So I'm going to run through 4 emergency, sort of key emergency areas, and then I'm going to just break this up, sort of the common things being common with maybe some of the less common and slightly unexpected, and I'm gonna present for slightly unusual cases just to give you an idea of some of the variety of things that you might be dealing with. OK, so I think the first thing is to make sure that you've got a plan in place, and certainly something in your head, obviously those of you who've got more experience will have been there, seen it, done it before, although it's always worth remembering that there's always one horse that hasn't read the textbook. But for those of you who are maybe undergraduate students or are fairly new graduates, I think it does empower people by being confident, by knowing that they've got a plan as to what they do from the minute that they get out of the car and have a look at the horse.
And as we all know, what is reported to us over the telephone may be completely different, and in that case, the plan, original plan might have to go out the window and you may have to go to Plan B. So I think it's always good to have a plan in your head as to what you're probably going to do, but just bear in mind that there might be something slightly different, and it is often quite useful to think about plan B and potentially plan C as well. And just some reading for you, there's various textbooks, so the one which I wrote together with some other ones that come out of North America, useful to carry one round in the car just again so that If you've got something that you just need to have a refresher on, just to remind you of the key points, or something that's a little bit more unusual that you might want to look up, particularly, differentials.
And I think it is important to be prepared because it certainly makes them much less scary. I'm also going to mention the British Animal Rescue and Trauma Care Association a little bit later on in this presentation. As they are developing materials for owners, rescue personnel, and veterinary surgeons for dealing with some of these emer emergency scenarios.
OK, so first question, if I can get you to pull that up, it's just so I've got a rough idea as to who's in my audience. So first question is, what do you do? I've launched that poll question for you, Debbie, and people are busy voting away when it's not just me and you on the webinar, which is good to know.
OK, so the vast majority of people have voted now, and there's still a few more people voting. OK, so I'll just end that whole question now. So we have 43% of attendees that worked in mixed or other vet work.
We have 27% who say they do equine work only, 14% who say farm and equine, and 17% are students. That's great. OK, thank you very much.
All right, so. First emergency situation that we're going to run through is equine rescues. This is not an uncommon situation and the reason why I wanted to know how many of you might be doing other veterinary work is that any veterinary surgeon may be expected, even if you A small animal veterinary surgeon, certainly within the UK, if you're called to deal with an emergency, you would be expected to attend and potentially wait for an equine vet who has the relevant medications and equipment to potentially arrive.
So I think it is very important for both those vets dealing with large animals, but also vets who might not be doing this on a frequent basis to know some of the key principles, because they're really important. So, some key things to think about, you may be working along with other emergency rescue services such as fire and rescue Service, ambulance and police, and it's important to be aware of the, the importance of having that teamwork structure in place. You may also have the owner or carer of the horse present, but remember, you may have a situation, for example, a horse that's escaped from a field, has been hit by a car, you might have a situation where there's no owner or carer present and you might be dealing with a fairly critical situation, which may involve having to euthanize or intensively treat a horse without having that permission.
As I'm sure many of you will have been aware from dealing with these situations, you may have to be able to manage members of the public who may be involved either in a very helpful or perhaps in a slightly less helpful way. So it could be that you've got kind of distressing situation, not all of the emergency personnel who will be working with you may necessarily be used to dealing with, horses, and they may actually find the situation difficult to deal with, it might be something a little bit different than usual. And there may be some pressure placed upon you, particularly by members of the public, passersby who don't necessarily understand the situation, to just get on and do something.
So my key sort of top tips would be, as I'm sure all of you would do anyway, but just to remember to stay professional even if people around you are, being quite inflammatory, to make sure that you stay calm. And importantly, don't be pressurised into making any hasty decisions or decisions that you're not happy with. And if to be on the safe side, particularly if you're having to make a decision to euthanize a horse without the owner or carer being present, it is useful to get notes, take photos, have videos, and have witnesses available if the situation arises that somebody, contends that that was the wrong thing to do.
So in terms of advice over the telephone, potentially before you even get there, and on the way, you may have a very distressed horse owner to deal with, make sure that they keep the horse calm. And it is, remember, they're pack animals, so by keeping a companion horse nearby may help to keep them calm, and if they're conscious and able to eat feed, that may just be enough to be able to keep them settled. Again, it's very important not to put human safety at risk.
You know, horses are potentially dangerous animals, particularly when they're thrashing around, and especially in situations that may involve deep water. And in terms of first aid, very simple things such as airway, breathing, make sure that their nostrils aren't covered, and if there's any obvious haemorrhage, get somebody to place some clean, dry material over the site and put pressure on there. And I'd just like to acknowledge Jim Green from Hampshire Fire and Rescue Service who has provided a number of the images in this bit of the presentation.
In terms of equipment to have, and I mentioned about vets who may not be dealing with horses on a regular basis in that you may be asked to attend, it is important that you at least have somebody on standby if you aren't able to get hold of these, get a, a practise vet who does have equine sedative or anaesthetic agents, because this may be required to extricate a horse and potentially where One or more casualties are involved, and certainly in multi-vehicle accidents, potentially, you may have to euthanize several horses. So it is very important to attend, provide as much assistance as you can, but to make sure if you don't have, you're not fully equipped, that you get the backup as needed, but those first aid, measures can still be life saving and very reassuring to the fire and rescue services and the owners. In terms of key principles and tips.
Well, if at all possible, unless there's a situation where it really it is not possible to do so, make sure a head collar's been placed. It is very important that you have control of the horse's head that provides much more control of the situation. And always have a plan for where the horse is going to be released, because you may be releasing a horse that actually is contained, but within a relatively safe situation.
It's not particularly good if the horse then disappears off at high speed and gallops straight onto a dual carriageway. You can imagine that the catastrophe that might arise. So make sure before you actually release that horse that it does have somewhere safe that you can get it into.
And I think one of the most critical things is to make sure that you work from the spine side and the fire and rescue Service would term this the safer working zone. Of course it isn't a completely safe working zone, but it is safer. So definitely involved.
Avoid standing on the other side where you've got 4 legs that can potentially cause quite a severe blow. And also remember horse's head is pretty heavy, and when a horse violently moves that, that can cause potentially serious injury. And ideally, if you do have a hard hat in your car with you, and then put that on as well, and the fire and rescue Service will frequently provide headwear for your safety.
If horses are recumbent or thrashing around, do your best to protect their eyes, and certainly if they're recumbent, and once you've got a head collar on and try and protect the facial nerve by just putting a padded jacket or something just to keep the head off the ground and try and avoid them traumatising the site until they are freed. And potentially if a horse is being disturbed by noise, some horses it works better than others, but placing cotton wool in their, ears can be quite helpful. And finally, I think a very important tip is, remember that these are horses that are under situations where they've got quite a lot of adrenaline circulating, and they're fight or flight animals, and if they're trapped, they will probably be quite distressed and quite panicky.
So giving your normal amount of sedative is likely to underdose them. And as you'll be aware from all species, this can result in having to give multiple top-ups and finding that a horse, you never really get that horse properly sedated, particularly once you start stimulating that horse. You can quite safely give a horse 2 or even 3 times the normal sedative dose.
If you think of the dose that you would give for pre-medicating a horse prior to a general anaesthetic, you can go reasonably high. So just remember, use a sedative that you're used to working with and give more, maybe double what you would normally do for a quiet, relaxed horse compared to one that is potentially very stressed. It's then important to monitor the patients, you want to assess vital signs.
You might not be able to get to the whole horse, but you do need to be able to monitor it throughout rescue. And in the box, I've just, listed some factors that you do, need to monitor. And obviously, you may need to alter your plan if the horse is starting to deteriorate, it dies, or you discover, for example, once the horse has been rolled onto its other side, that it's got some form of catastrophic injury, in which case, that the decision to euthannase may have to be taken.
So just coming on to sedation and a handy little thing that I think is useful to be able to do is to administer administer a continuous rate infusion of sedative, and particularly in rescues that might be going on a while, it can allow you to give a nice smooth, sedation, rather than having to wait till the horse wakes up a little bit more and having to give another bolus. So you just need a 500 mL bag, a bag of sterile saline, an intravenous catheter and a giving set. Make up your sedative mix.
So, there are various recipes given in books. This is the Xylazine recipe, so you make up 500 milligrammes of Xylazine. Most would be 100 mg per mL, so 5 mLs in 500 mLs of saline.
Place your intravenous catheter. And then you give an initial bolus of Xylazine together with an opiates. Some people use morphine, but I think in practical situations out in the field, you may end up using theorphenol.
And then after about 5 minutes, just wait for that station to take effect. Start the continuous rate infusion. It's about 1 drop per second.
But again, because you've got a horse that's in a very different situation compared to, for example, the one that's here that's having a standing surgical procedure, you may have to alter that. And then once you've finished the infusion, it generally takes about 10 to 15 minutes for those effects to wear off, which is why zylazine's quite useful compared to domidine, which would obviously take a longer duration of action and to wear off. So following release, medication should be administered, make sure you check for other injuries and check that, for example, the horse hasn't become trapped because they had colic in the first place, and then the horse may require antimicrobials, non-steroidals, oral or intravenous fluids.
And, for example, the horse shown, you may be able to get that horse freed, but it's highly likely to be hypothermic and quite weak. So, this horse may need more involved medical treatment. So you have to discuss with the owner or carer where and when this is going to be done.
Any further investigations that might need to be done, and occasionally, for example, a horse with a severe wound, you might have to go down the route of a general anaesthetic and surgical management in clinic facilities. In terms of management of burn injuries, just the same. As we would do for, injuries in people.
And the key thing to remember is not to use really, really cold water. Ideally, the water should just be cool to around about 10 degrees C, and you may need to keep cooling those tissues for even up to an hour. The horse should have non-steroidals and antimicrobials, and then using the rule of nines, assess the degree and the percentage of burns, and the extent of burns.
So I'm sure you've all heard of 1 through to 4th degree burns. And the critical thing in terms of anything that you apply on these sites is not to apply an oil-based substance, like the old wives' tale about putting butter on burns. All that happens is that heated tissue will just cook, just in the same way that you cook meat in in oil.
So there must be water-based substances. If you've got a horse that may develop burn shocks, so these are ones that may have smoke inhalation injuries together with minor injuries such as the horse shown that had burning embers drop onto its flank and its blue teals and over its back. These horses should have an intravenous catheter placed quite early because they can develop quite spectacular edoema quite quickly.
Get them onto intravenous fluids and these horses do require hospital management and they potentially may need placement of tracheostomy. As I mentioned, previously, euthanasia might be indicated, so these are horses that are in severe shock and might be close to death anyway. But as a general guide, any horse that has, full to thickness burns over more than 30 to 50% of the total body surface area has a really poor prognosis for survival.
So again, every situation is different, and if you're unsure, speak to, a specialist for further advice. Just going to briefly mention the British Animal Rescue and Trauma Care Association. Their website is given below, and they are developing online courses and other training courses for vets.
So if you're interested in this area, then that's the place to have a look at. So just first of all, tales of the unexpected. This was a horse that had been seen for assessment of colic in the fields, had rectal examination and nasogastric intubation performed, appeared to be settling relatively, well following that, but then developed severe respiratory distress 20 minutes later.
And as you can see from the picture at the top, it's got quite a lot of swelling around its pharyngeal area into, it's Nitta region. It had its head and neck extended and was very tacky neck. And in this case, we had to perform an emergency tracheostomy, prior to doing further diagnostics, primarily endoscopy.
And this was a bit of an unusual case. Actually a similar case was presented in equine veterinary education around about the same. Time, but we suspect that the nasogastric tube actually went into the guttural pouch and caused a large hematoma to form within.
Unfortunately, the haemorrhage was contained within the soft tissues, but we had to make sure that the horse first had a patient airway until all that swelling went down. So I thought what I would cover is how to perform a tracheostomy. Again, this is a life saving measure.
And ideally, I think it is worth carrying an equine tracheostomy tube in the car with you, particularly if you are doing any amount of equine emergency work. But, even a 9 millimetre small animal, tracheostomy tube can be enough just to save a life until you can work out a plan to get something slightly wider diameter. You can also use a small animal endotracheal tube of a similar diameter, so anything 1518 millimetres or potentially, something that every bat dealing with horses on a regular basis will have in the back of the car.
You could use the end bit of the equine nasogastric tube, so the bit that's got the bit that you sort of fit into any funnel. Just so the tube obviously doesn't disappear into the trachea, and you can cut that to size, obviously you don't want a full length of tube, so you can cut that to size and use that if you've got nothing else available. So just to run through how you would perform a tracheostomy, so, the key landmarks are on the midline at the junction between the middle and the upper thirds of the neck.
And so you clip the skin and do an initial sterile preparation and inject local anaesthetic into the site. Bear in mind if you've got a horse that's actually collapsed and has stopped breathing or maybe close to stopping breathing, then at this point, that's gonna take too long. You just need to get that tube in there to save that horse's life, and you can deal with the aftermath afterwards, not ideal, but in some situations, you may be desperate just to get that tube in.
So don't waste time and doing all of that. But obviously, if you've got time or if you're doing it electively, you should try to be as aseptic as possible, aseptic preparation, and put on sterile gloves. So the key areas to palpate are the paired sterno thyrohyois muscles here, and strap muscles that run down here and right on the midline, if you put a little bit of pressure, you'll be able to feel those tracheal rings.
There's not much tissue between the skin and the trachea. And again, if you remember nothing else, the key thing is to make a vertical incision through the skin, about 8 to 10 centimetres in diameter and critically stay on that midline and keep on palpating those tracheal rings. You then make a horizontal incision between the rings, and some little tips here are, don't incise more than a third of the tracheal circumference.
So if you can just imagine what a normal equine trachea diameter or circumference would be. You can actually incise a reasonable area before you risk, transecting any of the vascular and neural structures that, lie on the very, dorsal aspects. But the critical thing is it's very inelastic tissue and you will Struggle to get a tracheostomy tube in if you don't have quite enough movement.
So the other thing is don't make the incision too small either. And make sure you don't use just a scalpel blade on its own. You could risk losing that into the trachea.
Make sure you use one attached to a scalpel blades. And then you use your index finger just to guide the tip of the tube between the adjacent tracheal rings. You may need to rotate the tube a little bit and go with the curve of the tube and make sure that you have got the tube into the tracheal lumen.
A common mistake for people who haven't done this before is to panic and to end up just ramming the tube in and driving it into the subcutaneous tissues. So make sure you can feel air moving in and out of the tube, secure the tube in place. There are wings on either side.
We usually put a bandage and thread that through a plaque in the main, and then you can then take a little bit of time just to get that patient stabilised and, and do any further diagnostics. OK, so coming on to emergency scenario two, which would be our colic case, and I'm sure this is an emergency that many of you will have seen. And as I'm sure you're all aware, the majority, about 90% of cases will respond to medical treatments.
But around 9% seen within the first opinion general population will be surgical in nature, and obviously if surgery is not an option, euthanasia might have to be performed. So I think one of the take-home messages I wanted to get across is that early identification of colic cases that might require referral for surgery is the key challenge, and it's, that is the, the, the thing that is going to save that horse's life. So these are all epiloic frame and entrapment cases.
This is a case that was sent in very early by referring vets, and the horse was not responding to analgesia and was quite painful. This horse did not require resection of, intestine and had a reasonably good prognosis, certainly better than if we'd had to perform a resection. This horse is maybe just a little bit more on, on the borderline of whether we have to resect or not, but this is the case that we want to avoid.
This case is very, very clearly surgical. The horse was very sick, so sick that, the horse's prognosis was so poor that this horse was euthanized on the operating table. So, just to run through the general approach for these cases, we want to get a history.
Do we have any clues? We want to observe it, and I'll go through this in one of the latest slides. Is it a gastrointestinal related colic?
We'll go through the clinical examination and whether you think more diagnostic tests are required, making a plan as to whether you can treat this horse medically or surgically, and a plan in terms of analgesia and other treatments or potentially the need for referral. So a general background, I've just put some factors here that you would want to ask them, and remember to get this information before you then, start asking about the colic episodes. And importantly, it is good to know, if they saw the horse start collicking, they might have seen it actually start, but in some cases it may be that they were found, the horse was found when somebody went onto the yard, and in which case it is useful to know when they were last seen normal.
And the reason for getting a history, is that we have some idea, there are some epidemiological clues as to factors that might increase or decrease the risk of particular types of colic. So for example, we know potentially related lipomas tend to occur in horses and ponies. Particularly geldings over the age of 8, large colon vulvulus or torsion is more common, is certainly common in brood mares.
Tapeworm infection is associated with ilealactions, and in some parts of the world, sand colics may be more common. And we also know that for example, stereotypic behaviours such as crib biting or wind sucking might be associated with epic frame and entrapments, or, might make a horse more likely to have colic episodes. And we also know, from research that there are some seasonal patterns, of, colic as well.
So in your initial examination, you want to just take a look at the horse, and actually look, does it actually have colic? And I'll run through some situations when owners may mistakenly horse, think that their horse has colic when it may actually be recumbent for other reasons. Get a heart rate, I think a heart rate is one of the most useful pieces of information you can have.
And ideally, do this, or it's good practise to do this prior to any drug administration, because certainly, butyl scopolamine and any alpha 2 agonist can alter the heart rates. Mucous membrane colour, can, can be sometimes useful but certainly if it's very abnormal, you'll have a guide, you know, if it's very bright red or purple, then you know that the horse is very cardiovascularly compromised. And then I've listed some of the other features that you might want to measure.
Obviously, within clinic situations, it's easier to run haematology and biochemistry, but in a field situation that may be a little bit more difficult and you may have to do that once back at the practise. But just to mention that, measurement of systemic lactate, which can be done quite easily in the field, is an important thing to consider. So coming on to rectal examination, which is a key part of the examination of the colic case.
And I've just taken an image from the handbook, just to run through the locations where you would normally find various structures. And just to simplify things, there are some fantastic, obviously textbook chapters on rectal examination and the glass horse, which I'd highly recommend to anyone who's not confident about palpating, rectal findings, I'd say the glass horse, three dimensional visualisation is superb. But I'm just gonna take you through a slight slightly more simplistic way to evaluate findings on rectal examination.
So the first thing is when you put your hand in, is there actually room in the abdomen? Can you, does it feel empty or does it feel like there's intestine trying to push your sort of hand out? And then the critical thing is, can you feel any distended intestine or any abnormal mass that shouldn't be where it is?
And the key thing to remember is that distended small intestine, when it is distended, feels like the inner tubes of bike tyres. It's got a diameter of about 6 to 7 centimetres, so it's quite characteristic. Whereas the large intestine, you'll know where the pelvic, what the pelvic flexure feels like and where it should normally be positioned.
And, when it's, when large colon's distended, obviously it's going to be fairly large diameter, anywhere between sort of 10 up to even 20 centimetres across. So that should be quite easy to characterise. The secum, remember, is on the right side of the abdomen, and classically, when it's very distended, they get a very secum has a very prominent vertical band.
And people sometimes do find it challenging to differentiate between distended large colon and secum. But remember, the secum is very firmly attached to the body wall, so you won't be able to get your hands up and over the top of it. And finally, don't forget the small colon.
You can get small colon impactions and other obstructions. You may have faecal balls, palpable, but it's slightly, in between, the diameter of the small colon of the small intestine and the large colon. Abdominocentesis again, something that, you can perform very easily in the field.
I'm not going to go into it in a great amount of detail. The key thing to remember is the landmarks are on the ventral midlight on the midline on the most dependent part of the abdomen. I usually use a 1.5 inch needle, but remember, quite fat horses, you might need to use a longer needle.
You can use a teat cannula in certain, indications. And contraindications for using a needle, would be marked intestinal distension, you may end up lacerating that gut and folds because they do have very thin intestinal walls. And normal peritoneal fluid should be yellow and clear, should have a total protein of less than 20 grammes per litre.
You can carry a refractometer in the car and measure that. You can also carry a lactate metre in the car as well, and that should have a lactate of less than 2 million miles per litre. And I've put there the white blood cell count, but obviously, that would be something that would normally be done, once you're back at the clinic.
And I think one of the key messages that I wanted to put across is don't wait until obvious signs of discoloration become evident, because you may not see quite obvious sanguineous changes until a horse has a lot of devitalized gut, where even a horse with a very short area of compromise may potentially have reasonably normally. Normal looking and peritoneal fluid, but you would certainly find that the total protein and the lactate are increased. And there are some studies showing that differences, changes in lactate, progression, worsening between sequential samples is a very sensitive and specific indicator of the need for surgery.
Nasogastric intubation, I'm sure many of you are very familiar with the technique of doing this. Remember, it's diagnostic. It can confirm that you've got a small intestinal obstruction, and you should normally get a less than a net of 2 litres.
And it's also therapeutic. So, for example, horses that have a pelvic flexure impaction or just general gaseous distension of the large colon that isn't too severe, that can sometimes assist with, stimulating a little bit of colonic motility. And this, together with, rectal examination might not always be indicated on the initial visit, but if you're having to re-examine a colic case for a second time, it should always be done.
And I always do warn owners about that, risk of epistaxis, which generally is self-limiting, particularly if you've had to tube the horse two or more times. So if we could pull up the 2nd poll question for me, please. OK, Debbie, I've just launched that whole question for you.
So colic and ultrasonography, how often do you use abdominal ultrasonography to assess equine colic cases? OK, so the vast majority of people have now voted and we're fairly evenly split, actually. So, We have 34% of people saying that they've never used ultrasonography for equine colic cases.
33% saying they would like to try but don't have the equipment. 23% are saying occasionally, and 11% of attendees are saying frequently. OK, so it looks like quite a number of you are quite used to performing, I'll just close that, performing abdominal ultrasonography.
And I think it is a technique that's very useful, particularly in falls, but I think we are seeing more and more people within the UK, certainly within North America. Using it, and this can be done either a per rectum, you can use a standard 5 or 7.5, linear probe, the ones that you would use for doing, reproductive work on, horses and cattle, or you can use a percutaneous probe, normally would be around 2.5 to 3 megahertz.
And the key areas to look at, if you don't want to spend a lot of time preparing the site is the inguinal regions because they're not terribly head, the ventral midline, particularly if you're clipping them to do an abdominalcentesis, and if you're worried about a nephrosplenic entrapment, the left para lumbar fossa. So you don't potentially need an awful lot of equipment, even just doing it per rectum would be enough to even pick up distended small intestine, if you're not sure what your, you know, whether a a horse does have a small intestinal obstruction or not. And at the top of the image you can see there are multiple loops of distended small intestine, about 56 millimetres in diameter.
This is quite thin walled in comparison, this is a horse actually with an epiloic frame entrapment. You can see they're distended, but they're also very thickened, and this was a horse that had edematous changes due to strangulation. So I'd encourage you to try to get something you haven't done, and if nothing else, you can always try per correct and scanning if you don't have, the equipment to do percutaneous scanning.
Oh, right. Oh, right, sorry, my computer doesn't want to move on to the next one. OK.
So just a few colic challenges. I just wanted to mention donkeys, just to remember that over colic pain may not actually be evident in donkeys, they may just look dull. So a dull donkey could potentially be quite sick, and certainly in a regular sized donkey, you can certainly perform a rectal examination in them.
And just be aware if you're performing an abdominocentesis that they can have quite a lot of retroperitoneal fats, sometimes up to about 10 centimetres. So, you may have to use a spinal needle. And just remember that impactions are quite a common, cause, and always check their teeth following the colic episode.
Folds, just a few little things to point out is that they can be very difficult. The degree of pain is actually quite unreliable. So, falls with actually medically treatable colics can sometimes be quite painful.
Remember that meconium retention and ruptured bladders are common. Neonates. They can also develop enteritis, which is usually managed medically, and they can also develop things like small intestinal vulvullus, that does require surgical management, and they can have fairly similar degrees of pain.
And don't forget congenital abnormalities as well. And in these cases, ultrasound and radiography can be very helpful. OK.
So just a further question for you. So you're asked to see a colic case for the first time that's a little bit tachycardic. It's got a heart rate of 48.
It's got moderate discomfort, but you can't find anything abnormal on rectal examination, and there's nothing abnormal on nasogastric intubation. So I'd be just quite interested to hear what would be your preferred analgesic. Referral is an option for this, pony, who is a 14 year old Welsh cross gelding.
So, what would you prefer, phenylbutazone, fluexin, buscapan compositum, or an alpha 2 agonist? Sorry, I misspelt alpha 2, but you know what I mean. OK, on you go.
OK, so I've launched that whole question for you, Debbie, and people are busy voting away, which is excellent. So more than half attendees have voted now, and there is an outright winner. So I'll just end that whole question.
So the vast majority, 48%, have said they would use Buscopan. Next we have 28% of people saying phenylbutazone, then 16% have said flenexin, and 8% have said an alpha 2 agonist slashaugesic. Great.
OK. Right, thank you very much. So it's always, it's always interesting to hear what people like to use, and obviously, you will have your preferred analgesic depending on what you're used to using.
One thing that I think is quite important, and I know that there are some vets who would like using clinics and then they get used to it, and they're using it for all the right reasons, but we do occasionally see And horses and ponies that come in to see us that every colic gets blanket fluix in, and I think we're all used to not necessarily getting a good night's sleep anyway. That's generally not what you join the profession for. But just a few things about Fluix and just to be aware of, and I'm sure many of you are aware of this anyway, given the choice that you used.
If you're using, and which we often do, the heart rate and the signs of colic pain to decide whether something might need surgery, then the potent effects of it can make that a little bit more difficult. And I'm sure those who use Flunixin are very careful to make sure that owners are aware that these horses should be absolutely back to normal, kicking the door down, looking for food. If they in any way look mildly colicky or miserable, then you must go back and reassess them.
And that's my little sort of concern sometimes with giving something a bit more potent, is that that owner who's desperate to avoid colic, then thinks, oh, it's a bit better and leaves it. Obviously, it's not our patient that calls it, the owner is that gatekeeper. It also, masks the effects of SERS if you're using heart rates, as I've already mentioned, and it can just make that decision making more difficult.
So, Generally, unless it's something that you use and you're happy that the owner is aware what to look for, you're happy that you're going to reassess it to check that everything is OK. Then I would generally avoid it, and I would usually use something like buscapan compositing or phenylbutazone. If nothing else, if they don't respond to that, the owner is then shown something that this horse isn't quite right, and maybe there is something more serious going on.
Obviously, there are other situations that I've listed where Fluixin is perfectly suitable. So it's not a message to say don't use clinics in, but if it's a horse where surgery is an option, moderate signs of colic could potentially be the start of it, I think I would just use it with caution. And obviously, if you're very experienced using it and you're comfortable with it, fine.
But if you're not comfortable with using dealing with colics on a frequent basis, I would certainly avoid it. And these are the guys that, we frequently see. So, this one obviously is gonna need a resection, poorer prognosis.
If we can avoid the need for resection, then that's ideal. So here I've just listed some guides to managing a colic case medically and I always say to people, colics are a bit like jigsaw puzzles and putting the pieces together, some colic cases are more easy than others. And just to run through the situations in which surgical intervention is needed.
And again, you know, horse might fulfil a few of these criteria and not others. So, again, if I was going to give a take-home message, I'd always say that non-response to analgesia is always an indicator of the need for potential surgery. And situation which euthanasia may be warranted is uncontrollable pain despite flu mixing any analgesic you can give, courses that have severe cardiovascular compromise and those in which gastrointestinal rupture has already occurred and remember, it's not bright green that you see the stomach's ruptured, there's been haemorrhage.
It's usually a red brown colour and obviously not sending anything that's sick to avoid, collapse and death on the journey into the clinic, which obviously can be very distressing for everyone involved. OK, so we've got a plan here, and what I'd say, is that communication with the owner or carer is key. Make sure that you either revisit the horse a couple of hours later or get the owner to update you if they're happy that the horse is right, back to normal passing faeces, and you're happy with it.
And in the more severe cases, start, initiate that surgery discussion early if surgery is an option for the owner and is available in that case. And I think transport is the thing that always causes delay. So whilst you're initiating that discussion, I don't think it does any harm.
It doesn't need to be something as snazzy as this. It just needs to be a horse box that's work or trailer, and something that works, and we'll get the horse from A to B as quickly as possible if that is under the decision. And just some key final bits about surgical colic cases.
Early surgical intervention is really key in maximising survival, and I think it's really important. Don't get fixated on your initial diagnosis. Thing to remember is, is it responding to analgesia?
If it's not, it Doesn't really matter what the diagnosis is, get it to facilities where they can work up the case, and, undertake exploratory laparotomy. And as I've already said, just be careful with flu flunixin, and I certainly wouldn't, wouldn't use it as a blanket analgesic in all cases. All right, so coming on to the second tales of the unexpected.
This is a filly, that the owner called the vet out, and, was transported into us. It was thought to have colic, it was recumbent, looking quite painful. Rectal palpation was fairly unremarkable, but the horse did have, or the filly did have a very large bladder, and we retrieved a large amount of urine obtained that was quite dark brown in colour.
So just coming on to those colic cases and that observation and that history taking, now, has it actually got gastrointestinal colic? Could it have something else going on somewhere else? So the classic things might be laminitis or very rare, but a potential is urinary tract obstruction.
So just be aware of some of those what we call false colics. And this case, obviously, was in an atypical myopathy, that urine being very classic of the myoglobinuria that's seen in these cases. And I know that there was one question from a participant wanting a little bit more detail, about, what, how to manage these cases.
So what I've done is pulled up a few equine veterinary education tutorial articles that cover this very comprehensively because it is quite involved. So as you're all aware, it's, thought to be related to a toxin that's ingested via sycamore seeds. It's certainly more common in the autumn.
But the key, there isn't an awful lot that you can do to treat them medically, but early transport to somewhere where they can be maintained and care as for a recumbent horse, where they can be monitored closely, potentially hospital facilities do that early rather than later. They're obviously gonna need fluid therapy to stop them going into renal failure, analgesia. And then, at present, supportive vitamins and antioxidants are currently recommended, and then general nursing care as for the recumbent horse.
And warning owners that they may actually worsen over the 1st 1 to 2 days, and they can have a very high mortality rate. But if they survive over 5 days, then the prognosis may be slightly more favourable. So it's a little bit of an overview, but as I said, if you want to read into more detail, then I'd recommend these two articles on very detailed management of these cases.
So we're going to run through wounds, briefly. I'm sure many of you will be used to dealing with these, but just have a very sort of set protocol for dealing with these, a history, how it happened, if they saw it, and when, or again, if it happens in the field when the horse was last seen normal. And don't get fixated maybe on one very large striking wound, make sure you don't miss other puncture wounds that actually might be fairly catastrophic.
You want to put some KY or jelly or hydrogel in the wounds and then clip around the wounds and you can scrub around the site with your typical sort of scrub solutions, but make sure that those concentrated solutions don't go into the wound. Can then remove the jelly and lavage. And lavage ideally would be with sterile saline or dilute solutions of chlorhexine, which should be 0.05% or 0.1 mLs of poidone iodine.
But if nothing else is available, tap water is acceptable. And then put on sterile gloves and you can use your gloved fingers to palpate and probe in the wound, or you can use a sterile probe. And then you need to work out whether you've got just skin or other structures involved.
And if you think there's something more involved going on, do you think that radiography or synoviacentesis is warranted? And just a note about synovicentesis, you can see in this picture here, this horse has actually got a wound over the lateral side of its heart. So the key thing, if you are going to perform synovicentesis, is to try and do this distant to the wound at a separate site.
So we've gone in immediately here to try and avoid if a horse hasn't got communication between the outside world and the joint, to actually avoid iatrogenic sepsis by taking bacteria from a contaminated site into the joints. So I'm just gonna very briefly go through some things about location, which is very important with horse wounds. You may, for example, if a horse has lacerated, the digital artery, you may have quite a lot of haemorrhage that you may need to control.
And just to remember that the distal limb, so from the carpus and tarsus downwards, it actually got relatively little soft tissue coverage. So be aware of structures such as the digital flexor tendon sheath, which has been penetrated in this horse. And the carpus and particularly the tarsicroural joints that are tight, superficial, and which may be involved.
And remember that if the horse, for example, has fallen onto its knees, the leg may have been flexed, so the wounds may be in a slightly different position to how the, the skin was relative to those structures when the wound occurred. So the distal limb obviously is a little bit more problematic. It's got less soft tissue coverage, whereas this horse that was actually a horse hit by a drunk driver, and this is what a wing mirror does to a horse's blue teals at high speed.
Horses have got quite a lot of muscle mass protecting those bones and synovial structures, and this horse went on to do, very well. Again, sometimes the bigger wounds over the thoracic and abdominal cavities might look more serious, but in the horse at the top, this was just skin, whereas in the horse at the bottom, a very small puncture wound caused by, this end of a stake, but led to changes in the peritoneal fluid, and we knew that this horse, potentially had, a penetration, which indeed it did of the large colon. So the size doesn't correlate necessarily with severity.
And remember again, wounds over the thorax, examine the horse for increased respiration that may give you a clue as to whether a, a wound has penetrated into the thoracic cavity. And then some wounds around the head, wounds around the jaw. Just be careful not to place a a mouth gag, because if it's got a mandibular fracture, you may displace it.
And then wounds around the nostril and eyes, eyelids, just to make a comment that these should always be, sutured, otherwise you'll get very, cosmetically important and functionally important deformities. And then just to mention about axillary wounds, which can look quite spectacular. Fortunately, they, frequently avoid lacerating key structures, but they can develop quite a lot of subcutaneous emphysema, so they do require really careful mon monitoring and ideally, would be, assessed, and maintained within a hospital facility in case they do develop respiratory compromise.
So just in terms of wound management, remember medication with non-steroidals and anti-inflammatories. Check the horse's tetanus status very importantly, and if they haven't had a tetanus vaccination within the last two years, they should have a tetanus antitoxin. The decision to suture or not to go to second intention wound healing is a lecture probably in itself, but if the wound is fairly clean and fresh, such as this carpal laceration, and that's suitable.
But if you've got big skin defects, and if the wounds contaminated, such as this one here, then healing by second tension is necessary. And even if you've got a slightly older wound, or potentially contaminated wound around the nostrils or the eyelid margins, they should be sutured closed. And then it's important to consider and discuss with the owner about ongoing wound management, including bandage changes and suture removal.
So I thought I'd just pull up tales of the unexpected 3 here, which is a horse, a 20 year old gelding that was found by the owner in a field, with blood around its face and its mate's rug covered in blood. And then, they found the tongue, in the field. It's been stumped over by the horses, in the field, and as you can see, it's covered in grass and it's quite cold.
So, examination of this horse, we could see that the tongue had been transected to this day, we don't know how the horse managed to do this. But it was just to say that sometimes you can have an injury that you might think is completely catastrophic, but actually horses can survive with, the tongue being transected, at the level of the renulum. And beyond that, more cordially, obviously.
Less likely to be survivable. But just to say that sometimes something that you might think catastrophic, just take a think first. If you're not sure, go and have a look up in a textbook or speak to a specialist because this horse went on to do very well and is very fat and happy, little boy.
So just to finish off, coming on to the last of our key themes, which is looking at severe lameness, and I'm sure you're all very familiar with the differentials for acute severe lameness. So the critical thing again is to get a good history, any previous lameness or injury when the horse was last charred in case it's got a nail bind. And then to perform a full examination, you can see even from these images here looking at the horse's posture, any swelling or deformity or asymmetry and looking for any obvious wounds.
Obviously, if the horse is severely lame, you want to just make sure which leg, the case of the laminitis case at the bottom, it's obviously very sore on multiple limbs and will have increased digital pulses, as will the horse in the bottom corner that has a subsolar abscess. So make sure there's nothing stuck in the foot, check the hoof test on the hoof tester application. And then check whether the horse resents or exhibits any pain on flexion or extension of the leg, whether the leg has altered or reduced range of motion, there's any crepitus, or if there's any obvious altered tone, heat, pain, or asymmetry in any of the large muscle groups.
So always check the foot and apply hoof testers if the cause isn't obvious before you start working your way up the limb. Just gonna make a note about foot penetrations. This is a cadaver limb.
It's not an unlucky horse that's just stood on 4 clenches. But just to demonstrate the anatomy relative to the external landmarks. So these two, the 1st and the 4th nail, hopefully going to be less severe, obviously.
Still potentially very important, but the middle two certainly are likely to have penetrated key structures. This one here will obviously have gone into navicular bursa and potentially, will involve the, distal interphalangeal joint, as in this horse here. So the male nail may be in situ, which can help with diagnosis, but than other circumstances, it may need assessment, at a clinic, to determine to contrast or potentially even MRI, what structures are involved.
Just to note about fractures, and to say that sometimes a horse may have acute severe initial lameness, but if it's got a hairline fracture, which is not uncommon with these radial fractures, you may have to stabilise the horse's leg prior to taking radiographs, and make sure you're quite happy with the region of the limb and what splint is applied. And in this radiograph shown, it can actually Take several days for a hairline or a particular radiographic view for a hairline fracture to be shown. But these horses, if they've had a history of being almost fracture lame immediately, they mustn't be transported or kept stabled without having some support.
You may have other fractures that may be surgical in nature, and again, it's absolutely essential that these cases are stabilised properly prior to transport, because you could turn a survivable fracture with no penetration of the skin into something that becomes more comminuted, displaced, or where the skin becomes open and the prognosis much worse. And then you may have other horses in which a fracture may not need to be the first thing that you deal with, other aspects of wound management may be more important, and then fracture removal, fragment removal at a later date. And here, just to refresh your memory with regards to the different zones, and the different types of stabilisation, remember within the distal limb, then applying a cast, bandage may be quite useful to stabilise the leg.
And Just to finish with our Tales of the Unexpected for, talking about, fractures. Remember that fractures just don't affect the limbs. So this is a horse that panicked whilst being loaded into the horse box, and it then decided to go for a gallop round the site, and this is how it returned to the owner, and it was suspected to potentially have hit a bridge or a tree at pretty high speed.
So just to finish off, I'm just going to show you a video of this horse, just to show you, why it's so important to have an observation. You can see this horse hasn't actually got any wounds over the actual front of the sinus, but you can see there's air moving in and out of here, which would be consistent with the horse having sustained some form of facial fracture. You can see as well, if I just pray this a grain, that the horse has obviously suffered severe ocular trauma, and this horse, you can see how difficult it is to assess.
So we, initially performed, oxography of the eye, and this globe had, completely ruptured the, the nature and force of the blow, just blew that eye, apart and, the horse then, sustained. Several fractures, which are shown on these three dimensionally reconstructedd CT images, and you can see that this horse had multiple compressed fractures of the frontal bone and actually had quite a nasty and compressed fracture adjacent to the medial campus of the eye and also around the orbital rim. So, horses can get themselves up to all sorts of mischief, but, initial careful examination, not doing anything hasty unless you are sure that you're happy with what you're doing, stabilising the horse prior to further assessment, using other diagnostic tests, and in the end we were able to stabilise many of these structures.
Unfortunately, the horse lost its eye, but, has now returned into full work. So, a little bit of a gallop through some equine emergencies, but I just wanted to bring out some key tips and points. So hopefully, equine emergencies shouldn't be scary now.
Be prepared and have a plan prior to arriving. Make sure that you take a good history and perform a thorough clinical examination. Communication with the owner or carer is key, and if you're unsure, referral hospitals are always happy to provide advice.
And thank you very much for attending this and for donating towards the broken sorry, I've run a little bit over time webinar team. Thank you very much, Debbie, for that amazing presentation. And just before we start questions and answers, I just wanted to mention that we would be very grateful for people listening to the live webinar this evening.
If you could spare 30 seconds to provide feedback to help improve our services, we would be incredibly grateful. The survey should have popped up in a new tab in your browser, but I've also added it to the chat box as well, so you can click on the link. And finally this evening, we have a short presentation from Ebony Escalonna, who is a veterinary partner training advisor for Brooke.
So I'll now hand over to Ebony to talk about the Brook. Hi, thank you so much to all of you for viewing this, to webinar vets for hosting this, and Professor Archer for giving up her time to educate us all. The Brook is an international animal welfare charity, and we work with working horses, donkeys, and mules and the people that depend on them.
We reach about 1.8 million horses, donkeys, and mules across Africa, Asia, Latin America, and the Middle East. And we're just gonna play a short 2 minute video to showcase some of our work in visual form and I'll just talk a little bit about what we do as the vet team here.
So Holly, if you wanna play, that would be great. Our staff include vets, animal welfare experts, advocacy and development specialists. So we work with animals, we work with owners, we work with governments, and like myself, we work with health service providers in the field at the point of contact with these animals.
So we employ over 150 vets, and more than 6000 vets, para vets, and other healthcare professionals that work through us, through our partners or through training programmes that we run on the ground. Our national vet teams understand how the local population of working at quids and their owners work and the specific challenges that they face. These can be anything from, you know, lack of awareness of welfare friendly practises through to traditional practises.
And Debbie mentioned one in her burns, it's quite common to put oil, oil on on burns in the places that we work in or slip nostrils of donkeys to help improve airflow, which of course doesn't work. We also suffer from access to quality healthcare, access to medication and cultural views on equines, and we try to help increase the invisible nature of these working quis, through training people on the ground. We're moving away from direct service provision and providing education in the field, and a bit like the proverb says, with the amount of fish and he can eat for a day, teach him how to.
Fish can eat for a lifetime and that's what we strive to do to support these quality services in the field. So as a vets visor from the UK and from our vets in the field, we help to do this through things like we've just done today. So distance online support through to in-field support with workshops, mentoring and resources.
We also help to link owners to service providers and and barriers and vets. And we all work as ambassadors for working equines at all levels of work with governments and legislation makers. So how can you help?
Well, we just really want to raise awareness, so it's absolutely great that over 400 of you, have registered for this webinar. If you'd like to look at more of our work, you can go onto our website or check us out on social media, on Twitter, Instagram and Facebook. We are also really keen to work with practises in the UK as well to increase awareness through client evenings and we've got a great welfare team, that team that can come out and do that with you.
And we also appreciate any donation or any fundraising efforts that you might want to do as an individual or as a practise, and we've got a whole team dedicated to support these efforts. So I think there's gonna be a link sent round which is just giving page, with some suggested donations, but even if you're super skin, if you could pop in a beer's worth or a coffee's worth, if you think that this webinar has been of value to us, then we will be greatly, greatly appreciated. Thank you very, very much.