Evaluation and First Aid in MK Equine Injuries (not done)

What are the ddx for non-weight bearing lameness?

Fracture, septic joint, hoof abscess, tendon/ligament rupture, solar foreign body penetration

What is the associated trauma causes with non-weight bearing lamenss?

Car accident

Natural disaster

Athletic accident

Unknown

What are the goals of initial assessment with a MK injury in a horse?

Stabilize patient and initial wound management

Minimize further trauma

Advise the client on cost, transport, and prognosis

What are some important considerations for MK injuries?

Temperament, age, size, use, prognosis, transport, referral center, euthanasia

How do you stabilize a patient?

Triage, sedation and analgesia, anti-infammatories, antibiotics and tetanus, fluids, hemorrhage, prevention of thrombosis

What should you do before nerve blocks?

Do you PE looking for a fracture

Why is sedation useful?

Allows for a more thorough evaluation and makes it safer for you and the horse

Need to not over-sedate

What antibiotics do you want to use?

Penicillin and gentamicin are a good choice

How can you control hemorrhage?

Ligate if possible, pack wound

If it cannot be controlled use aminocaproic acid, 10% formalin or yunnan baiyao

What wound care do you initially need?

Prevent contamination or inection

Sterile lube in wound, clip hair

Lavae with antiseptic solutions

Evaluate for synovial or bone involvement

Apply sterile dressings

What should you do if there are open fractures?

Immediately give IV broad spectrum ABs like B-lactam and aminoglycoside

What should you do for rads during initial fracture assessment?

Try to stabilize the limb first

Stressed rads and evaluate for soft tissue injuries

How do you transport these injured horses?

Minimize distance to trailer

Ramps

Forelimb injury

Hind limb injury

Head and neck free for balance

What is an emergency treatment before loading a horse?

GA, only done if horse cannot stand and you are in a precarious location

Needs a dedicated equine ambulance and well-trained team

What are the principles of fracture stabilization?

Prevent further injury

Assist with weight bearing

Relieve anxiety and pain

Immobilize adjacent joints

T/F you should apply sterile dressing to any wounds?

True

What order do you add things on a bandage?

Cotton combine

Brown gauze

Vet rap

Need tight and even pressure with all layers

What are robert jones bandages?

Thick and heavy, 3 layers leading to a bulk stabilization of the limb BUT is no longer recommended due to insufficient stabilization

What can splints be used for?

PVC, wood, broom handle, cast material

What are the layers of a fiberglass cast?

Wound dressings

Stockinet

Cast padding

Orthopedic felt

What do fiberglass casts need to incorporate?

The foot to prevent transmission of force to the fracture

Can cut a window if concerned about wound or bone penetration

What are level 2 forelimb splints for?

Mid MC

Prox MC

Carpus

Distal radius

What is the goal of a level 2 forelimb splint?

Maintain alignment of bony column

How do you place a level 2 forelimb splint?

Caudal and lateral splints from elbow to ground

Cast from hoof to elbow

What are level 2 hindlimb splints used for?

Mid MT

Proximal MT

What is the goal of a level 2 hind limb splint?

Align bony column

Immobilize distal limb

How do you place a level 2 hind limb splint?

Caudal splint from ground to calcaneus

Lateral splint from ground to stifle

What do you use a level 3A forelimb splint on?

Mid radius

Proximal radius

What is the goal of a level 3A forelimb splint?

Maintain alignment of bony column

Immobilize distal limb

Prevent abduction of limb

How do you place a level 3A forelimb splint?

Caudal splint from ground to elbow

Lateral splint from ground to shoulder

What do you use level 3B forelimb splints for?

Ulna

Radial nerve paralysis

What is the goal of level 3B forelimb splints?

Maintain alignment of bony column and maintain passive stay of forelimb

How do you place a level 3B forelimb splint?

Caudal splint from ground to elbow

What do you use level 4 forelimb and hindlimb splints for?

Humerus, scapula

Femur, pelvis

What stabilization is needed for level 4 fore and hindlimb splints?

None

What is the goal of a level 4 forelimb and hindlimb splint?

Minimize stress and pain

Usually severe neurovascular compromise and swelling due to hemorrhage

Discuss prognosis prior to transportation

What is the problem with equine ambulances?

Not usually available, usually have to use a normal trailer

What are some challenges of equine distal limb fractures?

Large fractious animals

Little to no surrounding musculature

Stabilization needed before transport

Usually in bad locations

What sedation is good?

Alpha 2s

Phenothiazines like ace

Opioids like butorphanol (analgesia)

What anti inflammatories can be used?

NSAIDs

DMSO

Mannitol

Why do you want to control inflammation?

Limits risk of thrombosis

Maximize perfusion to leg

Do it after stabilization

When do you want to use mannitol?

Reduce edema in skull fractures

When do you want IV crystalloids?

Patients with a lot of sweat, pain, or hemorrhage

What should you add to neonate fluids if they cannot nurse?

Dextrose

When should you be sure to prevent thrombosis?

Fractures that disable the suspesory ligament or with servere ST damage

Any injury causing stretch of palmar or plantar vessels

How do you prevent thrombosis?

Aspirin and heparin

How should you stabilize in an emergency?

Bandage and splint combo with whatever you have

Pillows are not ideal though

How much padding should you add to a splint?

Only enough to make a cylinder to protect soft tissue and allow uniform distribution of splint

What happens if there is excessive padding and inadequate tension when applying a splint/bandage/

Fracture will be able to move

How can you make a bandage cast?

Compression bandage with 5-6 layers of fiberglass cast material over top

What are the downsides to a fiberglass cast?

Expensive and not always available int he field

Requires horse to stand still for 20 minutes

BUT has better stability than a splint

Where should you place a splint?

Immobilize joint proximal and distal to fraxure

Never cast in mid diaphysis of a long boen

Never cast or splint near fracture line (fulcrum effect)

What are level 1 splints used for?

Middle, proximal phalanx fractures

Proximal sesamoid bones

Distal MC3

PIP and MCP luxations

What are the goals of level 1 splints?

Align dorsal cortices

Neutralize bending forces

What is a level 1 splint?

Forelimb placed on dorsal side from ground to carpus

Hindlimb placed caudal side from ground to tarsus

What are level 3 hindlimb splints used for?

Tarsus and tibia

What is the goal of a level 3 hind limb splint?

Maintain alignment of bony column

Immobilize distal limb

Prevent abduction of limb

How do you place a level 3 hind limb splint?

Wide lateral splint from ground to widest part of the hip

In foals cast foot to above stifle

Why do you not splint level 4 hind limb fracture of femur or pelvis?

Fulcrum effect

What are the ideal transportation equipment?

Spacious well lit interior with access to horse on all sides

Strong frame

Video camera access to driver

Inflatable air mattress and loading sled if needed

How should you unload the horse?

Back off if in front fracture

Walk off if rear fracture

Adjust trailer nose height or unload onto a platform level with trailer floor

Mild sedation may be needed

What usually happens when a horse gets to a referral facility?

Can go straight to surgery or stabilize depending on case

Usually stabilize and repair the next day or two

What should you do for head trauma patients?

Stabilize and examine for defects

Anti-inflammatories are very important