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Y4 Equine - Lameness & Orthopaedics > Triage and 1st aid > Flashcards

Triage and 1st aid Flashcards

1
Q

What cases are emergencies?

A

▪ 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

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2
Q

Emergency considerations

A

▪ 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)

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3
Q

Priority 1

A

= Immediate action (or might die)

Examples:
- History of head or spinal trauma
- History consistent with internal injuries
- Life threatening haemorrhage

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4
Q

Priority 2

A

= Do not move (or could become unfixable)

Examples:
- Fracture,
- Tendon rupture/laceration,
- Joint instability,
- Vascular or neurological damage

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5
Q

Priority 3

A

= 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

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6
Q

Priority 4

A

= 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)

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7
Q

Observation

A

▪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)

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8
Q

Superficial wounds alone do not cause significant lameness, look for:

A

▪severe contusions / muscle damage
▪tendons / ligaments
▪joints / bones
▪neurological involvement

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9
Q

Physical exam - general points

A

▪Animal is in pain – risk to yourself, owner / handler and animal
▪May need to sedate / anaesthetise / give analgesia first
▪May need to re-examine

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10
Q

Kit list

A
  • 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)
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11
Q

What to look for on physical exam

A

▪Presence / absence of crepitus (distinguishing fractures and emphysema)
▪Degree of contamination ▪Soft tissue involvement ▪Bony involvement ▪Swellings and effusions

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12
Q

7 steps of 1st aid

A
  1. Restraint
  2. Control haemorrhage
  3. Control pain
  4. Reduce contamination
  5. Close wound?
  6. Bandage for wound protection
  7. Splint fractures and tendon injuries
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13
Q

Important factors to consider when thinking about restraint

A

▪ Is there significant blood loss?
▪Will ataxia / weight-bearing make this injury worse?

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14
Q

Physical restraint

A

▪ 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

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15
Q

First aid starting point

A
  • analgesia and supporting unstable injuries (+/- sedation)
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16
Q

Chemical restraint

A

▪ 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

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17
Q

Which animals should you avoid ACP in?

A
  • Animals with blood loss / hypovolaemia / exhaustion
  • Remember also has no analgesic effect
18
Q

Control of haemorrhage - options

A

▪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

19
Q

Controlling pain

A

▪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

20
Q

The use of NSAIDs in trauma

A

▪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

21
Q

Analgesia - opioid options

A

▪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

22
Q

Splinting - regions 1-4

A

▪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

23
Q

Splinting region 1

A
  • 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
24
Q

Splinting region 2

A
  • 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
25
Q

Splinting region 3

A
  • between the carpus to elbow, or tarsus to stifle
  • require a splint on the lateral aspect, if you can fit one to the leg, the medial aspect as well – again a large piece of wound or strong guttering can be used to create splints
  • biggest problems with these are the radius or tibia popping out laterally - so need to stabilise and place a splint on the lateral aspect
26
Q

Splinting region 4

A
  • anything above the elbow and stifle, we can’t splint effectively
  • some of the olecranon or more proximal fractures may struggle to stabilise the carpus, and may benefit from these being splinted
  • but the weight of the splint can be a problem and make things worse, so use clinical judgement on this
  • if your splint does not improve things, then take it off
27
Q

Client considerations for decision making

A

▪prognosis for athletic function
▪prognosis for pasture soundness
▪cost
▪duration of box rest
▪time out of work
▪amount of nursing required

28
Q

Injuries with poor prognosis for recovery

A

▪compound, open fractures with significant contamination or soft tissue damage
▪complete fractures involving the femur, humerus and tibia
▪complete laceration SDFT, DDFT and SL (above the fetlock)
▪complete laceration of SDFT, DDFT and distal sesamoidean ligaments (below the fetlock)

Some of these fractures can be repaired in smaller equids (e.g. foals and mini ponies) but otherwise these cause major disruptions of the limb biomechanics and there aren’t implants strong enough to hold these together while they repair

29
Q

Rehab - long term analgesic options

A
  • NSAIDs
  • Oral paracetamol (not licenced)
  • Intra-synovial corticosteroids
  • PsGAGs
  • Sarapin
  • Shock wave therapy
  • iRAP
  • Arthramid
30
Q

Rehab - long term analgesia with NSAIDs (Bute)

A

▪ Phenylbutazone (Oral doses: Day 1 4.4 mg/kg BID, Day 2 2.2mg/kg BID, then reduce to 2.2mg/kg SID or every other day)
▪ Licensed for long term use, but warn client about possible complications
▪ Side effects include: right dorsal colitis, gastric ulceration, renal disease, blood dyscrasias
▪ Safety threshold is low - work doses out correctly
▪ Horses cannot compete on medication for most
regulatory organisations
▪ Should not be used in young foals

31
Q

Alternatives to bute

A
  • oral flunixin
  • oral suxibuzone
  • oral meloxicam
32
Q

Rehab - intra-synovial corticosteroids

A
  • triamcinolone, methylprednisolone
    ▪Can be very effective for relatively long periods of time post injection, think carefully about loading and use of joints after medication
33
Q

Rehab - PsGAGs

A
  • intra-articular or IM administration
  • some anti- inflammatory action as well as effect on joint biology
34
Q

Rehab - Sarapin

A
  • some use for back pain
  • ? effect
35
Q

Rehab - shock wave therapy

A
  • proximal suspensory, navicular and some other conditions
  • ? effect
36
Q

Rehab - iRAP

A

= interleukin receptor antagonist protein
- some anti-inflammatory effects

37
Q

Rehab - athramid

A
  • polyacrimide hydrogel
  • adheres to synovial lining and reduces inflammation
38
Q

Other rehab considerations - weight loss

A

– Plan diet appropriate to reduced exercise or to help with weight
loss
– Consider whether need to add medication for obese/EMS animals that cannot exercise, ertugliflozin may become drug of choice
– Mobilisation and controlled exercise

39
Q

Rehab - behaviour management

A
  • mirrors?
  • enrichment games, etc
    – hang things from stables
  • bars between stables
  • phermonatheraphy
  • hand walking: equipment, steady companion, location
  • pre-op/preventative: can you train to cope with box rest/frustration
  • drugs? – ACP
  • change diet to high fat, low starch
    – can be used in modifying their behavioural response and making them less aroused
40
Q

Rehabilitation- exercise management

A

▪ What are the expectations for horse function?
▪ Consider not just the injured area but the effect of rest on the whole horse

Consider structures affected and implications regarding healing times:
▪Bone – requires loading for a strength (Wolfs Law)
▪Tendon ligament – requires loading for future elasticity
▪Muscle – resolving oedema and restoring function minimising scarring

▪Utilise physiotherapist to promote wound healing, assess function, range of motion and gait symmetry changes
▪Specific exercises used to target certain deficits
A veterinary physiotherapist will be best placed to assess whole horse needs, maximise exercise prescription effect and allow better functional outcomes.

41
Q

What do periods of box rest cause?

A
  • decreased weight bearing which leads to asymmetry in loading, decreased flexibility, weakness and back pain
42
Q

When to turn out?

A

▪Can be the most likely time to reinjure.
▪Consider temperament and small paddock options (e.g. size of 4 stables or smaller), use
sedation, consider tissue effects of high speed and sudden braking when turned out.
▪Ideally do not start turn out or ridden work before ground work to strengthen whole horse has been completed if behaviour allows.
▪Duty of care to those handling horse
▪For the horse to carry a person, the back must be strong to prevent
future problems.

Y4 Equine - Lameness & Orthopaedics (34 decks)

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