Management of Equine Acute Colic Flashcards
what does analgesia choice depend on (2)
- degree of pain
- duration of action
what are short acting analgesics (4)
- xylazine
- buscopan
- morphine
- ketamine
what are longer acting analgesics (3)
- detomidine
- butorphanol
- NSAIDs
what NSAIDs can be used (4)
- flunixin meglumine
- phenylbutazone
- meloxicam
- ketoprofen
what are side effects of NSAIDs (3)
1, renal injury
- right dorsal colitis
- delayed mucosal healing
what is the dose of flunixin megulmine
1.1 mg/kg IV
how long does flunixin last
up to 24 hours, dose q 12 hours max
how potent is flunixin
potent
take any signs of discomfort very seriously
how long before you refeed after a dose of flunixin
until 24 hours after last dose
what routes are used to administer flunixin
IV or oral
not IM –> clostridial myositis
what is the dose for phenylbutazone
4.4 mg/kg IV max
which is more potent flunixin or phenylbutazone
flunixine
what routes can phenylbutazone be given
IV only – perivascular tissue damage
oral
what is buscopan made of
butylscopolamine
what is the dose of buscopan
0.1-0.3 mg/kg IV
how does buscopan act
blocks muscarinic receptors
parasympatholytic
what are side effects of buscopan
tachycardia
how long acting is buscopan
short acting
what are a-2 adrenergic agonists
xylazine
detomidine
which is shorter acting xylazine and detomidine
xylazine is shorter acting
what is the dose of xylazine used
0.4mg/kg IV or IM
what dose of detomidine is used
0.01 mg/kg IV or IM
what dose of butorphanol is used
0.01-0.02 mg/kg IV or IM
what dose of morphine is used
0.12 mg/kg IV or IM
what dose of ketamine is used
0.5 mg/kg IM or IV
what is the maintanence amout of fluid for an adult horse
60 ml/kg/day
what is the maintanence amout of fluid for a foal
100 ml/kg/day
when would IV fluids be indicated
reflux or hypovolemia
what is an appropriate amount of enteral fluid
5L for 500kg horse
how often should you repeat enteral fluid
repeat every 30 mins to 2 hours
what is a recipe for enteral fluids to make them isotonic
- table salt (NaCl) and Lo salt (NaCl/KCl)
15ml tablesalt and 15 Losalt in 4L of water
- 5.27g NaCl, 0.37g KCl, 3.78g sodium bicarbonate
what are the isotonic crystalloid fluids (4)
- hartmanns
- LRS
- Plasmalyte
- replacement fluids
what are hypertonic crystalloid fluids
7.2% saline
what are colloid fluids
- hetastarch
- plasma
how do you assess IV therapy and how much fluid
goal directed based on mucus membranes, heart rate, urine output, jugular fill, PCV, lactate
how much should you give in a bolus of IV fluids
10-20 ml/kg and re-assess
what would 6% dehydration HR, CRT, PCV/TP and creatinine be
HR: 40-60
CRT: 2 secs
PCV/TP: 40/70
creatinine: 90-180 umol/l
what would 8% dehydration HR, CRT, PCV/TP and creatinine be
HR: 60-80
CRT: 3
PCV/TP: 45/75
creatinine: 180-270 umol/l
what would 10% dehydration HR, CRT, PCV/TP and creatinine be
HR: 80-100
CRT: 4
PCV/TP: 50/80
creatinine: 270-350
what would 12% dehydration HR, CRT, PCV/TP and creatinine be
HR: >100
CRT: >4
PCV/TP: >50/>80
creatinine: >350
how do you calculate the estimated fluid deficit
BW (kg) x % dehydration (decimal)
what is the goal for treating impactions (3)
- soften impaction/ease passage
- increase motility
- maintain comfort
what are 3 ways you could soften an impaction
- repeated high volume gastric lavage: 1-2L of water in
- coke administration (1-2L)
- CRI isotonic enteral fluids
what are ways the owner can manage an impaction
stimulate motility
hand walking
what is bethanechol
pro kinetic
for impaction
what is the most common type large colon impaction
pelvic flexure impaction
what are 4 methods of softening a large colon impaction
- isotonic enteral fluids
- cathartic MgSO4/epsom salt - ONCE
- (liquid paraffin/mineral oil)
- IV fluids: requires 3x maintenance
how much isotonic enteral fluids can you give to soften a large colon impaction
5L every 1 hr until resolved
what analgesic can you give for a large colon impaction
flunixin 1.1 mg/kg
how long does flunixin last
except to last 12 hours
how do you treat a cecal impaction
surgery
how do you medically manage a cecal impaction (3)
- soften through enteral fluids
- increase motility: hand walking
- maintain comfort: usually not very painful –> if painful surgery is indicated
how do you treat a small colon impaction
soften
or if not surgery and guarded prognosis
how do you soften a small colon impaction
enema –> gravity admin using stomach tube
IV fluids 1-3x maintenance
mineral oil/liquid paraffin
(enteral fluids are less effective)
why are enteral fluids less effective in managing a small colon impaction
because most of the fluids are absorbed by the colon
what is phenylephrine
a-1 adrenergic agonist
peripheral vasoconstriction and splenic contraction
what is phenylephrine used for
nephrosplenic entrapment to induce vasoconstriction and splenic contraction
what is the dose of phenylephrine
20ug/kg IV over 15 mins
what are the risks of phenylephrine
fatal hemorrhage in older horses (>15 years)
bradycardia –> slow infusion or walk
lunge horse for 15 mins after admin
what can rolling the horse be used to treat
nephrosplenic entrapment
how is rolling procedure performed when treating a nephrosplenic entrapment
phenyephrine admin and general anesthesia induced
dorsal recumbency and agitated
assess by US and repeat transrectal palpation
what is a percutaneous cecal trocharization
performed to reduce gas distention of the cecum in large colon impaction or displacement
what are the risks of percutaneous cecal trocharization
risk of peritonitis (potentially fatal)
what is seen with enteritis on US
distended SI on rectal and US with large volumes of reflux
only mild pain once stomach decompressed
how is enteritis treated
frequent gastric decompression
IV fluids (can have significant losses)
anti endotoxemic therapy
lidocaine
antimicrobials
how is sand impaction diagnosed
fecal test
mix with water in glove, sand sediments
diagnosis confirmed by rads
how are sand impactions treated
psyllium by NGT
surgery
what is the prognosis of colic surgery related to (4)
- heart rate
- PCV
- type of surgery
- length of resection
what are postoperative complications of colic surgery (7)
- anesthesia
- ileus
- peritonitis
- incisional infection/hernia
- laminitis
- jugular vein thrombosis
- adhesion formation
what increases the risk of post operative ileus
SI lesions esp resection and anastomosis
how is postoperative ileus managed (4)
- frequent gastric decompression (1-4 hours)
- IV fluid therapy
- prokinetics
- partial parenteral nutrition?
what are prokinetics that can be used to treat postoperative ileus (4)
- lidocaine
- metaclopramide
- erythromycin
- bethanechol
how is lidocaine administered as a pro kinetic to treat post op ileus
bolus then CRI
how is metaclopramide administered as a pro kinetic to treat post op ileus
CRI
what is a side effect of metaclopramide
side effect is severe aggression
how is erythromycin administered as a pro kinetic to treat post op ileus
intermittent bolus q 6 hours
expensive
