What to do in an emergency was the subject of a presentation at Penn Vet New Bolton Center on May 1. Equine emergencies: First aid and emergency stabilization was presented by Dr. Samantha Hart, DACVS, DACVECC and lecturer in Large Animal Emergency and Critical Care at Penn Vet. The lecture was part of the First Tuesday Lecture series at New Bolton Center, offering the public open lectures on equine topics, at no charge, the first Tuesday of each month.

Dr. Hart is an emergency care veterinarian at New Bolton Center and was part of the veterinary team that cared for Olympic-hopeful Neville Bardos following a fire at his home barn. Part one of the summary of this presentation appeared in last month’s Pennsylvania Equestrian. Here is the second part of that recap.

Wounds
Not every wound or scrape that your horse sustains needs to be evaluated by your veterinarian. However, there are cases where further evaluation and treatment by a veterinarian are highly recommended.

1. Excessive bleeding or drainage. The majority of wounds bleed; however, if after application of a pressure bandage the wound is continuing to bleed, or if you see arterial bleeding (“pulsing”), then a veterinarian should be called. Wounds that involve synovial structures such as joints and tendon sheaths may drain clear, yellow synovial fluid, and should be seen by a veterinarian to determine if a synovial structure is involved. These are potentially life-threatening wounds in a horse.
2. Puncture wounds and foreign bodies. It is important in cases of puncture wounds to leave any foreign object in place until your horse is assessed by a veterinarian. There is the potential to disturb structures such as vessels by moving an object; it can also help to determine which structures are involved. This is especially important in wounds to the sole of the foot, where removing the penetrating object is actually counter-productive. The foot is a very dynamic structure, and removing the penetrating object typically allows the sole to close over, which makes the hole extremely difficult--sometimes impossible--to find. If the penetrating object is left in place, your veterinarian can take radiographs and better determine what potential structures are involved.
3. Location: Wounds are like real estate – it’s all about location. A tiny wound can cause major problems in a horse if it involves a synovial structure such as a joint or tendon sheath, and, wounds that involve joints may drain joint fluid, and result in more severe lameness than you would expect from a small wound.
4. Severe contamination. Horses are not living in a sterile environment, and wounds typically occur outside where there is the potential for contamination. Mild contamination can be addressed by gentle rinsing using a sterile water solution. More significant contamination should be addressed by a veterinarian.
5. Severe or persistent lameness. If your horse is showing severe, non-weight-bearing or persistent lameness, it should be seen by a veterinarian to rule out something more sinister, such as a fracture.
6. Severe swelling. Mild swelling is to be expected with most wounds. Severe swelling, swelling that progresses or persists despite bandaging should be evaluated by a veterinarian.
7. Wounds to the head/neck/chest/abdomen. These wounds should be evaluated by a veterinarian because of the possibility of involvement of other, deeper structures such as the sinuses or eyes (head), esophagus/major vessels/major nerves (neck), thoracic cavity (chest) and abdominal cavity (abdomen).
8. Systemic clinical signs. Most wounds cause only a local inflammatory response. Any time a wound is associated with a fever, or other clinical signs, such as a change in attitude (quiet/dull, decreased appetite), your horse should be evaluated by a veterinarian.

Initial stabilization of a wound involves stopping any bleeding, cleaning the wounds and keeping the horse confined. Put a water-based lubricant in the wound before clipping to make removing any fur that may fall in the wound easier. Although counter-intuitive, leave any foreign bodies in place for a veterinarian to remove.

Bandaging
Once the wound has been clipped/cleaned, bandage by placing some 4" x 4" gauze squares over the wound and securing them in place with conforming roll gauze.

If the wound is deeper than a superficial abrasion, avoid using ointments. A bandage can be placed using either pound cotton or a leg cotton. Pound cotton can be rolled up and torn in half which makes it easier to apply. Vetrap® or some other similar conforming bandage material can then be placed over the cotton.

Sudden Lameness or Swelling
The most common cause of sudden lameness is a foot abscess. These can often cause very severe lameness. Other potential causes of severe, sudden lameness include a fracture, laminitis (“founder”), tendon and ligament injuries, or cellulitis or lymphangitis. Any severe or sudden lameness should be evaluated by a veterinarian, to rule out more serious causes of lameness such as a fracture.

Confine your horse to avoid further damage, and then consult a veterinarian. Assess the limb, to determine if there is any swelling or open wound. A temporary bandage can be placed to provide support. A single dose of a non-steroidal anti-inflammatory may be administered, preferably after speaking with your veterinarian. It is important to remember that multiple doses of a non-steroidal such as bute (phenylbutazone) or Banamine® (flunixin meglumine) do not provide additional pain-relief, but do significantly increase the risk of adverse effects on the kidneys and gastrointestinal tract.

Eye Injuries
The clinical signs most commonly seen in horses with eye emergencies such as ulcers are excessive squinting and tear production, light sensitivity, and a cloudy or blue eye (corneal edema). There may also be abnormal discharge and/or swelling of the eyelids. A laceration will be obvious.

Eye injuries such as ulcers can progress rapidly, with the potential for loss of sight. Call a veterinarian if you notice any of the clinical signs mentioned. Don’t attempt to treat your horse without a veterinary examination. While waiting for your veterinarian, try to prevent your horse from rubbing its eye.

Head Trauma
Head trauma is relatively uncommon, but the consequences and complications are potentially serious. Cases of head trauma are typically seen after a horse rears and falls over backwards, or runs into something. Clinical signs include swelling, wounds and/or bloody nasal discharge. Typically, there are changes in consciousness and the horse may appear dull or quiet, with decreased or increased response to stimulation. In severe cases, your horse may not be able to walk normally, or may be down and not able to get up. The head is a very complex structure, and in cases of head trauma there is the potential for other structures to be affected. Any time your horse sustains head trauma, you should call your veterinarian to assess the horse and determine whether further treatment and/or referral to a hospital is necessary.

Thoracic and Abdominal Trauma
Cases of thoracic and abdominal trauma are rare, but can be life-threatening because of the potential involvement of deeper structures. Because of the possibility for communication of wounds with either the thoracic or abdominal cavity, any deep wounds should be covered immediately. For wounds and other trauma that involve the chest, it is important to assess your horse’s respiration as well. An increased respiratory rate, increased effort when breathing or a change in breathing could indicate potential involvement of the thoracic cavity. For wounds and other trauma that involves the abdomen, any signs of colic could potentially indicate involvement of the gastrointestinal tract or other organs within the abdomen. Contact your veterinarian is because of the risk for complications associated with wounds in the chest or abdomen.

Foaling (Parturition)
Foaling can be a potential emergency. Knowing the normal stages of foaling is important, so that you can readily determine when there is an abnormality.

The first stage of foaling is associated with behavioral changes in the mare. The mare will look at her flank, get up and down frequently, stretch as if to urinate, and pass small amounts of feces. Some mares will leak colostrum. Passage of urine-like allantoic fluid (“water breaking”) concludes the first stage of labor.

The second stage of labor is very rapid, with the most foals being delivered within 20 to 30 minutes of the start of contractions, after the water breaks. Mares that have never had a foal before may take longer; however, if your mare is actively straining for longer than 30 minutes, you should consult your veterinarian. Occasionally, when a foal is born, the membranes will be stuck over the foal’s nose. Foaling attendants should free the foal’s head from any membranes that may be over the foal’s nose to prevent suffocation.

Stage three involves passage of the fetal membranes (placenta), and takes 30 minutes to three hours. Mares are extremely sensitive to the effects of a retained placenta, which can result in life-threatening complications such as laminitis (founder) and endotoxemia (presence of bacterial toxins in the bloodstream). Contact your vet immediately if the placenta has not passed in three hours.

Dystocia, a difficult or delayed labor, is a true emergency in horses. Any delay in stage two labor can result in increased foal mortality. Mares that have dystocia are more prone to developing retained fetal membranes. Call your veterinarian immediately if the foaling is not progressing as expected. While waiting for your veterinarian, there are a few things that you can do to help facilitate your veterinarian’s examination of your mare. Bandage her tail with Vetrap® or a reusable polo wrap. Clean the vaginal area with a dilute solution of Betadine and water. Trying to keep your mare calm can be difficult but useful. Avoiding manipulating the foal unless you have experience, as complications such as trauma to the foal and the mare’s reproductive tract can occur.

Emergency transport
Finally, a note about transporting emergencies. It is important to understand that in cases of wounds, suspected fractures and other cases of trauma, there is the risk of further damage to a horse during transport. However, there are things you can do to minimize this risk in cases where transport is necessary.

The design of the trailer can certainly help in decreasing the risk of problems occurring during transport. Using a loading ramp instead of a step-up trailer can decrease the work your horse has to do during loading. Providing non-slip flooring such as mats can help stabilize your horse during transport. Additionally, transporting your horse in a confined space is preferable to an open box. For example, horse ambulances that are designed to transport injured horses have a variety of tires or similar structures which can be placed alongside the horse to prevent the horse from moving in the stall during transport.

It has been suggested that the direction a horse faces during transport should be determined by which limb is affected. Horses which have injured a forelimb should face backward, so that when the vehicle and trailer stop, the horse’s weight is concentrated on the hind limbs. For an injured a hind limb, it is recommended that the horse faces forward, so that when the vehicle and trailer stop, the horse’s weight is concentrated on the forelimbs. Obviously, this is not possible for many trailers, so the other precautions already talked about should be taken. Even though I think it is relatively common practice, I do not recommend riding in the back of the trailer with your horse. The potential for you to be hurt is too great. Even if something does happen, such as your horse going down, you are not going to be able to prevent this. Rather, make frequent stops to check on your horse.

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There are no First Tuesday lectures scheduled for August. Future lectures include: September 4, Dr. Dean Richardson, New Techniques in Equine Fracture Repair, and October 2, Dr. Eric Parente, My Horse has Nasal Discharge: Should I be concerned?

For a complete list of scheduled lectures visit http://www.vet.upenn.edu/FirstTuesdays. Though the lectures are free, seating is limited. Please RSVP to beltb@vet.upenn.edu.