Sunday, May 22, 2011

Equine 911: What to do in an Emergency Until the Vet Arrives


An equine emergency is something all horse owners dread, but knowing what to do and being adequately prepared can make the difference between life and death for your horse.  This means having the necessary supplies on hand, and practicing emergency procedures so that both you and your horse will be comfortable with them.  It is also extremely useful to know what is normal for your horse – including his temperature, resting heart rate, respiratory rate, capillary refill time and gut sounds – so that you can recognize and report any abnormalities during an emergency. 

When an emergency is actually happening, it may be some time until your veterinarian can get there to help you, so below are some practical steps you can take to give your horse the best chance of making it through in some common scenarios.

1.  PROBLEM:   SEVERE BLEEDING 

A horse losing a lot of blood is a very scary thing, but the good news is that the average horse has over 12 gallons of blood in its body, and can lose over 3 gallons before showing signs of shock.  This means that a horse can lose what seems like a lot of blood to us, but still often make it through just fine with appropriate intervention and veterinary attention.   

SYMPTOMS:

- profuse bleeding
- pulsing or spurting bleeding indicating a damaged artery.

WHAT TO DO:

If possible, get the horse to a calm, quiet, safe area.  If it will take more than a few minutes to get there, better to treat the horse where it is.

-  Immobilize the horse as best you can.

For a wound on the body where you cannot apply a wrap:  Apply direct pressure to the area where the blood is coming from.  Use a clean, dry cloth or sterile pad. Disposable diapers can do in a pinch.   Keep the pressure on for 10-15 minutes.  Do not remove pad, but try to ascertain if blood has stopped flowing.  If it has, you can tape the pad on (surgical tape works well, as it can be removed from hair more easily than duct tape), but be prepared to add pressure again if there is evidence of further bleeding.  If bleeding isn’t stopping, try to keep pressure on until vet arrives.  If at any time the padding becomes completely soaked, do not remove it, as you may disturb any clot that has started to form.  Instead, add more material to the top and continue holding.

For a wound on a limb:  You can apply a pressure bandage to a limb, similar to how you would apply a support wrap.  Start with an inch thick pad of gauze or clean cloth.  Press this against the wound, then wrap firmly with a roll of gauze or strip of cloth to keep the pad in place.  Next, wrap a layer of thicker padding around the area, and hold that on with an outer wrap that will apply firm, even pressure like Vet-Wrap or a knit bandage. Leave some padding sticking out at the top and bottom, and remember that you want the bandage firm, but not overly tight.  THIS IS A GOOD PROCEDURE TO LEARN HOW TO DO BEFORE YOU NEED IT.  HAVE SOMEONE KNOWLEDGEABLE SHOW YOU HOW.

-  If injury is to a limb, the blood flow won’t stop and it appears life-threatening, you may have to apply a tourniquet above the wound.  A sturdy leather strap or belt can be used, and may have to be tightened by inserting a short stick under the strap and twisting it until it is tight enough to stop the bleeding.  VERY IMPORTANT:  A tourniquet may stop the bleeding, but it will also cut off blood and oxygen to the entire area below the tourniquet, which can kill tissue.  The tourniquet MUST THEREFORE BE RELEASED EVERY FEW MINUTES to allow some blood flow, then tightened again if necessary.  It is recommended to move the tourniquet a little higher or lower each time you reapply it.

-  Apply an ice pack to the area if the source of the bleeding is inaccessible.

-  If you have help and are able to safely do so, take the horse’s vital signs:  heart rate, respiration, temperature.

-  Monitor gum color and capillary refill time (CRT).  To assess CRT, press thumb firmly on gums near teeth, release, then count the seconds it takes for color to return to the pale mark your thumb made. Normal time is 1-2 seconds.  Longer than that may indicate shock.

-  Pinch skin on neck and see if it snaps back in place completely and quickly.  If not, the horse is becoming dehydrated.

WHAT NOT TO DO


-  Avoid wiping or dabbing at the area, as this can promote bleeding. 

-  Do not attempt to clean the area until bleeding is well stopped.  Any aggravation to the area may promote further bleeding.

-  Do not administer any drugs unless advised to do so by your veterinarian.  Some people think giving acepromazine (ace) will be helpful to keep the horse calm, but it can lower blood pressure and worsen shock.

-  Do not continually remove a pressure bandage to see if the bleeding has stopped.

-  If applying a pressure bandage to a leg wound, do not apply too tightly or you can cause injury to the leg.

2.  PROBLEM:  COLIC

Most colics resolve themselves without major intervention, but the problem is that you generally can’t tell at the onset if the colic will be just a minor belly ache or a potentially life-threatening problem. 

SYMPTOMS:

The symptoms of colic can vary depending on the severity of the colic and the individual.  Some common symptoms are:

-  Decrease or total lack of appetite
-  Listlessness or depression
-  Kicking or biting at belly
-  Looking at belly or flank
-  Pawing
-  Grinding teeth
-  Swishing tail
-  Sweating
-  Rolling, especially violent rolling.
-  Lying down with reluctance to get up, or repeatedly lying down and getting up.
-  Groaning
-  Lack of bowel movements
-  Standing as if trying to urinate but not doing so
-  Resting heart rate of more than 52 beats per minute
-  Respirations greater than 30 breaths per minute; flared nostrils
-  Lack of or reduced digestive sounds
-  Pale, yellow, blue, or very red gums

WHAT TO DO:

Most of what you will do during a colic episode is monitor your horse’s condition.  The information you gather will help your vet determine how the episode is progressing.

Remove all feed and water.  Ingesting anything could make the problem worse.

Monitor vital signs – heartbeat, respiration, temperature

-  Monitor gum color and capillary refill time (see instructions under Severe Bleeding above)

-  Monitor for gut sounds.  You can do this by using a stethoscope of by pressing your ear against the horse’s barrel just behind his last rib.  Check from both sides.

-  Monitor passage of manure.

-  Slowly walk horse ONLY if he is rolling, kicking or pawing excessively or seems likely to otherwise harm himself.  This may distract him and prevent injury. 

-  If horse is rolling violently or throwing itself around, try to get it to an area where it will do the least damage to itself.  However, you must take care to avoid injury yourself, as your own safety must be of primary importance.

WHAT NOT TO DO:

Do not force the horse to walk if he is resting quietly.

-  Do not force the horse to stand if he is lying down quietly.

-  Do not give the horse any medication before clearing it with a veterinarian.  Doing so may mask symptoms and make it difficult for the vet to do an accurate assessment upon arrival.

3.  PROBLEM:  PUNCTURE WOUND

It is said that puncture wounds are often worse than they look.  This is because it can be difficult to assess the depth and internal damage of the wounds, and because puncture wounds provide the perfect environment for bacteria to grow in.  Puncture wounds in or near the joints are always worrisome, as are punctures to the chest or abdomen.

SYMPTOMS:

(obvious) a protruding object.

-  (less obvious) a wound of any size that appears to have a hole in the center.

-  (harder to find) swelling or soreness in an area that may have “closed up” over the actual puncture.  This is often the case with puncture wounds to the frog  heels.

WHAT TO DO:

-  If the puncture is on the bottom of the foot and there is still an object such as a nail protruding, clean the foot and gently remove the object if leaving it in could allow it to penetrate deeper and further damage internal structures.  Another option is to wrap the object and foot such that the object cannot penetrate further, if this is possible.

-  If an object is protruding from the legs or body, stabilize the object by holding or wrapping it in place, and keep the horse as still as possible until the vet arrives. 

-  If there is no object but there is an open hole in the chest or barrel area, listen to discern if there is any air being moved into or out of the wound (aspiration).  If you hear such sounds, cover the hole with something like a piece of clean plastic wrap and tape it on to stop the air flow.

WHAT NOT TO DO:

-  Do not flush the wound with anything unless instructed to do so, as this could push foreign material deeper into the wound.

-  Though it is awful to see a foreign object sticking into your horse, removing it can cause further damage or bleeding, so it is usually best to leave it in until the vet arrives.

-  Do not apply pressure to or bandage a puncture wound unless there is a life threatening loss of blood or the need to stabilize a protruding object.  Leaving the wound open will facilitate drainage, which is helpful.


4.  PROBLEM:  EYE INJURY

Because of the placement and anatomy of the horse’s eyes, eye injuries are unfortunately quite common.  They can range from mild to serious, but it is always a good idea to get a vet to look at an injured eye, as even a mild injury can potentially become infected. 

SYMPTOMS:

-  Tearing or discharge from the eye

-  Squinting or excessive blinking

-  Swollen eyelid or puffiness around eye

-  Unusual redness anywhere in eye

-  Whitish or bluish tinge to the cornea

WHAT TO DO:

Examine eye carefully, with someone helping to restrain the horse’s head if possible.

-  If you see a foreign body that is not penetrating the eye, gently remove if possible.

-  If there is mucus or debris but no penetrating object, sterile saline can be used to rinse the eye.

-  Once you have examined horse and done what you can, move him to a safe area that is not brightly lit, as bright light can be painful to an injured or irritated eye.

-  If there is a penetrating object, do not turn the horse loose, as it may worsen the injury by rubbing.

-  If flies are a problem, you can carefully wipe on fly spray around the face, but not within two inches of the eye.  Avoid putting on any kind of fly mask that might touch the eye or trap dirt.

WHAT NOT TO DO:

-  Do not attempt to remove any penetrating object.  Wait for the vet.

-  Do not apply any ointment to the eye until advised to do so by the vet.  Many eye ointments contain steroids, which can actually make certain eye injuries worse.

5.  PROBLEM:  FRACTURED LIMB

In the past, a fractured leg was often a death sentence for a horse, but medical and technological advances have made it possible to save many horses that would previously have been hopeless cases.

SYMPTOMS:

Sudden, usually extreme lameness

-  Refusal to move

Refusal to bear weight on a limb

-  Protruding bone

-  Unnatural crookedness of the limb

WHAT TO DO:

-  Keep the horse calm, but consult the vet before administering any tranquilizers.

-  Immobilize the limb with a splint.  First wrap the limb in two or more layers of padding:  you want it fairly thick.  Next, use slats of wood or split PVC pipe (wide enough to firmly hold the leg + padding) to form a brace.  Place the braces in two places:  one on the side, and one on either the front or back of the leg to provide stability in all directions.  Lastly, use plenty of duct tape to FIRMLY tape the braces into place over the padding.

-  If fracture is below fetlock, splint from top of cannon to the ground.

-  If fracture is above the fetlock, splint the entire limb.

-  Gather vital signs to report to veterinarian.

-  If there is bleeding, follow instructions above for SEVERE BLEEDING

WHAT NOT TO DO:

Do not move the horse any more than is necessary.


EMERGENCY SUPPLIES:

Ask your veterinarian to help you put together a emergency supply kit.  Keep it all in one place in your barn (a tool box is a good way to store it), and keep another in your trailer.  Make note of supplies that have an expiration date, and replace them as necessary.  Items you may want to have in your kit include:

-  veterinarian’s phone number
-  syringes (large and small)
-  cotton leg wraps
-  sterile gauze
-  non-stick pads
- disposable diapers (good for padding, etc.)
- Vet wrap or similar product
- disinfectant such as Betadine or Nolvasan
- sterile saline solution
- thermometer
- stethoscope
- cling wrap
- duct tape
- white medical tape (1” is a good width)

NORMAL VITAL SIGNS:

What is normal varies somewhat from horse to horse, and can vary a bit throughout the day.  Therefore, it is a good idea to take your horse’s vitals (when at rest) a number of times over the course of a few days, then note these down to see what the normal range is for your horse.

-  Resting pulse:  30-50 beats per minute
-  Resting respiration:  10-24 breathes per minute
-  Temperature:  99.5-101.5
-  Capillary refill time:  less than 2 seconds
-  Mucous membrane colour:  pink
-  Hydration:  Pinched neck skin should snap back into place immediately.  If it doesn’t, this indicates dehydration.