Emergency care in horses involves the immediate assessment and treatment of acute medical conditions or injuries to stabilize the animal and prevent further harm. This area of veterinary practice encompasses a range of situations, including colic, traumatic injuries, respiratory distress, and sudden lameness. Emergency care procedures may involve physical examinations, diagnostic imaging, fluid therapy, pain management, and, in some cases, surgical intervention. This topic includes peer-reviewed research studies and scholarly articles that explore the methods, protocols, and outcomes associated with emergency interventions in equine medicine.
Furr MO, Lessard P, White NA.Thirty-two physical examination and laboratory variables were recorded during examination of 165 horses admitted for acute abdominal disease. Univariate analyses were performed to determine which of the variables were significantly different between horses that lived or died. Stepwise logistic regression was performed to identify variables with the best predictive value. Four variables (heart rate, peritoneal fluid total protein concentration, blood lactate concentration, and abnormal mucous membrane) remained significant when entered into the model. Histograms for each significant variable we...
Seahorn TL, Cornick-Seahorn J.Fluid therapy is an integral part of treatment of the equine emergency patient. In this article, general principles of fluid therapy are discussed, including formulas for calculation of fluid volumes, fluid types and their indications, and specific therapy for several emergency conditions.
Bertone JJ.Often in emergency situations minimal data are collected, decisions are made, manipulations are performed, and therapeutics are administered without the collection of complete data sets that would indicate a detailed history and laboratory analysis. The incomplete clinical analysis may lead to occasional mistakes, but most often expediency is necessary and admirable. This article presents a clinical approach to emergency patients that requires minimal data collection in the face of the need for timely decision development. Medicolegal considerations are addressed briefly.
Moore BR, Moore RM.Clinical examination of the equine patient with acute abdominal pain should identify the affected body system and yield a provisional diagnosis. Determination of signalment, history, physical examination, and basic laboratory tests should assist in classification of the gastrointestinal disorder and direct the therapeutic plan. Determination of the definitive diagnosis of abdominal pain based on clinical examination is not crucial. For a successful outcome, efforts should be directed toward early recognition of the need for surgery and treatment of cardiovascular compromise in horses with seve...
Reed SM.Trauma to the nervous system in horses may involve the brain, brainstem, spinal cord, or peripheral nerves. Trauma may occur to any part of the nervous system with or without a fracture.
Mason DE, Ainsworth DM, Robertson JT.Responding to an equine respiratory emergency requires rapid localization of the problem and appropriate choices for therapy. Localizing the cause of respiratory distress is aided by history and thorough physical examination. When examining the patient, one must focus on the presenting signs as indicators of URT or LRT dysfunction. Table 3 summarizes the characteristic presenting signs based on respiratory tract location and suggests the initial treatment course indicated. Respiratory distress in the absence of signs related to the pulmonary system suggests inadequate oxygen delivery secondary...
Perkins NR, Frazer GS.This article briefly reviews the clinical management of emergency conditions likely to be encountered by veterinarians responsible for the reproductive health of mares. The article discusses rectal tears, breeding injuries, uterine torsion, placental hydrops, and prepubic tendon rupture. A major component discusses a recommended approach to dystocias, and the management of such complications as uterine rupture and prolapse and postpartum hemorrhage. Management of retained fetal membranes and septic metritis is addressed.
Brumbaugh GW.In emergency conditions, antimicrobial treatment is subordinate to truly life-supporting measures. Antimicrobial treatment should be formulated rationally for each patient and should not simply be a matter of following a recipe. This article presents principles for guiding rational therapeutic decision-making and examples of conditions in which those principles can be applied.
Rebhun WC.Most ocular and orbital injuries or acute ocular inflammation in horses result in similar signs of adnexal swelling, photophobia, blepharospasm, and lacrimation. It is hoped that detailed examination and the suggestions in this article will enable veterinarians attending horses having ocular emergencies to arrive at a correct diagnosis and appropriate therapy.
Perkins NR, Frazer GS.Topics addressed in this article include complications of castration, scrotal and inguinal hernias, torsion of the spermatic cord, traumatic injuries to the external genitalia, and posthumous collection of spermatozoa. A concise overview of the clinical management of emergency cases is provided.
French DA.Equine practitioners are frequently called to attend to soft tissue injuries. The majority of these cases are routine and straightforward; however, a certain percentage may present as a life-threatening situation with potentially serious complications. Client communication, adequate preparation, patient stabilization, accurate injury assessment and appropriate wound preparation are key factors to expedite recovery and achieve a favorable outcome. Understanding the limitations of field therapy and deciding when to transport the case to a clinic or referral center plays an important role in the ...
Hubbell JA, Muir WW.Clinical examination of the equine patient with acute abdominal pain should identify the affected body system and yield a provisional diagnosis. Determination of signalment, history, physical examination, and basic laboratory tests should assist in classification of the gastrointestinal disorder and direct the therapeutic plan. Determination of the definitive diagnosis of abdominal pain based on clinical examination is not crucial. For a successful outcome, efforts should be directed toward early recognition of the need for surgery and treatment of cardiovascular compromise in horses with seve...
Schmidt B, Mayr J, Fasching G, Nöres H.The rate of pediatric equestrian injuries is relatively low, but the severity of injuries is greater than in many other pediatric sport activities. In a 4-year period the charts of 109 patients up through the age of 15 years, who were admitted for equestrian-related injuries were reviewed. Falls from horses are the most frequent cause of injuries and responsible for their anatomic localization and type of injury. In our study the upper extremity was the most common (38%) area injured and head injuries comprised the second largest group with 36%. Forty percent of all injuries were fractures, 72...
Bertone AL.Initial management of injuries includes safely gaining control of the animal and assessing and treating systemic shock. If hemorrhage is life threatening, it must be controlled. If the limb is nonfunctional it should be stabilized. Any open orthopedic injury should be treated by cleaning the tissues, protecting the exposed tissues, and administering systemic antibiotics. A commercial splint is available (Equine Regular Leg Saver Splint, Kimzey Welding Works, Woodland, CA) that can immobilize and relieve weightbearing for cases of phalangeal fracture, flexor tendon rupture, fetlock breakdown, a...
Sertich PL.The events surrounding parturition are well orchestrated, and normal delivery of a foal is an explosive, rapidly occurring event. Any aberration may jeopardize the pregnancy and cause clinical complications. This article discusses problems associated with the periparturient period that require immediate attention.
Bernard WV, Reimer JM.Recent advances in veterinary diagnostics have improved our ability to diagnose and treat foal diseases. However, these advances do not replace the physical examination as the most valuable diagnostic aid available to the equine practitioner. The basic physical examination provides the majority of information needed to make a presumptive diagnosis, provide a direction for ancillary tests, and formulate a plan for emergency therapy if needed.
Palmer JE.Many sick neonatal foals have respiratory failure secondary to perinatal hypoxia, sepsis, or pneumonia. These foals require ventilatory support to prevent respiratory embarrassment and other complications associated with chronic hypoxia and hypercapnia. This article discusses practical aspects of ventilatory therapy, such as choosing a candidate for mechanical ventilation, choosing the proper ventilatory mode, placing a foal on a ventilator, maintaining a foal on mechanical ventilation, and weaning from mechanical ventilation. This article details some of the techniques that have been develope...
Hobbs GD, Yealy DM, Rivas J.A retrospective chart review was conducted to define the demographic and injury patterns of patients presenting to the emergency department (ED). The setting is a rural/small urban tertiary care center with approximately 40,000 visits per year. All patients presenting to the ED from January 1986 through December 1990 with equestrian-related injuries were enrolled in the study. Measurements included age, sex, mechanism of injury, injury or injuries diagnosed, admission to the hospital, morbidity, and mortality. A total of 142 patients met the inclusion criteria. The majority of injuries occurre...
Niskanen R, Lindahl J, Mokka R, Korkala O.Horse-related injuries form a notable part of sports and leisure time accidents. 54% of the injured were female riders under the age of 20 years. The most serious injuries were upper extremity ones. Over one third of the riders had suffered previously from horse-related injuries.
Ogawa Y, Kanno M, Shimizu Y, Suzuki M, Yoshimoto T.A 56-year-old man presented with an unusual cranial penetration injury due to a horse's hoof. The CT number of the hoof was 269, and thus clearly not that of a wooden fragment or bone. An emergency operation was performed to remove the foreign body. The operation went well, and no infection developed. Eight months later he could walk unaided and had only mild disorientation.
Lin HC, Wallace SS, Robbins RL, Harrison IW, Thurmon JC.In 4 mares suffering from dystocia, general anesthesia was induced with xylazine (1.1 mg/kg, IV) and ketamine (2.2 mg/kg, IV) and maintained with continuous intravenous infusion of ketamine (2 mg/ml), xylazine (0.5 mg/ml) and guaifenesin (50 mg/ml) in 1 L of 5% dextrose. The duration of the procedure of these mares were 40, 45, 180, and 35 minutes, respectively. For procedures required more than 1 hour (Mare 3), the dose of ketamine and xylazine in the mixture was reduced to 1 mg/ml and 0.25 mg/ml, respectively. Average infusion rate of the mixture used to maintain anesthesia for each mare was...
Giebel G, Braun K, Mittelmeier W.In a retrospective study we reviewed 262 horse riding related injuries in children younger than 16 which were treated between 1975 and 1989 at the Section of Traumatology in the Department of Surgery, University Hospital Homburg/Saar. In 155 of these accidents, detailed information was gained via a questionnaire. The typical patient profile was that of young female equestrians with little experience and little weekly riding practice, without practicing falling-exercises and warming up often using different horses. At the time of the accident only 59% were wearing a head protection. Most accide...
Buckley SM, Chalmers DJ, Langley JD.This study describes the epidemiology of injuries due to falls from horses in New Zealand. There were 54 fatalities from 1977 to 1986 (0.17 per 100,000 persons per year). There were 773 hospitalisations in 1987 (23.7 per 100,000 persons per year). Head injuries were predominant among both fatal and nonfatal injuries. The incidence of nonfatal head injury in the 10 to 19 age group was significantly higher than the incidence in all older groups (P = 0.003). Young people, particularly females, were the segment of the population most affected by the problem of falls from horses. Reference to data ...
The Journal of traumaFebruary 1, 1993
Volume 34, Issue 2 227-232 doi: 10.1097/00005373-199302000-00008
Hamilton MG, Tranmer BI.A review of 156 horseback-riding accidents that occurred in southern Alberta over a 6-year period and resulted in nervous system trauma, including 11 deaths, is presented. The majority (81%) of accidents occurred during recreational activity and 81% were associated with falling or being thrown from a horse. Head injury occurred in 92% of patients and accounted for all of the 11 deaths. Spinal injury occurred in 13% of the patients and was associated with head injury in 40%. One peripheral nerve injury was identified. Helmets were used by only two victims. The 11 deaths that occurred as a conse...
Kemper T, Spier S, Barratt-Boyes SM, Hoffman R.Five horses were admitted for treatment of smoke-inhalation injuries sustained in a barn fire. Three of the horses were mildly affected, with high respiratory rates (24 to 36 breaths/min) and normal to low arterial oxygen tensions (77.0 to 94.1 mm of Hg), and responded well to administration of diuretics, bronchodilators, corticosteroids, and antibiotics. The 2 remaining horses were severely affected. Both were in respiratory distress, with markedly low arterial oxygen tensions (50.4 and 57.1 mm of Hg) and cyanosis. These 2 horses required fluid resuscitation in addition to the treatments give...
Millichamp NJ.Horses with ocular trauma frequently present as emergency cases. This article provides a succinct review of various adnexal and globe injury issues. Accurate case assessment, management, prognosis, and follow-up considerations are presented.
Palmer JE.Cardiac arrest in foals is generally secondary to other serious systemic diseases. Although it can often be anticipated, a clear plan is vital to success. Establishing cardiac output through chest compressions is the most important first step. This step should be followed by ventilation, drug therapy, identifying the nonperfusing cardiac rhythm, and following a preplanned treatment algorithm. Birth resuscitation requires special treatment considerations. The clinician should be prepared to perform resuscitation any time a birth is attended.
Reed SM.Trauma to the nervous system in horses may involve the brain, brainstem, spinal cord, or peripheral nerves. Trauma may occur to any part of the nervous system with or without a fracture.
Burrell KL, Burford JH, England GCW, Freeman SL.The survival of horses diagnosed with critical colic (requiring referral or euthanasia) relies on rapid and effective decision-making by the owner and veterinary practitioner. Objective: To explore UK horse owners' and veterinary practitioners' experiences of decision-making for critical cases of equine colic. Methods: Qualitative study using a phenomenological approach. Methods: Individual, semi-structured telephone interviews were conducted with 14 horse owners and 13 veterinary practitioners (vets) who had experienced a critical decision (referral or euthanasia) for a horse with colic. A pu...
McIlwraith CW.The postoperative management of the surgical colic patient varies according to the complications experienced. Many of these complications can be related to the time at which surgery is performed
relative to commencement of the problem, the condition of the patient at the time of surgery, the particular condition, and, last but not
least, the surgeon's performance. Some of the points have been discussed elsewhere in the symposium. The maintenance of asepsis, attention to minimizing trauma to the bowel, and appropriate attention
to visceral and parietal closures are all important principles. ...
Freeman DE, Bauck AG.Repeat celiotomy can be lifesaving in horses with a surgically treatable postoperative obstruction, although guidelines for its use are lacking, except for uncontrollable postoperative pain. Overdiagnosis of ileus as the cause of postoperative obstruction could delay a second surgery so the disease progresses beyond a manageable level of severity. Although many horses respond favorably to repeat celiotomy, complications can be severe and life threatening, such as incisional infection and adhesions. Repeat celiotomy does not seem to exacerbate postoperative ileus, despite additional surgical ma...
Shah W.Medical Usage Rate (MUR) of Galway Races: The Galway Races is the most popular horse-racing festival in Ireland. It takes place for a week starting from the last Monday in July. The races are held at Ballybrit race course in Galway. During the 7 days of racing, about 180,000 people attend. The average temperature in Galway around that time of the year is around 15-200C. The aim of this study is to calculate the MUR of Galway Races and to develop a model to predict the MUR for Galway Races in future. The MUR of Galway Races is calculated by looking retrospectively at the medical records of the ...
Foth PW, Gardner A, Pereira CR, Cooper E, Schroeder E, Mudge MC.To assess oral buccal microcirculation by hand-held videomicroscopy in horses during colic surgery, comparing microcirculation values with macrocirculatory parameters and with those of healthy elective surgical horses. Methods: Clinical prospective study. Methods: Client-owned horses (nine in the colic group; 11 in the elective group). Methods: In the colic group, buccal mucosal side stream dark-field microscopy (DFM) videos, cardiac output (CO), mean arterial pressure (MAP), and lactate were obtained at three timepoints under general anesthesia (30, 90, and 150 min after induction). Video a...
Mardassi A, Turki S, Mbarek H, Hachicha A, Chebbi G, Benzarti S, Abouda M.Combat-related facial injuries involve various lesions of the mouth, the eye sockets and the facial bones. The goal of this study is to precise the particularities of these affections and their therapeutic management. Methods: A retrospective study was performed about 56 cases of combat-related facial injuries over a period of 5 years (2010 - 2014). Results: Our study included 56 male patients with an average age of 29 years (20-37). The trauma occurred during a real security intervention in all the cases. It was isolated in 18 cases and associated to other lesions in 38 cases. Clinical examin...
McConnico RS.There is no way to prepare for every situation that arises in a disaster. By working closely with other producers and agricultural leaders, however, horse owners can lessen the impact of a disaster on their operation. Preparation and detailed planning are the most important aspects of flood-related injury prevention. Encouraging animal owners and caretakers to have an evacuation plan and dispersing knowledge about local and regional disaster authorities are critical for a successful disaster response. Educational programs on future disaster response empower communities to care for their people...
Barton C, Hassel DM.A successful outcome to management of the critical colic patient is highly dependent on how the patient is monitored and treated, particularly, in the perioperative period. In this article, we will provide an update on monitoring techniques, advances in fluid therapy, nutrition management and pharmacotherapeutic agents, inclusive of pain monitoring and management, prokinetics, and management of systemic inflammatory response syndrome and the hypercoagulable state.
Mason DE, Ainsworth DM, Robertson JT.Responding to an equine respiratory emergency requires rapid localization of the problem and appropriate choices for therapy. Localizing the cause of respiratory distress is aided by history and thorough physical examination. When examining the patient, one must focus on the presenting signs as indicators of URT or LRT dysfunction. Table 3 summarizes the characteristic presenting signs based on respiratory tract location and suggests the initial treatment course indicated. Respiratory distress in the absence of signs related to the pulmonary system suggests inadequate oxygen delivery secondary...
Dechant JE.Equine toxicologic emergencies are relatively uncommon but can cause significant morbidity and mortality in a group of comanaged horses. The field veterinarian's role is to triage the situation, as well as the individual animal. Individual patient stabilization should focus on support of essential organ functions, providing time for treatments to have an effect or for elimination of the toxicant. Decontamination procedures can follow patient stabilization, if appropriate. Antidotes are often not available or feasible for equine intoxications. The field veterinarian should emphasize triage and ...
Brumbaugh GW.In emergency conditions, antimicrobial treatment is subordinate to truly life-supporting measures. Antimicrobial treatment should be formulated rationally for each patient and should not simply be a matter of following a recipe. This article presents principles for guiding rational therapeutic decision-making and examples of conditions in which those principles can be applied.
Koljonen V, Söderlund T, Mäkisalo H, Gissler M.Contacts between humans and animals inevitably involve encounters possibly resulting in the human being injured. During the period of 2000 to 2014 almost 90 people died in this kind of conflict in Finland. Of these deaths, one third were associated with horses. In addition, over the same period 85 people died in traffic accidents in which an animal was hit by a car. Accidents requiring hospitalization occurred for approx. 8 000 people.
Rebhun WC.Most ocular and orbital injuries or acute ocular inflammation in horses result in similar signs of adnexal swelling, photophobia, blepharospasm, and lacrimation. It is hoped that detailed examination and the suggestions in this article will enable veterinarians attending horses having ocular emergencies to arrive at a correct diagnosis and appropriate therapy.
Boyle AG.Respiratory distress in the horse and foal is an emergency. Managing equine respiratory distress in the field starts with appropriate assessment of the patient to determine whether the breathing obstruction stems from the upper or lower respiratory tract or is nonrespiratory in origin. From a thorough, but efficient, physical examination to point-of-care ultrasound and endoscopy, the veterinarian has many tools in the field to help diagnose the patient.
Donawick WJ.The horse with an abdominal crisis caused by acute gastro-intestinal tract obstruction develops hypovolaemia, haemoconcentration, electrolyte depletion, metabolic acidosis and shock. During preparation for operation, treatment with fluids, antibiotics and bicarbonate will impede metabolic imbalance. Stomach decompression may slow the passage of sodium, water and potassium to the gut lumen, reduce pain and minimize the risk of stomach rupture. Selected laboratory determinations and the monitoring of arterial and venous pressures will provide a measure of security, and serve as a guide to replac...
Perkins NR, Frazer GS.Topics addressed in this article include complications of castration, scrotal and inguinal hernias, torsion of the spermatic cord, traumatic injuries to the external genitalia, and posthumous collection of spermatozoa. A concise overview of the clinical management of emergency cases is provided.
Goldstein MA, Schwark WS, Short CE, White KK.Depression of the cardiopulmonary system of the horse during anesthesia is not an uncommon event. In many situations simple approaches for improving the function of the horse are necessary to avoid loss of life. This study has been completed utilizing an anesthetic approach frequently used in horses and a cardioresuscitative technique which can be utilized by the practicing veterinarian. Severe depression to arrest were produced experimentally and each animal was resuscitated through support of ventilation and circulation.
Estell K.Acute central nervous system (CNS) trauma in the field is best approached by a systematic and thorough physical and neurologic examination that allows the practitioner to localize the brain or spinal cord injury. The skull and vertebral canal are complex 3-dimensional structures, and orthogonal radiographic views are necessary for an accurate diagnosis. Therapeutics aimed at decreasing pain, inflammation, and edema or increased intracranial pressure in the case of traumatic brain injury should be administered. Survival and return to athleticism can be achieved even in moderate-to-severe trauma...
Trauma case reportsFebruary 21, 2019
Volume 20 100179 doi: 10.1016/j.tcr.2019.100179
van Delft EAK, Thomassen I, Schreuder AMM, Sosef NL.Every year patients present to the emergency department due to bites, scratches and falls caused by animals. Although bite and scratch injuries have been described in literature, the exact number of patients that visit the emergency department due to all animal related injuries has never been described before. Methods: A retrospective analysis of all emergency department visits throughout a 1-year period was performed from April 2015 until March 2016. Results: 516 Patients were treated at the emergency department because of animal related injuries. Most were female and the median age was 38 ...
Hofstee W.Vet and owner of Unicorn Trails Wendy Hofstee explains how she developed a horse-riding holiday business alongside a successful career in emergency veterinary work.
Freeman DE.Wounds of the esophagus and trachea are uncommon, but closed wounds can be difficult to diagnose and treat. Esophageal wounds are the more serious and can be life-threatening; however, appropriate surgical and medical treatment applied without delay can be successful in some cases, especially in full-thickness longitudinal wounds. Tracheal wounds are usually less severe, but the high risk of iatrogenic injuries to the trachea should be recognized. Also, tracheal injuries can limit the athletic potential of a horse.
Whitlock MR.To determine the distribution of injuries in the eventing discipline of equestrian sports and the effectiveness of the protective equipment worn. Methods: Data on all injuries sustained in the cross country phase over fixed obstacles were collected from 54 days of competition from 1992 to 1997. This involved 16,940 rides. Results: Data on a total of 193 injuries were collected, which included two deaths. This represents an injury rate of 1.1%. Head and facial injuries represented the largest group (31%), with one third of these requiring treatment in hospital. All riders were wearing protectiv...
Morgan JM, Galuppo LD.Management of fractures in the field starts with successful assessment and stabilization of the patient by the practitioner on the front lines. A careful examination is vital to succesful patient management. This includes identifying the fracture location and severity, evaluating skin integrity and potential contamination of the fracture, and treating any ongoing hemorrhage, hypovolemia or stress. Appropriate application of splints in the field will minimize ongoing tissue damage and improve patient comfort. This ultimately aids further assessment, facilitates referral, and improves opportunit...
Saulez MN, Slovis NM, Louden AT.Tracheal trauma with resultant rupture is uncommonly reported in veterinary literature. We report the case of a 16-year-old Thoroughbred gelding that sustained a 1 cm longitudinal perforation of the dorsal tracheal membrane in the proximal cervical region. The horse subsequently developed dyspnoea due to acute upper respiratory obstruction secondary to severe emphysema of the guttural pouches. A temporary tracheostomy caudal to the site of tracheal perforation was performed under local anaesthesia. This procedure helped relieve the upper airway obstruction and aided resolution of the injury by...
Freeman DE.Many surgical procedures of the head and neck can be safely performed in the standing horse, with easy access to all aspects of the surgical field. Some procedures, such as tracheotomy, are easier to perform with the horse standing with the head in a more natural position than with the horse under general anesthesia. Procedures of the neck and thorax that require evacuation of purulent and necrotic material from confined spaces, such as occur in horses with esophageal ruptures and extensive intrathoracic abscesses, can be done as standing procedures to avoid the risks of general anesthesia on ...
Schröter C, Bielefeld M, Bielefeld D, Macke C, Winkelmann C, Mommsen P, Krettek C, Zeckey C.The upper limb is one of the most frequently injured body regions in equestrian sports, but it is unclear which injuries are involved, and there are no data on the associated accident mechanism. The present study is aimed at evaluating the accident mechanisms, injuries of the upper limbs, and the circumstances of the accident in equestrian sports. We included 218 patients who were all treated between 2006 and 2014 at the level I trauma center at the Medical University in Hannover because of equestrian-related accidents. The most frequent injuries were fractures and bruising in the shoulder ...
