first aid and triage

• Major injuries that disrupt the stability of the limbs can be made a lot worse by moving an animal with appropriate support or splinting, so assess this early. Then decide whether the problem is urgent or can be treated as a routine visit.

  • Anything with synovial or bone involvement, or with heavy wound contamination will have a better prognosis if seen as soon as possible, and wound lavage and antimicrobials can be started.
• fill in the blanks

  A) immediate

  B) do not move

  C) urgent

  D) trauma

  E) fracture

  F) synovial

  
• • Severity of lameness is a good indicator, the more severe lameness usually means more severe problems, so check for these carefully.
  • Remember there are exception: pus in the foot can be 10/10, fracture level lame, and synovial wounds can initially be walking with minimal lameness, but it’s a good starting point for most problems.
• Before you dive in and get hands-on with any wounds or injuries, start by looking at the animal overall…

  • What are the overall problems, what is the horse's demeanour?
  • What is the degree of lameness?
  • Are there any gross postural changes or conformational abnormalities
  • What does the wound look like, where is it, what is coming out of it, and how clean is it (consider what structures may be involved)
  • What is the degree of blood loss (Severity and duration)
  • What is the degree of contamination (type, duration and extent
• These are the steps and order in which you will need to them….

  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
• Avoid ACP in animals with blood loss / hypovolaemia / exhaustion, and remember this has no analgesic effect
• For sedation options, go for the alpha-2 agonists and add in opioids. Opioids will reduce touch sensation (but not remove it and some horses can still react and kick fast and unpredictably).
• • 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, especially good for travelling horses)
  • Always include opioids (butorphanol or buprenorphine most readily available in field situation) – analgesia and reduce touch sensation
• Most haemorrhages can be controlled with a pressure bandage initially. Pressure for 5-10 minutes can reduce bleeding significantly.

  • You 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. 
• When you use pain relief, there are lots of different components and consider a multi-modal approach

  • NSAIDs IV
  • Adding opioids will help severe cases
  • Covering and stabilising a painful region with a bandage or splint if needed will make a significant difference to the horse’s level of pain and distress.
• NSAIDs IV are contraindicated in hypovolaemia, severe haemorrhage, renal and liver compromise
• Paracetamol can be administered IV and orally, and used in conjunction with the NSAIDs. It isn’t licensed and will likely only be available in the hospital setting.
• Opioids provide additional short-term analgesia. Butorphanol and buprenorphine are partial agonists but are the main opioids as methadone and morphine tend to only be available in hospital settings. Buprenorphine is usually a better choice than butorphanol for most conditions, but it is a lot more expensive, which again becomes a consideration in practice for some cases.

  • Use opioids with alpha 2 agonists or acepromazine in horses as this 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 they are very efficacious and provide excellent analgesia (side effects are less common in animals in pain)
• In large animals, we use different splints according to the biomechanical forces across each region.

  • Region 1: alignment of dorsal cortices, splint placed dorsally (commercial splints)
  • Region 1 is from the fetlock and below,
  • Region 2: splint placed laterally and caudally
  • This region involves the fetlock and carpus or tarsus,
  • Region 3: splint placed laterally (and medially)
  • This region is the carpus to elbow, or tarsus to stifle.
  • Region 4: forelimb -stabilise carpus
  • This involves anything above the elbow and stifle
• Injuries that are not salvageable/have a poor prognosis for recovery include…

  • Compound, open fractures with significant contamination or soft tissue damage
  • Complete fractures involving the femur, humerus and tibia
  • Complete laceration SDFT, DDFT and SL
  • Complete laceration of SDFT, DDFT and distal sesamoid ligaments
• Options for long term analgesia are…

  • NSAIDs
  • Licensed for long term use and is very effective but, warn client about possible complications. The side effects include: right dorsal colitis (causing a PLE, D+ and weight loss), gastric ulceration, renal disease and blood dyscrasias
  • Young horses are especially susceptible to ulceration – do not use in foals less than 6 weeks
  • Oral paracetamol (not licensed)
  • Intra-synovial corticosteroids e.g., triamcinolone, methylprednisolone
  • PsGAGs–intra-articular or IM administration
• If analgesia is required for joint or tendon sheath problems, then consider the use of intrathecal drugs which can give high local doses with minimal systemic effects if used appropriately. There are a range of other options, depending on the lesion / structure involved,…

  • Sarapin–some use for back pain
  • Unknown effect
  • Shock wave therapy for proximal suspensory, navicular and some other conditions
  • iRAP (Interleukin Receptor Antagonist Protein)
  • Arthramid – polyacrimide hydrogel
• what priority is this case and why?

  3 due to the location over the synovial structures