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Y4 - Equine > Management of iatrogenic injuries and other equine emergencies > Flashcards

Management of iatrogenic injuries and other equine emergencies Flashcards

1
Q

What does a iatrogenic injury mean?
Examples?

A
  • Injury caused by medical (veterinary) examination or treatment
    E.g.
  • Nasal haemorrhage during nasogastric intubation / endoscopy
  • Rectal tears during rectal examination
  • Evisceration following castration
  • Adverse drug reaction
  • Anaesthetic death
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2
Q

What are complications of nasogastric intubation?

A
  • Haemorrhage (common)
  • Oesophageal perforation (uncommon)
  • Inhalational pneumonia (uncommon)
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3
Q

What can be done to minimise risk of damage with nasogastric intubation?

A
  • Use an appropriate tube
  • Ensure the horse is restrained
  • Pass the tube along the ventral meatus
  • Never force the tube
  • Ensure it is placed in the oesophagus / stomach before administering fluids
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4
Q

What should be done if there is a haemorrhage?

A
  • Can be alarming to the owner = Mention possible complication
  • Leave the horse quietly for 5-10 minutes
  • Haemorrhage will usually stop by this time
  • Do not pack the nasal passages
  • Further assessment required if haemorrhage continues (uncommon)
  • Endoscopy
  • Clotting profiles
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5
Q

When would you suspect oesophageal perforation?

A
  • If blood on tube (in absence of epistaxis)
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6
Q

How would you assess / treat oesophageal perforation?

A
  • Endoscopic assessment of the oesophagus +/- radiography
  • Full thickness perforations have poor prognosis
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7
Q

How does inhalational pneumonia occur?

A
  • Passage of nasogastric tube into the trachea
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8
Q

What happens with water inhalation?

A
  • Small quantities not usually a problem
  • Large quantities can result in pulmonary oedema / inhalational pneumonia
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9
Q

What happens with liquid paraffin inhalation?

A
  • Severe lipoid pneumonia
  • LIFE THREATENING
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10
Q

What are the biggest complication of rectal examination?
What increases this risk?

A
  • Rectal Tears
  • Increased risk:
  • Arabians
  • Stallions / colts
  • Colics
  • Fractious horses
  • Using an ultrasound probe
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11
Q

How can you reduce risk of rectal tears on rectal examination?

A
  • Be in a safe position
  • Ensure the horse is restrained
  • Sedate if necessary +/- butylscopolamine
  • Never push against the rectum if the horse strains
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12
Q

When would you suspect a rectal tear?

A
  • Blood on rectal sleeve
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13
Q

What would your initial action to a rectal tear be?

A
  • Inform the owner
  • Sedation
  • Butylscopolamine
  • +/- epidural anaesthesia
  • Evaluate rectal mucosa - Lubrication and lidocaine
  • Proctoscopy
  • Determine the location and grade
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14
Q

What are the grades of rectal tears?

A
  • Grade 1 = Mucosa & submucosa torn
  • Grade 2 = Muscularis only
  • Grade 3a = Mucosa and muscularis (serosa intact)
  • Grade 3b = Mucosa and muscularis (tear into mesocolon) - further caudal
  • Grade 4 = All layers torn
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15
Q

How would you treat each grade of rectal tear?

A
  • Grade 1 = medical management
  • Grade 2 = medical management
  • Grade 3+4 = Medical / surgical management (euthanasia?)
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16
Q

What is medical treatment of rectal tears?

A
  • Broad spectrum antimicrobials – penicillin / gentamicin
  • Flunixin meglumine
  • Tetanus status
  • +/- epidural anaesthetic and packing of rectum
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17
Q

What are surgical management of rectal tears?

A
  • Direct suturing - single handed long needle
  • Placement of a rectal liner - GA
  • Temporary diverting colostomy - May require 2 GA ££
18
Q

What are other iatrogenic injuries / accidents?

A
  • Adverse drug reaction
  • Anaphylaxis
  • Intracarotid drug administration
  • Perivascular injections
  • Injection site abscess
  • Iatrogenic synovial sepsis
  • Broken needles
  • Catheter accidents
  • Anaesthesic-related complications
19
Q

What are golden rules of trapped horses?

A
  • Trapped horses can be unpredictable = Offering food and keeping a companion nearby may help
  • Be aware of your own and others’ safety - Work from the spine side of the horse
  • Have control of the horse’s head - Place a headcollar
  • Be prepared to sedate / anaesthetise
  • Never release the horse unless it has somewhere safe to go
  • Always plan an exit route for you and others
20
Q

What should be done after freeing a horse?

A
  • Full clinical exam
  • Assessment + Tx of -
  • limb fractures
  • wounds
  • head / ocular injuries
  • dehydration / hypothermia
  • acute haemorrhage
  • URT/LRT inflammation
21
Q

What injuries need to be considered with stable fires?

A
  • Smoke inhalation - black sut around nose
  • Skin burns
  • Corneal ulceration
  • Hypovolaemia ‘burn shock
22
Q

How would you assess a horse initially after a stable fire?

A
  • Lukewarm water; remove rugs
  • Sedation / anxiolytics if required
  • Administer flunixin
  • +/- oxygen
  • IV catheter +/- tracheostomy
  • Referral / euthanasia may be needed
23
Q

What should be done with less severe burn cases?

A
  • Cool skin
  • Clip hair
  • Lavage (0.05% chlorhexidine solution)
  • Water (not oil) based antimicrobial ointment = Silver sulfadiazine
24
Q

With wounds what would be your initial advice to the owners?

A
  • Control haemorrhage: = Dressing, Pressure
  • Do not move the horse if it is very lame unless in imminent danger
  • Minor wounds in low-risk areas = telephone advice may be all that is needed
  • More severe cases = tell owners not to apply anything to the wound
25
Q

What history would you want to know with wounds?

A
  • Tetanus status
26
Q

With wounds what would you assess on clinical exam?

A

PRIOR TO EXAM = stop haemorrhage + stabilise limb

  • Shock/ other injuries
  • Assess stance / weightbearing
  • Vital parameters
  • Blood loss
  • Other smaller wounds
27
Q

What would you do with the wound?

A
  • Sedation
  • Assess - age of wound, contamination + location
  • Apply sterile gel
  • Clip + clean around site
28
Q

What would you use to lavage the wound?

A
  • 0.05 chlorohexidine
  • 0.1 povidone iodine
    -35-60ml syringe w 18/19G needle
29
Q

Whilst assessing wounds what would you check?

A
  • Sterile gloves, use finger / sterile probe
  • Depth and direction
  • Foreign material
  • Subcutaneous pockets
  • Bone / tendon exposure
  • Joint / tendon sheath?
  • Thoracic / abdominal organs?
  • Trachea / oesophagus?
30
Q

What would your considerations with injuries be?

A
  • Time since injury
  • Contamination / infection
  • Tissue defects
  • Tissue flaps / viability
  • Patient compliance
  • Is GA needed
31
Q

What is ideal conditions for wound suturing?

A
  • <8h old
  • Healthy tissue
  • Eyelids, nostrils, lips (full thickness)
32
Q

What can be used for local anaesthesia with wounds to suture? What nerve block could you do?

A
  • Mepivacaine
  • Lignocaine
  • regional nerve block
  • Ring / L-block
33
Q

How would you suture a horse?

A
  • Remove necrotic tissue
  • Preserve tissue flaps
  • Skin staples = quick + easy - NO TENSION
  • Skin suture = 2-0 - 0 USP monofilament = polypropylene
  • SC suture = 2-0 USP, absorbable = poliglecaprone
  • Drain
  • Dress / bandage
34
Q

What are other ongoing management of wounds?

A
  • Analgesia / anti-inflammatories
  • IV at first, followed by oral
  • Antimicrobials - IM followed by oral
  • Tetanus toxoid booster
  • Box rest
  • Suture / staple removal - 10-14days
  • Dressing / bandage change - as often as needed (exudate)
35
Q

How is secondary intention healing carried out?

A
  • Sterile hydrogel + non-adherent, absorbent dressing
  • Bandaging of distal limb
36
Q

What are complications of wounds?

A
  • Synovial sepsis / fracture (missed initially)
  • Sequestrum formation - Where cortex of the bone exposed
  • Dehiscence - wound bursting open
  • Foreign material remains in situ - Be careful if wood involved
  • Bandage sores
37
Q

What must a wound bed be for a successful graft?

A
  • Vascularised
  • No necrotic tissue
  • No overt infection
  • No evidence of delayed wound healing
  • Sequestrum
  • Foreign body
38
Q

What are indications for grafting?

A
  • Traumatic injuries
  • Non- / slow-healing granulating wounds
  • Adjunct to management of skin neoplasia
  • Extensive skin burns
  • Deformity-causing scarring
39
Q

How is pinch / punch grafting carried out?

A
  • Well lit, quiet
  • Sedation
  • Equipment ready
  • Donor site prepared =
  • Neck
  • +/- abdomen
  • Clipped, local anaesthesia
  • Skin preparation
  • Grafting site prepared = Cleaned & superficial debridement already performed

Placing grafts
* Start at the lowest site (prevents haemorrhage obscuring sites)
* Make a pocket in the granulation bed - No 15 scalpel blade
* Tuck grafts into each pocket
* Non-adhesive dressing, bandage
* Box rest
* Change bandage in 5-7 days

40
Q

What do you need to identify for referral horses?

A
  • Identify cases needing -
  • More intensive care
  • Detailed investigations
  • Surgical intervention
  • Initiate honest discussion with owner / carer
  • If appropriate start arranging possible transport
  • If referral is declined, the client should be aware of potential outcomes
41
Q

What should be done if considering referral?

A
  • Good communication between vet, referral centre and owner
42
Q
A

Y4 - Equine (46 decks)

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