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Equine (fourth year) > Iatrogenic injury > Flashcards

Iatrogenic injury Flashcards

1
Q

what does iatrogenic mean?

A

illness caused by medical examination or treatment

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2
Q

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

A

communication and informing owner of risks/complications

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3
Q

what are some complications associated with nasogastric intubation?

A

haemorrhage
oesophageal perforation
inhalation pneumonia

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4
Q

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

A

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

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5
Q

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

A

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

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6
Q

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

A

blood on tube in the absence of epistaxis

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7
Q

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

A

further investigation - endoscope, radiography…

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8
Q

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

A

large quantities of water
liquid parafin in lungs

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9
Q

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

A

arabians
stallions/colts
colics
fractious horses
ultrasound probes

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10
Q

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

A

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

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11
Q

what is a grade 1 rectal tear?

A

mucosa and submucosa torn

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12
Q

what is a grade 2 rectal tear?

A

only muscularis only (may not see blood)

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13
Q

what is a grade 3a rectal tear?

A

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

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14
Q

what is a grade 3b rectal tear?

A

mucosa and muscularis (torn into mesorectum)

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15
Q

what is a grade 4 rectal tear?

A

all layers torn

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16
Q

what grade rectal tears can be managed medically?

A

1 and 2 (offer referral)

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17
Q

what drugs are administered to rectal tear cases?

A

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

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18
Q

what are the options for treating rectal tears?

A

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

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19
Q

what is the most common adverse drug reaction?

A

penicillin

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20
Q

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

A

smoke inhalation
skin burns
corneal ulceration
hypovolaemia (burn shock)

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21
Q

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

A

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

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22
Q

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

A

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

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23
Q

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

A

tetanus status

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24
Q

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

A

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

25
Q

what should be assessed about a wound on a horse?

A

age of wound
contamination
location

26
Q

what should be done before clipping a wound?

A

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

27
Q

what are some options for lavageing a wound?

A

sterile polytonic fluid
0.05% chlorhexidine
0.1% povidone iodine

28
Q

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

A

10-15psi

29
Q

what are you palpating for when assessing a wound?

A

depth and direction
foreign material
subcutaneous pockets
bone/tendon exposure

30
Q

what must be considered when further assessing wounds and treating?

A

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

31
Q

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

A

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

32
Q

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

A

eyelid, nostril, lips (aesthetically)

33
Q

what can be used for local anaesthesia when suturing wounds?

A

mepivacaine/lignocaine (not with adrenaline)

34
Q

what type of suture material is used for hoses skin?

A

3-3.5 metric monofilament (eg. polypropylene)

35
Q

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

A

3 metric absorbable

36
Q

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

A

tension throughout the wound

37
Q

how are wounds managed after suturing closed?

A

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

38
Q

when can trimethoprim sulphonamide not be administered IV?

A

when sedating the horse at the same time - fatal arrhythmias

39
Q

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

A

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

40
Q

when are sutures/staples taken out?

A

10-14 days

41
Q

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

A

amount of exudate produced

42
Q

what is secondary intention healing?

A

manage wound as open with a granulation tissue bed

43
Q

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

A

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

44
Q

what are the main complications of wounds?

A

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

45
Q

how is a sequestrum (wound complication) fixed?

A

removal of piece of bone causing this

46
Q

how fast does epithelialisation occur?

A

<1mm/week

47
Q

what is the most commonly used skin graft in horses?

A

free graft (autographs)

48
Q

what are the types of free grafts?

A

pinch, punch, tunnel
solid or meshed sheets

49
Q

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

A

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

50
Q

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

A

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

51
Q

what are some indications for a skin graft?

A

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

52
Q

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

A

white hairs can form at the donor site

53
Q

when taking multiple punch grafts where should you start?

A

lowest site - bleed and will obscure view for further punches

54
Q

what should be made when placing a punch graft?

A

pocket in the granulation bed to tuck graft into

55
Q

what type of dressing is used for grafts?

A

non-adhesive!!

56
Q

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

A

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

57
Q

what is a common donor site for full thickness grafts?

A

pectoral region

58
Q

what are modified meek micrografts?

A

lot of tiny island grafts

59
Q

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

A

sedate mare

Equine (fourth year) (11 decks)

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