LASx7: MSK Triage

How much blood can an animal safely lose in an acute traumatic event as a percentage of blood vol?

15%

What is the blood volume of a horse in ml/kg

80ml/kg

What blood volume can 500kg horse lose safely

6L.

What methods do you have to stop hemorrhage? (3)

Tourniquets/Pressure.

Cautery (in Sx).

Bandage.

Emergency stabilization requirements: prevent (4)

ST injury.

closed fx from becoming open.

contamination.

further fx/comminution

Splinting techniques uses (5)

Emergency stabilization for fxs.

Prevent movement for suture lacerations.

Radial n. paralysis.

Triceps myopathy.

Forcibly apply pressure to Flexural or ALD.

Initial Fx management: firsy

Stabilize the jt above and below.

Fx management: Region 1

Lowest region.

Splint from ground to below capus/tarsus.

Fx management: Region 2

Splint from ground to elbow or stifle.

Fx management: Region 3

Splint(s) from ground to shoulder/tuber coxae.

Fx management: Region 4

Shoulder region.

No splint or rarely splint.

Splinting Technique (3)

1. Bandage.

2. Apply splint.

3. Stabilize w/ tape or elastic bandage.

Splint can be made of (4)

PVC pipe.

wood.

cast material.

Kimzey splint for region 1 and 2.

Region 1 Fxs: Stabilization is done

in flexion

Region 1 Fxs: Stabilization in flexion is done for (3)

painful limbs when horses toe touch.

Distal limb fxs.

Places weight down bony column.

Region 1 Fxs: Stabilization in flexion is done w/

Kimzey splint.

palmar/plantar splint.

Region 2 fxs: splint used

single palmar splint from elbow to coronary band.

Region 2 splints are also used for

tricep myopathy or radial n. paralysis.

Characteristics of region 2 splints (1)

unable to lock the knee.

Bandage cast for region 1 and 2: provide

less support than standard cast

Bandage cast for region 1 and 2: Used for (3)

emergency stabilization of fxs.

regular eval of incisions/wounds over high motion areas.

contracted limb foals.

Method for Bandage cast in Region 1 and 2 (3)

2 layers cotton quilt, brown gauze, vetwrap.

Then apply cast material: 4-6 layers.

If it will be re-used over many bandage changes: split into Cr and Ca. halves.

Splint used in region 3

Thomas-Schroeder splint - ring at the top that wires go through.

Thomas Schroeder splint (region 3): used for

traction splint for fixation of radius and tibia fxs.

Stabilization of lighter LA fxs.

(Not generally used in adult horses due to their size. They need internal fixation)

Region 3 Fx generally require

Lateral splints going all the way up the leg.

Know what splints are an option based on region for exam

Check

Splint for triage (3)

Applied w/o GA.

incomplete immobilization

Region 1-4 fxs.

Cast for triage (3)

Not often used for triage as they take longer to apply than a splint and often require GA.

Better immobilization than a splint or bandage cast.

Not useful for region 3 or 4 fxs.

Bandage casting for triage (4)

Rapidly applied.

Can change regularly to monitor.

Less immobilization than a cast.

Not useful for Region 3 or 4 fxs.

Foot casts are used for

P3 fxs or laceration to heel bulb or coronary band that require immobilization to heal. Need rubber to prevent ware through the bottom of cast.

Purposes of a Bandage (5)

Support.

Immobilization.

Pressure - edema, proud flesh, hemorrhage.

Protection.

Prevent or reduce contamination.

Types of bandages (4)

Light bandage.

Compression bandage.

Standing wrap.

Robert Jones Bandage.

Innermost layer of the bandage

Wound dressing.

Wound dressing for clean wounds

Telfa, Curad: Nonstick, sterile

Wound dressing for infected wounds (3)

Calcium alginate, Foam: absorption, sterile.

Hypertonic saline on gauze.

Silver sulfadiazine on gauze.

Wound dressing for dry wounds

Hydrogel, parrasin (adaptic)

Wound dressing for proud flesh

Hydrogel, silicone gel.

Light bandage uses

cover incision or superficial wound not needing compression

Material used for light bandages (3)

Nonstick wound dressing - telfa/curad.

Roll gauze (kerlix).

Elasticon.

Brown gauze in LA is used for

compression

The stretchier the material is

the more likely it is to have a tourniquets effect

Compression Bandage uses (2)

Injuries.

Post Sx.

Material for compression bandage

Sterile interior bandage (if needed) - Nonstick wound dressing and roll gauze.

Compression bandage.

Compression bandage components (4)

cotton quilt (Gamgee, sheet cotton).

+/- brown gauze.

Vetwrap.

Elasticon.

Stable/Standing Bandage

Washable cotton quilt w/ outer wrap. Low level of compression. Usually something O' has at home

Full TL bandage

Stacked wrap: place interior bandage followed by lower gamgee, brown gauze, upper gamgee, brown gauze, vetwrap, elasticon.

EXAM: Pressure points in Full TL bandage (4)

Accessory CB - back of the knee.

Cut w. a blade into the vetwrap over this area to relieve pressure.

Then elasticon over incision to prevent cotton from migrating out the incision.

If an active pressure sore is apparent, use a dont of cotton quilt to relieve pressure.

Exam: Full HL Bandage pressure point/preventing bandage rub

Tuber Calcanei - point of the hock (worst place as far as pressure sore).

Cut the vetwrap and brown gauze, elasticon over the incision.

Cut hole in a piece of gamgee and donut-style over the tuber calcanei.

Hock Bandage placement.

Cover the tarsus only and leaves distal limb exposed.

Hock bandages are used for

after tars crural arthroscopy or focal swelling.

Consideration w/ hock bandage. (2)

Can slide down the limb.

Use a full limb when trauma/swelling needs to be tx'ed

Robert Jones (Multilayer) Bandage (2)

2-3 layer bandage (gamgee and brown gauze x 3, then vet wrap and elasticon).

Increases compression and mobilization

RObert Jones bandage tx

severe swelling or to immobilize a fx prior to splinting.

Foot bandages layer

gamgee, vetwrap, elasticon on top. Then apply duct tape to waterproof.

Bandage chewers: Chew inhibitors (3)

Vasoline w/ cayenne powder.

wood cradle.

muzzle.

Tips for bandaging (4)

Direction of wrap and where to begin (top v. bottom) does not matter.

Use plenty of Gamshee.

Only pull vet wrap to get the crimp out (do not pull tight)

Tension varies depending on materials elasticity and amount of padding (if you have a lot of elasticity or minimal padding, don't pull hard).