Topic:Emergency Care
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.
Fluid therapy. 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.
Approach to the emergency equine patient. 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.
Examination of the equine patient with gastrointestinal emergency. 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...
Medical and surgical emergencies of the nervous system of horses: diagnosis, treatment, and sequelae. 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.
Respiratory emergencies in the adult horse. 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...
Reproductive emergencies in the mare. 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.
Antimicrobial therapy of adult horses with emergency conditions. 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.
Ocular emergencies. 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.
Reproductive emergencies in the stallion. 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.
Soft tissue emergency in adult horses. 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 ...
Emergency analgesia and chemical restraint in the horse. 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...
[Equestrian accidents in children and adolescents]. 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...
Management of orthopedic emergencies. 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...
Periparturient emergencies. 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.
Examination of the foal. 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.
Ventilatory support of the neonatal foal. 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...
Equestrian injuries: a five-year review. 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...
Is horse riding a dangerous recreation for young girls? A study at emergency departments of Lahti City Hospital and Päijat-Häme Central Hospital, Lahti. 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.
Penetration injury of the pyramis caused by a kick from a racehorse. 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.
A case report on the use of guaifenesin-ketamine-xylazine anesthesia for equine dystocia. 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...
[Equestrian accidents in children]. 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...
Injuries due to falls from horses. 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 ...
Nervous system injuries in horseback-riding accidents. 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...
Treatment of smoke inhalation in five horses. 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...
Ocular trauma. 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.
Complications of nasogastric intubation in horses: nine cases (1987-1989). Pharyngeal or esophageal trauma was diagnosed in 9 horses after nasogastric intubation. Evidence of trauma (edema or ulceration) was detected in the pharynx of 3 horses and in the esophagus of 6 horses. Complications associated with nasogastric intubation were first observed in 5 horses while they were intubated and in 4 horses after extubation. Clinical signs of pharyngeal or esophageal trauma were similar, and included salivation, bruxism, coughing, and nasal discharge. Treatment, including extubation, enteral feeding through a small nasogastric tube, or esophagostomy distal to the affected ...