How to deal with a traumatic injury [H&H VIP]

  • Seeing a horse trapped in an overturned lorry, or stuck fast in boggy ground or barbed wire can be a truly terrifying experience. Yet knowing what — and what not — to do in an emergency could be a lifesaver, as Gil Riley MRCVS explains

    Horses are not tremendously robust when it comes to physical trauma.

    Their skin is quite thin and is easily injured. Their eyes, positioned at the side of the head, are prone to traumatic injury and their limbs, with relatively little tissue protection, can sustain horrific wounds and fractures.

    Additionally, horses tend to panic. Hence a horse caught over a partition, or even cast, will struggle — often wildly — to try to extract himself from the predicament.

    Further injury is then likely, not just to the horse but to helpers, too, via his flailing limbs and swinging head. Few owners are aware just how dangerous a struggling and distressed horse can be.

    Ironically, the more trapped a horse is, the less he’ll feel able to struggle and he may remain surprisingly calm and emerge unscathed.

    If you are the first person on the scene, take steps, if you can, to prevent any further injury. Call your vet and impress on the receptionist or answering service that this is an emergency. If the horse is trapped, call the fire and rescue service as well.

    If you arrive first, do not rush in and risk causing further injury. Instead, seek assistance. The vet does not want to be distracted by having to arrange an ambulance for an injured person or administering first aid to a human rather than the horse.

    Unless there is something obvious and safe you can do to alleviate the stress of the horse, it is best to stand well back and await help.

    Those in attendance must stay calm and keep their voices down; noise and shouting will only exacerbate the horse’s distress and increase the likelihood of additional self-injury.

    Initial examination
    The first step a vet usually takes upon arrival is to heavily sedate the horse so that a detailed examination can take place in relative safety. Sedation also allows the vet to treat any potentially life-threatening injuries.

    The aim of the initial examination is to assess if there are any injuries or conditions that warrant immediate destruction of the horse, such as fracture of the spine or the long bones of the limbs.

    Bleeding nearly always looks much worse than it actually is, especially if the blood is of the bright red, arterial type. A horse can lose up to almost a third of his circulating blood volume before his system starts to become compromised — a condition called hypovolaemic shock.

    A horse has about 80ml of blood per kg of bodyweight — that’s roughly 55 litres for an average-sized, adult horse. He could lose 18 litres before developing any ill-effects or weakness. However, to assist in a speedy recovery, the less blood loss the better.

    Signs of excess loss include whole body sweating, colic, a progressively elevated heart rate and pale or white mucous membranes. Where possible, stem or reduce bleeding by applying a pressure pad such as a towel to the haemorrhaging vein or artery.

    A common cause of blood loss is a severed digital artery around the pastern, when the horse traps a limb through a partition or door.

    A pressure pad in the form of gamgee and a cohesive bandage can be applied to stop the haemorrhage. A tourniquet should be used only in the most exceptional and extreme of circumstances, as it cuts off blood flow to an entire area and can result in extensive tissue death.

    Once the immediate health threats are addressed, the challenge moves on to extricating the horse.

    If he is caught in a ditch, for example, this may involve administering a heavy sedative or full general anaesthetic by injection and, with the help of the fire and rescue service, pulling or lifting the horse onto adjacent ground using straps and hoists.

    Reflex test
    The vet can now perform a more thorough examination. For horses still recumbent, the limbs must be fully assessed for injury and the spinal reflexes assessed to establish whether a possibly catastrophic fracture of the spinal column has occurred.

    The “panniculus reflex” is a quick and approximate test for assessing damage to the spinal cord. Using a ballpoint pen, the vet will press on the skin at intervals along the side of the body, starting at the shoulder and moving back to the pelvis.

    Pressure on the skin sends a nerve message to the region of the spinal cord next to the site.

    As a result, a message is sent back down from the cord to the skin muscle where the pressure is applied, causing a twitch or shiver. If there is damage to the spinal cord, as soon as we reach that site the cord is unable to send a message to the muscle.

    Severe spinal cord damage would be grounds for immediate euthanasia; it can be hard to be definitive however. Even if there are no life-threatening injuries, there is still the risk that a recumbent horse will hurt himself on recovery. Attempting to rise but falling in the process may result in a limb fracture.

    On the other hand, prolonged periods of recumbency can result in extensive muscle damage (myopathy). In such cases, a blood test will reveal hugely elevated readings for muscle enzymes. Damaged muscle tissue swells and puts pressure on previously uninvolved adjacent muscle tissue and on the nerves running between the muscles, causing “compartment syndrome”.

    There can be many complications including colic, possibly related to stress.

    The best approach to emergency first aid is to minimise the risk of accidents. Always be aware of your horse’s surroundings and try to work out how he might be injured before it actually happens.

    Make a habit of routinely checking your stable, fields and transport, especially trailer floors, removing or repairing anything that looks dangerous. And think ahead, programming relevant emergency numbers and directions into your phone or sat-nav. Basic preparation could make all the difference.

    This article was first published in the 11 September issue of Horse & Hound magazine

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