

Answer 25

age of wound contamination location

Question 26

what should be done before clipping a wound?

Answer 26

apply sterile gel to ensure the wound doesn't becoming increasingly contaminated

Question 27

what are some options for lavageing a wound?

Answer 27

sterile polytonic fluid 0.05% chlorhexidine 0.1% povidone iodine

Question 28

what is the correct pressure to flush a wound to keep it healthy and remove debris?

Answer 28

10-15psi

Question 29

what are you palpating for when assessing a wound?

Answer 29

depth and direction foreign material subcutaneous pockets bone/tendon exposure

Question 30

what must be considered when further assessing wounds and treating?

Answer 30

time since injury contamination tissue defects/viability patient compliance GA needed?

Question 31

how old should wounds ideally be if you are suturing them closed?

Answer 31

<8 hours (less chance of smooth closure if older and more likely to break down)

Question 32

what are some examples of structures which must be sutured immediately no matter how old the wound?

Answer 32

eyelid, nostril, lips (aesthetically)

Question 33

what can be used for local anaesthesia when suturing wounds?

Answer 33

mepivacaine/lignocaine (not with adrenaline)

Question 34

what type of suture material is used for hoses skin?

Answer 34

3-3.5 metric monofilament (eg. polypropylene)

Question 35

what type of suture material is used for the subcutaneous layer in horses?

Answer 35

3 metric absorbable

Question 36

what does the size of the suture material largely depend on?

Answer 36

tension throughout the wound

Question 37

how are wounds managed after suturing closed?

Answer 37

analgesia and anti-inflammatories antimicrobials tetanus booster box rest (care with colic) removal of suture and bandage change

Question 38

when can trimethoprim sulphonamide not be administered IV?

Answer 38

when sedating the horse at the same time - fatal arrhythmias

Question 39

why does care need to be taken when putting a horse on box rest?

Answer 39

more prone to colic (ensure adequate water, faeces production...)

Question 40

when are sutures/staples taken out?

Answer 40

10-14 days

Question 41

what does the frequency of bandage change for a wound depend on?

Answer 41

amount of exudate produced

Question 42

what is secondary intention healing?

Answer 42

manage wound as open with a granulation tissue bed

Question 43

what should be used to dress wounds healing by second intention?

Answer 43

sterile hydrogel, non-adherent and absorbent dressing important to have no movement (splint, cast...)

Question 44

what are the main complications of wounds?

Answer 44

synovial sepsis or fracture (missed initially) sequestrum formation dehiscence foreign material bandage sores

Question 45

how is a sequestrum (wound complication) fixed?

Answer 45

removal of piece of bone causing this

Question 46

how fast does epithelialisation occur?

Answer 46

<1mm/week

Question 47

what is the most commonly used skin graft in horses?

Answer 47

free graft (autographs)

Question 48

what are the types of free grafts?

Answer 48

pinch, punch, tunnel solid or meshed sheets

Question 49

what is the most important aspect needed to carry out a skin graft?

Answer 49

healthy granulating wound bed (can still put one on a fresh wound)

Question 50

what conditions need to be met for a skin graft to be accepted?

Answer 50

vascularised no necrotic tissue no infection no evidence of delayed healing (sequestrum, foreign body...)

Question 51

what are some indications for a skin graft?

Answer 51

traumatic injuries slow healing granulating wounds management of skin neoplasia extensive burns deformity causing scarring

Question 52

what is the aesthetical risk to warn owners of if carrying out a pinch graft?

Answer 52

white hairs can form at the donor site

Question 53

when taking multiple punch grafts where should you start?

Answer 53

lowest site - bleed and will obscure view for further punches

Question 54

what should be made when placing a punch graft?

Answer 54

pocket in the granulation bed to tuck graft into

Question 55

what type of dressing is used for grafts?

Answer 55

non-adhesive!!

Question 56

how long needs to be left before replacing a bandage after a graft?

Answer 56

5-7 days (otherwise graft will come off with bandage)

Question 57

what is a common donor site for full thickness grafts?

Answer 57

pectoral region

Question 58

what are modified meek micrografts?

Answer 58

lot of tiny island grafts

Question 59

what needs to be done if mare and foal need to be separated to take a foal on an emergency referral?

Answer 59

sedate mare