The Down Horse Flashcards
What general approach to the down Hose?
- SAFETY
- Take thorough hx inc meds administered vacc, and recent travel
- Thorough clinical exam required
- May not reach a diagnosis in first instance
- Need to instigate supportive tx prior to having a dx in those cases
How to stay safe around down horses?
- Stay ‘spine side’
- Head restraint
- Wear helmet
Potential outcomes of recumbent horse?
- Spontaneous recovery
- Not usually called out to these but may see them if attending equestrian
events - Assisted recovery
- Prolonged recumbency
What to take with ?
- Safety helmet
- Stethoscope
- Thermometer
- Ropes/leadrope/head collar
- (Urinary catheter)
What is your primary focus?
Make the horse comfortable NOT to get horse up
What are non-neuro causes of recumbency
Neuro causes of recumbency?
What relevant hx to ask?
- Age, breed, gender, use
- Vaccination
- Is it on tx?
- Feed/toxin access ?
- When last checked/ last seen normal ?
- Weakness or change in demeanour before recumbency?
) Exercised prior to recumbency? - Attempts to rise ?
- Struggling?
- Traumatic incident
- Progression
CE?
- Environment
- CE
- hydration
- Faeces/ urine?
- Haemorrhage?
- Fractures? limb crepitus; spine discontinuity, St swelling
- Chek feet
- Rectal IF safe
- Neuro exam
what to do before sedating down horse?
PErform a CE -> may affect findings if done after
Considerations of sedation?
- Desired length of action
- Desired depth of sedation
- Head trauma evident?
- CVS compromise- Fluids?
- Ataxia?
example sedation for a horse stuck in a ditch otherwise healthy?
- Alpha 2 agonist (romifidine: longest duration of action and less ataxia)
- opioid (butorphanol).
What might you need to do when sedating a down horse?
- May need higher dose than usual due to adrenaline levels
- Might need to top up sedation
- Consider IM if needed but remember need higher doses and 30-40 mins before onset of action
- GA may be required in some cases
Detail rolling a horse?
- will often stand if rolled over
- Give analgesia
- Sedation usually required
What additional diagnostics might you consider?
- Full haem/ biochem/ lactate
- NP swab & serum to test EHV 1
- Urinalysis: cath bladder as black urine supports diagnosis of atypical myopathy
- CSf exam ?
- Imaging - upper airway endoscopy
Management?
Supportive
-> Reduce risk of further injury
- > Shelter?
- hydration & nutrition
- Iv cath?
- Deep bed/ good footing
- Sedation if distressed/ strugglign
- Support in sternal if poss
- turn/ reposition q 2-6 hrs
- Physio
how to manage hydration?
- Fresh water access
- Water & electrolytes via NG tube/indwelling NG tube if safe
- IVFT (bolus or ongoing)
- Hypertonic 5ml/kg (2.5L) followed by shock rate (bolus 20L) Hartmann’s
if dehydration severe - Maintenance: 2-3ml/kg/hr
how to manage nutrition?
- Highly digestible feeds little & often
- Picked grass, sloppy mashes
- If not eating:
*Pelleted food gruel via NG tube
*Feeding through small lumen feeding (NG) tube
*Parenteral nutrition
Physio if intermittent recumbency?
Controlled exercise - inc strength and proprioception
Physio while recumbent?
*Manipulating limbs: passive flexion & extension to maintain ROM
*Assistance to stand regularly with a sling
*Massage, therapeutic ultrasound, hydrotherapy of affected muscle groups?
Use of Sling?
- Time to recover whilst avoiding/minimising complications of
recumbency - Easier to assess lameness/weakness/ataxia in an upright horse
- Need some strength and control of limbs
- Need appropriate mentation
- Not all horses will tolerate
- Continuous monitoring needed (hospital)
Therapeutics?
- Analgesics – caution with NSAIDs if dehydrated/myoglobinuria
- Sedatives if distressed/dangerous (anaesthesia?)
- Diazepam if seizures (+/- additional anti-seizure medication)
- Antibiotics: for primary disease or complications such as
pneumonia, decubital ulcers, UTI. only if indicated
What about therapeutic for head/spinal cord trauma?
Anti-inflammatory and oedema-reducing agents:
*Corticosteroids (dexamethasone 0.1mg/kg IV)
*DMSO (1g/kg IV as 10-20% solution BID)
*Hypertonic saline (4-6mL/kg q6-12hr) OR
* 20% mannitol (1g/kg IV q6-12h)
Complications of recumbency?
