Triage and 1st aid Flashcards
What cases are emergencies?
▪ Respiratory distress
▪ Colic
▪ Dystocia
▪ Collapse/recumbency ▪Extreme pain
▪ Sudden onset lameness
▪ Fractures
▪ Severe wounds (including synovial injuries)
▪ Ocular injuries / severe ocular disease
▪ Urinary obstruction
▪Toxin ingestion
Emergency considerations
▪ Situation control: public safety, owner / rider safety, patient safety and personal safety – involvement of other service (police, fire service, ambulance)
▪ Owner consent (e.g. RTA with no owner present)
▪ Distressed owners (don’t forget the owner, may need to separate from
situation / animal)
▪ Experienced handlers are invaluable (nurses or colleagues)
▪ Safety of staff involved (your safety and those working around you)
Priority 1
= Immediate action (or might die)
Examples:
- History of head or spinal trauma
- History consistent with internal injuries
- Life threatening haemorrhage
Priority 2
= Do not move (or could become unfixable)
Examples:
- Fracture,
- Tendon rupture/laceration,
- Joint instability,
- Vascular or neurological damage
Priority 3
= Requires urgent attention (cases where you need to recognise the complications and treat them urgently or the prognosis will be compromised)
Examples:
- synovial or bony involvement
- contaminated wounds
Priority 4
= Delayed action (does not need an urgent / emergency visit)
- Can be difficult to decide without examining in patient
- If in doubt, always offer emergency visit and advise on potential issues / complications if not seen. If client has called as an emergency, they are usually worried enough to need an emergency visit..
▪ Examples: chronic wounds/injuries, but remember these can progress and become urgent (e.g. development of synovial infection)
Observation
▪Start by standing back and getting an overall impression of the patient – look for gross abnormalities and observe stance and demeanour
▪Degree of lameness
▪Conformational changes / Gross abnormalities
▪Location and discharge from wound (what structures might be involved)
▪Degree of Blood loss (severity and duration) ▪Degree of contamination (type, duration and extent)
Superficial wounds alone do not cause significant lameness, look for:
▪severe contusions / muscle damage
▪tendons / ligaments
▪joints / bones
▪neurological involvement
Physical exam - general points
▪Animal is in pain – risk to yourself, owner / handler and animal
▪May need to sedate / anaesthetise / give analgesia first
▪May need to re-examine
Kit list
- gloves
- KY jelly /hydrogel (to prevent hair or dirt getting in during clipping)
- sterile probe (for any small wounds you can’t palpate to the bottom of)
What to look for on physical exam
▪Presence / absence of crepitus (distinguishing fractures and emphysema)
▪Degree of contamination ▪Soft tissue involvement ▪Bony involvement ▪Swellings and effusions
7 steps of 1st aid
- Restraint
- Control haemorrhage
- Control pain
- Reduce contamination
- Close wound?
- Bandage for wound protection
- Splint fractures and tendon injuries
Important factors to consider when thinking about restraint
▪ Is there significant blood loss?
▪Will ataxia / weight-bearing make this injury worse?
Physical restraint
▪ Competent handler (ideally nurse or colleague), if owner is very upset or injured,
involve someone else
▪ If horse is injured whilst competing, remove all tack and boots, except for bridle
▪ Ensure you clear an area to examine and treat the horse (large events will have screens and team to help with this)
▪ Remember that injured horses can react and kick unpredictably, even when sedated
▪ Wear a hat
First aid starting point
- analgesia and supporting unstable injuries (+/- sedation)
Chemical restraint
▪ Start with lower doses of alpha-2 agonists and add as needed
▪ Choose alpha-2 based on duration needed (short duration, e.g. applying splint – xylazine, longer duration, e.g. wound debridement, bandaging and transport – romifidine)
▪ Can use combination of IV and IM routes (IM has slower onset but longer duration and less ataxia – esp good for travelling horses)
▪ Always include opioids (butorphanol or buprenorphine most readily available in field situation) – analgesia and reduce touch sensation
Which animals should you avoid ACP in?
- Animals with blood loss / hypovolaemia / exhaustion
- Remember also has no analgesic effect
Control of haemorrhage - options
▪Pressure (bandage)
– most haemorrhage can be controlled with a pressure bandage initially for 5-10 mins
▪ tourniquet
– can apply a tourniquet in the standing horse which can help you find and ligate major bleeders, or perform standing surgery with minimal blood in the surgical field
▪use of ligatures?
– can be difficult and can act as a source of infection
Controlling pain
▪Consider pain relief as a first aid priority
▪ Go for a multi-modal approach
– NSAIDs (administer IV) NB Passport!
– +/- Opioids
– Splinting / bandaging to prevent movement
– +/- Sedation
– Local anaesthesia infiltration
▪Avoid distal limb local blocks where weight bearing could result in catastrophic injury
The use of NSAIDs in trauma
▪NB NSAIDs contraindicated in hypovolaemia, severe
haemorrhage, renal/liver compromise
▪Commonly used in equine practice are flunixin meglumine (1.1mg/kg SID), phenylbutazone (initial dose 4.4mg/kg IV SID, reducing to 2.2mg/kg IV or oral) and meloxicam (0.6mg/kg)
▪ Can use paracetamol IV and follow up with oral (20mg/kg BID orally) – not licensed, usually added when horse reaches practice/hospital
Analgesia - opioid options
▪Equine e.g. butorphanol, buprenorphine, methadone, morphine
– butorphanol and buprenorphine are partial agonists but the main opioids carried in vets cars
– methadone and morphine tend to only be available in hospital setting
– buprenorphine is usually a better choice than butorphanol for most conditions but is a lot more expensive
▪Notes: use opioids with alpha 2 agonists or acepromazine in horses, reduces side effects associated with opioids
▪Care with use of potent opioids e.g. with respiratory depression, bradycardia, but don’t let that stop you choosing them as v efficacious and provide excellent analgesia (side effects are less common in animals in pain)
▪Ketamine ‘stun’ dose of 0.2mg/kg IV can be helpful in some cases
Splinting - regions 1-4
▪Region 1: alignment of dorsal cortices, splint placed dorsally (commercial splints)
▪Region 2: splint placed laterally and caudally
▪Region 3: splint placed laterally (and medially)
▪Region 4: forelimb - stabilise carpus
Splinting region 1
- Region 1 is from the fetlock and below
- all the distal tendon and ligament injuries
- need to bring the bones into alignment and remove the hyperextension forces around the fetlock
- done by raising the heel with a wedge and applying a splint down the dorsal aspect of the limb
- can make homemade ones, but the heel wedges are difficult to keep in position, and there are some excellent commercial ones which are quick and easy to apply
Splinting region 2
- between the fetlock and carpus or tarsus
- require splints placed on the lateral and palmar or plantar aspects
- can use any sturdy materials, strong plastic guttering or wooden splints
